Effect of Group-Based Rehabilitation Combining Action Observation with Physiotherapy on Freezing of Gait in Parkinson's Disease.

Freezing of gait (FoG) is among the most disabling symptoms of Parkinson's disease (PD) patients. Recent studies showed that action observation training (AOT) with repetitive practice of the observed actions represents a strategy to induce longer-lasting effects compared with standard physiotherapy. We investigated whether AOT may improve FoG and mobility in PD, when AOT is applied in a group-based setting. Sixty-four participants with PD and FoG were assigned to the experimental (AO) or control groups and underwent a 45-minute training session, twice a week, for 5 weeks. AOT consisted in physical training combined with action observation whereas the control group executed the same physical training combined with landscape-videos observation. Outcome measures (FoG questionnaire, Timed Up and Go test, 10-meter walking test, and Berg balance scale) were evaluated before training, at the end of training, and 4 weeks later (FU-4w). Both groups showed positive changes in all outcome measures at posttraining assessment. Improvements in FoG questionnaire, Timed Up and Go test, and Berg balance scale were retained at FU-4w evaluation only in the AOT group. AOT group-based training is feasible and effective on FoG and motor performance in PD patients and may be introduced as an adjunctive option in PD rehabilitation program.

Treadmill training frequency influences walking improvement in subjects with Parkinson's disease: a randomized pilot study.

BACKGROUND: Treadmill training (TT) has been indicated as a potential therapeutic tool for improving balance and gait in patients with Parkinson's disease (PD). However, the lack of evidences about the best modality of intervention (e.g.: number of sessions) and the lack of reliable follow-up measures, made difficult to hand down these results into the clinical practice. AIM: The aim of this study was to compare the efficacy of 3 different modalities of TT program on gait performance in PD patients. DESIGN: A randomized, single-blind pilot study. SETTING: Outpatients clinic, Department of Neuroscience, University of Genoa. POPULATION: Thirty patients (out of 42 screened) with PD were randomized. METHODS: Participants underwent the same TT program (ten sessions, 45 minute each) but with a different frequency throughout a week: 1) low-frequency (LF) group: 2-times a week; 2) intermediate-frequency (IF) group: 3-times a week; and 3) high-frequency (HF) group: 5-times a week. Patients were evaluated by Timed Up and Go (TUG) test, 10-meter walking test (10M-WT), Berg Balance Scale (BBS), Falls Efficacy Scale (FES) and falls diary before TT, immediately after the training was stopped, and 2 and 4 months later. RESULTS: At baseline, no significant differences were found among groups. Immediately after the end of the TT, TUG Test, 10 MWT, FES and falls diary scores significantly improved in the LF and IF groups, whereas they did not change in the HF group. Improvements were sustained for up 2-months in the IF and LF groups. At 4-months evaluation, outcome measures were either comparable or sometimes even better than at baseline in the LF and IF groups, whereas in the HF group, 10M-WT and FES score worsened. CONCLUSIONS: According to the results of this study, we might postulate that the frequency of TT influences short and long-lasting effects on walking performance and falls. CLINICAL REHABILITATION IMPACT: The present study confirms that TT is effective in improving gait disturbances and reducing falls risk in patients with PD. The short- and long-lasting effects induced by TT on walking performance are specifically affected by the frequency of training, possibly in relationship to learning mechanisms and fatigue.