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States RA, Dewan B, Lynam P, Mensah N, Pottorf O. Group exercise for balance in people with Parkinson's disease: a systematic review with meta-analysis. Physiother Theory Pract 2024:1-18. [PMID: 38975875 DOI: 10.1080/09593985.2024.2374063] [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: 03/23/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND High-quality evidence shows that exercise helps people with Parkinson's disease improve functional abilities including balance. However, few studies have investigated whether the setting and format through which balance-focused exercise programs are provided matters. This systematic review investigated group exercise compared to individual exercise, and to no-exercise control (CTL), on clinical measures of balance for people with Parkinson's disease. METHODS MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL databases were searched through March 24, 2024, on terms for Parkinson's disease; exercise or physical activity; community-based or group classes; balance or postural control. Citations, abstracts and full-text articles were independently reviewed, and included studies were rated on risk of bias by two authors. RESULTS Twenty-seven randomized controlled trials (30 reports) with 1200 participants met criteria. Meta-analysis using mean difference (MD) compared group exercise to CTL on seven clinical measures of balance. Three yielded significant differences favoring group exercise: Timed Up and Go = -2.29 (MD), -3.56 to -1.02 (95% Confidence interval) (95% CI); Mini-BEST = 2.72 (MD), 1.88 to 3.57 (95% CI); Berg Balance Scale = 4.31 (MD), 1.33 to 7.29 (95% CI). Meta-analyses were also conducted on six clinical measures of balance, comparing group exercise to individual exercise, yielding no significant differences. CONCLUSIONS For people with Parkinson's disease, group exercise may be more effective than CTL on some clinical measures of balance and it yields similar results to individual exercise. People with Parkinson's disease are encouraged to participate regularly in group or individual exercise based on preference and accessibility.
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Affiliation(s)
- Rebecca A States
- Doctor of Physical Therapy Program, Hofstra University, Hempstead, NY, USA
| | - Birendra Dewan
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA
| | - Peggy Lynam
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA
| | - Nia Mensah
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA
| | - Ofra Pottorf
- Doctor of Physical Therapy Program, Hofstra University, Hempstead, NY, USA
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Morton A, Fraser H, Green C, Drovandi A. Effectiveness of Deep Brain Stimulation in Improving Balance in Parkinson's Disease: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 186:242-251.e3. [PMID: 38608807 DOI: 10.1016/j.wneu.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Balance dysfunction is a debilitating feature of advanced Parkinson's disease (PD), potentially improved by deep brain stimulation (DBS). This systematic review and meta-analysis pooled evidence from randomized controlled trials (RCTs) on DBS effectiveness in improving balance in PD. METHODS A systematic search was conducted to identify eligible RCTs investigating the effectiveness of DBS on improving balance in people with PD. Meta-analysis was performed using random effects models and reported as mean difference and 95% confidence intervals. Risk of bias was assessed using Cochrane's ROB-2 tool. RESULTS Seventeen RCTs were eligible (n = 333), utilizing a range of stimulation sites, parameters, reporting tools for balance outcomes, and control/comparator groups, making the identification of clear trends and recommendations difficult. Eleven studies were deemed as having some risk of bias, 4 having low risk of bias and 2 having high risk of bias. One small meta-analysis was conducted and found no significant difference in balance outcomes. Most studies reported no significant improvement in Timed Up-and-Go scores, Berg Balance Scale scores, frequency of falls, and balance-related items of the Movement Disorder Society's Unified Parkinson's Disease Rating Scales. Some studies reported improvements in the Tinetti balance test, posturography readings, and reduction in falls though these were not supported by other studies due to a lack of reporting on these items or conflicting findings. CONCLUSIONS Current research suggests that DBS results in no significant improvement in balance dysfunction for people with PD, though such assertions require larger RCTs with clear reporting methods using validated reporting tools.
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Affiliation(s)
- Amy Morton
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Holly Fraser
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Chloe Green
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | - Aaron Drovandi
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
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Dave AR, Shamal SS, Sharath HV. A Comprehensive Management of Devic's Disease: A Pediatric Case Study. Cureus 2024; 16:e62512. [PMID: 39022489 PMCID: PMC11253554 DOI: 10.7759/cureus.62512] [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: 02/23/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Devic's disease, also known as neuromyelitis optica (NMO), is an uncommon autoimmune condition that affects the optic nerves and spinal cord. It is characterized by recurrent optic neuritis and myelitis, which can cause paralysis and visual impairment. Because NMO mimics multiple sclerosis, diagnosing it is difficult and necessitates particular testing, such as magnetic resonance imaging (MRI) and aquaporin-4 antibody detection. Patients with NMOs are susceptible to severe, erratic episodes that can result in rapid impairment. As such, timely and efficient therapy with immunosuppressive medicines and continued supportive care are crucial. Improving mobility, strength, coordination, and quality of life while treating the functional deficiencies associated with NMOs requires the use of physiotherapy. This case study emphasizes how crucial it is to manage a young NMO patient using a multidisciplinary strategy in order to maximise results. This case report discusses a 16-year-old male presenting with a sudden onset of balance impairment, slurred speech, difficulty walking and breathing, and weakness in limbs, with the right side more affected. Over three months, he experienced increasing eyesight issues, fatigue, tremors during activities of daily living, difficulty swallowing, and night cramps. Diagnostic investigations including MRI, angiography, visual evoked potentials (VEP) study, and cerebrospinal fluid (CSF) analysis confirmed demyelinating changes consistent with NMO, also known as Devic's disease. The patient received management with steroidal medications, immunosuppressants, and plasma therapy, along with physiotherapy rehabilitation. The physiotherapy protocol aimed to address muscle weakness, coordination impairment, balance issues, fine motor deficits, fatigue, sensory impairment, and dependence on activities of daily living. Motor, sensory, and cranial nerve assessments were conducted, revealing impairments consistent with NMO. Outcome measures pre- and post-intervention showed improvements in functional independence, balance, and fatigue severity. The medical management included a combination of medications and investigations to manage NMO symptoms and monitor disease progression. The physiotherapeutic approach employed a multidisciplinary strategy focusing on education, exercise, and functional tasks to improve the patient's quality of life and independence.
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Affiliation(s)
- Anandi R Dave
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Snehal S Shamal
- Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - H V Sharath
- Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Park C, Lee BC. A Systematic Review of the Effects of Interactive Telerehabilitation with Remote Monitoring and Guidance on Balance and Gait Performance in Older Adults and Individuals with Neurological Conditions. Bioengineering (Basel) 2024; 11:460. [PMID: 38790328 PMCID: PMC11117498 DOI: 10.3390/bioengineering11050460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Recognizing the growing interests and benefits of technology-assisted interactive telerehabilitation in various populations, the aim of this review is to systematically review the effects of interactive telerehabilitation with remote monitoring and guidance for improving balance and gait performance in older adults and individuals with neurological conditions. The study protocol for this systematic review was registered with the international prospective register of systematic reviews (PROSPERO) with the unique identifier CRD42024509646. Studies written in English published from January 2014 to February 2024 in Web of Science, Pubmed, Scopus, and Google Scholar were examined. Of the 247 identified, 17 were selected after initial and eligibility screening, and their methodological quality was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies. All 17 studies demonstrated balance and gait performance improvement in older adults and in individuals with stroke, Parkinson's disease, and multiple sclerosis following 4 or more weeks of interactive telerehabilitation via virtual reality, smartphone or tablet apps, or videoconferencing. The findings of this systematic review can inform the future design and implementation of interactive telerehabilitation technology and improve balance and gait training exercise regimens for older adults and individuals with neurological conditions.
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Affiliation(s)
- Catherine Park
- Division of Digital Healthcare, Yonsei University, Wonju 26493, Republic of Korea
| | - Beom-Chan Lee
- Department of Health and Human Performance, University of Houston, Houston, TX 77204, USA
- Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX 77204, USA
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Irons JY, Williams A, Holland J, Jones J. An Exploration of People Living with Parkinson's Experience of Cardio-Drumming; Parkinson's Beats: A Qualitative Phenomenological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:514. [PMID: 38673425 PMCID: PMC11050379 DOI: 10.3390/ijerph21040514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/13/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
Research has shown that physical activity has a range of benefits for people living with Parkinson's (PLwP), improving muscle strength, balance, flexibility, and walking, as well as non-motor symptoms such as mood. Parkinson's Beats is a form of cardio-drumming, specifically adapted for PLwP, and requires no previous experience nor skills. Nineteen PLwP (aged between 55 and 80) took part in the regular Parkinson's Beats sessions in-person or online. Focus group discussions took place after twelve weeks to understand the impacts of Parkinson's Beats. Through the framework analysis, six themes and fifteen subthemes were generated. Participants reported a range of benefits of cardio-drumming, including improved fitness and movement, positive mood, the flow experience, and enhanced social wellbeing. A few barriers to participation were also reported. Future research is justified, and best practice guidelines are needed to inform healthcare professionals, PLwP and their care givers.
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Affiliation(s)
- J. Yoon Irons
- School of Psychology, College of Health, Psychology and Social Care, University of Derby, Derby DE22 1GB, UK
| | - Alison Williams
- Parkinson’s Scotland Office, 1/14 King James VI Business Centre, Friarton Road, Perth PH2 8DY, UK; (A.W.); (J.H.)
| | - Jo Holland
- Parkinson’s Scotland Office, 1/14 King James VI Business Centre, Friarton Road, Perth PH2 8DY, UK; (A.W.); (J.H.)
| | - Julie Jones
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen AB10 7QG, UK;
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Lorenzo-García P, Cavero-Redondo I, Núñez de Arenas-Arroyo S, Guzmán-Pavón MJ, Priego-Jiménez S, Álvarez-Bueno C. Effects of physical exercise interventions on balance, postural stability and general mobility in Parkinson's disease: a network meta-analysis. J Rehabil Med 2024; 56:jrm10329. [PMID: 38298133 PMCID: PMC10847976 DOI: 10.2340/jrm.v56.10329] [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: 03/07/2023] [Accepted: 11/30/2023] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE To assess which type of physical exercise intervention has the most beneficial effects on balance, postural stability and general mobility in patients with Parkinson's disease. These parameters were assessed using the Activities-specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (MiniBESTest) and Timed Up and Go Test (TUG). DESIGN Network meta-analysis. METHODS The PubMed, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched up to August 2022 to identify randomized controlled trials on the effects of physical exercise interventions on balance, postural stability, and general mobility. The network meta-analysis included pairwise and indirect comparisons of results on the ABC scale, BBS, MiniBESTest, and TUG across 8 categories of physical exercise. RESULTS Eighty-six studies with a total of 4,693 patients were included. For the ABC scale, the indirect comparison showed that the highest effect size was observed for balance vs sensorimotor training without including endurance interventions (0.62; 95% confidence interval (95% CI) 0.06, 1.17). The highest effect sizes for BBS were observed for alternative exercises (1.21; 95% CI 0.62, 1.81), body-weight supported (BWS) interventions (1.31; 95% CI 0.57, 2.05), dance (1.18; 95% CI 0.33, 2.03) and sensorimotor training, including endurance interventions (1.10; 95% CI 0.46, 1.75) vs control groups. Indirect comparisons showed that the highest effect size for the MiniBESTest were observed for balance (0.75; 95% CI 0.46, 1.04) and resistance (0.58; 95% CI 0.10, 1.07) vs control groups. For the TUG, comparisons showed a significant effect size for alternative exercises (-0.54; 95% CI -0.82, -0.26), balance (-0.42; 95% CI -0.75, -0.08), resistance (-0.60; 95% CI -0.89, -0.31), and sensorimotor training including endurance interventions (-0.61; 95% CI -0.95, -0.27) vs control comparisons. CONCLUSION Balance interventions improve balance, postural stability, and general mobility in people with Parkinson's disease. Moreover, alternative exercises, dance, BWS interventions, resistance, and sensorimotor training, including and not including endurance interventions, are also effective.
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Affiliation(s)
| | - Iván Cavero-Redondo
- Universidad de Castilla La Mancha, Health and Social Research Center, Cuenca, Spain; Facultad de Ciencias de La Salud, Universidad Autónoma de Chile, Talca, Chile
| | | | | | | | - Celia Álvarez-Bueno
- Universidad de Castilla La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
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Giancatarina M, Grandperrin Y, Nicolier M, Gimenez P, Vidal C, Tio G, Haffen E, Bennabi D, Grosprêtre S. Acute effect of transcranial direct current stimulation (tDCS) on postural control of trained athletes: A randomized controlled trial. PLoS One 2024; 19:e0286443. [PMID: 38236903 PMCID: PMC10795979 DOI: 10.1371/journal.pone.0286443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/20/2023] [Indexed: 01/22/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) is used to modulate brain function, and can modulate motor and postural control. While the acute effect of tDCS is well documented on patients, little is still known whether tDCS can alter the motor control of healthy trained participants. This study aimed to assess the acute effect of tDCS on postural control of parkour practitioners, known for their good balance abilities and their neuromuscular specificities that make them good candidates for tDCS intervention. Eighteen parkour practitioners were tested on three occasions in the laboratory for each stimulation condition (2 mA; 20 minutes)-primary motor cortex (M1), dorsolateral prefrontal cortex (dlPFC) and sham (placebo). Postural control was evaluated PRE and POST each stimulation by measuring Center of Pressure (CoP) displacements on a force platform during static conditions (bipedal and unipedal stance). Following M1 stimulation, significant decreases were observed in CoP area in unipedal (from 607.1 ± 297.9 mm2 to 451.1 ± 173.9 mm2, P = 0.003) and bipedal (from 157.5 ± 74.1 mm2 to 117.6 ± 59.8 mm2 P<0.001) stances. As well, the CoP total length was significantly reduced in bipedal (from 3416.8 ± 295.4 mm to 3280.6 ± 306.2 mm, P = 0.005) as well as in unipedal stance (from 4259.6 ± 398.4 mm to 3846.5 ± 468.9 mm, P<0.001), only after M1 stimulation. Relative pre-post changes observed after M1 stimulation were negatively correlated to experience in parkour only after unipedal stance (r = 0.715, P<0.001), meaning that the more participants were trained the less tDCS was effective. No significant changes were noticed after sham and dlPFC stimulation. These results suggested that the modulation of gait performance in athletes following an acute intervention of tDCS is specific to the targeted brain region, and that postures with reduced base of support (such as unipedal stance) were more sensitive to tDCS.
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Affiliation(s)
- Mary Giancatarina
- Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université de Franche-Comté, Besançon, France
| | - Yohan Grandperrin
- Service de Psychiatrie de l’Adulte, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Centre d’Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Magali Nicolier
- Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université de Franche-Comté, Besançon, France
- Service de Psychiatrie de l’Adulte, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Centre d’Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Philippe Gimenez
- EA4660, C3S Culture Sport Health Society, Université de Franche -Comté, UFR STAPS, Besançon, France
| | - Chrystelle Vidal
- Centre d’Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Gregory Tio
- Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université de Franche-Comté, Besançon, France
- Service de Psychiatrie de l’Adulte, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Centre d’Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Emmanuel Haffen
- Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université de Franche-Comté, Besançon, France
- Service de Psychiatrie de l’Adulte, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Centre d’Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Centre Expert Dépression Résistante FondaMental, Centre Hospitalier Universitaire de Besançon Besançon, France
| | - Djamila Bennabi
- Laboratoire de Neurosciences Intégratives et Cliniques EA481, Université de Franche-Comté, Besançon, France
- Service de Psychiatrie de l’Adulte, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Centre d’Investigation Clinique, INSERM CIC 1431, Centre Hospitalier Universitaire de Besançon, Besançon, France
- Centre Expert Dépression Résistante FondaMental, Centre Hospitalier Universitaire de Besançon Besançon, France
| | - Sidney Grosprêtre
- EA4660, C3S Culture Sport Health Society, Université de Franche -Comté, UFR STAPS, Besançon, France
- Institut Universitaire de France (IUF), Paris, France
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Padilha C, Souza R, Grossl FS, Gauer APM, de Sá CA, Rodrigues-Junior SA. Physical exercise and its effects on people with Parkinson's disease: Umbrella review. PLoS One 2023; 18:e0293826. [PMID: 37917715 PMCID: PMC10621990 DOI: 10.1371/journal.pone.0293826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Parkinson's disease is neurodegenerative, complex and progressive, manifesting in a slow and irreversible way. Physical exercise has been proposed as therapeutic alternative to people with Parkinson´s disease. OBJECTIVE To synthesize knowledge about the effects of physical exercise on people with Parkinson´s Disease as presented by published systematic reviews. METHODS Nine electronic databases and two grey literature databases were searched for systematic reviews reporting the effects of physical exercises on people with Parkinson´s Disease. Searches involved a two-phase process, by, at least, two independent reviewers. Methodological quality of the included systematic reviews was assessed using AMSTAR-2. RESULTS From 2,122 systematic reviews, 139 were included. Motor outcomes were assessed in 91% of the studies, with balance being the most studied. Non-motor outcomes were assessed in 68% of the studies, with emphasis on quality of life. Physical exercises were classified into five categories: aerobic exercises, strength, combined, sensorimotor activities and other activity protocols. Findings of the systematic reviews suggest that all exercise categories can be prescribed to improve balance and mobility, while combined exercises, strength, and specific activities improve both motor and non-motor outcomes, and aerobic exercise and sensorimotor activities improve motor outcomes. CONCLUSION Current evidence from systematic reviews suggests that physical exercises impacts both motor and non-motor outcomes in people with Parkinson´s Disease. Limits in evidence provided by the systematic reviews were related to methodological issues and to the description of the interventions and must be considered to improve decision-making and clinical application.
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Affiliation(s)
- Cristiano Padilha
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Renan Souza
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Fernando Schorr Grossl
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Ana Paula Maihack Gauer
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Clodoaldo Antônio de Sá
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
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Lockhart T, Frames C, Olson M, Moon SH, Peterson D, Lieberman A. Effects of protective step training on proactive and reactive motor adaptations in Parkinson's disease patients. Front Neurol 2023; 14:1211441. [PMID: 37965161 PMCID: PMC10642212 DOI: 10.3389/fneur.2023.1211441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
The aim of this study was to investigate to what extent PD affects the ability to walk, respond to balance perturbations in a single training session, and produce acute short-term effects to improve compensatory reactions and control of unperturbed walking stability. Understanding the mechanism of compensation and neuroplasticity to unexpected step perturbation training during walking and static stance can inform treatment of PD by helping to design effective training regimens that remediate fall risk. Current rehabilitation therapies are inadequate at reducing falls in people with Parkinson's disease (PD). While pharmacologic and surgical treatments have proved largely ineffective in treating postural instability and gait dysfunction in people with PD, studies have demonstrated that therapy specifically focusing on posture, gait, and balance may significantly improve these factors and reduce falls. The primary goal of this study was to assess the effectiveness of a novel and promising intervention therapy (protective step training - i.e., PST) to improve balance and reduce falls in people with PD. A secondary goal was to understand the effects of PST on proactive and reactive feedback responses during stance and gait tasks. Multiple-baseline, repeated measures analyses were performed on the multitude of proactive and reactive performance measures to assess the effects of PST on gait and postural stability parameters. In general, the results indicate that participants with PD were able to use experiences with perturbation training to integrate and adapt feedforward and feedback behaviors to reduce falls. The ability of the participants with PD to adapt to changes in task demands suggests that individuals with PD could benefit from the protective step training to facilitate balance control during rehabilitation.
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Affiliation(s)
- Thurmon Lockhart
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Chris Frames
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
- Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Markey Olson
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
- Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Seong H. Moon
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Dan Peterson
- Gait and Balance Dysfunction Laboratory, College of Health Solutions, Arizona State University, Tempe, AZ, United States
- Department of Veteran’s Affairs, Phoenix, AZ, United States
| | - Abraham Lieberman
- Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
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Yang Y, Wang Y, Gao T, Reyila A, Liu J, Liu J, Han H. Effect of Physiotherapy Interventions on Motor Symptoms in People With Parkinson's Disease: A Systematic Review and Meta-Analysis. Biol Res Nurs 2023; 25:586-605. [PMID: 37070664 DOI: 10.1177/10998004231171587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of different types of physiotherapy interventions in people with Parkinson's disease (PD). DESIGN Systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS Five databases (PubMed, Embase, Cochrane Library, CINAHL and Web of Science Core Collection) were searched for relevant RCTs published from database inception to July 14, 2022. Reviewers independently screened the literature, extracted data, and assessed the literature quality according to the Cochrane Collaboration Risk of Bias Tool and PEDro Scale. This meta-analysis was conducted using RevMan 5.4.1 and reported in compliance with the PRISMA statement. RESULTS Forty-two RCTs with 2,530 participants were included. Across all types of physiotherapy, strength training, mind-body exercise, aerobic exercise, and non-invasive brain stimulation (NiBS) were effective in improving motor symptoms as measured by the (Movement Disorders Society-) Unified PD Scale, whereas balance and gait training (BGT) and acupuncture were not. The pooled results showed that the change in mind-body exercise (MD = -5.36, 95% CI [-7.97 to -2.74], p < .01, I2 = 68%) and NiBS (MD = -4.59, 95% CI [-8.59 to -0.59], p = .02, I2 = 78%) reached clinical threshold, indicating clinically meaningful improvements. Considering the effectiveness of the interventions on motor symptoms, balance, gait and functional mobility, mind-body exercise was recommended the most. CONCLUSIONS Exercise appears to be a better form of physiotherapy than NiBS and acupuncture for improving motor function. Mind-body exercise showed beneficial effects on motor symptoms, balance, gait and functional mobility in people with PD, and is worthy of being promoted.
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Affiliation(s)
- Yajie Yang
- School of Nursing, Peking University, Beijing 100191, China
| | - Yang Wang
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
| | - Tianzi Gao
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
| | | | - Jiaxin Liu
- Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - Jiajia Liu
- School of Nursing, Peking University, Beijing 100191, China
| | - Hongbin Han
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
- NMPA Key Laboratory for Evaluation of Medical Imaging Equipment and Technique, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging Technology, Beijing 100191, China
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Monleón Guinot S, San Martín Valenzuela C, Aranda Asensi V, de Salazar Antón C, Villanueva Navarro M, Tomás JM. Functional balance training in people with Parkinson's disease: a protocol of balanceHOME randomized control trial with crossover. Front Aging Neurosci 2023; 15:1137360. [PMID: 37266404 PMCID: PMC10231658 DOI: 10.3389/fnagi.2023.1137360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/29/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction Balance disturbances in Parkinson's Disease (PD) are usually assessed in a single-task as well as standard balance physiotherapy is carried out in isolated environments. Conversely, daily activities are developed in highly challenging environments. Although functional balance training (FBT) is included in the latest protocols, several methodological issues have not yet been considered. In the proposed single-blinded randomized control trial with crossover (NCT04963894), the aims are (1) to quantify the effects achieved by domiciliary FBT (balanceHOME program) in participants with and without cognitive impairment, and (2) to compare them with the effects of a passive-control period and a conventional face-to-face physiotherapy program for PD. Methods The initial recruitment was estimated at 112 people with idiopathic PD. Two-thirds of the participants will be randomized to one of the two groups to make the crossover. In contrast, the other third will do a face-to-face group program only. The balanceHOME protocol consists of challenging balance exercises incorporated into functional daily tasks, developed in-home and conducted two times per week for 60-min over an 8-weeks period. The primary strategy will consist of splitting functional tasks of daily life into static and dynamic balance components, besides standardized facilitate and disturbing strategies to execution of each exercise. Biomechanics and clinical performance of balance and gait, perception of quality of life, cognitive and mental functioning, and severity of PD will be measured at baseline (T0), post-8 weeks training (T1), and follow-up (T2). Results The primary outcome of the study will be the center of pressure sway area. The secondary outcomes consist of biomechanics and clinical variables related to static and dynamic balance. Outcomes from biomechanical of gait, quality of life, cognitive and mental state, and severity of PD, represent the tertiary outcomes. Discussion The balanceHOME program standardizes the FBT in demanding and daily environments for people with PD who prefer individualized treatment from home. This is the first time that the effects of group versus individual balance rehabilitation have been compared in people with and without cognitive impairment and evaluated in complex environments. This still-to-be-finished study will open the possibility of new strategies according to changes in post-pandemic therapeutic approaches.
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Affiliation(s)
- Sara Monleón Guinot
- Department of Methodology for the Behavioral Sciences, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Constanza San Martín Valenzuela
- Unit of Personal Autonomy, Dependency, and Mental Disorders Assessment, INCLIVA Biomedical Research Institute, Valencia, Spain
- Departament of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Jose M. Tomás
- Department of Methodology for the Behavioral Sciences, Faculty of Psychology, University of Valencia, Valencia, Spain
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García-Muñoz C, González-García P, Casuso-Holgado MJ, Martínez-Calderón J, Heredia-Rizo AM. Are movement-based mindful exercises (QIGONG, TAI CHI, AND YOGA) beneficial for stroke and Parkinson's disease? A scoping review. Complement Ther Med 2023; 72:102912. [PMID: 36565791 DOI: 10.1016/j.ctim.2022.102912] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/04/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To synthesize evidence from systematic reviews on the effects of qigong, tai chi, and yoga in people with neurological diseases. METHODS A systematic search was conducted in PubMed, PsycINFO, Embase, CINAHL and Cochrane Library until September 2022. Methodological quality was assessed using the AMSTAR 2 tool. A qualitative synthesis of included reviews and meta-analyses was performed. Citation matrices and the corrected covered area were used to explore the overlap of randomized controlled trials among reviews. RESULTS Nineteen systematic reviews (containing 74 trials and 80 meta-analyses) in people with Parkinson's disease (PD) or stroke were included. The critical domains of the AMSTAR 2 were not satisfied in more than half of the reviews, and only 4 evaluated the certainty of the evidence. The overlap was very high (21.7%) and high (11%) for tai chi studies in PD and stroke, respectively. In people with PD, qigong, yoga, and tai chi can improve balance, with tai chi being beneficial to increase functional mobility. For stroke patients, tai chi was better than controls to enhance motor function and independence, but not for health-related quality of life and quality of sleep. Findings on balance, walking ability and depression were inconclusive in stroke population. CONCLUSIONS Qigong, tai chi, and yoga appear to be effective to improve balance performance in people with PD. Tai chi practice enhances motor function and independency in stroke patients.
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Affiliation(s)
- Cristina García-Muñoz
- Departamento de Enfermería y Fisioterapia, Facultad de Enfermería y Fisioterapia, Universidad de Cádiz, Avda. Ana de Viya 52, 11009 Cádiz, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
| | - Paula González-García
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain..
| | - María Jesús Casuso-Holgado
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
| | - Javier Martínez-Calderón
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
| | - Alberto Marcos Heredia-Rizo
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
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López-Liria R, Vega-Tirado S, Valverde-Martínez MÁ, Calvache-Mateo A, Martínez-Martínez AM, Rocamora-Pérez P. Efficacy of Specific Trunk Exercises in the Balance Dysfunction of Patients with Parkinson's Disease: A Systematic Review and Meta-Analysis. SENSORS (BASEL, SWITZERLAND) 2023; 23:1817. [PMID: 36850413 PMCID: PMC9959840 DOI: 10.3390/s23041817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative pathology classified as a movement disorder. Physical exercise within a physiotherapy program is an important element to improve postural stability, balance and mobility in order to reduce falls in people with PD. The aim of this work was to determine the efficacy of specific balance and trunk mobility exercises, as well as their benefits for and effects on patients with idiopathic PD. A systematic review and meta-analysis was conducted according to PRISMA standards. The search was performed in five databases: Cochrane Library, SciELO, PEDro, Scopus and PubMed, in February 2022 with the following descriptors: Parkinson's disease, trunk, exercise, therapy and physical therapy. The inclusion criteria were randomized controlled trials (RCTs) over the last ten years. A meta-analysis on static and dynamic balance was conducted with the software Review Manager. Nine articles met the objectives and inclusion criteria, with a total of 240 participants. The trials had moderate methodological quality according to the PEDro scale. The studies included differed with regard to intervention protocol and outcome measures. Finally, eight studies were included in a quantitative analysis in which it was shown that trunk-specific exercises interventions did not significantly improve static balance (SMD = -0.10, 95% CI = -0.29, 0.08; p = 0.28) or dynamic balance (SMD = 0.64 95% CI = -0.24, 1.52; p = 0.15). However, significant differences were found in static balance measured subjectively using the Berg Balance Scale (SMD = -0.52, 95% CI = -1.01, -0.02; p = 0.04). Although some differences were not significant, the studies included in this systematic review consider that specific trunk exercises or balance training combined with muscle strengthening in patients with idiopathic PD should be a complement to pharmacological treatment for improving balance dysfunction and postural instability, preventing falls and promoting wellness.
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Affiliation(s)
- Remedios López-Liria
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, 04120 La Cañada de San Urbano, Almería, Spain
| | - Sofía Vega-Tirado
- Hum-498 Research Team, University of Almería, 04120 La Cañada de San Urbano, Almería, Spain
| | - María Ángeles Valverde-Martínez
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, 04120 La Cañada de San Urbano, Almería, Spain
| | - Andrés Calvache-Mateo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración 60, 18016 Granada, Granada, Spain
| | | | - Patricia Rocamora-Pérez
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, 04120 La Cañada de San Urbano, Almería, Spain
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Halakoo S, Ehsani F, Hosnian M, Kheirkhahan A, Samaei A, Emadi A. The comparative effects of anodal and cathodal trans-cranial direct current stimulation on balance and posture: A systematic review of literature and meta-analysis. J Clin Neurosci 2023; 107:68-76. [PMID: 36516671 DOI: 10.1016/j.jocn.2022.12.001] [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: 08/02/2022] [Revised: 10/31/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
Application of anodal trans-cranial direct current stimulation (a-tDCS) versus cathodal tDCS (c-tDCS) can influence the physiological results of tDCS intervention on postural control and balance in patients or healthy adults. According to the evidence, some studies demonstrated that postural control or balance is facilitated by the application of the a-tDCS more than the c-tDCS. On the other hand, some studies indicated that there were no significant differences between a-tDCS and c-tDCS. In contrast, other studies have shown a more significant effect of c-tDCS than a-tDCS on postural control and balance. This study aimed to systematically review the studies which investigated the effectiveness of a-tDCS and c-tDCS intervention on postural control and balance. The search was performed from databases in Google Scholar, PubMed, Elsevier, Medline, Ovid, and Science Direct with the keywords of balance, balance test, postural control, postural stability, postural sway, posture, postural balance, trans-cranial direct current stimulation, tDCS, neuromodulator, neurostimulation, tDCS, a-tDCS or anodal tDCS, c-tDCS or cathodal tDCS from 2000 to 2022. The results confirmed that the study population was a key factor in determining the study's findings. Data meta-analysis showed no significant differences between active tDCS and sham tDCS on postural control in healthy individuals (P > 0.05). In addition, the results indicated the efficacy of both a-tDCS over the affected motor cortex (M1) and c-tDCS over unaffected M1 as compared to sham tDCS on postural improvement in patients with stroke (P < 0.05), however, there were no differences between the two techniques on posture and balance in these patients.
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Affiliation(s)
- Sara Halakoo
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Fatemeh Ehsani
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Motahareh Hosnian
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Afshin Samaei
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Alireza Emadi
- Food Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, Iran
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15
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Matsuda N, Takamatsu Y, Aiba I. Effect of therapeutic exercise on the balance of patients with progressive supranuclear palsy: A pilot study. Front Neurol 2022; 13:955893. [PMID: 36176548 PMCID: PMC9513196 DOI: 10.3389/fneur.2022.955893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Progressive supranuclear palsy (PSP) is a parkinsonian-like progressive neurodegenerative syndrome. Key clinical features include ocular motor dysfunction, postural instability, and cognitive dysfunction. Maintaining and improving balance function and gait function are very important for patients with PSP with severe postural dysfunction and repeated falls. In addition, patients with PSP have a poor response to pharmacological treatment; hence, rehabilitation is a key approach in dealing with this syndrome. However, no conclusion on the beneficial effects of rehabilitation for patients with PSP have been established in the literature. Objectives The effectiveness of multiple therapeutic exercise program with probable or possible PSP according to the Movement Disorder Society criteria for the clinical diagnosis of PSP was validated. Methods Participants underwent multiple therapeutic exercise program customized for each participant, including resistance training, balance training, and walking exercises that were performed for 60–80 minutes a day, 5 days a week for 4 weeks. The outcomes measured were as follows: pull test, Berg Balance Scale (BBS), timed up and go test (TUG), and gait speed test. Results A total of 117 patients with PSP were enrolled and the analysis was performed on 20 patients with probable PSP. Four-week rehabilitation significantly improved pull test (p = 0.034) and BBS scores (p = 0.001). There were no significant differences both TUG (p = 0.502) and gait speed (p = 0.813). Conclusion The multiple therapeutic exercise program had beneficial effects on balance performance in patients with PSP in 4 weeks and could be an essential element in their rehabilitation. Although this pilot study was conducted without a control group, it provided valuable information for future prospective randomized controlled trials.
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Affiliation(s)
- Naomi Matsuda
- Department of Rehabilitation, National Hospital Organization Higashinagoya National Hospital, Nagoya, Japan
- *Correspondence: Naomi Matsuda
| | - Yasuyuki Takamatsu
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Ikuko Aiba
- Department of Neurology, National Hospital Organization Higashinagoya National Hospital, Nagoya, Japan
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16
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Gaßner H, Trutt E, Seifferth S, Friedrich J, Zucker D, Salhani Z, Adler W, Winkler J, Jost WH. Treadmill training and physiotherapy similarly improve dual task gait performance: a randomized-controlled trial in Parkinson's disease. J Neural Transm (Vienna) 2022; 129:1189-1200. [PMID: 35697942 PMCID: PMC9463305 DOI: 10.1007/s00702-022-02514-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/09/2022] [Indexed: 12/02/2022]
Abstract
Motor-cognitive dual tasks are used to investigate the interplay between gait and cognition. Dual task walking in patients with Parkinson's disease (PD) results in decreased gait speed and more importantly in an increased fall risk. There is evidence that physical training may improve gait during dual task challenge. Physiotherapy and treadmill walking are known to improve single task gait. The aim of this study was to investigate the impact of individualized physiotherapy or treadmill training on gait during dual task performance. 105 PD patients were randomly assigned to an intervention group (physiotherapy or treadmill). Both groups received 10 individual interventional sessions of 25 min each and additional group therapy sessions for 14 days. Primary outcome measure was the dual task gait speed. Secondary outcomes were additional gait parameters during dual task walking, UPDRS-III, BBS and walking capacity. All gait parameters were recorded using sensor-based gait analysis. Gait speed improved significantly by 4.2% (treadmill) and 8.3% (physiotherapy). Almost all secondary gait parameters, UPDRS-III, BBS, and walking capacity improved significantly and similarly in both groups. However, interaction effects were not observed. Both interventions significantly improved gait in patients with mild to moderate PD. However, treadmill walking did not show significant benefits compared to individualized physiotherapy. Our data suggest that both interventions improve dual task walking and therefore support safe and independent walking. This result may lead to more tailored therapeutic preferences.
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Affiliation(s)
- Heiko Gaßner
- Department of Molecular Neurology, Universitätsklinikum Erlangen, Molekulare Neurologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
- Fraunhofer IIS, Fraunhofer Institute for Integrated Circuits IIS, Am Wolfsmantel 33, 91058, Erlangen, Germany.
| | | | - Sarah Seifferth
- Department of Molecular Neurology, Universitätsklinikum Erlangen, Molekulare Neurologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Jana Friedrich
- Department of Molecular Neurology, Universitätsklinikum Erlangen, Molekulare Neurologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | | | | | - Werner Adler
- Institut für Medizininformatik, Biometrie und Epidemiologie, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Jürgen Winkler
- Department of Molecular Neurology, Universitätsklinikum Erlangen, Molekulare Neurologie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
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Weerathunge HR, Tomassi NE, Stepp CE. What Can Altered Auditory Feedback Paradigms Tell Us About Vocal Motor Control in Individuals With Voice Disorders? PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2022; 7:959-976. [PMID: 37397620 PMCID: PMC10312128 DOI: 10.1044/2022_persp-21-00195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Purpose The goal of this review article is to provide a summary of the progression of altered auditory feedback (AAF) as a method to understand the pathophysiology of voice disorders. This review article focuses on populations with voice disorders that have thus far been studied using AAF, including individuals with Parkinson's disease, cerebellar degeneration, hyperfunctional voice disorders, vocal fold paralysis, and laryngeal dystonia. Studies using AAF have found that individuals with Parkinson's disease, cerebellar degeneration, and laryngeal dystonia have hyperactive auditory feedback responses due to differing underlying causes. In persons with PD, the hyperactivity may be a compensatory mechanism for atypically weak feedforward motor control. In individuals with cerebellar degeneration and laryngeal dystonia, the reasons for hyperactivity remain unknown. Individuals with hyperfunctional voice disorders may have auditory-motor integration deficits, suggesting atypical updating of feedforward motor control. Conclusions These findings have the potential to provide critical insights to clinicians in selecting the most effective therapy techniques for individuals with voice disorders. Future collaboration between clinicians and researchers with the shared objective of improving AAF as an ecologically feasible and valid tool for clinical assessment may provide more personalized therapy targets for individuals with voice disorders.
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Affiliation(s)
- Hasini R. Weerathunge
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Nicole E. Tomassi
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Graduate Program for Neuroscience, Boston University, MA
| | - Cara E. Stepp
- Department of Biomedical Engineering, Boston University, MA
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, MA
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18
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Gassner L, Dabnichki P, Pokan R, Schmoeger M, Willinger U, Maetzler W, Moser H, Zach H. Therapeutic climbing in Parkinson’s disease: Differences in self-reported health and well-being, feasibility and clinical changes. Physiother Theory Pract 2022; 39:1163-1177. [DOI: 10.1080/09593985.2022.2036279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lucia Gassner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- School of Engineering, RMIT University, VIC Australia
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, Vienna, Austria
| | | | - Rochus Pokan
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, Vienna, Austria
| | | | - Ulrike Willinger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Hermann Moser
- Therapy Center Gmundnerberg, Altmünster Am Traunsee, Austria
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Heidemarie Zach
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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19
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Cabrera-Martos I. Clinician's Commentary on Lavoie et al. Physiother Can 2021; 73:351-352. [PMID: 34880540 PMCID: PMC8614593 DOI: 10.3138/ptc-2019-0108-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Behrangrad S, Zoghi M, Kidgell D, Jaberzadeh S. The Effect of a Single Session of Non-Invasive Brain Stimulation on Balance in Healthy Individuals: A Systematic Review and Best Evidence Synthesis. Brain Connect 2021; 11:695-716. [PMID: 33798002 DOI: 10.1089/brain.2020.0872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: To evaluate the effects of a single session of non-invasive brain stimulation (NIBS) on postural balance. Introduction: The NIBS has been used widely in improving balance. However, the effect of a single session of NIBS on balance in healthy individuals has not been systemically reviewed. Methods: A systematic literature review and best evidence synthesis were conducted, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, to determine the effects of different NIBS techniques on balance function in healthy individuals. The methodological quality of included articles was assessed by the risk of bias, and the Downs and Black tool. Data were analyzed by using the best evidence synthesis. Thirty-five articles were included that used the following NIBS techniques: anodal transcranial direct current stimulation (a-tDCS), cathodal transcranial direct current stimulation (c-tDCS), continuous theta burst stimulation (cTBS), and repetitive transcranial magnetic stimulation (rTMS) on primary motor cortex (M1), supplementary motor area (SMA), dorsolateral prefrontal cortex (DLPFC), and cerebellum on balance. Results: Strong evidence showed that a-tDCS of M1, SMA improve balance in healthy participants, and the a-tDCS of DLPFC induces improvement only in dual task balance indices. Also, the findings indicate that cerebellar a-tDCS might significantly improve balance, if at least 10 min cerebellar a-tDCS with an intensity of ≥1 mA, over or maximum 1.5 cm below the inion, is used. Strong evidence showed that c-tDCS, cTBS, and rTMS are not effective on the balance. Conclusion: According to the results, the a-tDCS may be a useful technique to improve balance in healthy adults.
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Affiliation(s)
- Shabnam Behrangrad
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Maryam Zoghi
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Bundoora, Australia
| | - Dawson Kidgell
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Shapour Jaberzadeh
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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21
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Hawk C, Amorin-Woods L, Evans MW, Whedon JM, Daniels CJ, Williams RD, Parkin-Smith G, Taylor DN, Anderson D, Farabaugh R, Walters SA, Schielke A, Minkalis AL, Crivelli LS, Alpers C, Hinkeldey N, Hoang J, Caraway D, Whalen W, Cook J, Redwood D. The Role of Chiropractic Care in Providing Health Promotion and Clinical Preventive Services for Adult Patients with Musculoskeletal Pain: A Clinical Practice Guideline. J Altern Complement Med 2021; 27:850-867. [PMID: 34314609 DOI: 10.1089/acm.2021.0184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: To develop evidence-based recommendations on best practices for delivery of clinical preventive services by chiropractors and to offer practical resources to empower provider applications in practice. Design: Clinical practice guideline based on evidence-based recommendations of a panel of practitioners and experts on clinical preventive services. Methods: Synthesizing the results of a literature search for relevant clinical practice guidelines and systematic reviews, a multidisciplinary steering committee with training and experience in health promotion, clinical prevention, and/or evidence-based chiropractic practice drafted a set of recommendations. A Delphi panel of experienced practitioners and faculty, primarily but not exclusively chiropractors, rated the recommendations by using the formal consensus methodology established by the RAND Corporation/University of California. Results: The Delphi consensus process was conducted during January-February 2021. The 65-member Delphi panel reached a high level of consensus on appropriate application of clinical preventive services for screening and health promotion counseling within the chiropractic scope of practice. Interprofessional collaboration for the successful delivery of clinical preventive services was emphasized. Recommendations were made on primary, secondary, tertiary, and quaternary prevention of musculoskeletal pain. Conclusions: Application of this guideline in chiropractic practice may facilitate consistent and appropriate use of screening and preventive services and foster interprofessional collaboration to promote clinical preventive services and contribute to improved public health.
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Affiliation(s)
- Cheryl Hawk
- Texas Chiropractic College, Pasadena, Texas, USA
| | | | - Marion W Evans
- University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - James M Whedon
- Southern California University of Health Sciences, Whittier, California, USA
| | | | | | | | | | - Derek Anderson
- VA Puget Sound Health Care System American Lake Division, Tacoma, Washington, USA
| | | | | | | | | | | | | | | | | | | | | | - Jason Cook
- VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
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22
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Chen Y, Gao Q, He CQ, Bian R. Effect of Virtual Reality on Balance in Individuals With Parkinson Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Phys Ther 2020; 100:933-945. [PMID: 32157307 DOI: 10.1093/ptj/pzaa042] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/01/2019] [Accepted: 11/24/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Virtual reality (VR) is a frequently used intervention for the rehabilitation of individuals with neurological disorders. PURPOSE The aims of this review were to identify the short-term effect of VR on balance and to compare it with the effect of active interventions in individuals with Parkinson disease (PD). DATA SOURCES Searches for relevant articles available in English were conducted using the MEDLINE (via PubMed), EMBASE, CENTRAL, CINAHL, PsycINFO, and Physiotherapy Evidence Database databases from inception until March 2019. STUDY SELECTION All randomized controlled trials comparing the effect of training with VR and the effect of training without VR on balance in individuals with PD were included. DATA EXTRACTION Two authors independently extracted data, assessed the methodological quality, and evaluated the evidence quality of the studies. DATA SYNTHESIS Fourteen randomized controlled trials including 574 individuals were eligible for qualitative analyses, and 12 of the studies involving 481 individuals were identified as being eligible for meta-analyses. Compared with active interventions, the use of VR improved the Berg Balance Scale score (mean difference = 1.23; 95% CI = 0.15 to 2.31; I2 = 56%). The Dynamic Gait Index and Functional Gait Assessment results were also significant after the sensitivity analyses (mean difference = 0.69; 95% CI = 0.12 to 1.26; I2 = 0%). Both provided moderate statistical evidence. However, the Timed "Up & Go" Test and the Activities-Specific Balance Confidence Scale did not differ significantly. LIMITATIONS Publication bias and diversity in the interventions were the main limitations. CONCLUSIONS Existing moderate evidence of the effectiveness of VR with the Berg Balance Scale, Dynamic Gait Index, and Functional Gait Assessment for individuals with PD was promising. Although the differences did not reach the clinically important change threshold, VR was comparable to active interventions and could be considered an adjuvant therapy for balance rehabilitation in individuals with PD.
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Affiliation(s)
- Yi Chen
- Y. Chen, MS, Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; and Key Laboratory of Rehabilitation Medicine of Sichuan Province, Chengdu, Sichuan Province, China
| | - Qiang Gao
- Q. Gao, PhD, Department of Rehabilitation Medicine, West China Hospital, Sichuan University; and Key Laboratory of Rehabilitation Medicine of Sichuan Province
| | - Cheng-Qi He
- C-Q. He, PhD, Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, Sichuan Province, 610041, China; and Key Laboratory of Rehabilitation Medicine of Sichuan Province. Address all correspondence to Dr He at:
| | - Rong Bian
- R. Bian, PhD, Rehabilitation Department, Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Gelaw AY, Janakiraman B, Gebremeskel BF, Ravichandran H. Effectiveness of Home-based rehabilitation in improving physical function of persons with Stroke and other physical disability: A systematic review of randomized controlled trials. J Stroke Cerebrovasc Dis 2020; 29:104800. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104800] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/21/2020] [Accepted: 03/02/2020] [Indexed: 11/30/2022] Open
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Cabrera-Martos I, Jiménez-Martín AT, López-López L, Rodríguez-Torres J, Ortiz-Rubio A, Valenza MC. Effects of a core stabilization training program on balance ability in persons with Parkinson's disease: a randomized controlled trial. Clin Rehabil 2020; 34:764-772. [PMID: 32349543 DOI: 10.1177/0269215520918631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the effects of an eight-week core stability program on balance ability in persons with Parkinson's disease. DESIGN Randomized controlled trial. SETTING A local Parkinson's association. SUBJECTS A total of 44 participants with a clinical diagnosis of Parkinson's disease were randomly assigned to an experimental (n = 22) or control group (n = 22). INTERVENTION The experimental group received 24 sessions of core training, while the control group received an intervention including active joint mobilization, muscle stretching, and motor coordination exercises. MAIN MEASURES The primary outcome measure was dynamic balance evaluated using the Mini-Balance Evaluation Systems Test. Secondary outcomes included the balance confidence assessed with the Activities-specific Balance Confidence Scale and standing balance assessed by the maximal excursion of center of pressure during the Modified Clinical Test of Sensory Interaction on Balance and the Limits of Stability test. RESULTS After treatment, a significant between-group improvement in dynamic balance was observed in the experimental group compared to the control group (change, 2.75 ± 1.80 vs 0.38 ± 2.15, P = 0.002). The experimental group also showed a significant improvement in confidence (change, 16.48 ± 16.21 vs 3.05 ± 13.53, P = 0.047) and maximal excursion of center of pressure in forward (change, 0.86 ± 1.89 cm vs 0.17 ± 0.26 cm, P = 0.048), left (change, 0.88 ± 2.63 cm vs 0.07 ± 0.48 cm, P = 0.010), and right (change, 1.63 ± 2.82 cm vs 0.05 ± 0.17 cm, P = 0.046) directions of limits of stability compared to the control group. CONCLUSION A program based on core stability in comparison with non-specific exercise benefits dynamic balance and confidence and increases center of mass excursion in patients with Parkinson's disease.
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Affiliation(s)
- Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | - Laura López-López
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Janet Rodríguez-Torres
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortiz-Rubio
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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LaGrone S, Joseph C, Johansson H, Enberg B, Franzén E. Choreographing life-experiences of balance control in people with Parkinson's disease. BMC Neurol 2020; 20:50. [PMID: 32039713 PMCID: PMC7008524 DOI: 10.1186/s12883-020-01632-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 01/31/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a devastating neurodegenerative disorder. Reduced balance is one of the cardinal symptoms of PD, predisposing people living with PD to experience difficulties with the execution of tasks and activities, as well as hindering their involvement in meaningful life areas. The overarching aim of this study was to explore how deficits in balance control manifest in everyday life and how it is managed by people with PD (PwPD). METHODS Qualitative description was used as methodology, and in-depth interviews were conducted with 18 participants, between the ages of 46 to 83 years, with mild to severe PD. Interview transcripts were analyzed using qualitative content analysis, following an inductive approach. RESULTS One theme emerged from the analysis: Increased planning-choreographing life. Within this overarching theme, two categories were identified, namely Limitations in mobility and New restricted functioning in everyday life, each with 3-4 sub-categories. The categories described how PwPD handled decreased balance control in their everyday life by using motor and cognitive strategies as a consequence of not trusting their body's capacity to control balance. Activities in everyday life, as well as the ability to partake in leisure and social activities were profoundly affected. CONCLUSION People with mild to severe PD used strategies to handle decreased balance and they choreographed their lives around their individual current state of mobility and balance. The knowledge gained from this study can be used to develop targeted interventions addressing the nuances of balance deficits in everyday life.
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Affiliation(s)
- Sofie LaGrone
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Conran Joseph
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa
| | - Hanna Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Birgit Enberg
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Karolinska Institutet and Function Area Occupational Therapy and Physiotherapy, Function of Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
- Stockholms Sjukhem R&D unit, Stockholm, Sweden
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Szymura J, Kubica J, Wiecek M, Pera J. The Immunomodulary Effects of Systematic Exercise in Older Adults and People with Parkinson's Disease. J Clin Med 2020; 9:jcm9010184. [PMID: 31936624 PMCID: PMC7019419 DOI: 10.3390/jcm9010184] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 02/07/2023] Open
Abstract
We sought to investigate whether regular balance training of moderate intensity (BT) has an effect on changes in selected cytokines, neurotrophic factors, CD200 and fractalkine in healthy older adults and participants with Parkinson’s disease (PD). Sixty-two subjects were divided into groups depending on experimental intervention: (1) group of people with PD participating in BT (PDBT), (2) group of healthy older people participating in BT (HBT), (3,4) control groups including healthy individuals (HNT) and people with PD (PDNT). Blood samples were collected twice: before and after 12 weeks of balance exercise (PDBT, HBT), or 12 weeks apart (PDNT, HNT). The study revealed significant increase of interleukin10 (PDBT, p = 0.026; HBT, p = 0.011), β-nerve growth factor (HBT, p = 0.002; PDBT, p = 0.016), transforming growth factor-β1 (PDBT, p = 0.018; HBT, p < 0.004), brain-derived neurotrophic factor (PDBT, p = 0.011; HBT, p < 0.001) and fractalkine (PDBT, p = 0.045; HBT, p < 0.003) concentration only in training groups. In PDBT, we have found a significant decrease of tumor necrosis factor alpha. No training effect on concentration of interleukin6, insulin-like growth factor 1 and CD200 was observed in both training and control groups. Regular training can modulate level of inflammatory markers and induce neuroprotective mechanism to reduce the inflammatory response.
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Affiliation(s)
- Jadwiga Szymura
- Department of Clinical Rehabilitation, Faculty of Motor Rehabilitation, University of Physical Education in Krakow, 31–571 Krakow, Poland
- Correspondence: (J.S.); (J.K.)
| | - Jadwiga Kubica
- Institute of Physiotherapy, Faculty of Health Science, Jagiellonian University Medical College, 31–126 Krakow, Poland
- Correspondence: (J.S.); (J.K.)
| | - Magdalena Wiecek
- Department of Physiology and Biochemistry, Faculty of Physical Education and Sport, University of Physical Education in Krakow, 31–571 Krakow, Poland;
| | - Joanna Pera
- Department of Neurology, Faculty of Medicine, Jagiellonian University Medical College, 31–503 Krakow, Poland;
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Terra MB, Barboza NM, Almeida IAD, Bueno MEB, Smaili SM. Does physiotherapy plus cognitive training improve balance in Parkinson's disease? Randomized clinical trial. MOTRIZ: REVISTA DE EDUCACAO FISICA 2020. [DOI: 10.1590/s1980-6574202000020160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Rodrigues IB, Ponzano M, Giangregorio LM. Practical tips for prescribing exercise for fall prevention. Osteoporos Int 2019; 30:1953-1960. [PMID: 31471663 DOI: 10.1007/s00198-019-05141-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/22/2018] [Indexed: 11/28/2022]
Abstract
CLINICAL RELEVANCE There is strong evidence from meta-analyses that exercise as a single intervention can reduce the number and risk of falls in community-dwelling older adults, yet not all types of exercise are equal. OBSERVATIONS Programs that include 3 h a week of exercise and provide a high challenge to balance can reduce falls by almost 40%. Reactive and volitional stepping interventions have also been shown to reduce falls by about 50%. Evidence is less clear regarding the efficacy of exercise in individuals who have experienced a stroke, who live in long-term care, who have been recently discharged from the hospital, or who have visual impairments, but there is some evidence that multifactorial programs may be useful. CONCLUSION Depending on the population, exercise as a single or as part of a multifactorial intervention may be beneficial in reducing falls.
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Affiliation(s)
- I B Rodrigues
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
| | - M Ponzano
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - L M Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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Palmisano C, Brandt G, Pozzi NG, Leporini A, Maltese V, Canessa A, Volkmann J, Pezzoli G, Frigo CA, Isaias IU. Sit-to-walk performance in Parkinson's disease: A comparison between faller and non-faller patients. Clin Biomech (Bristol, Avon) 2019; 63:140-146. [PMID: 30889433 DOI: 10.1016/j.clinbiomech.2019.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Falls are one of the main concerns in people with Parkinson's disease, leading to poor quality of life and increased mortality. The sit-to-walk movement is the most frequent postural transition task during daily life and is highly demanding in terms of balance maintenance and muscular strength. METHODS With the aim of identifying biomechanical variables of high risk of falling, we investigated the sit-to-walk task performed by 9 Parkinson's disease patients with at least one fall episode in the six months preceding this study, 15 Parkinson's disease patients without previous falls, and 20 healthy controls. Motor performance was evaluated with an optoelectronic system and two dynamometric force plates after overnight suspension of all dopaminergic drugs and one hour after consumption of a standard dose of levodopa/benserazide. FINDINGS Poor trunk movements critically influenced the execution of the sit-to-walk movement in patients with a history of falling. The peak velocity of the trunk in the anterior-posterior direction discriminated faller from non-faller patients, with high specificity and sensitivity in both the medication-off and -on state. INTERPRETATION Our results confirm the difficulties in merging consecutive motor tasks in patients with Parkinson's disease. Trunk movements during the sit-to-walk can provide valuable measurements to monitor and possibly predict the risk of falling.
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Affiliation(s)
- Chiara Palmisano
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany; Department of Electronic, Information and Bioengineering, MBMC Lab, Politecnico di Milano, via Colombo 40, 20133 Milan, Italy
| | - Gregor Brandt
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Nicoló Gabriele Pozzi
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Alice Leporini
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Virginia Maltese
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Andrea Canessa
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, via all'Opera Pia 13a, 16145 Genoa, Italy; Fondazione Europea di Ricerca Biomedica (FERB Onlus), Via Uboldo 18, 20063 Cernusco s/N, Milan, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Gianni Pezzoli
- Centro Parkinson ASST G. Pini-CTO, via Bignami 1, 20126 Milan, Italy
| | - Carlo Albino Frigo
- Department of Electronic, Information and Bioengineering, MBMC Lab, Politecnico di Milano, via Colombo 40, 20133 Milan, Italy
| | - Ioannis Ugo Isaias
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany; Centro Parkinson ASST G. Pini-CTO, via Bignami 1, 20126 Milan, Italy.
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Olson M, Lockhart TE, Lieberman A. Motor Learning Deficits in Parkinson's Disease (PD) and Their Effect on Training Response in Gait and Balance: A Narrative Review. Front Neurol 2019; 10:62. [PMID: 30792688 PMCID: PMC6374315 DOI: 10.3389/fneur.2019.00062] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/17/2019] [Indexed: 01/30/2023] Open
Abstract
Parkinson's disease (PD) is a neurological disorder traditionally associated with degeneration of the dopaminergic neurons within the substantia nigra, which results in bradykinesia, rigidity, tremor, and postural instability and gait disability (PIGD). The disorder has also been implicated in degradation of motor learning. While individuals with PD are able to learn, certain aspects of learning, especially automatic responses to feedback, are faulty, resulting in a reliance on feedforward systems of movement learning and control. Because of this, patients with PD may require more training to achieve and retain motor learning and may require additional sensory information or motor guidance in order to facilitate this learning. Furthermore, they may be unable to maintain these gains in environments and situations in which conscious effort is divided (such as dual-tasking). These shortcomings in motor learning could play a large part in degenerative gait and balance symptoms often seen in the disease, as patients are unable to adapt to gradual sensory and motor degradation. Research has shown that physical and exercise therapy can help patients with PD to adapt new feedforward strategies to partially counteract these symptoms. In particular, balance, treadmill, resistance, and repeated perturbation training therapies have been shown to improve motor patterns in PD. However, much research is still needed to determine which of these therapies best alleviates which symptoms of PIGD, the needed dose and intensity of these therapies, and long-term retention effects. The benefits of such technologies as augmented feedback, motorized perturbations, virtual reality, and weight-bearing assistance are also of interest. This narrative review will evaluate the effect of PD on motor learning and the effect of motor learning deficits on response to physical therapy and training programs, focusing specifically on features related to PIGD. Potential methods to strengthen therapeutic effects will be discussed.
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Affiliation(s)
- Markey Olson
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
- Muhammad Ali Movement Disorders Clinic, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Thurmon E. Lockhart
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Abraham Lieberman
- Muhammad Ali Movement Disorders Clinic, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
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A High-Intensity Exercise Boot Camp for Persons With Parkinson Disease: A Phase II, Pragmatic, Randomized Clinical Trial of Feasibility, Safety, Signal of Efficacy, and Disease Mechanisms. J Neurol Phys Ther 2019; 43:12-25. [DOI: 10.1097/npt.0000000000000249] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Johansson C, Lindström B, Forsgren L, Johansson GM. Balance and mobility in patients with newly diagnosed Parkinson's disease - a five-year follow-up of a cohort in northern Sweden. Disabil Rehabil 2018; 42:770-778. [PMID: 30451551 DOI: 10.1080/09638288.2018.1509240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: The presence of early balance impairment in patients with Parkinson's disease has not been fully investigated.Purpose: The purpose of this study was to examine balance and mobility, self-perceived unsteadiness, self-reported falls, and effects of medication on balance among patients at their first visit to a neurological clinic and during the ensuing five years.Materials and methods: The participants were collected from a prospective longitudinal study. One hundred and forty-five patients with idiopathic Parkinson's disease and 31 healthy controls were included. The outcome measures were the Berg Balance Scale, the Timed Up and Go, the Postural Stability test and a questionnaire.Results: At their first visit to the neurological clinic, the patients performed less well on the Berg Balance Scale (p < 0.001, r = 0.36), the Timed Up and Go (p < 0.001, r = 0.32), and the Postural Stability test (p < 0.001, r = 0.35) compared with the controls. In addition, a higher percentage of the patients reported self-perceived unsteadiness (p < 0.001, phi = 0.47). During the ensuing five years, balance and mobility worsened both with and without medication (p < 0.01, r = 0.24-0.37), although with small median differences.Conclusions: Further studies are needed to confirm that minor balance impairments exist even at the time of diagnosis and worsen during the ensuing five years.IMPLICATIONS FOR REHABILITATIONImpairments in balance and mobility may occur early in Parkinson's disease, especially in the elderly patients, and seem to worsen during the first five years.There is a need to use sensitive outcome measures and to ask the patients about unsteadiness and falls to detect balance impairment in this cohort.Parkinsonian medication has a limited effect on balance and may preferably be complemented with balance exercises to target balance impairment early in Parkinson's disease.
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Affiliation(s)
- Christer Johansson
- Department of Community Medicine and Rehabilitation; Physiotherapy, Umeå University, Umeå, Sweden
| | - Britta Lindström
- Department of Community Medicine and Rehabilitation; Physiotherapy, Umeå University, Umeå, Sweden
| | - Lars Forsgren
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Gudrun M Johansson
- Department of Community Medicine and Rehabilitation; Physiotherapy, Umeå University, Umeå, Sweden
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McIsaac TL, Fritz NE, Quinn L, Muratori LM. Cognitive-Motor Interference in Neurodegenerative Disease: A Narrative Review and Implications for Clinical Management. Front Psychol 2018; 9:2061. [PMID: 30425673 PMCID: PMC6218850 DOI: 10.3389/fpsyg.2018.02061] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 10/05/2018] [Indexed: 11/13/2022] Open
Abstract
This paper provides a narrative review of cognitive motor interference in neurodegeneration, including brain imaging findings specific to interference effects in neurodegenerative disease, and dual task assessment and intervention in Parkinson’s disease (PD), multiple sclerosis (MS), and Huntington’s disease (HD). In a healthy central nervous system the ability to process information is limited. Limitations in capacity to select and attend to inputs influence the ability to prepare and perform multiple tasks. As a result, the system balances demands, switching attention to the most task-relevant information as it becomes available. Limitations may become more apparent in persons with neurodegenerative diseases (ND) with system-specific impairments in PD, MS, and HD. These ND affect both cognitive and motor function and are thus particularly susceptible to dual task interference. Issues related to performer and task characteristics and implications of these findings for both the standard assessment of dual task abilities as well as development and evaluation of interventions aimed at improving dual task ability are discussed. In addition, we address the need for optimizing individualized assessment, intervention and evaluation of dual task function by choosing cognitive and motor tasks and measures that are sensitive to and appropriate for the individual’s level of function. Finally, we use current evidence to outline a 5-step process of clinical decision making that uses the dual task taxonomy as a framework for assessment and intervention.
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Affiliation(s)
- Tara L McIsaac
- Department of Physical Therapy, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, United States
| | - Nora E Fritz
- Program in Physical Therapy and Department of Neurology, Wayne State University, Detroit, MI, United States
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Lisa M Muratori
- Department of Physical Therapy, SHTM, Stony Brook University, Stony Brook, NY, United States
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Cheng FY, Yang YR, Wu YR, Lu CF, Cheng SJ, Wang RY. Beta event-related desynchronization can be enhanced by different training programs and is correlated with improved postural control in individuals with Parkinson's disease. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1957-1964. [PMID: 30183638 DOI: 10.1109/tnsre.2018.2868140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study was to investigate the effects of a specific exercise (SE) training program focusing on balance and muscle strengthening and a turning-based treadmill (TT) training program on cortical desynchronization and postural control in Parkinson's disease (PD). METHODS Eighteen patients with PD were recruited and randomly assigned to the SE group, TT training group or control exercise (CE) group and participated in 12 30-min training sessions focusing on balance and strengthening, turning-based treadmill training, or general exercise training, respectively, followed by 10 minutes of over-ground walking in each session for 4 to 6 weeks. The outcomes included alpha event-related desynchronization (ERD), beta ERD, postural control ability indicated by postural instability and gait disorder (PIGD), the step/quick turn test (SQT), and the sensory organization test (SOT). All measurements were assessed at baseline and after training. RESULTS The results (n=6 for each group) showed that both the SE and TT groups had improved beta ERD, but not alpha ERD, in the Cz area, PIGD score, and turn sway/time in the SQT compared with the CE group. Furthermore, postural control ability was positively correlated with beta ERD in the Cz area. However, there was no significant correlation between SOT total score and alpha ERD in the Cz area. CONCLUSIONS This study showed that beta ERD in the central area and postural control can be improved with balance training, along with lower extremity muscle strengthening exercise and turning-based treadmill training, in patients with PD. Furthermore, improvement in beta ERD in the central area correlated with improvements in postural control ability. This trial was registered at http://www.anzctr.org.au/ (ACTRN12616000198426).
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Jang YC, Hwang DJ, Koo JH, Um HS, Lee NH, Yeom DC, Lee Y, Cho JY. Association of exercise-induced autophagy upregulation and apoptosis suppression with neuroprotection against pharmacologically induced Parkinson's disease. J Exerc Nutrition Biochem 2018; 22:1-8. [PMID: 29673238 PMCID: PMC5909076 DOI: 10.20463/jenb.2018.0001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/13/2018] [Indexed: 01/12/2023] Open
Abstract
[Purpose] We investigated whether treadmill exercise (TE)-induced neuroprotection was associated with enhanced autophagy and reduced apoptosis in a mouse model of pharmacologically induced Parkinson's disease (PD). [Methods] PD was induced via the administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). C57BL/6 male mice were randomly assigned to the following three groups: control (C57BL, n=10), MPTP with probenecid (MPTP/C, n=10), and MPTP/ C plus exercise (MPTP-TE, n=10). The MPTP-TE mice performed TE training (10 m/min, 60 min/day, 5 days/week) for 8 weeks. The rotarod test was used to assess motor function. [Results] TE restored MPTP/P-induced motor dysfunctionand increased tyrosine hydroxylase levels. Furthermore, TE diminished the levels of α-synuclein (α-syn), a neurotoxin; modulated the levels of autophagy-associated proteins, including microtubule-associated protein 1 light chain 3-II, p62, BECLIN1, BNIP3, and lysosomal-associated membrane protein-2, which enhanced autophagy; inhibited the activation of proapoptotic proteins (caspase-3 and BAX);and upregulated BCL-2, an antiapoptosis protein. [Conclusion] Taken together, these results suggested that the TE-induced neuroprotection against MPTP-induced cell death was associated with enhanced autophagy and neuronal regeneration based on the findings of inhibited proapoptotic events in the brains of the TE-trained animals.
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Cerebellar transcranial direct current stimulation improves adaptive postural control. Clin Neurophysiol 2017; 129:33-41. [PMID: 29136550 DOI: 10.1016/j.clinph.2017.09.118] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 09/11/2017] [Accepted: 09/28/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Rehabilitation interventions contribute to recovery of impaired postural control, but it remains a priority to optimize their effectiveness. A promising strategy may involve transcranial direct current stimulation (tDCS) of brain areas involved in fine-tuning of motor adaptation. This study explored the effects of cerebellar tDCS (ctDCS) on postural recovery from disturbance by Achilles tendon vibration. METHODS Twenty-eight healthy volunteers participated in this sham-ctDCS controlled study. Standing blindfolded on a force platform, four trials were completed: 60 s quiet standing followed by 20 min active (anodal-tDCS, 1 mA, 20 min, N = 14) or sham-ctDCS (40 s, N = 14) tDCS; three quiet standing trials with 15 s of Achilles tendon vibration and 25 s of postural recovery. Postural steadiness was quantified as displacement, standard deviation and path derived from the center of pressure (COP). RESULTS Baseline demographics and quiet standing postural steadiness, and backwards displacement during vibration were comparable between groups. However, active-tDCS significantly improved postural steadiness during vibration and reduced forward displacement and variability in COP derivatives during recovery. CONCLUSIONS We demonstrate that ctDCS results in short-term improvement of postural adaptation in healthy individuals. SIGNIFICANCE Future studies need to investigate if multisession ctDCS combined with training or rehabilitation interventions can induce prolonged improvement of postural balance.
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Zhang YN. Can a Smartphone Diagnose Parkinson Disease? A Deep Neural Network Method and Telediagnosis System Implementation. PARKINSON'S DISEASE 2017; 2017:6209703. [PMID: 29075547 PMCID: PMC5624169 DOI: 10.1155/2017/6209703] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 07/25/2017] [Accepted: 08/14/2017] [Indexed: 11/18/2022]
Abstract
Parkinson's disease (PD) is primarily diagnosed by clinical examinations, such as walking test, handwriting test, and MRI diagnostic. In this paper, we propose a machine learning based PD telediagnosis method for smartphone. Classification of PD using speech records is a challenging task owing to the fact that the classification accuracy is still lower than doctor-level. Here we demonstrate automatic classification of PD using time frequency features, stacked autoencoders (SAE), and K nearest neighbor (KNN) classifier. KNN classifier can produce promising classification results from useful representations which were learned by SAE. Empirical results show that the proposed method achieves better performance with all tested cases across classification tasks, demonstrating machine learning capable of classifying PD with a level of competence comparable to doctor. It concludes that a smartphone can therefore potentially provide low-cost PD diagnostic care. This paper also gives an implementation on browser/server system and reports the running time cost. Both advantages and disadvantages of the proposed telediagnosis system are discussed.
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Affiliation(s)
- Y. N. Zhang
- School of Computer Science and Technology, Beijing Institute of Technology, Beijing 100081, China
- College of Computer Science and Information Engineering, Tianjin University of Science and Technology, Tianjin 300222, China
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Chaudhuri KR, Bhidayasiri R, van Laar T. Unmet needs in Parkinson's disease: New horizons in a changing landscape. Parkinsonism Relat Disord 2016; 33 Suppl 1:S2-S8. [PMID: 27932224 DOI: 10.1016/j.parkreldis.2016.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 11/15/2022]
Abstract
The success of levodopa and other classes of drugs have meant that most people with Parkinson's disease enjoy a good quality of life for many years. However, despite the availability of several drugs and formulations that can be used as monotherapy and in combination, there are a number of disease features that the current therapies are unable to address. The disease continues to progress despite treatment, patients suffer from a myriad of motor and non-motor symptoms, and a neuroprotective therapy is urgently required. To move forward with medical and surgical management, it is important to consider new insights that recent research offers and in this review we examine how a better understanding of the disease pathology and progression might improve and enrich our daily clinical practice. It is also timely to consider the service provision changes that will increasingly be needed to effectively manage the needs of the aging population.
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Affiliation(s)
- K Ray Chaudhuri
- The Maurice Wohl Clinical Neuroscience Institute, King's College London and National Parkinson Foundation Centre of Excellence, King's College Hospital London, UK
| | - Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan.
| | - Teus van Laar
- Department of Neurology, University of Groningen, Groningen, The Netherlands
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