Muscular activation changes in lower limbs after underwater gait training in Parkinson's disease: A surface emg pilot study.

BACKGROUND: Under water gait training (UT) has been proposed as an innovative rehabilitative strategy for the treatment of axial disorders in Parkinson Disease (PD) patients, in particular for balance and gait impairment. However, the basis for the improvement is unclear. RESEARCH QUESTION: The aim of this study was to evaluate improvements in the muscular activation in the lower limbs in a cohort of PD patients after UT. METHODS: Ten PD participants in the "off" state and 10 controls (mean ± standard deviation of age and BMI were respectively: 71 ± 6 years, 28 ± 3 kg/m2; 65.5 ± 7 years, 28 ± 3 kg/m2) were enrolled in the study. After signing informed consent, they walked barefoot at their preferred speed on a 10 m walkway, before and after UT. The electrical activity of four muscles were collected bilaterally by means of a surface electromyography system (sEMG), two force plates and a motion capture system. All signals were synchronized in time with the gait cycle. The sEMG activity of Rectus Femoris (RF), Tibialis Anterior (TA), Biceps Femoris (BF) and Gastrocnemius Lateralis (GL) were acquired. The average from each signal was used to extract the peak of the Envelope (PoE) and its occurrence with respect to the gait cycle (PoPE%). Time and space parameters were determined. RESULTS: Our results showed that UT in PD patients improved the muscle's recruitment pattern towards normal. The PD patients POPE% was comparable with the one of the controls (TA: 20-35 %, 75-80 % of gait cycle; GL: 0-15 %, 25-45 %, 85-100 % of gait cycle) after UT on each muscle with the exception of BF. The muscle co-activation plots failed to show improvement in line with the muscle activation. SIGNIFICANCE: These results suggest that the muscle activation improvement with UT in PD participants might be due to a reorganisation at the executive rather than at the command level.

Efficacy of Osteopathic Manipulative Treatment on postural control in Parkinsonian patients with Pisa syndrome: A pilot randomized placebo-controlled trial.

BACKGROUND: Pisa syndrome (PS) is a clinical condition frequently associated with Parkinson's disease (PD). It is characterized by a trunk lateral flexion higher than 10 degrees and reversible when lying. One pathophysiological hypothesis is the altered verticality perception, due to a somatosensory impairment. Osteopathic Manipulative Treatment (OMT) manages fascial-system alterations, linked to somatic dysfunctions. Fascial system showed to be implicated in proprioceptive sensibility. OBJECTIVE: The aim of the study was to assess OMT efficacy on postural control in PD-PS patients by stabilometry. METHODS: In this single-blinded trial we studied 24 PD-PS patients, 12 of whom were randomly assigned to receive a multidisciplinary physical therapy protocol (MIRT) and sham OMT, while the other 12 received four OMT plus MIRT, for one month. The primary endpoint was the eye closed sway area assessment after the intervention. Evaluation of trunk lateral flexion (TLF) with DIERS formetrics was also performed. RESULTS: At one month, the sway area of the OMT group significantly decreased compared to placebo (mean delta OMT - 326.00±491.24 mm2, p = 0.01). In the experimental group TLF showed a mean inclination reduction of 3.33 degrees after treatment (p = 0.044, mean d = 0.54). Moreover, a significant positive association between delta ECSA and delta TLF was observed (p = 0.04, r = 0.46). DISCUSSION: Among PD-PS patients, MIRT plus OMT showed preliminary evidence of postural control and TLF improvement, compared to the control group.

Correction to: Effectiveness of Rotigotine plus intensive and goal­based rehabilitation versus Rotigotine alone in "de­novo" Parkinsonian subjects: a randomized controlled trial with 18­month follow­up.

The original version of this article unfortunately contained a mistake. The funding information was incorrect. The corrected funding information is given below.

Effectiveness of Rotigotine plus intensive and goal-based rehabilitation versus Rotigotine alone in "de-novo" Parkinsonian subjects: a randomized controlled trial with 18-month follow-up.

BACKGROUND: Dopamine Replacement Therapy (DRT) represents the most effective treatment for Parkinson's disease (PD). Nevertheless, several symptoms are unresponsive to treatment and its long-term use leads to serious side effects. To optimize the pharmacological management of PD, dopamine-agonists are often prescribed to "de-novo" patients. Moreover, several studies have shown the effectiveness and the synergic effect of rehabilitation in treating PD. OBJECTIVE: To evaluate the synergism between DRT and rehabilitation in treating PD, by investigating the short and the long-term effectiveness of a multidisciplinary, intensive and goal-based rehabilitation treatment (MIRT) in a group of patients treated with Rotigotine. MATERIALS AND METHODS: In this multicenter, single blinded, parallel-group, 1:1 allocation ratio, randomized, non-inferiority trial, 36 "de-novo" PD patients were evaluated along 18 months: 17 were treated with Rotigotine plus MIRT; 19 were treated with Rotigotine alone (R). The primary outcome measure was the total score of Unified Parkinson's Disease Rating Scale (UPDRS). The secondary outcomes included the UPDRS sub-sections II and III (UPDRS II-III), the 6-Minute Walk Test (6MWT), the Timed Up and Go Test (TUG) and the amount of Rotigotine. Patients were evaluated at baseline (T0), 6 months (T1), 1 year (T2), and at 18 months (T3). RESULTS: No differences in UPDRS scores in the two groups (total score, III part and II part, p = 0.48, p = 0.90 and p = 0.40, respectively) were found in the time course. Conversely, a greater improvement in Rotigotine + MIRT group was observed for 6MWT (p < 0.0001) and TUG (p = 0.03). Along time, the dosage of Rotigotine was higher in patients who did not undergo MIRT, at all observation times following T0. CONCLUSIONS: Over the course of 18 months, the effectiveness of the combined treatment (Rotigotine + MIRT) on the patients' global clinical status, evaluated with total UPDRS, was not inferior to that of the pharmacological treatment with Rotigotine alone. Importantly, rehabilitation allowed patients to gain better motor performances with lower DRT dosage.

Crossover versus Stabilometric Platform for the Treatment of Balance Dysfunction in Parkinson's Disease: A Randomized Study.

Balance dysfunctions are a major challenge in the treatment of Parkinson's disease (PD). Previous studies have shown that rehabilitation can play a role in their treatment. In this study, we have compared the efficacy of two different devices for balance training: stabilometric platform and crossover. We have enrolled 60 PD patients randomly assigned to two groups. The first one (stabilometric group) performed a 4-week cycle of balance training, using the stabilometric platform, whereas the second one (crossover group) performed a 4-week cycle of balance training, using the crossover. The outcome measures used were Unified Parkinson's Disease Rating Scale (UPDRS) part II, Berg Balance Scale (BBS), Timed Up and Go (TUG), and Six Minutes Walking Test (6MWT). Results showed that TUG, BBS, and UPDRS II improved in both groups. There was not difference in the efficacy of the two balance treatments. Patients in both groups improved also the meters walked in the 6MWT at the end of rehabilitation, but the improvement was better for patients performing crossover training. Our results show that the crossover and the stabilometric platform have the same effect on balance dysfunction of Parkinsonian patients, while crossover gets better results on the walking capacity.

[Role of depression in the functional recovery and cost of stay in patients with acute cerebrovascular lesions]. / Ruolo della depressione sul recupero funzionale e sui costi di degenza dei pazienti con lesioni cerebrovascolari acute.

BACKGROUND AND PURPOSE: The constant increase in health costs in recent years has led to the introduction of instruments such as DRG--diagnosis-related groups--with the declared aim of best rationalizing in-hospital costs. As part of this rationalisation it has become necessary to identify the causes of prolonged admissions in health-care structures. As far as concerns the rehabilitation of cerebrovascular diseases, attention has been centred on the presence of post-stroke depression. Our study was aimed at analysing the effect of depression on the time spent in hospital and whether the depression also affected on the patient's potential for functional recovery. METHODS: Patients with acute cerebrovascular lesions admitted to our center for rehabilitation were enrolled in this study. Depressive syndromes and functional deficits were evaluated at admission and discharge. RESULTS AND CONCLUSIONS: The most depressed patients were those who spent a longer time in hospital, but they were also those who had a greater functional deficit. The depression did not affect the efficacy and efficiency of the rehabilitation treatment. The time spent in hospital did, however, correlate with the clinical condition of the patient at admission and the age of the lesion.

[Peripheral neuropathy rehabilitation. Indications for a diagnostic-rehabilitation approach]. / La riabilitazione delle neuropatie periferiche. Indicazioni per un percorso diagnostico-riabilitativo.

The increased incidence of occupational neurological disorders has led, in recent years, to the development of new specialties in neurorehabilitation for the recovery of deficits of central nervous system (CNS) lesions. This same development has not occurred for damage to the peripheral nervous system (PNS), the treatment of which is still based on empirically applied rehabilitation techniques. This is due to the fact that the peripheral neuropathies comprise a vast groups of disorders caused by a huge variety of etiological agents; in order to identify their exact cause and thus be able to differentiate rehabilitation techniques it is necessary to classify them. The aim of this study is to summarize the main rehabilitation strategies, pharmacological treatments and surgical techniques used most effectively in the management of peripheral neuropathies in order to develop a therapeutic rehabilitation strategy for each of the different forms and lay the bases for the development of specific guidelines.