Abstract
Backgroundto date, there are no medical or surgical treatments for progressive supranuclear palsy (PSP). It is possible to speculate that patients with PSP could benefit from rehabilitative treatments designed for Parkinson’s disease, including the use of robot-assisted walking training.Objectiveto evaluate whether the use of the robotic device Lokomat® is superior in PSP patients to the use of treadmill with visual cues and auditory feedbacks (treadmill-plus) in the context of an aerobic, multidisciplinary, intensive, motor-cognitive and goal-based rehabilitation treatment (MIRT) conceived for Parkinsonian patients.Methodswe enrolled twenty-four PSP patients. Twelve subjects underwent a 4-week MIRT exploiting the use of the treadmill-plus (MIRT group). Twelve subjects underwent the same treatment, but replacing the treadmill-plus with Lokomat® (MIRT-Lokomat group). Subjects were evaluated with clinical and functional scales at admission and discharge. The primary outcomes were the total PSP Rating Scale (PSPRS) score and its “limb” and “gait” sub-scores. Secondary outcomes were Berg Balance Scale (BBS), Six Minutes Walking test (6MWT) and the number of falls.Resultstotal PSPRS, PSPRS-gait sub-score, BBS, 6MWT and number of falls improved significantly in both groups (p ≤ 0.003 all, except 6MWT, p = 0.032 and p = 0.018 in MIRT-Lokomat and MIRT group respectively). The PSPRS-limb sub-score improved significantly only in the MIRT group (p = 0.002). A significant difference between groups was observed only for total PSPRS, indicating a slightly better improvement for patients in the MIRT group (p = 0.047). No differences between groups were revealed for the other outcomes, indicating that the effect of rehabilitation was similar in both groups.ConclusionsLokomat® training, in comparison with treadmill-plus training, does not provide further benefits in PSP patients undergoing MIRT. Our findings suggest the usefulness of an aerobic, multidisciplinary, intensive, motor-cognitive and goal-based approach for the rehabilitation of patients suffering from such a complex disease as PSP.Trial RegistrationThis trial was registered on ClinicalTrials.gov, NCT02109393.
Highlights
Progressive supranuclear palsy (PSP) represents the most common form of atypical Parkinsonism[1], with a prevalence of 6.5 cases/1.000.000 people.[2]
Our findings suggest the usefulness of an aerobic, multidisciplinary, intensive, motor-cognitive and goal-based approach for the rehabilitation of patients suffering from such a complex disease as PSP
The neuropathological hallmark of PSP is a biochemical alteration in the tau protein, which results in a neurodegeneration and gliosis in the basal ganglia, brainstem, prefrontal cortex and cerebellum.[3]
Summary
Progressive supranuclear palsy (PSP) represents the most common form of atypical Parkinsonism[1], with a prevalence of 6.5 cases/1.000.000 people.[2] The neuropathological hallmark of PSP is a biochemical alteration in the tau protein, which results in a neurodegeneration and gliosis in the basal ganglia, brainstem, prefrontal cortex and cerebellum.[3]. There are no effective medical or surgical treatments for PSP. Rehabilitative interventions are described in sporadic case reports[6,7,8] or in few studies with limited sample sizes[9,10] and consist of exercise programs focused to improve muscle strength, gait, coordination and balance.[6,7,8,9,10,11] data from these studies are not consistent and no specific rehabilitation treatment exists for this disease.[4]
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