Rehabilitation Of Parkinson's Disease Patients Research Articles

Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait.

Background: The sequence effect (SE), referring to step-to-step reduction in amplitude, is considered to lead to freezing of gait (FOG) in Parkinson's disease (PD). Visual cues may alleviate SE and help reduce freezing episodes. FOG patients show significant SE prior to turning or toward a doorway, but the SE toward a destination has not been clearly studied.Objectives: To examine the SE when approaching a destination in PD patients with FOG, and to further explore the effects of different types of visual cues on destination SE.Methods: Thirty-five PD patients were divided into a freezing (PD+FOG, n = 15) group and a non-freezing (PD–FOG, n = 20) group. Walking trials were tested under three conditions, including without cues (no-cue condition), with wearable laser lights (laser condition), and with transverse strips placed on the floor (strip condition). Kinematic data was recorded by a portable Inertial Measurement Unit (IMU) system. The destination SE and some key gait parameters were evaluated.Results: The PD+FOG group showed greater destination SE in the no-cue and laser conditions when compared to the PD–FOG group. There were no significant differences in the strip condition when comparing destination SE of the two groups. The destination SE was alleviated only by using the transverse strips on the floor. In contrast, transverse strips and wearable laser lights could increase the step length.Conclusions: The significant destination SE may explain why FOG patients are prone to freezing when heading toward their destination. Visual cues using transverse strips on the floor may be a more effective strategy for FOG rehabilitation in PD patients.

The role of dance therapy in the rehabilitation of Parkinson disease patients

Introduction: Parkinson disease is the second most common neurodegenerative disease which requires a complex approach including pharmacological and non-pharmacological treatment. While kinesiotherapy is a must in Parkinson’s disease patients, dance therapy in rehabilitation programs is not often taken into consideration. Dance therapy is a challenging non-pharmacological treatment which merges physical activity with musical synchronization, socialization , disease acceptance and creativity with daily activities. The aim of this study is to evaluate the effect of dance therapy on the quality of life, functionality and decrease of depression in Parkinson patients. Material and method: We developed a case control study to evaluate the benefit of dance therapy in Parkinson Patients. The study group consisted in 10 patients from “Puterea Sperantei Project”. The intervention consisted in 40 minutes/day of dance therapy during two weeks. First control group consisted of 10 patients admitted to Cluj-Napoca Rehabilitation Hospital for two weeks. The second control group consisted in 5 patients enrolled in the “Puterea Sperantei Project” which did not attended dance classes. All three groups followed standard therapy: kineto-therapy and ergo-therapy. To assess the effect of dance therapy we used: Beck scale, Parkinson Disease Questionnaire (PDQ-39) and a satisfaction questionnaire which we developed, for the dance therapy. Results and discussions: In the study group we registered an improvement of depression symptoms (p=0,017) and an increase in the life quality (p=0,005). In the hospital control group and in the “Puterea Speratei Project” control group there was no decrease in the depressions score (p >0,05). However, the quality of life increased also in the control group enrolled in the Rehabilitation Hospital, probably due to medication change. The mean of satisfaction questionnaire for dance therapy in the study group was 39,70 from a maximum of 48 points. Conclusions: Dance therapy is a holistic non-pharmacological therapy which improves the depression index, the quality of life and functionality of Parkinson disease patients. This initial results raise the possibility of including dance therapy as an alternative of non-pharmacological therapy in the rehabilitation programs for Parkinson Disease Patients.

The Use of Footstep Sounds as Rhythmic Auditory Stimulation for Gait Rehabilitation in Parkinson's Disease: A Randomized Controlled Trial.

The use of rhythmic auditory stimulation (RAS) has been proven useful in the management of gait disturbances associated with Parkinson's disease (PD). Typically, the RAS consists of metronome or music-based sounds (artificial RAS), while ecological footstep sounds (ecological RAS) have never been used for rehabilitation programs. The aim of this study was to compare the effects of a rehabilitation program integrated either with ecological or with artificial RAS. An observer-blind, randomized controlled trial was conducted to investigate the effects of 5 weeks of supervised rehabilitation integrated with RAS. Thirty-eight individuals affected by PD were randomly assigned to one of the two conditions (ecological vs. artificial RAS); thirty-two of them (age 68.2 ± 10.5, Hoehn and Yahr 1.5-3) concluded all phases of the study. Spatio-temporal parameters of gait and clinical variables were assessed before the rehabilitation period, at its end, and after a 3-month follow-up. Thirty-two participants were analyzed. The results revealed that both groups improved in the majority of biomechanical and clinical measures, independently of the type of sound. Moreover, exploratory analyses for separate groups were conducted, revealing improvements on spatio-temporal parameters only in the ecological RAS group. Overall, our results suggest that ecological RAS is equally effective compared to artificial RAS. Future studies should further investigate the role of ecological RAS, on the basis of information revealed by our exploratory analyses. Theoretical, methodological, and practical issues concerning the implementation of ecological sounds in the rehabilitation of PD patients are discussed. www.ClinicalTrials.gov, identifier NCT03228888.

Aerobic rehabilitation program for improving muscle function in Parkinson's disease.

Parkinson's Disease (PD) is characterized by progressive and disabling symptoms. An impaired oxidative metabolism efficiency was supposed to be involved in the systemic impairment. Rehabilitative treatment represents a valid tool in promoting skeletal muscle's adaptations, even if no solid studies on muscle metabolic features are still available. To evaluate the efficiency of skeletal muscle oxidative metabolism in PD patients in comparison with age-matched controls and test the role of an intensive aerobic treatment on muscle oxidative metabolism and its clinical effects. 60 PD patients and 32 age-matched healthy controls participated. Haematic lactate values were detected during and after a submaximal incremental exercise on treadmill. The number of steps completed during the exercise was recorded. From these patients 10 underwent to an intensive aerobic treatment on treadmill (4 sessions/week for 4 weeks). Haematic lactate values and functional scales were recorded before (T0) and after (T1) treatment. At rest no significant difference in hematic lactate values between PD and control subjects was found. Lactate blood levels were significantly higher (p < 0,001) after the aerobic exercise test in PD patients compared to controls. These values remained higher at any time during recovery period (p < 0,001). No significant relationship between lactate values and the number of completed steps was found. After the rehabilitation treatment haematic value of lactate showed a significant reduction (p < 0,05) at 0, 5 and 10 minutes of recovery period with a normalization of value at 30'. All functional scales showed an improvement trend at T1, in particular Berg Balance Scale and 6 Meter Walking Test showed a significant reduction (p < 0,001 and p < 0,05 respectively). Our data clearly show an impaired muscle oxidative efficiency in PD subjects. The intensive rehabilitation program on treadmill showed a beneficial effect on muscle oxidative metabolism, endurance and balance, confirming the focal role of rehabilitation in PD patients.

The impact of cognitive reserve on the effectiveness of balance rehabilitation in Parkinson's disease.

Cognitive reserve (CR) can be considered an active expression of brain resilience in response to a damage. Several studies have shown the influence of CR on cognitive impairment and its relationship with cognitive function in Parkinson's disease (PD). The aim of the present study was to show if CR influences the effectiveness of balance rehabilitation in PD patients who performed a conventional rehabilitative treatment. Observational longitudinal study. Neurology Outpatient Unit, University Hospital. Fifty-three patients affected by idiopathic PD, stage 2-3 at the Hoehn and Yahr Scale. Each patient underwent 32 group sessions of conventional rehabilitative treatment. At baseline, patients' CR was assessed by the Cognitive Reserve Index questionnaire (CRIq). The primary outcome was the evaluation of static and dynamic balance modifications, induced by the treatment, through the Berg Balance Scale (BBS), assessed at T0 and T1. Mini Mental State Examination, Unified Parkinson's Disease Rating Scale Part III (clinician-scored monitored motor evaluation) and Brief Intelligence Test were assessed only at T0 and used as descriptive variables. Considering the clinically meaningful change, BBS improved in 26% of patients, worsened in 2% and was unchanged in 72%. BBS score significantly improved in older patients, and in those with lower CRI total score. A significant inverse correlation was observed between changes in BBS and work and education related CR. Patients with lower baseline BBS score showed better improvement in balance. We found an inverse correlation between CR level and balance improvement in PD patients who underwent conventional rehabilitation: higher improvement in BBS was observed in those with a lower CRI score. This may suggest that patients with higher CRI could benefit from more stimulating types of non-conventional rehabilitation (e.g. robotic, virtual reality). Rehabilitation should be individually tailored considering CR as a significant variable.

Sensor-based evaluation and treatment of nocturnal hypokinesia in Parkinson's disease: An evidence-based review

The manifestations of nocturnal movements in Parkinson's disease (PD) are protean, with major disabilities related to nocturnal hypokinesia. While it can be assessed by clinical interviews and screening instruments, these are often inaccurate and prone to recall bias. In light of advances in sensor technology, we explored the use of sensors in the study of nocturnal hypokinesia, by performing a systematic review of the professional literature on this topic. Evidence suggests that nocturnal hypokinesia exists even in patients in the early stages, and PD patients turned significantly less and with much slower speed and acceleration than controls, partly related to low nocturnal dopamine level. We conducted another systematic review to evaluate the evidence of the efficacy of dopaminergic agents in the treatment of nocturnal hypokinesia. Several lines of evidence support the use of long-acting drugs or by continuous administration of short-acting agents to control symptoms. Sensor parameters could be considered as one of the important objective outcomes in future clinical trials investigating potential drugs to treat nocturnal hypokinesia. Physicians should be aware of this technology as it can aid the clinical assessment of nocturnal hypokinesia and enhance the quality of patient care. In addition, the use of sensors currently is being considered for various aspects of research on early diagnosis, treatment, and rehabilitation of PD patients.

A pilot study on the effect of cognitive training on BDNF serum levels in individuals with Parkinson's disease.

Parkinson’s disease (PD) patients, besides motor dysfunctions, may also display mild cognitive deficits (MCI) which increase with disease progression. The neurotrophin brain-derived neurotrophic factor (BDNF) plays a role in the survival of dopaminergic neurons and in the regulation of synaptic connectivity. Moreover, the brain and peripheral level of this protein may be significantly reduced in PD patients. These data suggest that a cognitive rehabilitation protocol aimed at restoring cognitive deficits in PD patients may also involve changes in this neurotrophin. Thus, in this pilot study we evaluated the effect of a cognitive rehabilitation protocol focused on the training of executive functioning and measured BDNF serum levels in a group of PD patients with mild cognitive impairment, as compared to the effect of a placebo treatment (n = 7/8 group). The results showed that PD patients undergoing the cognitive rehabilitation, besides improving their cognitive performance as measured with the Zoo Map Test, also displayed increased serum BDNF levels as compared to the placebo group. These findings suggest that BDNF serum levels may represent a biomarker of the effects of cognitive rehabilitation in PD patients affected by MCI. However, the functional significance of this increase in PD as well as other neuropathological conditions remains to be determined.

Effects of dance on motor functions, cognitive functions, and mental symptoms of Parkinson's disease: A quasi-randomized pilot trial

To examine the effectiveness of dance on motor functions, cognitive functions, and mental symptoms of Parkinson's disease (PD). This study employed a quasi-randomised, between-group design. Dance, PD exercise, and all assessments were performed in community halls in different regions of Japan. Forty-six mild-moderate PD patients participated. Six PD patient associations that agreed to participate in the study were randomly assigned to a dance group, PD exercise group, or non-intervention group. The dance and PD exercise groups performed one 60-min session per week for 12 weeks. Control group patients continued with their normal lives. All groups were assessed before and after the intervention. We used the Timed Up-and-Go Test (TUG) and Berg Balance Scale (BBS) to assess motor function, the Frontal Assessment Battery at bedside (FAB) and Mental Rotation Task (MRT) to assess cognitive function, and the Apathy Scale (AS) and Self-rating Depression Scale (SDS) to assess mental symptoms of PD. The Unified Parkinson's Disease Rating Scale (UPDRS) was used for general assessment of PD. When comparing results before and after intervention, the dance group showed a large effect in TUG time (ES=0.65, p=0.006), TUG step number (ES=0.66, p=0.005), BBS (ES=0.75, p=0.001), FAB (ES=0.77, p=0.001), MRT response time (ES=0.79, p<0.001), AS (ES=0.78, p<0.001), SDS (ES=0.66, p=0.006) and UPDRS (ES=0.88, p<0.001). Dance was effective in improving motor function, cognitive function, and mental symptoms in PD patients. General symptoms in PD also improved. Dance is an effective method for rehabilitation in PD patients.

Dramatic Improvement of Parkinsonism While Dancing Tango

A 73-year -old woman with a 15-year history of idiopathic Parkinson disease (PD) had severe difficulties in initiating gait and walked only with cane assistance with short shuffling steps. On examination, she had severe bilateral rigidity and bradykinesia. On the pull test, she lost balance spontaneously or with just a gentle pull on the shoulders (UPDRS-III score: 59). She has been an Argentine tango dancer since she was 10 years old, and because she is part of a traditional family of tango dancers, she usually participates in “milongas” (tango parties). When dancing, she could reliably overcome gait disturbance, being able to dance the steps of tango, dramatically improving her motor and gait disturbance, walking backward, making cross-steps, and controlling her balance dynamically. There exists the hypothesis that basal ganglia are involved in providing phasic cues to the supplementary motor area (SMA), which is responsible for activating and deactivating each submovement within the movement sequence, as well as their accurate execution.1 In PD, basal ganglia dysfunction could lead to the loss of internal gait rhythm causing their characteristic gait disorders. Sensory cues appear to be powerful means of improving gait in PD by circumventing dopaminergic, or perhaps nondopaminergic, deficits.1 However, different types of auditory cueing could provide an external rhythm compensating for the defective internal rhythm of the basal ganglia in PD.1 Similarly, certain visual stimuli are also effective in improving gait. Therefore, sensory cues could be employed as a strategy of rehabilitation in PD patients.2 Tango is a particular type of dance that includes external cues, movement strategies, and exercises for balance improvement.3 There is evidence of increased activation of the putamen during the performance of regular, metric-rhythm movements as observed in tango dancing.4 Furthermore, in healthy tango dancers, there was a shift in cortical activation with increased activity in the premotor area and SMAs during imagined series of dancing steps.3 It is believed that auditory cues may bypass the basal ganglia to access the SMA through the thalamus or the premotor cortex through the cerebellum.3 Tango may have a significant contribution in order to supersede involved motor circuits in PD. In PD patients, mobility impairments are exacerbated when they perform a simultaneous secondary task and it is known that multitasking exercises could improve their deteriorated motor performance. Some dances, such as tango, constitute a valuable multitasking activity. Furthermore, it has been observed that patients greatly enjoy this kind of exercise program with high compliance (>90%) and discover that they are able to perform tasks beyond the restrictions caused by PD.5 We consider that tango dancing, being a multitasking activity using auditory, visual, and sensory cues, offers an enjoyable strategy for rehabilitation in PD patients, allowing them to connect with movement through the melody of music. (1) Research Project: A. Conception, B. Organization, C. Execution; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript: A. Writing of the First Draft, B. Review and Critique. S.A.R.-Q.: 3A, 3B R.D.R.: 3B T.A.: 3A, 3B N.S.G.: 3A, 3B The authors acknowledge the tango teacher, Humberto “El Puchu” Pauchulú. Funding Sources and Conflicts of Interest: The authors declare that there are no funding sources or conflicts of interest to report. Financial Disclosures for preceding 12 months: The authors declare that there are no disclosures to report. A video accompanying this article is available in the supporting information here. Video. Segment 1: The patient with severe difficulties in initiating gait, with short shuffling steps and moderate compromise of stability in the pull-test maneuver (UPDRS). Segment 2: The patient improving her gait and mobility through the melody of tango. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Feasibility of virtual therapy in rehabilitation of Parkinson's disease patients: pilot study

INTRODUCTION: Among Parkinson's disease (PD) motor disabilities, postural and balance alterations are important parameters to physical therapists who need to choose specific, targeted therapies for their patients. Among many therapy options, virtual therapy is studied as to whether it can be a viable rehabilitation method. OBJECTIVE: To verify the applicability of virtual rehabilitation in PD patients for the improvement of their balance and quality of life. MATERIAL AND METHODS: Six volunteers, diagnosed to be in Stages II and III of PD (Hoehn and Yahr Scale), were recruited for this study. Patients (65 ± 13 years old) participated in activities involving Wii Fit, for a total of twelve interventions, twice per week. Clinical and qualitative methods were used for the data collection for the initial and final evaluations: Borg's Scale, Berg Functional Balance Scale, Time Up and Go, anterior and lateral functional reach and Nottingham's Scale were performed during the study. Penguin Slide, Ski Slalom, Soccer Heading and Table Tilt were the Wii games selected as a form of virtual therapy. RESULTS: The collected data were analyzed using the Wilcoxon test. Motor skill, functional capacities and quality of life were analyzed as variables of the patients' balance. Statistically significant differences were found in the following tests: Borg's Scale (p = 0.0464), Berg Functional Balance Scale (p = 0.0277), lateral functional reach to the right (p = 0.0431*) and lateral functional reach to the left (p = 0.0277). CONCLUSION: It is believed that exercises with virtual reality therapy can be a useful tool to improve the balance in PD patients.

Effects of vibratory orthosis on balance in idiopathic Parkinson's disease

Purpose. It was hypothesised that lumbar vibration stimulation applied by a vibratory orthosis improves balance in people with Parkinson's disease (PD).Methods. The overall stability index and the percent of elapsed time in different zones and quadrants on the platform of Biodex balance system were evaluated. General conditions of eyes-open and eyes-close, each with two situations of motors On and motors Off of vibratory orthosis were considered.Results. Balance in PD patients improved in eyes-open condition rather than eyes-close. The balance also improved in eyes-open condition with motors On rather than that in motors Off. In eyes-close condition, balance was lesser in motors On than that in motors Off situation. The results also suggest that in PD patients, body trajectories on the platform of Biodex balance system follow a random-like chaotic behaviour.Conclusions. A new orthosis in rehabilitation of PD patients was introduced to enhance balance and decrease risk of fall. It promotes new ideas for rehabilitation of similar neurological diseases. The possibility of enhancing balance in PD patients in a short-term setting was evaluated. Results showed balance enhancement in PD patients in eyes-open condition. However, in eyes-close condition, we are not sure of its effectiveness.