Group physiotherapy and quality of life in parkinsonism: quasi-experimental study

According to systematic reviews, a short-term treatment of aquatic physiotherapy, mind-body therapies and exergame improve quality of life of people with parkinsonism. But few studies examined the group physiotherapy effects on quality of life of people with parkinsonism. Objective: We aimed to investigate the short-term effects of group physiotherapy protocols on the quality of life of people with Parkinson's disease or secondary parkinsonism. Methods: This is a quasi-experimental study, a controlled, non-randomized, unmasked trial, with consecutive arms for one group and parallel to another, with 15 participants with parkinsonism. They were organized in 3 groups: OG-E1wI (n = 9), observed group treated with group physiotherapy once a week; EG-C (n = 6), in the control phase without treatment, concomitant with OG-E1wI; EG-2wI (n = 6), the same subjects as EG-C, they were treated with group physiotherapy twice a week, in a posterior consecutive phase. The PDQ-39 scale was used to assess Quality of Life. Results: The mean differences between OG-E1wI and EG-C and between EG-2wI and EG-C in the various domains of PDQ-39 were not statistically significant. Conclusion: A group physiotherapy protocols performed once or twice a week may not be enough to improve quality of life for people with parkinsonism. The literature suggests that group physiotherapy protocols performed three to five times a week improve quality of life in a short period

Contexto: Revisões sistemáticas sugerem que fisioterapia aquática, terapias corporais complementares e exergame aumentam a qualidade de vida da pessoa com parkinsonismo em tratamento de curto prazo. Porém, os efeitos da fisioterapia em grupo na qualidade de vida da pessoa com parkinsonismo são pouco estudados. Objetivo: Investigar os efeitos em curto prazo de protocolos de fisioterapia grupal sobre a Qualidade de Vida de pessoas com doença de Parkinson e parkinsonismo secundário. Métodos: Estudo quasi-experimental, ensaio controlado não randomizado, sem mascaramento, com braços consecutivos para um grupo e paralelo para outro, com 15 participantes com parkinsonismo. Os participantes foram organizados em 3 grupos: OG-E1wI (n= 9), intervenção de fisioterapia em grupo uma vez por semana; EG-C (n= 6), em fase controle sem tratamento, concomitante ao OG-E1wI; EG-2wI (n=6), os mesmos sujeitos do EG-C, em fase consecutiva com intervenção de fisioterapia em grupo, duas vezes por semana. A escala PDQ-39 foi utilizada para avaliar a Qualidade de Vida. Resultados: As diferenças médias entre OG-E1wI e EG-C e entre EG-2wI e EG-C nos vários domínios da PDQ-39 não são estatisticamente significativas. Conclusão: Protocolos de fisioterapia em grupo com frequência de uma ou duas vezes por semana podem não ser suficiente para promover ganhos na qualidade de vida de pessoas com parkinsonismo. A literatura sugere que protocolos de fisioterapia em grupo feitos três a cinco vezes por semana obtêm ganho de qualidade de vida em um período de curto prazo

The effect of balance training with Tetra-ataxiometric posturography on balance function in patients with parkinsonism.

BACKGROUND: Balance impairment is a major clinical concern in patients with parkinsonism. Balance training with tetra-ataxiometric posturography (Tetrax) is known to improve balance function through visual biofeedback effects. OBJECTIVE: In this study, we evaluated the effects of balance training with Tetrax in patients with parkinsonism. METHODS: Patients with parkinsonism (idiopathic Parkinson's disease, multiple systemic atrophy, and multiple systemic atrophy) who were able to stand with or without an assistive device were recruited for the study. Twenty patients with parkinsonism were randomly assigned to one of the following two groups: (1) the Tetrax group, in which patients received Tetrax biofeedback balance training for 30 min/day for 2 weeks (10 sessions); and (2) the control group, in which patients received conventional balance training for 30 min/day for 2 weeks (10 sessions). One day before and after training, we measured patients' balance parameters using the Berg balance scale (BBS) and fall index (FI). RESULTS: The BBS and FI scores of the Tetrax group showed significant improvements after compared to before training. However, the scores in the control group were not significantly changed after vs. before conventional balance training. CONCLUSIONS: For patients with parkinsonism, Tetrax biofeedback balance training had a positive effect on balance function.

Muscle-targeted nutritional support for rehabilitation in patients with parkinsonian syndrome.

OBJECTIVE: We evaluated the efficacy of muscle-targeted nutritional support on the functional outcomes of multidisciplinary intensive rehabilitation treatment (MIRT) in patients with Parkinson disease (PD) or parkinsonism. METHODS: We conducted a pragmatic, bicentric, randomized (1:1), assessor-blind controlled trial (Protein, Leucine and Vitamin D Enhancing Rehabilitation [PRO-LEADER]; April 2017 to January 2018) in cognitively intact patients with PD or parkinsonism and undergoing a 30-day MIRT. Patients (n = 150) received a standard hospital diet with or without a whey protein-based nutritional supplement enriched with leucine and vitamin D twice daily. The primary efficacy endpoint was the increase in the distance walked during a 6-minute walking test (6MWT). Secondary endpoints were changes in 4-meter walking speed, Timed Up and Go test (TUG), Berg balance scale, handgrip strength, Self-assessment Parkinson's Disease Disability Scale, body weight, and skeletal muscle mass (SMM). RESULTS: Nutritional support resulted in greater increase in the distance walked during 6MWT (mean 69.6 meters [95% confidence interval (CI) 60.7-78.6]) than no support (51.8 meters [95% CI 37.0-66.7]): center-adjusted mean difference, 18.1 meters (95% CI 0.9-35.3) (p = 0.039). Further adjustment for changes in dopaminergic therapy and SMM yielded consistent results: mean difference, 18.0 meters (95% CI 0.7-35.2) (p = 0.043). A meaningful effect was also found for the following secondary endpoints: 4-meter walking speed (p = 0.032), TUG (p = 0.046), SMM, and SMM index (p = 0.029). Six patients discontinued the nutritional therapy due to mild side effects. CONCLUSION: The consumption of a whey protein-based nutritional formula enriched with leucine and vitamin D with MIRT improved lower extremity function and preserved muscle mass in patients with PD or parkinsonism.Clinicaltrials.gov IDENTIFIER: NCT03124277. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients with parkinsonism undergoing intensive rehabilitation, a whey protein-based nutritional formula enriched with leucine and vitamin D increased distance walked on the 6MWT.

Neurofeedback Control in Parkinsonian Patients Using Electrocorticography Signals Accessed Wirelessly With a Chronic, Fully Implanted Device.

Parkinson's disease (PD) is characterized by motor symptoms such as rigidity and bradykinesia that prevent normal movement. Beta band oscillations (13-30 Hz) in neural local field potentials (LFPs) have been associated with these motor symptoms. Here, three PD patients implanted with a therapeutic deep brain neural stimulator that can also record and wirelessly stream neural data played a neurofeedback game where they modulated their beta band power from sensorimotor cortical areas. Patients' beta band power was streamed in real-time to update the position of a cursor that they tried to drive into a cued target. After playing the game for 1-2 hours each, all three patients exhibited above chance-level performance regardless of subcortical stimulation levels. This study, for the first time, demonstrates using an invasive neural recording system for at-home neurofeedback training. Future work will investigate chronic neurofeedback training as a potentially therapeutic tool for patients with neurological disorders.

Neural pathway interference by retained acupuncture: a functional MRI study of a dog model of Parkinson's disease.

OBJECTIVE: The aims of this study were to investigate the interference of the brain activation during a passive movement task (PMT) by retained acupuncture at the ST 36 acupoint and to compare these effects between normal brain and Parkinson's disease (PD) brain. METHODS: Functional magnetic resonance imaging (fMRI) techniques have been used to study neurophysiology in animals. Eight healthy beagle dogs were divided into two groups of four dogs each, a normal control group and a PD model group. PD was induced by intravenous injection of 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-HCl. During fMRI, the PMT was performed in the right tarsal joint during three different sessions, which consisted of PMT only, PMT while an acupuncture needle was inserted at the ST 36 acupoint, and PMT while needle was inserted at a sham point. RESULTS AND DISCUSSION: Standard veterinary neurological examination was performed on dogs with MPTP-induced PD. A homogeneous grade similar to human PD patients was evident in all dogs. The fMRI study showed that insertion of the acupuncture needle at acupoint ST 36 significantly affected the proprioceptive brain activation by decreasing blood oxygenation level-dependent signal intensity in basal ganglia, limbic system, and cerebellum. Compared with normal and PD brain, we suggest that acupuncture at ST 36 has different modulation effects depending on the pathologic condition of the brain. The study provides evidence of the potential clinical applications of retained acupuncture at ST 36 for rehabilitation therapy of PD patients.

Effects of exercise and B vitamins on homocysteine and glutathione in Parkinson's disease: a randomized trial.

BACKGROUND: Individuals with Parkinson's disease (PD) have decreased glutathione levels and elevated homocysteine levels. These substances are considered markers of health, and an inverse relationship has been suggested through the transsulfuration pathway. This experiment tested the effects of exercise and B vitamin supplementation on homocysteine and glutathione levels, and if a relationship was present between these two markers in those with PD. Secondary aims included examining the impact of the interventions on aerobic efficiency and strength. METHODS: Thirty-six subjects were randomly assigned to 4 groups. The Vit group received vitamins B(6), B(12) and folic acid daily for 6 weeks. The Ex group received aerobic and strength training twice weekly for 6 weeks. The Vit + Ex group received both interventions. A control group received no intervention. Subjects were tested prior to and after intervention on the following measures: glutathione and homocysteine levels, strength measures and oxygen consumption. RESULTS: Subjects who received 6 weeks of B vitamin supplementation had lowered homocysteine levels. Subjects who received 6 weeks of exercise training had increased glutathione levels, strength and aerobic capacity. The combination of vitamin and exercise did not yield greater changes than the separate intervention. The control subjects did not change on any measures. CONCLUSION: Positive results were realized with each intervention; however, the expected relationship between glutathione and homocysteine was not found in this sample of subjects with PD. Homocysteine and glutathione levels can be improved independently in individuals with PD with exercise or vitamins B(6), B(12) and folic acid supplementation.

[Neurorehabilitation in parkinsonian syndromes]. / Neurorééducation des syndromes parkinsoniens.

Parkinson's disease is a frequent and major source of motor disability, for which physical therapies currently involve less than a third of ambulatory patients and are thus underutilized when compared to chemical and surgical treatments. However, dopaminergic therapies alone prove unable to prevent worsening of motor disability after a number of years. There is rising interest about physical neurorehabilitative therapy for Parkinson's disease, for its symptomatic therapeutic properties, but also for its potential neuroprotective effects in the light of compelling, recent animal literature. The approach to therapy in an individual patient may be governed at the most basic level by the disease stage. For moderate stages of Parkinson's disease (ambulatory patients who have retained a certain degree of physical independence), therapy may focus on the teaching of exercises to the patient: strategies established in controlled studies when used over few weeks periods include motor strengthening programs in the lower limb, high intensity aerobic exercises, attentional strategies using in particular verbal instruction sets, sensory cueing, active axial rotation exercises and high-number repetition of specific tasks. A randomized protocol will soon evaluate the concept of asymmetric motor training, combining a strengthening program in extensor, abductor, external rotator and supinator muscles and a stretching program in their antagonists. For advanced stages (individuals with compromised sit-to-stand, ambulation and significant disability), the therapeutic focus may shift to the teaching of compensation strategies to the patient and the caregiver, both to lessen the effects of motor impairment and to optimize safety. A number of these compensatory strategies are reviewed, some being validated in controlled protocols. In idiopathic Parkinson's disease, clinicians must continue evaluating the symptomatic and perhaps neuroprotective value of physical treatment strategies used over the long term. In atypical parkinsonism, physical treatments often remain the only realistic methods to improve motor behavior and reduce functional deficiencies. The relatively short duration of the effects of physical therapies implies that such programs be pursued over long periods of time, or repeated frequently, for their benefits to be maintained over time.

[Rehabilitation in the elderly subject with Parkinson's disease]. / Rééducation des sujets agés presentant un syndrome parkinsonien.

In the elderly, the aging of the locomotor, cardiorespiratory, and sensory apparatus, the cognitive and psychic changes, and the interaction of several pathologies require adaptation of the rehabilitation techniques in Parkinson's disease. Rehabilitation should be initiated early and directed toward functional objectives defined by a pluridisciplinary team. To maintain movements is a fundamental aim and must take into account the tiredness of the old subject. Gymnic, active and passive techniques are proposed to preserve the posture, balance and walk. The prevention of falls is a major goal to avoid the risks of grabatisation and trauma. Multiple respiratory disorders are related to disturbances of swallowing and affect the deficiencies of voice and speech. The objectives of care are different if the patient presents a parkinsonan syndrome different from Parkinson's disease or if dementia is associated. The treatment by neurostimulation in old subjects also raises new questions for rehabilitation.