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Bezerra PT, Santiago LM, Silva IA, Souza AA, Pegado CL, Damascena CM, Ribeiro TS, Lindquist AR. Action observation and motor imagery have no effect on balance and freezing of gait in Parkinson's disease: a randomized controlled trial. Eur J Phys Rehabil Med 2022; 58:715-722. [PMID: 36052889 PMCID: PMC10019482 DOI: 10.23736/s1973-9087.22.07313-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Combining action observation (AO) and motor imagery (MI) training may induce greater brain activity in areas usually involved in Parkinson's disease (PD) and lead to greater behavioral and neurophysiological effects than when used separately. AIM To determine the effects of combining AO, MI, and gait training on balance and freezing of gait in individuals with PD. DESIGN This is a single-blinded, randomized controlled clinical trial. SETTING Laboratory of Intervention and Analysis of Movement (LIAM) from the Department of Physical Therapy of a Brazilian University. POPULATION Study sample consisted of individuals diagnosed with idiopathic PD by a neurologist specialized in movement disorders. METHODS 39 individuals with PD were divided into experimental (EG=21) and control groups (CG=18). EG performed 12 sessions of AO, MI, and gait training, whereas CG watched PD-related educational videos and performed 12 sessions of gait training. Balance (measured using the Mini Balance Evaluation Systems Test [MiniBESTest]) and freezing of gait (measured using the Freezing of Gait Questionnaire) were reassessed one day after the end of the intervention. RESULTS We did not observe significant intra- and intergroup differences in freezing of gait. For the EG, we observed a significant intragroup difference in the total score of MiniBESTest (F=5.2; P=0.02), and sensory orientation (F=4.5; P=0.04) and dynamic gait (F=3.6; P=0.03) domains. MiniBESTest domains were not different between groups. CONCLUSIONS Combining AO, MI, and gait training was not more effective than isolated gait training for balance and freezing of gait in individuals with PD. CLINICAL REHABILITATION IMPACT MI training can moderate AO effects and enhance motor learning when both therapies are combined. Therefore, this approach may still have the potential to be included in the treatment of PD. New studies should investigate whether the factors that influence these results are related to the protocol's sensitivity in changing the evaluated parameters or to the time and intensity of AO and MI training.
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Affiliation(s)
- Paula T Bezerra
- Department of Physical Therapy, Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil
| | - Lorenna M Santiago
- Department of Physical Therapy, Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil.,Anita Garibaldi Education and Health Research Center, Santos Dumont Institute, Macaíba, Rio Grande do Norte, Brazil
| | - Isaíra A Silva
- Department of Physical Therapy, Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil
| | - Aline A Souza
- Department of Physical Therapy, Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil
| | - Camila L Pegado
- Department of Physical Therapy, Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil
| | - Clécia M Damascena
- University of Estácio do Rio Grande do Norte (Fatern), Natal, Rio Grande do Norte, Brazil
| | - Tatiana S Ribeiro
- Department of Physical Therapy, Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil
| | - Ana R Lindquist
- Department of Physical Therapy, Rio Grande do Norte Federal University, Natal, Rio Grande do Norte, Brazil -
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Sweeney D, Quinlan LR, Browne P, Richardson M, Meskell P, ÓLaighin G. A Technological Review of Wearable Cueing Devices Addressing Freezing of Gait in Parkinson's Disease. SENSORS 2019; 19:s19061277. [PMID: 30871253 PMCID: PMC6470562 DOI: 10.3390/s19061277] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 11/16/2022]
Abstract
Freezing of gait is one of the most debilitating symptoms of Parkinson’s disease and is an important contributor to falls, leading to it being a major cause of hospitalization and nursing home admissions. When the management of freezing episodes cannot be achieved through medication or surgery, non-pharmacological methods such as cueing have received attention in recent years. Novel cueing systems were developed over the last decade and have been evaluated predominantly in laboratory settings. However, to provide benefit to people with Parkinson’s and improve their quality of life, these systems must have the potential to be used at home as a self-administer intervention. This paper aims to provide a technological review of the literature related to wearable cueing systems and it focuses on current auditory, visual and somatosensory cueing systems, which may provide a suitable intervention for use in home-based environments. The paper describes the technical operation and effectiveness of the different cueing systems in overcoming freezing of gait. The “What Works Clearinghouse (WWC)” tool was used to assess the quality of each study described. The paper findings should prove instructive for further researchers looking to enhance the effectiveness of future cueing systems.
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Affiliation(s)
- Dean Sweeney
- Electrical & Electronic Engineering, School of Engineering and Informatics, NUI Galway, University Road, H91 TK33 Galway, Ireland.
- Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, NUI Galway, University Road, H91 TK33 Galway, Ireland.
| | - Leo R Quinlan
- Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, NUI Galway, University Road, H91 TK33 Galway, Ireland.
- Physiology, School of Medicine, NUI Galway, University Road, H91 TK33 Galway, Ireland.
| | - Patrick Browne
- Neurology Department, University Hospital Galway, H91 YR71 Galway, Ireland.
- School of Nursing and Midwifery, NUI Galway, University Road, H91 TK33 Galway, Ireland.
- School of Medicine, NUI Galway, University Road, H91 TK33 Galway, Ireland.
| | - Margaret Richardson
- Neurology Department University Hospital Limerick, Dooradoyle, V94 F858 Limerick, Ireland.
| | - Pauline Meskell
- Department of Nursing and Midwifery University of Limerick, Castletroy, V94 T9PX Limerick, Ireland.
| | - Gearóid ÓLaighin
- Electrical & Electronic Engineering, School of Engineering and Informatics, NUI Galway, University Road, H91 TK33 Galway, Ireland.
- Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, NUI Galway, University Road, H91 TK33 Galway, Ireland.
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Jonasson SB, Nilsson MH, Lexell J, Carlsson G. Experiences of fear of falling in persons with Parkinson's disease - a qualitative study. BMC Geriatr 2018; 18:44. [PMID: 29409443 PMCID: PMC5801775 DOI: 10.1186/s12877-018-0735-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 01/28/2018] [Indexed: 12/02/2022] Open
Abstract
Background Fear of falling is common among persons with Parkinson’s disease and is negatively associated with quality of life. However a lack of in-depth understanding of fear of falling as a phenomenon persists. This qualitative study aimed to explore the experiences of fear of falling in persons with Parkinson’s disease. Methods Individual interviews were performed with twelve persons with Parkinson’s disease (median age 70 years, median Parkinson duration 9 years, 50% women). The interviews were semi-structured and followed a study-specific interview guide. The transcribed interviews were analyzed using qualitative content analysis. Results Fear of falling was experienced as a disturbing factor in everyday life. It generated a feeling of vulnerability and made daily activities and everyday environments seem potentially hazardous. Persons also missed performing previous activities. The fear of falling was a varying experience, fueled by an awareness of falls and near falls, Parkinson-related symptoms and disabilities, and by others in their environment. The persons adopted different strategies to handle their fear of falling. Activities were adapted, avoided, performed with help, or carried out despite their fear of falling. Conclusions The experiences of fear of falling were complex, multifaceted and varied over time and in relation to different activities and environments. This indicates that interventions targeting fear of falling need to be individually tailored for persons with Parkinson’s disease and should focus on several aspects, such as Parkinson-related symptoms and disabilities, activities and environmental factors. This study provides new information that increases the understanding of fear of falling, which has implications for researchers as well as clinicians working with persons with Parkinson’s disease and fear of falling. Electronic supplementary material The online version of this article (10.1186/s12877-018-0735-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stina B Jonasson
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden. .,Department of Neurology and Rehabilitation, Skåne University Hospital, Lund, Sweden.
| | - Maria H Nilsson
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Jan Lexell
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden.,Department of Neurology and Rehabilitation, Skåne University Hospital, Lund, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Gunilla Carlsson
- Department of Health Sciences, Lund University, Box 157, 221 00, Lund, Sweden
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Kader M, Ullén S, Iwarsson S, Odin P, Nilsson MH. Factors Contributing to Perceived Walking Difficulties in People with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2018; 7:397-407. [PMID: 28505982 DOI: 10.3233/jpd-161034] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND While walking difficulties are common in people with Parkinson's disease (PD), little is known about factors that independently contribute to their perceived walking difficulties. OBJECTIVE To identify factors that independently contribute to perceived walking difficulties in people with PD. METHODS This study involved 243 (62% men) participants; their mean (min-max) age and PD duration were 70 (45-93) and 8 (1-43) years, respectively. A postal survey preceded a home visit that included observations, clinical tests, questions and questionnaires that were administered as a structured interview. Perceived walking difficulties (dependent variable) were assessed with the self-administered generic Walk-12 (Walk-12G, scored 0-42, higher = worse). Independent variables included personal (e.g., age and general self-efficacy) and social environmental factors (e.g., social support and living situation) as well as disease-related factors including motor (e.g., freezing of gait (FOG) and postural instability) and non-motor symptoms (e.g., fatigue and orthostatic hypotension). Linear multiple regression analysis was used to identify factors that independently contributed to perceived walking difficulties. RESULTS Eight significant independent variables explained 56.3% of the variance in perceived walking difficulties. FOG was the strongest significant contributing factor to perceived walking difficulties, followed by general self-efficacy, fatigue, PD duration, lower extremity function, orthostatic hypotension, bradykinesia and postural instability. CONCLUSION Motor and non-motor symptoms as well as personal factors (i.e., general self-efficacy) seem to be of importance for perceived walking difficulties in PD. These findings might nurture future interventions that address modifiable factors in order to enhance walking ability in people with PD.
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Affiliation(s)
- Manzur Kader
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Susann Ullén
- Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden
| | | | - Per Odin
- Department of Clinical Sciences, Section for Neurology, Skåne University Hospital, Lund, Sweden.,Department of Neurology, Central Hospital, Bremerhaven, Germany
| | - Maria H Nilsson
- Department of Health Sciences, Lund University, Lund, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
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Ishii M, Okuyama K. Characteristics associated with freezing of gait in actual daily living in Parkinson's disease. J Phys Ther Sci 2017; 29:2151-2156. [PMID: 29643593 PMCID: PMC5890219 DOI: 10.1589/jpts.29.2151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/20/2017] [Indexed: 11/30/2022] Open
Abstract
[Purpose] Parkinson’s disease (PD) patients often freeze in actual daily living but
seldom in clinical setting. This study aimed to identify the factors contributing to
freezing of gait (FOG). [Subjects and Methods] The participants included 28 adults with
PD. Principal component analysis was used to investigate the characteristics of 14 common
FOG situations adopted from previous studies. Cluster analysis classified the subjects
into four groups. Kruskal-Wallis test was performed to compare the PD Questionnaire-39
mobility dimension between the groups. [Results] The major variables of the first
principal component in 14 FOG situations were unfamiliar places, unpredictable schedule
changes, entering an automatic door, when another person suddenly crossed, and change in
the walking surface. These situations were unrelated to the second principal component.
Getting on/off a public transport and crowded places were major variables for the second
principal component, and related to both the first and second principal components.
Although fatigue was the most frequent FOG situation, not all principal components were
influenced. The values of the PD Questionnaire-39 revealed significant differences between
the groups. [Conclusion] Actual FOG situations may be categorized into (1) task
complexity, (2) both task complexity and emotional factors, and (3) fatigue as decreased
attentional resources.
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Affiliation(s)
- Mitsuaki Ishii
- Department of Physical Therapy, School of Health Science, Bukkyo University: 7 Nishinokyo Higashi-toganoocho, Nakagyo-ku, Kyoto 604-8418, Japan
| | - Kohei Okuyama
- Department of Physical Therapy, Second Ueda Rehabilitation Clinic, Japan
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Peek J. 'There was no great ceremony': patient narratives and the diagnostic encounter in the context of Parkinson's. MEDICAL HUMANITIES 2017; 43:35-40. [PMID: 27821537 PMCID: PMC5339567 DOI: 10.1136/medhum-2016-011054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 05/05/2023]
Abstract
This paper draws on stories of diagnosis that emerged from a broader narrative study exploring the lived experience of Parkinson's (n.37). Despite the life-changing nature of their diagnosis, participants' narratives highlighted considerable shortcomings in the way in which their diagnostic encounter was handled, echoing the findings of previous research in which it has been noted that 'the human significance' of diagnosis was passed over. Building on the literature, this paper provides empirical material that reveals the sensitivities involved at the moment of diagnosis. By examining both the structure and content of participants' narratives, this article discusses the diagnostic encounter in relation to three key concepts that connected many participants' stories: a 'bareness' or lack of 'ceremony', a sense of emotional and physical 'abandonment' and the impact on a person's illness story when faced with a 'hierarchy' of illness. This paper aims to raise awareness of contemporary issues related to the diagnosis of Parkinson's, and invites reflection on how diagnosis might be undertaken in a way that truly acknowledges its human significance.
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Ottosson J, Lavesson L, Pinzke S, Grahn P. The Significance of Experiences of Nature for People with Parkinson's Disease, with Special Focus on Freezing of Gait--The Necessity for a Biophilic Environment. A Multi-Method Single Subject Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:7274-99. [PMID: 26132480 PMCID: PMC4515656 DOI: 10.3390/ijerph120707274] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/03/2015] [Accepted: 06/18/2015] [Indexed: 11/29/2022]
Abstract
Freezing of Gait (FOG) is a common condition in people with Parkinson's disease (PD). FOG entails suddenly experiencing difficulties moving or feeling that one's feet are as glued to the ground. It is triggered, e.g., when passing through doorways. Earlier studies suggest that being in natural environments affects FOG in a positive way. Five subjects were recruited to serve as five single subject cases. We used interviews, observations, questionnaires and collected gait pattern data with aid of an accelerometer. A special designed outdoor setting was used, where we investigated whether passing through hedge openings with or without built elements triggered FOG. We found that no one experienced a FOG reaction when they passed through hedge openings without built elements. However, FOG was triggered when a doorframe was inserted into a hedge opening, and/or when peripheral vision was blocked. We interpret the results such that the doorframe triggered a phobic reflex, causing a freezing reaction. Passing through hedge openings does not trigger FOG, which we interpret as a biophilic reaction. Our results, if repeated in future studies, may have significance to everyday lives of PD patients, who could get a simpler life by consciously prioritizing stays in natural surroundings.
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Affiliation(s)
- Johan Ottosson
- The Department of Work Science, Business Economics and Environmental Psychology, Swedish University of Agricultural Sciences, P.O. Box 88, SE-230 53 Alnarp, Sweden.
| | - Lillian Lavesson
- The Department of Work Science, Business Economics and Environmental Psychology, Swedish University of Agricultural Sciences, P.O. Box 88, SE-230 53 Alnarp, Sweden.
| | - Stefan Pinzke
- The Department of Work Science, Business Economics and Environmental Psychology, Swedish University of Agricultural Sciences, P.O. Box 88, SE-230 53 Alnarp, Sweden.
| | - Patrik Grahn
- The Department of Work Science, Business Economics and Environmental Psychology, Swedish University of Agricultural Sciences, P.O. Box 88, SE-230 53 Alnarp, Sweden.
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Nieuwboer A, Giladi N. Characterizing freezing of gait in Parkinson's disease: Models of an episodic phenomenon. Mov Disord 2013; 28:1509-19. [DOI: 10.1002/mds.25683] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/13/2013] [Accepted: 08/22/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Alice Nieuwboer
- Department of Rehabilitation Sciences; KU Leuven Leuven Belgium
| | - Nir Giladi
- Movement Disorders Unit, Department of Neurology; Tel-Aviv Medical Center, Sackler School of Medicine; Sagol School of Neuroscience; Tel-Aviv University; Tel-Aviv Israel
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