Aquatic Physiotherapy and Parkinson’s Disease: Effects on Functional Motor Skills

Abstract

Parkinson’s Disease (PD) is a progressive disease with motor impairment, and as such requires a multidisciplinary team that includes physiotherapy. Physiotherapy can stimulate learning ability, motor recovery, neuroplasticity and neuroprotection. The aquatic physiotherapy (AP) for PD enables movements to be progressively and safely executed, reducing the risk of falls. Hence, the objective of this study is to analyze the effects of an AP program on the functional motor skills of people with PD. This is a controlled quasi-experimental clinical trial, with blind assessor. The participants were male and female, diagnosed with PD, Hoehn and Yahr stages 1 to 4 and medical certificate for AP. The exclusion criteria were: not presenting independent walking; sensorial deficit; contraindications for attending a heated pool; alterations in levodopa ingestion. The functional assessments conducted on land were: walking speed test; Five Times Sit to Stand Test; Mini BESTest, Unified Parkinson’s Disease Rating Scale (UPDRS) for activities of daily living (ADL); and motor skill parts, evaluated before, after and 4 months after AP. The aquatic assessment was conducted through the Aquatic Functional Assessment Scale (AFAS). The participants were allocated in two groups: Control Group (CG), which did not take part in the pool activities, and Experimental Group (EG), which was submitted to AP, throughout 32 twice-a-week, 50-minute-long appointments. Functional exercises were proposed to respect the principles of specificity and progression regarding complexity in the aquatic activities through aquatic motor skills learning phases. Groups and times were compared statistically. At the end of the study, the EG was composed of 11 participants and the CG 7. There were no differences between the groups at the beginning of the study. A difference was observed between groups for gait speed in evaluation 2; difference between assessment 1 and 2 for GE in the ADL and motor, as well as between assessment 2 and 3 for GE in the motor assessment. CG presented a decline from assessment 1 and 3. In the aquatic assessment, the EG had a statistical difference after the intervention. It was observed that the AP program can modify the aquatic motor skills and the land motor skills of walking speed, the UPDRS ADL and the UPDRS motor.