Association between fatigue and MDS-UPDRS in individuals with Parkinson's disease: cross-sectional study.

BACKGROUND: Fatigue is significant in the context of Parkinson's disease (PD), considering that one-third of patients classify it as the most restricting symptom in their daily life activities (DLAs). The objective was to verify the relationship (association) between fatigue and non-motor and motor symptoms of PD. METHODS: A cross-sectional study which included 100 individuals with PD. Initially, demographic and clinical data (modified Hoehn and Yahr scale-HY, anxiety, and depression) were collected. To assess the non-motor and motor symptoms of PD, the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) was applied. Fatigue was evaluated using the Parkinson Fatigue Scale. RESULTS: A higher HY score, greater severity of non-motor aspects of DLAs and motor aspects of DLAs, more motor complications, and higher levels of anxiety as well as depression were observed in the "fatigue" group. Fatigue was associated with a lower daily equivalent levodopa dose (LEDD), a higher body mass index (BMI), anxiety, depression, and the presence of non-motor symptoms. CONCLUSION: Non-motor symptoms are more determining factors for fatigue than the motor condition itself, with an association between fatigue and higher BMI scores, increased anxiety and depression, lower LEDD, and greater severity of non-motor aspects of DLAs. Individuals in the "fatigue" group had higher HY scores, anxiety, and depression, worse non-motor and motor symptoms related to experiences of daily life, as well as motor complications.

Effectiveness of Neurofunctional Physical Therapy on the Quality of Sleep of Individuals with Parkinson's Disease: Case Series.

Objective Sleep disorders are disabling and highly prevalent comorbidities in Parkinson's disease (PD). This study's objective was to verify the effectiveness of neurofunctional physiotherapy in sleep quality, objectively and subjectively assessing it among individuals with PD. Methods A sample of individuals with PD was assessed before and after 32 physiotherapy sessions and three months later (follow-up). The following instruments were used: Pittsburgh Sleep Quality Index (PSQI); Epworth Sleepiness Scale (ESS); Parkinson's Disease Sleep Scale (PDSS), and actigraphy. Results Nineteen individuals aged 67.37 years old ( ± 8.03) on average were included. No differences were found in any of the variables measured by the actigraphy or the ESS. Improvement was found from pre- to post-intervention in terms of nocturnal movements (p = 0.04; d = 0.46) and total score (p = 0.03; d = 0.53) obtained on the PDSS. Improvement was also found in the PDSS sleep onset/maintenance domain (p = 0.001; d = 0.75) between pre-intervention and follow-up. The participants' total score obtained in the PSQI improved from pre- to post-intervention (p = 0.03; d = 0.44). Significant differences were found in nighttime sleep (p = 0.02; d = 0.51) and nocturnal movements (p = 0.02; d = 0.55), and in the PDSS total score (p = 0.04; d = 0.63) between pre- and post-intervention when only the poor sleepers subgroup (n = 13) was considered, while improvements were found in sleep onset/maintenance (p = 0.003; d = 0.91) between pre-intervention and follow-up. Discussion Neurofunctional physiotherapy was ineffective in improving objective parameters of sleep but was effective in improving the perception of sleep quality subjectively assessed among individuals with PD, especially those who perceived themselves to be poor sleepers.

Immediate Effect of Augmented Reality, Virtual Reality, and Neurofunctional Physiotherapy on Postural Control and Executive Function of Individuals with Parkinson's Disease.

Objective: To assess the immediate effect of augmented reality (AR), virtual reality (VR), and neurofunctional physiotherapy (NPT) on postural control (PC) and executive function (EF) of individuals with Parkinson's disease (PD). Materials and Methods: Forty subjects from mild-to-moderate PD stages, with no cognitive impairment were submitted to one session of NPT, one session of AR, and one session of VR for 50 minutes each (7 days interval between them). PC was evaluated before and after each therapy, using force platform in bipedal positions: tandem with eyes opened (EO), eyes closed (EC), and with double-task and one-legged stance. We recorded the center of pressure area, and anteroposterior (AP) and mediolateral (ML) displacement amplitude and velocity. EF was assessed by Trail Making Test (TMT). Results: PC improved (pre- vs. postintervention) after the three modalities: AP velocity decreased after AR (tandem EC 2.3 [1.7 to 2.9] vs. 2.1 [1.5 to 2.9], one-legged 3.0 [1.9 to 4.0] vs. 2.9 [1.9 to 3.6]), NPT (tandem EC 2.2 [1.7 to 3.1] vs. 2.1 [1.6 to 3.0]), and VR (tandem EO 1.9 [1.4 to 2.6] vs. 1.8 [1.4 to 2.4], tandem EC 2.3 [1.6 to 3.0] vs. 2.0 [1.5 to 2.8]); ML velocity decreased after AR in one-legged (P = 0.04); and permanence time in one-legged position increased in AR (Δ: 2.5 [-0.2 to 6.9]). There was also improvement in EF: TMT part A (TMTA)'s time decreased after AR (-9.3 [-15.7 to 1.9]), and TMT part B (TMTB)'s time decreased after the three modalities (ΔNPT: -7.7 [-29.4 to 0.0] vs. ΔAR: -4.6 [-34.6 to 0.6] vs. ΔVR: -4.9 [-28.2 to 0.9]). There were no differences between the modalities. Conclusion: The three treatment modalities improved PC and EF of subjects with PD. Moreover, AR and VR generated similar immediate effects to NPT on both outcomes in these patients. Trial registration: Brazilian Clinical Trial Registration: RBR-5r5dhf.

Telehealth For Individuals with Parkinson's Disease During Covid-19 In Brazil: A Prospective Case Series.

Objective: To implement a telerehabilitation prevention, treatment, and follow-up physical therapy protocol for monitoring individuals with Parkinson's disease (PD) and to verify its effectiveness in minimizing the deleterious effects of the COVID-19 pandemic. Design: Prospective case series, involving 40 participants with mild to moderate PD recruited from a specialized neurorehabilitation group. The study was divided into four parts: (1) Phone calls to assess the feasibility of participating in remote physical therapy. (2) Social media training. (3) Baseline and post-intervention assessment for functional lower extremity strength, fear of falling, quality of life, depression, anxiety, activities of daily living, verbal fluency. (4) Intervention protocol consisting of 20 remote weekly physical therapy sessions, graphic material for physical and cognitive training, social activities, and education. Conclusion: The telerehabilitation protocol was viable and effective for patients with PD as an alternative to in-person treatment during the COVID-19 pandemic.

Is fatigue associated with balance in Parkinson's disease?

Abstract Background: Fatigue is a disabling symptom in the spectrum of Parkinson's disease (PD), affecting from 30% to 70% of the persons. Even though it is a common symptom, with negative repercussions for PD individuals, its correlation with balance is not established. Aim: The aims of this study were to verify the correlation between fatigue and balance in individuals with PD and to compare balance in individuals with PD that presents low fatigue or high fatigue. Methods: This study included 37 individuals with PD, who were divided into two groups: low fatigue (n = 25) and high fatigue (n = 12). Fatigue was evaluated using the Parkinson's disease Fatigue Scale and a force platform was used to assess four balance tasks: bipedal, tandem with eyes open/closed, and tandem with the dual-task, in three parameters: (1) 95% confidence ellipse area of the center of pressure (COP) (2) mean velocity (3) root mean square of COP. To verify the correlation between fatigue and balance, the Spearman rank-order correlation coefficient was assessed. Comparison of medians between the groups was analyzed using the Mann-Whitney test. Results: There was no significant correlation between fatigue and balance. There was no difference between the groups with low and high fatigue. Conclusion: This study's findings, together with those reported in the literature, suggest there is no correlation between fatigue and balance, and even though individuals with PD report fatigue or experience situations of fatigue, they do not present greater posture instability than individuals with PD who do not report fatigue. Fatigue is a disabling symptom in the spectrum of Parkinson's disease (PD), affecting from

Center of pressure-based balance evaluation in individuals with Parkinson's disease: a reliability study.

OBJECTIVE: The purpose of this study was to assess the test-retest reliability of different balance task outcomes, based on center of pressure (COP) measures in individuals with Parkinson's disease. METHOD: In this cross-sectional study, 19 older individuals with idiopathic Parkinson's disease (seven females, 71 ± 7.8 years) performed a set of seven balance tasks on two occasions (a week apart) on an electronic force platform. Each set consisted of: 1) Bipedal; 2) Romberg with open eyes (OE); 3) Romberg with closed eyes (CE); 4) Tandem with OE; 5) Tandem with CE; 6) Tandem with OE using a dual task (DT) condition (simple mathematic operations concomitant with testing); and 7) One-leg stance, with the leg of preference over the force platform, with OE. The test-retest reliability of COP measures was tested using intraclass correlation coefficient (ICC) and Bland-Altman plots. RESULTS: The ICC results for the different tasks showed that the most reliable para- meters were derived from a 95% confidence ellipse around the COP and mean velocity, with the most reliable task being the Romberg with CE. Conclusions: We confirmed that balance based on COP measures was reliable in individuals with Parkinson's disease, especially during the Romberg condition with closed eyes.

Does physiotherapy plus cognitive training improve balance in Parkinsons disease? Randomized clinical trial

Abstract Aims: Postural instability is intrinsically related to cognitive dysfunctions in Parkinson's disease (PD), which supports the importance of multimodal treatments. The purpose of this study was to investigate the effectiveness of adding cognitive training to motor physiotherapy in comparison with motor physiotherapy in the balance of individuals with PD. Methods: randomized clinical trial, where the individuals were randomized to two treatments: Physiotherapy Group (PG; n=29; M=12; HY= 2.5 [2-3]) executed balance training; Physiotherapy plus Cognitive Training Group (PCG; n=29; 10M; HY= 2.5 [1.5-3]), balance training plus a cognitive training at the end of the therapy. Evaluation instruments: Balance Evaluation Systems Test (BESTest); Unified Parkinson Disease Rating Scale (UPDRS). Results: The intragroup analysis revealed that both groups presented improved balance and UPDRS total score after execution of the protocols, but without statistically significant intergroup differences. The effect sizes were small for all the comparisons. Conclusion: There was no difference between the proposed treatments (PCG and PG). However, both interventions benefitted the individuals' balance and signs and symptoms of PD, when considered the time effect.

Physiotherapy Versus Physiotherapy Plus Cognitive Training on Cognition and Quality of Life in Parkinson Disease: Randomized Clinical Trial.

OBJECTIVE: The aim of the study was to verify the effectiveness of physiotherapy associated with cognitive training to improve cognition and quality of life in individuals with Parkinson disease. DESIGN: This is a randomized clinical trial involving 58 individuals with mild to moderate Parkinson disease, randomly distributed into two groups: motor group and cognitive-motor group. Both groups were assessed for cognition and quality of life at the beginning of the study, at the end of the intervention protocols, and 3 mos after the end of the intervention. The following instruments were used to assess cognition and quality of life: Mini-Mental State Examination, Montreal Cognitive Assessment, Verbal fluency test, Rey Auditory Verbal Learning Test, Cognitive and perceptual assessment by pictures, Trail Making Test, Clock Drawing Executive Test, and Parkinson Disease Quality of Life Questionnaire. The motor group engaged in motor physiotherapy, whereas the cognitive-motor group underwent combined motor physiotherapy with cognitive training. RESULTS: The intragroup analysis revealed that both groups presented improved cognition (memory and visuospatial function domains) and quality of life after execution of the protocols, but without statistically significant intergroup differences. CONCLUSIONS: When comparing the intervention moments, the two treatment approaches used were effective for the outcomes: memory, visuospatial function, and quality of life in both groups.

Effectiveness of acute transcranial direct current stimulation on non-motor and motor symptoms in Parkinson's disease.

BACKGROUND: Transcranial direct current stimulation (tDCS) is an appropriate treatment for Parkinson's disease (PD). It offers promising results and is known to improve symptoms. Nevertheless, consistent parameters need to be established for research purposes. OBJECTIVE: To verify the effectiveness of acute tDCS on non-motor and motor symptoms in PD. METHODS: A double-blind, randomized and sham-controlled study, in which twenty individuals randomly underwent two (one real, one sham) stimulation sessions. The current was applied to the dorsolateral prefrontal cortex (DLPFC) for 20 min at 2 mA. Participants were assessed before and after the stimulation using the Trail Making Test (TMT), Verbal Fluency test, Stroop test, Timed Up and Go test and video gait analysis. In the statistical analysis, a two-way variance analysis of repeated measures was applied to the variables time, group and time vs. group interaction, using Sidak's post-hoc test. RESULTS: Statistically significant differences were found for TMT part B in both groups. For the Verbal Fluency test differences were found only within the group that received real stimulation. Additionally, both groups revealed improved reaction time in the congruent, incongruent and total phases of the Stroop test, but a significant difference in the Stroop effect was found only within the group that received real stimulation. CONCLUSION: The results confirm that improvements on cognitive tests are possible after a single session of DLPFC stimulation.

Efficacy of neurofunctional versus resistance training in improving gait and quality of life among patients with Parkinson's disease: a randomized clinical trial

Abstract AIMS to compare the efficacy of neurofunctional training versus resistance training in improving gait and quality of life among patients with PD METHODS This randomized controlled trial included 40 participants randomly assigned to two groups through random number table generator: resistance training (RT) (n=19) and neurofunctional training (NT) (n=21). The RT group performed resistance exercises emphasizing the lower limbs and trunk, while the NT group sessions were focused on gait, functional independence and balance training. Trained physical therapists supervised both groups. The training sessions lasted 60 minutes in each group and were performed twice a week, totalizing 24 sessions. The outcomes, gait and quality of life, were measured using video gait analysis and footprint analysis; and PDQL and PDQ-39 questionnaires, respectively RESULTS intra-group comparison revealed all gait variables (stride length, step length, number of steps, time of distance walked, gait speed and cadence) improved after the NT intervention with large effect size, while only stride length improved in the RT group with moderate effect size. The between group analyses means (Δ) shows that all the variables presented statistically significant differences in the NT group. Additionally, both groups showed significant improvements in quality of life. CONCLUSIONS The application of specific neurofunctional training, directed and enriched with sensorial resources, resulted in superior gait performance among individuals with PD when compared to those in the resistance training group; both treatments were efficacious in improving quality of life.

Comparison of three physical therapy interventions with an emphasis on the gait of individuals with Parkinson's disease / Comparação de três intervenções fisioterapêuticas com ênfase na marcha de indivíduos com doença de Parkinson

Abstract Introduction: Gait impairments are one of the earliest signs reported by patients with Parkinson's disease (PD) and cause an increased number of falls and decreased quality of life among these patients. Objective: To compare the effectiveness of three physical therapy interventions using Rhythmic Cues (RC), Swiss Ball (SB) and Dual Task (DT), with an emphasis on gait treatment (step and stride length, duration and velocity), in individuals with PD. Methods: Quasi-randomized clinical trial addressing a sample composed of 45 individuals assigned to three groups. The individuals were assessed before and after the intervention protocol using the following: Modified Hoehn and Yahr Scale (HY), Unified Parkinson's Disease Rating Scale (UPDRS), Footprint analysis, Video Gait analysis, and Timed Up and Go Test (TUG). The groups were homogeneous concerning age, HY and UPDRS. Statistical analysis was performed using SPSS, version 20.0. Results: Statistically significant differences were found in all the variables analyzed in the RC and SB groups when compared in the pre- and post-intervention. With the exception of the TUG variable, the DT group presented statistically significant differences in all the remaining variables. Conclusion: The three interventions were effective for the outcomes under study, but the SB group presented the greatest magnitude of change (effect size), while the RC group presented the greatest improvement in the temporal gait variables (duration and velocity) and TUG.

Resumo Introdução: As alterações na marcha são um dos sinais relatados mais precocemente pelos pacientes com doença de Parkinson (DP), ocasionando aumento do número de quedas e redução da qualidade de vida desses indivíduos. Objetivo: Comparar a efetividade de três intervenções fisioterapêuticas utilizando Pistas Rítmicas (RC), Bola Suíça (SB) e Dupla Tarefa (DT) com ênfase no tratamento da marcha (tamanho do passo, da passada, tempo e velocidade) em indivíduos com DP. Métodos: Foi realizado estudo do tipo ensaio clínico quase randomizado, com casuística composta por 45 indivíduos, divididos nos três grupos. Os indivíduos foram avaliados antes e após o protocolo de intervenção pelos seguintes instrumentos: Escala de Hoehn & Yahr Modificada (HY), Escala Unificada de Avaliação da doença de Parkinson (UPDRS), Teste de impressão plantar (footprint), Análise de marcha por vídeo e Teste Timed Up and Go (TUG). Os grupos eram homogêneos em relação à idade, HY e UPDRS. Para análise estatística foi utilizado o programa SPSS 20. Resultados: Foram encontradas diferenças estatisticamente significantes em todas as variáveis analisadas no RC e SB quando comparados os valores pré e pós intervenção. No DT, as variáveis também apresentaram diferenças estatisticamente significantes, exceto o TUG. Conclusão: As três intervenções foram efetivas para os desfechos estudados, porém o grupo que apresentou maior magnitude de mudança (tamanho do efeito) foi o SB, enquanto o RC apresentou maior porcentagem de melhora nas variáveis temporais da marcha (tempo e velocidade), bem como no TUG.

Impacto da doença de Parkinson na performance do equilíbrio em diferentes demandas atencionais / Impacto de la enfermedad de Parkinson en el equilibrio en distintas situaciones propuestas / Impact of Parkinson’s disease in the performance of balance with different attentional demands

RESUMO O objetivo deste estudo foi avaliar o equilíbrio de pacientes com doença de Parkinson (DP) na posição de tandem com os olhos abertos (OA), olhos fechados (OF) e em condição de dupla tarefa (DT). Trata-se de um estudo transversal composto por 19 indivíduos com DP nos estágios leve a moderado. Os pacientes foram avaliados em uma plataforma de força Biomec400. Os parâmetros analisados foram a área do centro de pressão dos pés (COP) e a amplitude e velocidade do COP nas direções anteroposterior (AP) e mediolateral (ML). Foram encontrados resultados estatisticamente significantes para amplitude AP e ML do COP e da área do COP, com valores maiores para as posições em tandem de OF e tandem com DT, quando comparados com a posição em tandem de OA. Os valores de velocidade média AP e ML foram maiores na posição em tandem de OF em comparação ao tandem de OA (p=0,009 e p=0), respectivamente. Concluiu-se que indivíduos com DP, quando submetidos a desafios cognitivos, comportam-se de forma semelhante à retirada do recurso visual no que diz respeito às alterações de equilíbrio. Isso reforça a necessidade de introduzir no plano terapêutico desses indivíduos atividades que requeiram o treino dessas habilidades.

RESUMEN El propósito de este estudio fue evaluar el equilibrio de pacientes con enfermedad de Parkinson (DP) en la posición tándem con los ojos abiertos (OA), ojos cerrados (OC) y en condición de doble tarea (DT). Se trata de un estudio transversal, del cual participaron 19 personas con DP en etapas leve a moderada. Se evaluaron a los pacientes en una plataforma de fuerza Biomec400. Los parámetros evaluados fueron el área del centro de presión de los pies (COP) y la amplitud y velocidad del COP en las direcciones anteroposterior (AP) y mediolateral (ML). Se encontraron resultados estadísticamente significativos para la amplitud AP y ML del COP y del área del COP, con mayores valores para las posiciones tándem con OC y tándem en DT, en comparación a la posición tándem con OA. Los valores de la velocidad media AP y ML fueron mayores en la posición tándem de OC comparados a la tándem de OA (p=0,009 y p=0, respectivamente). Se concluye que los sujetos con DP, en el momento que se les sometieron a los desafíos cognitivos, se portaron de manera semejante cuando se les taparon los ojos en lo que se refiere a las alteraciones de equilibrio. Este resultado señala la necesidad de introducir en la fisioterapia de los pacientes con DP actividades que les exigen el entrenamiento de estas habilidades.

ABSTRACT This study aimed to evaluate the balance of Parkinson’s disease (PD) patients in Tandem stance with eyes open (EO), eyes closed (EC), and in dual task condition (DT). This is a cross-sectional study, composed of 19 individuals with mild to moderate PD. Patients were evaluated in a BIOMEC400 force platform. The parameters analyzed were: area of the foot center of pressure (COP), COP amplitude and speed, in the anteroposterior (AP) and mediolateral (ML) directions. We found statistically significant results for AP and ML amplitude of the COP and COP area, with higher values for the stances EC Tandem and DT Tandem, when compared with EO Tandem. The values of AP and ML average speed were higher in EC Tandem when compared with EO Tandem (P=0.009 and P=0.000), respectively. We concluded that, when individuals with PD undergo cognitive challenges, they behave as if they were with eyes closed regarding balance changes. This reinforces the need to introduce, in the therapeutic plan of these individuals, activities that require the practice of these skills.

Comparing postural balance among older adults and Parkinson's disease patients

ABSTRACT The objective of this study was to compare postural balance among healthy older adults and Parkinson's disease (PD) patients during one-legged stance balance. We recruited 36 individuals of both sexes and divided them into two groups: healthy older adults (HG), and individuals with PD (PG). All the participants were assessed through a single-leg balance test, with eyes open, during 30 seconds (30 seconds of rest across trials) on a force platform. Balance parameters were computed from mean across trials to quantify postural control: center of pressure (COP) area and mean velocity in both directions of movement, anterior-posterior and medial-lateral. Significant differences between-group were reported for area of COP (P=0.002) and mean velocity in anterior-posterior direction (P=0.037), where poor postural control was related to PD patients rather than to healthy individuals. One-legged stance balance was a sensitive task used to discriminate poor postural control in Parkinson individuals.

Desempenho cognitivo-perceptual de indivíduos com doença de Parkinson submetidos à fisioterapia / Cognitive-perceptual performance of subjects with Parkinson's disease submitted to physiotherapy

Objetivo: Verificar a efetividade da fisioterapia no sistema cognitivo-perceptual de indivíduos com doença de Parkinson (DP). Métodos: Trata-se de série de casos prospectiva, composta por 16 indivíduos com DP, entre os estágios 1,5 a 3 na escala de Hoehn e Yahr modificada (HY), avaliados antes, ao final e três meses pós-intervenção (follow up) utilizando-se os seguintes instrumentos: Escala Unificada para Avaliação da DP, Escala de Estadiamento HY modificada, Escala de Depressão Geriátrica (GDS), Mini-exame do estado mental (MEEM), Índice de Katz e duas ilustrações visomotoras. Receberam intervenção fisioterapêutica totalizando 20 sessões visando a melhora do sistema cognitivo-perceptual. Resultados: Foram encontradas diferenças estatisticamente significantes entre os valores pré e pós (P=0,03) e entre o pós e o follow up (P=0,03) para a execução das duas ilustrações visomotoras. Quanto aos demais desfechos não foram encontradas diferenças significantes. Conclusão: A intervenção realizada foi efetiva para o sistema perceptual em indivíduos com DP. Entretanto, não foram observadas diferenças estatisticamente significantes entre os valores dos três momentos de avaliação nas escalas MEEM, GDS e Índice de Katz.

Objective: To investigate the effectiveness of physiotherapy in the cognitive-perceptual system of individuals with Parkinson's disease. Methods: This is a prospective case series, consisting of 16 individuals with PD between stages 1.5 to 3 on the Hoehn and Yahr scale, assessed before, at the end, and later than three months after the intervention (follow up) using the following instruments: Unified Parkinson's Disease Rating Scale, Degree of Disability Scale of Hoehn and Yahr, Geriatric Depression Scale, Mini Mental Test, the Katz Index, and two visuomotor graphics. A physiotherapy intervention, totaling 20 sessions targeting the improvement of cognitive-perceptual system, was received. Results: Statistically significant differences were found between pre and post (P=0.03) and between post and follow up (P=0.03) for the implementation of the two visuomotor graphics. As for the other outcomes, no significant differences were found. Conclusion: The intervention was made effective for the perceptual system in individuals with PD. However, no statistically significant differences were found between the values of the three evaluation moments in the MMSE scale, GDS and Katz Index.