Treadmill training in Parkinson’s patients after deep brain stimulation: Effects on gait kinematic

EFFECTS OF TREADMILL GAIT TRAINING ON BALANCE IN PARKINSON'S PATIENTS AFTER DEEP BRAIN STIMULATION

Objective

After deep brain stimulation (DBS), patients with Parkinson's disease (PD) typically still present significant gait and postural stability problems, and thus additional interventions are needed. In this way, our purpose was evaluate the comparative effectiveness of treadmill training, with and without body weight support, on balance outcomes among patients with PD after DBS.

Methods

Eleven patients with PD that were using bilateral subthalamic nucleus DBS were evaluated using Time Up and Go test (TUG); Berg Balance Scale (BBS) and Static Posturography. In phase 1, all subjects participated in 8-weeks of treadmill training in conjunction with conventional physiotherapy. After six weeks (wash-out), each patient then participated in a subsequent 8-weeks of treadmill training with partial body weight support.

Results

After the phase 1, there were improvements on the cognitive TUG performance (Before: 15.7 ± 1,8 sec; After: 13.7 ± 3.1 sec; p < 0.01) and an increase of anteroposterior and medio-lateral body oscillation with eyes closed. After the phase 2, there were improvements in conventional (Before: 12.3 ± 2.0 sec; After: 10.7 ± 1.7 sec; p < 0.01) and cognitive (Before: 14.6 ± 3.5 sec; After: 12.5 ± 1.6 sec; p < 0.05) TUG performances. There were no significant changes in the Berg Balance Scale following either training protocol.

Conclusion

Both trainings improved static and dynamic balance and had similar results; however, supported treadmill training seemed to be a potentially superior option, as patients tended to feel safer. Level of Evidence II, therapeutic studies - investigation of treatment outcomes.

Conservative interventions to improve foot progression angle and clinical measures in orthopedic and neurological patients - A systematic review and meta-analysis

To establish the comparative effects of conservative interventions on modifying foot progression angle (FPA) in children and adults with orthopaedic and neurological disease was the main aim of the literature review. Pubmed, Embase, Cinahl, and Web of Science were systematically searched for studies evaluating the effects of conservative interventions on correcting the FPA. The study protocol was registered with PROSPERO (CRD42020143512). Two reviewers independently assessed studies for inclusion and quality. Studies that assessed conservative interventions that could have affected the FPA and objectively measured the FPA were included. Within group Mean Differences (MD) and Standardized Mean Differences (SMDs) of the interventions were calculated for the change in FPA and gait performance (walking speed, stride/step length) and clinical condition (pain). Intervention effects on FPA were synthesized via meta-analysis or qualitatively. 41 studies were identified. For patients with knee osteoarthritis gait training interventions (MD = 6.69° and MD = 16.06°) were significantly more effective than mechanical interventions (MD = 0.44°) in modifying the FPA towards in-toeing (p < 0.00001). Increasing or decreasing the FPA significantly improved pain in patients with medial knee OA. Results were inconclusive for the effectiveness of gait training and mechanical devices in patients with neurological diseases. Gait feedback training is more effective than external devices to produce lasting improvements in FPA, reduce pain, and maintain gait performance in patients with medial knee OA. However, in neurological patients, the effects of external devices on improvements in FPA depends on the interaction between patient-specific impairments and the technical properties of the external device.

Body Weight Support Gait Training for Patients With Parkinson Disease: A Systematic Review and Meta-analyses

OBJECTIVE

To determine the effectiveness of body weight support (BWS) gait training to improve the clinical severity, gait, and balance in patients with Parkinson disease (PD).

DATA SOURCES

A literature search was conducted until July 2020 in MEDLINE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature.

STUDY SELECTION

Randomized controlled trials that aimed at determining the effectiveness of physical activity interventions with BWS during gait training in patients with PD.

DATA EXTRACTION

The methodological quality of randomized controlled trials was assessed using the Cochrane risk of bias tool (RoB 2.0). Effect size (ES) and 95% confidence intervals [CIs] were calculated for the Unified Parkinson Disease Rating Scale (UPDRS), the UPDRS section III, the 6-minute walk test (6MWT), gait parameters (ie, velocity, cadence, stride length), and the Berg Balance Scale (BBS).

DATA SYNTHESIS

Twelve studies were included in the systematic review. The pooled ES for the effect of BWS on total UPDRS was -0.35 (95% CI, -0.57 to -0.12; I²=1.9%, P=.418), whereas for UPDRS III it was -0.35 (95% CI, -0.68 to -0.01; I²=66.4 %, P<.001). Furthermore, the pooled ES for 6MWT was 0.56 (95% CI, -0.07 to 1.18; I²=77.1%, P=.002), for gait velocity was 0.37 (95% CI, -0.10 to 0.84); I²=78.9%, P<.001), for cadence was 0.03 (95% CI, -0.25 to 0.30; I²=0.0%, P=.930), for stride length was 1.00 (95% CI, 0.23 to 1.78; I²=79.5%, P=.001), and for BBS was 0.65 (95% CI, 0.30, 0.99; I²=51.8%, P=.042).

CONCLUSIONS

Interventions with BWS could improve the general and motor clinical severity of patients with PD, as well as other parameters such as stride length and balance. However, the effect does not appear to be statistically significant in improving gait parameters such as velocity, cadence, and distance.

A Case-Controlled Pilot Study on Rhythmic Auditory Stimulation-Assisted Gait Training and Conventional Physiotherapy in Patients With Parkinson's Disease Submitted to Deep Brain Stimulation

Deep brain stimulation (DBS) is indicated when motor disturbances in patients with idiopathic Parkinson's disease (PD) are refractory to current treatment options and significantly impair quality of life. However, post–DBS rehabilitation is essential, with particular regard to gait. Rhythmic auditory stimulation (RAS)-assisted treadmill gait rehabilitation within conventional physiotherapy program plays a major role in gait recovery. We explored the effects of a monthly RAS–assisted treadmill training within a conventional physiotherapy program on gait performance and gait-related EEG dynamics (while walking on the RAS–aided treadmill) in PD patients with (n = 10) and without DBS (n = 10). Patients with DBS achieved superior results than those without DBS concerning gait velocity, overall motor performance, and the timed velocity and self-confidence in balance, sit-to-stand (and vice versa) and walking, whereas both groups improved in dynamic and static balance, overall cognitive performance, and the fear of falling. The difference in motor outcomes between the two groups was paralleled by a stronger remodulation of gait cycle–related beta oscillations in patients with DBS as compared to those without DBS. Our work suggests that RAS-assisted gait training plus conventional physiotherapy is a useful strategy to improve gait performance in PD patients with and without DBS. Interestingly, patients with DBS may benefit more from this approach owing to a more focused and dynamic re–configuration of sensorimotor network beta oscillations related to gait secondary to the association between RAS-treadmill, conventional physiotherapy, and DBS. Actually, the coupling of these approaches may help restoring a residually altered beta–band response profile despite DBS intervention, thus better tailoring the gait rehabilitation of these PD patients.

Effects of Nordic Walking on Gait Symmetry in Mild Parkinson’s Disease

Individuals with Parkinson’s disease (PD) have gait asymmetries, and exercise therapy may reduce the differences between more and less affected limbs. The Nordic walking (NW) training may contribute to reducing the asymmetry in upper and lower limb movements in people with PD. We compared the effects of 11 weeks of NW aerobic training on asymmetrical variables of gait in subjects with mild PD. Fourteen subjects with idiopathic PD, age: 66.8 ± 9.6 years, and Hoehn and Yard stage of 1.5 points were enrolled. The kinematic analysis was performed pre and post-intervention. Data were collected at two randomized walking speeds (0.28 m·s−1 and 0.83 m·s−1) during five minutes on the treadmill without poles. The more affected and less affected body side symmetries (threshold at 5% between sides) of angular kinematics and spatiotemporal gait parameters were calculated. We used Generalized Estimating Equations with Bonferroni post hoc (α = 0.05). Maximal flexion of the knee (p = 0.007) and maximal abduction of the hip (p = 0.041) were asymmetrical pre and became symmetrical post NW intervention. The differences occurred in the knee was less affected and the hip was more affected. We concluded that 11 weeks of NW training promoted similarities in gait parameters and improved knee and hip angular parameters for PD subjects.

Effects of treadmill training on the balance, functional capacity and quality of life in Parkinson’s disease: A randomized clinical trial

Background

There is growing evidence that exercise modalities have considerable effects on Parkinson’s disease (PD). This trial aimed to provide a more detailed viewpoint of short-term and long-term treadmill training (TT) effects on some motor and non-motor features of PD.

Methods

In this prospective, randomized, single-blind clinical trial, 20 mild to moderate PD patients, admitted in Rasoul-e-Akram hospital in Tehran, Iran, were randomly allocated in case (11) and control (9) groups. Treadmill intervention was performed at moderate intensity with 60% of heart rate reserved (HRR) in two 30-min sessions/week for a duration of 10 weeks. Both the groups were evaluated for three times; at the baseline, 2 months later and then 2 months after the second evaluation. We assigned the Timed Up and Go test (TUG), 6-min walk test (6MW), and the SF-8 healthy questionnaire, for assessment of balance, functional capacity, and Quality of life (QoL), respectively.

Results

Balance and functional capacity were significantly improved in the case group after the intervention (TUG p-value: 0.003, 6MW p-value: 0.003). Moreover, the long-term analysis revealed significant results as well (TUG p-value: 0.001, 6MW p-value: 0.004). Mental condition’s scores of SF-8 in cases were not statistically different in short-term follow-up (F/U). However, analysis illustrated p-value: 0.016 for long-term assessment. The intervention induced significant changes in physical condition’s scores in both of the F/Us (PC p-value: 0.013).

Conclusions

This study provides evidence that a TT of mild to moderate intensity has significant and persistent benefits for the balance, functional capacity, and QoL in PD.

The effects of acupuncture and electroacupuncture on Parkinson's disease: Current status and future perspectives for molecular mechanisms

Among the progressive neurodegenerative disorders, Parkinson's disease (PD) is the second most common. Different factors have critical role in pathophysiology of PD such as apoptosis pathways, inflammatory cytokines, oxidative stress, and neurotransmitters and its receptors abnormalities. Acupuncture and electroacupuncture were considered as nondrug therapies for PD. Although numerous studies has been conducted for assessing the mechanism underlying electroacupuncture and acupuncture, various principal aspects of these treatment procedures remain not well-known. There have also been few investigations on the molecular mechanism of acupuncture and electroacupuncture therapy effects in PD. This review evaluates the effects of electroacupuncture and acupuncture on the molecular mechanism in PD.