Abstract
BackgroundLSVT-BIG® is an intensively delivered, amplitude-oriented exercise therapy reported to improve mobility in individuals with Parkinson’s disease (PD). However, questions remain surrounding the efficacy of LSVT-BIG® when compared with similar exercise therapies. Instrumented clinical tests using body-worn sensors can provide a means to objectively monitor patient progression with therapy by quantifying features of motor function, yet research exploring the feasibility of this approach has been limited to date. The aim of this study was to use accelerometer-instrumented clinical tests to quantify features of gait, balance and fine motor control in individuals with PD, in order to examine motor function during and following LSVT-BIG® therapy.MethodsTwelve individuals with PD undergoing LSVT-BIG® therapy, eight non-exercising PD controls and 14 healthy controls were recruited to participate in the study. Functional mobility was examined using features derived from accelerometry recorded during five instrumented clinical tests: 10 m walk, Timed-Up-and-Go, Sit-to-Stand, quiet stance, and finger tapping. PD subjects undergoing therapy were assessed before, each week during, and up to 13 weeks following LSVT-BIG®.ResultsAccelerometry data captured significant improvements in 10 m walk and Timed-Up-and-Go times with LSVT-BIG® (p < 0.001), accompanied by increased stride length. Temporal features of the gait cycle were significantly lower following therapy, though no change was observed with measures of asymmetry or stride variance. The total number of Sit-to-Stand transitions significantly increased with LSVT-BIG® (p < 0.001), corresponding to a significant reduction of time spent in each phase of the Sit-to-Stand cycle. No change in measures related to postural or fine motor control was observed with LSVT-BIG®. PD subjects undergoing LSVT-BIG® showed significant improvements in 10 m walk (p < 0.001) and Timed-Up-and-Go times (p = 0.004) over a four-week period when compared to non-exercising PD controls, who showed no week-to-week improvement in any task examined.ConclusionsThis study demonstrates the potential for wearable sensors to objectively quantify changes in motor function in response to therapeutic exercise interventions in PD. The observed improvements in accelerometer-derived features provide support for instrumenting gait and sit-to-stand tasks, and demonstrate a rescaling of the speed-amplitude relationship during gait in PD following LSVT-BIG®.
Highlights
LSVT-BIG® is an intensively delivered, amplitude-oriented exercise therapy reported to improve mobility in individuals with Parkinson’s disease (PD)
This study demonstrates the potential for wearable sensors to objectively quantify changes in motor function in response to therapeutic exercise interventions in PD
Temporal parameters of the gait cycle steadily decreased throughout therapy in both the Instrumented 10 m walk (i10MW) and Instrumented timed-up-and-go (iTUG) tasks, with significant reductions observed in step time (i10MW: F = 9.12, p < 0.001; iTUG: F = 7.54, p < 0.001), stride time (i10MW: F = 8.63, p < 0.001; iTUG: F = 7.03, p < 0.001), swing time (i10MW: F = 5.34, p < 0.001; iTUG: F = 4.31, p < 0.001) and stance time (i10MW: F = 3.22, p = 0.037; iTUG: F = 3.23, p = 0.004), Fig. 4
Summary
LSVT-BIG® is an intensively delivered, amplitude-oriented exercise therapy reported to improve mobility in individuals with Parkinson’s disease (PD). The aim of this study was to use accelerometer-instrumented clinical tests to quantify features of gait, balance and fine motor control in individuals with PD, in order to examine motor function during and following LSVT-BIG® therapy. A later study by Ebersbach et al, comparing LSVT-BIG® to a Nordic walking and a home exercise programme, reported significant improvements in MDS-UPDRS III motor scores and Timed-Up-and-Go times, whereas no significant differences were observed in the comparative therapies [9]. In a follow-on study examining cognitive aspects of motor preparation, LSVT-BIG® and Nordic Walking were both shown to improve cued reaction times, but not non-cued reaction times [14]. The disparities in clinical scoring emphasize the need for more objective, quantitative measures of motor function to accurately monitor and assess efficacy of therapeutic interventions in PD
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