Motor Memory Consolidation Deficits in Parkinson's Disease: A Systematic Review with Meta-Analysis.

BACKGROUND: The ability to encode and consolidate motor memories is essential for persons with Parkinson's disease (PD), who usually experience a progressive loss of motor function. Deficits in memory encoding, usually expressed as poorer rates of skill improvement during motor practice, have been reported in these patients. Whether motor memory consolidation (i.e., motor skill retention) is also impaired is unknown. OBJECTIVE: To determine whether motor memory consolidation is impaired in PD compared to neurologically intact individuals. METHODS: We conducted a pre-registered systematic review (PROSPERO: CRD42020222433) following PRISMA guidelines that included 46 studies. RESULTS: Meta-analyses revealed that persons with PD have deficits in retaining motor skills (SMD = -0.17; 95% CI = -0.32, -0.02; p = 0.0225). However, these deficits are task-specific, affecting sensory motor (SMD = -0.31; 95% CI -0.47, -0.15; p = 0.0002) and visuomotor adaptation (SMD = -1.55; 95% CI = -2.32, -0.79; p = 0.0001) tasks, but not sequential fine motor (SMD = 0.17; 95% CI = -0.05, 0.39; p = 0.1292) and gross motor tasks (SMD = 0.04; 95% CI = -0.25, 0.33; p = 0.7771). Importantly, deficits became non-significant when augmented feedback during practice was provided, and additional motor practice sessions reduced deficits in sensory motor tasks. Meta-regression analyses confirmed that deficits were independent of performance during encoding, as well as disease duration and severity. CONCLUSION: Our results align with the neurodegenerative models of PD progression and motor learning frameworks and emphasize the importance of developing targeted interventions to enhance motor memory consolidation in PD.

Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial.

BACKGROUND: Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult's population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown effectiveness for reducing fall rates, evidence around their putative cumulative effects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the effectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up. METHODS: This study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥ 1 criteria of the Frailty Phenotype) older adults (≥ 75 years) with high risk of falling (defined by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and flexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, effects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated. DISCUSSION: This trial will provide new evidence about the effectiveness of an individualized multidomain intervention by studying the effect of additive effects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive effects in the reduction of the incidence of falls and associated adverse outcomes. TRIAL REGISTRATION: NCT04911179 02/06/2021.

Validation of a dual-task exercise program to improve balance and gait speed in older people (DualPro): a Delphi study.

Background: Most physical exercise programs for older people work the physical component in isolation, excluding cognitive aspects. Previous studies reported that both components (physical and cognitive) are necessary for correct functioning of older people in the society. Purpose: To create and validate a dual-task exercise program (DualPro) to improve balance and gait speed in older people. Methods: Expert consensus or the Delphi Method was used for validation. A group of 17 experts in neurorehabilitation and geriatrics was recruited to assess the proposed exercise program. They were selected taking into account their experience in clinical practice as well as their knowledge of the subject through the use of the expert competence coefficient (K). Online questionnaires were sent with a total of 11 exercises, which had to be rated using a "Likert" scale from 1 to 7. Results: Two rounds were conducted to achieve 100% consensus in all exercises. The interquartile range of each exercise in both rounds was stable. During the second round, the relative interquartile range was less than 15% in all the questions, thus demonstrating consensus among the experts. Conclusion: Experts in neurorehabilitation and geriatrics have concluded the validity of the progressive and systematized program of dual-task exercises focused on improving balance and gait speed for older people. This exercise program can help in the homogenization of the use of dual-task exercises in future studies and in professional practice.

Development and Content Validity of the Physical Activity Questionnaire-Young Children (PAQ-YC) to Assess Physical Activity in Children between 5 and 7 Years.

Childhood is a critical period in the development and consolidation of healthy habits, such as the practice of physical activity (PA). It is essential to have valid instruments to measure PA from an early age. The aim of this study was to design and evaluate the content validity of the Physical Activity Questionnaire-Young Children (PAQ-YC) to measure the PA level in children aged 5-7 years. The first version of the questionnaire was tested by a 2-round Delphi study. It was established as a consensus criterion that the relative interquartile range (RIR) and/or the coefficient of variation (CV) were ≤20%. The most significant discrepancies in the Delphi survey (n = 11-13) were observed for items about hours of Physical Education or similar activities at school (item 7: RIR = 20, CV = 38.73) and for items about participation in Physical Education (item 8: RIR = 25, CV = 15.45). The cognitive interviews (n = 5) confirmed the version agreed by the experts. The results show that the PAQ-YC presents adequate content validity in terms of relevance, comprehensiveness and comprehensibility.

The effects of exercise on sleep quality in persons with Parkinson's disease: A systematic review with meta-analysis.

We conducted a systematic review with meta-analysis to determine the evidence in support of exercise to improve sleep quality assessed subjectively and objectively in Parkinson's Disease (PD). Standardized mean differences (SMD) comparing the effects of exercise and control interventions on sleep quality with 95% confidence intervals (CI) were calculated. Data from 10 randomized and 2 non-randomized controlled trials, including a total of 690 persons with PD were included. Exercise had a significant positive effect on sleep quality assessed subjectively (SMD = 0.53; 95% CI = 0.16-0.90; p = 0.005). However, the methodological quality of the studies showing positive effects on sleep quality was significantly poorer than the studies showing no effects. Only one study assessed the impact of exercise on objective sleep quality, showing improvements in sleep efficiency assessed with polysomnography (SMD = 0.94; 95% CI = 0.38-1.50; p = 0.001). Exercise performed at moderate to maximal intensities (SMD = 0.46; 95% CI = 0.05-0.87; p = 0.03) had significant effects on subjective sleep quality. In contrast, exercise performed at mild to moderate intensities showed non-significant effects (SMD = 0.76; 95% CI = -0.24-1.76; p = 0.14). These results support the use of exercise to improve sleep quality in persons with PD and reinforce the importance of achieving vigorous exercise intensities. Biases, limitations, practice points and directions for future research are discussed.

Traducción y validación al español del módulo neuromuscular de la escala Pediatric Quality of Life Inventory (PedsQL): evaluación de la calidad de vida autopercibida por niños de 5-7 años con enfermedades neuromusculares y por sus padres / Spanish translation and validation of the Neuromuscular Module of the Pediatric Quality of Life Inventory (PedsQL): evaluation of the quality of life perceived by 5-7 years old children with neuromuscular disorders and by their parents

Introducción: Los recientes avances en el abordaje terapéutico de las enfermedades neuromusculares pediátricas han permitido un mejor pronóstico y, en consecuencia, surge la necesidad de medir la calidad de vida relacionada con la salud como parte de un abordaje integral. Es importante disponer de instrumentos válidos y específicos para su correcta valoración que contemplen la calidad de vida relacionada con la salud tanto autopercibida por los niños como por los padres. Objetivo: Evaluar la validez y la fiabilidad de la versión española del módulo neuromuscular de la Pediatric Quality of Life Inventory (PedsQL) para la medición de la calidad de vida autopercibida por niños de 5 a 7 años con enfermedades neuromusculares y la de sus padres. Sujetos y métodos: Con autorización de Mapi-Research-Trust, se procedió a la adaptación transcultural de la versión española de la escala. Posteriormente, se realizó un test-retest a 27 niños de 5 a 7 años y a 37 padres para evaluar la consistencia interna, la fiabilidad y la validez de constructo. Resultados: El coeficiente alfa de Cronbach mostró una consistencia interna buena para los niños y excelente para los padres. La correlación intraobservador indicó una excelente fiabilidad para ambos. La validez de constructo sugirió que una estructura de más dimensiones podría ser más adecuada y explicaría un mayor porcentaje de variabilidad. Conclusiones: La versión española del módulo neuromuscular de la PedsQL para evaluar calidad de vida de niños de 5 a 7 años con enfermedades neuromusculares y de sus padres tiene buena consistencia interna y fiabilidad

Introduction: The recent advances in the therapies for some neuromuscular disorders imply a better prognosis. As a consequence, health-related quality of life has emerged as a core outcome. It is particularly important to know both the self-perceived health-related quality of life by children, as soon as possible, as well as the parental perception. Therefore, it is essential to have valid and specific scales for proper assessment. Aim: To assess the validity and reliability of the Spanish version of Pediatric Quality of Life Inventory (PedsQL) Neuromuscular Module for self-perceived and parent perceived quality of life of children aged 5-7 with neuromuscular disorders. Subjects and methods: Cross-cultural validity of the Spanish version was carried out with the permission of the Mapi-Research-Trust. Subsequently, a test-retest was administered to 27 children aged 5-7 and 37 parents in order to evaluate internal consistency, intra-observer reliability and construct validity. Results: The Cronbach alpha coeffi cient showed good internal consistency for children and was rated as excellent by parents. Furthermore, the intra-observer correlation indicated an excellent reliability for both. Construct validity analysis suggested that a new scale structure with more dimensions might be more adequate. Moreover, said structure will also explain a greater percentage of variability. Conclusion: The Spanish version of PedsQL Neuromuscular Module for the self-perceived and parent-perceived quality of life of children aged 5-7 showed good internal consistency and reliability

Development and Validation of an Exercise Programme for Recovery Balance Impairments in Poststroke Patients.

BACKGROUND: Deterioration of balance is one of the most common and disabling physical-motor deficits in patients after a stroke that have a negative impact on quality of life and increase the risk of falls. Previous studies have evaluated the effectiveness of the exercises on specific aspects of balance. However, there is no structured exercise program divided by levels for balance impairment in poststroke patients. METHODS: Delphi method was used to design the exercise programme, and then a pilot study was performed. For the pilot study, we included 14 poststroke adults patients (n = 7 in each group), with balance impairment, without previous severe functional dependence, sensorial deficit or dementia. Our 4 weeks intervention (5 times/week) is based on 9 exercise of progressive difficulty, offering a multidimensional approach training (biomechanical constraints, stability limits, anticipatory, postural responses, and sensory orientation). Patients in the intervention arm received 45 minutes of usual rehabilitation plus 15 minutes of the intervention proposed. The usual-care arm received 60 minutes of usual rehabilitation. Balance impairment (Mini BESTest) was assessed at the baseline and at 4 weeks. Differences between groups were analysed using Mann-Whitney U test. RESULTS: The agreement for the intervention designed was reached after 2 rounds. Participants in pilot study were 69 (SD = 9.7) years, 21.4% females. Post-treatment, median improvements in Mini BESTest were 20 (SD = 8) and 11 (SD = 10) points, P < .01 for intervention and control group respectively. CONCLUSION: A multidimensional approach of balance impairments in poststroke patients through the validated exercise programme proposed, may improve balance deficits.