Multicomponent and mat Pilates training increased gait speed in individuals with Parkinson's disease when walking and carrying a load: A single-blinded randomized controlled trial.

BACKGROUND AND PURPOSE: Gait disorders in individuals with Parkinson's disease (IwPD) are among the most disabling symptoms. Physical exercise has been proposed for the treatment of IwPD because it shows positive effects on gait variables. Given the importance of physical activity in the rehabilitation process of IwPD, the assessment of interventions to identify those most promising for improving or maintaining gait performance is of great relevance. Therefore, this study evaluated the effects of Mat Pilates Training (MPT) and Multicomponent Training (MCT) on the spatiotemporal variables of gait in situations of daily dual-task performance in IwPD. Gait analysis in a daily dual-task context allows the simulation of real-life conditions where individuals have a higher risk of falling than in single-task walking. METHODS: We conducted a single-blinded randomized controlled trial with 34 mild-to-moderate IwPD (Hoehn-Yahr stage 1-2). They were randomized to one of two interventions: MPT or MCT. All participants performed the training for 60 min, three times per week, for 20 weeks. Spatiotemporal gait variables were evaluated in a daily life situation to increase the ecological validity of the measurements, which included gait speed, stride time, double support time, swing time, and cadence. The individuals walked on a platform holding two bags with a load corresponding to 10% of their body mass. RESULTS: After the intervention, there was a significant improvement in gait speed in both groups: MPT (p = 0.047) and MCT (p = 0.015). The MPT group reduced the cadence (p = 0.005) and the MCT group increased the stride length (p = 0.026) after the intervention. DISCUSSION: Both groups had positive effects on gait speed with load transport resulting from the two proposed interventions. However, the MPT group showed a spatiotemporal adjustment of speed and cadence that can increase gait stability, which was not found in the MCT group.

Quedas na doença de Huntington / Falls in Huntington's Disease

Introdução: Quedas estão associadas com injúrias, medo de cair, diminuição da mobilidade funcional e piora na qualidade de vida. Entretanto, pouco se sabe sobre os fatores potencialmente contribuintes para ocorrência de quedas na Doença de Huntington (DH) assim como sobre as circunstâncias nas quais elas ocorrem. Objetivos: Investigar as características clínicas potencialmente associadas com o aumento do risco de quedas na DH, assim como as circunstâncias nas quais as quedas ocorrem e suas consequências. Métodos: Dados demográficos e clínicos foram obtidos através de entrevista, revisão do prontuário e exame físico. Instrumentos para avaliação de risco de quedas (TUG), sintomas motores (UHDRS, UPDRS), distúrbios da marcha (10MWT, FOG), distúrbios cognitivos (MEEM, FAB, FDT, Hayling,Ekman), alterações comportamentais (Irritability Scale, BIS-11, BDI-II, NPI-Q) e distúrbios do equilíbrio (BBS) foram aplicado em todos pacientes. Resultados: Foram obtidos dados de 40 pacientes e 24 (60%) apresentaram ≥ 2 quedas nos últimos 6 meses e foram considerados "caidores recorrentes". Idade, idade de início da doença e duração da doença (DCL) não diferiram entre os grupos. Em contrapartida, a dose de neurolépticos medida em equivalentes de Olanzapina (OE) foi maior no grupo dos "caidores recorrentes." Os pacientes "caidores recorrentes" também apresentaram pior performance no desempenho da UHDRS-TMS, UPDRS, BBS e mais coreia do que os "não-caidores". Houve também diferença estatística na comparação dos tempos de escolha e alternância do FDT indicando pior desempenho cognitivo do grupo dos "caidores recorrentes" no teste. "Caidores- recorrentes" também apresentaram mais comportamento motor aberrante do que os "não- caidores". Não houve diferença na comparação dos parâmetros espaço-temporais da marcha estudados, assim como no desempenho do TUG. Ambos os grupos apresentaram altos índices de medo de queda. Somente o modelo contento o BBS alcançou significância estatística na regressão logística. Cerca de 80% das quedas ocorreram dentro de casa, caminhar foi o ato mais comum durante as quedas. Ainda, 40% das quedas foram classificadas como intrínsecas. Conclusão: As quedas são frequentes na DH assim como o medo de cair. Nosso estudo sugere que o risco de quedas na doença de Huntington seja multifatorial. Altas doses de neurolépticos, coreia, sintomas cognitivos e comportamentais e particularmente distúrbios do equilíbrio contribuem para ocorrência de quedas na HD.

Introduction: Falls are associated with injuries, fear of falling, decreased functional mobility and worsening in quality of life. However, little is known about the potentially contributing factors to the occurrence of falls in Huntington's Disease (HD) as well as the circumstances in which they occur. Objectives: To investigate clinical features potentially associated with an increased risk of falls in HD, as well as the circumstances in which falls occur and their consequences.Methods: Demographic and clinical data was obtained through interviews, chart review and physical examination. Instruments for fall risk assessment (TUG), motor symptoms (UHDRS, UPDRS), gait disorders (10MWT, FOG), cognitive disorders (MMSE, FAB, FDT, Hayling, Ekman), behavioral changes (Irritability Scale, BIS- 11, BDI-II, NPI-Q) and balance disorders (BBS) were applied to all patients.Results: Data from 40 patients was obtained and 24 (60%) had ≥ 2 falls in the last 6 months and were considered "recurrent fallers". Age, age of disease onset and disease duration (DCL) did not differ between groups. In contrast, the dose of neuroleptics measured in olanzapine equivalents (EO) was higher in the "recurrent fallers" group. The "recurrent fallers" also showed worse performance in the execution of the UHDRS-TMS, UPDRS, BBS and more chorea than the "non-fallers". There was also a statistical difference in the comparison of times of choice and alternation of the FDT, indicating worse cognitive performance of the "recurrent fallers" group in the test. "Recurrent fallers" also showed more aberrant motor behavior than "non-fallers". There was no difference in the comparison of the spatio-temporal gait parameters studied, nor in the TUG performance. Both groups had high rates of fear of falling. Only the model containing the BBS reached statistical significance in the logistic regression. About 80% of falls occurred indoors, walking was the most common act during falls. In addition, 40% of falls were classified as intrinsic. Conclusion: Falls are frequent in HD as well as the fear of falling. Our study suggests that the risk of falls in Huntington's disease is multifactorial. High doses of neuroleptics, chorea, cognitive and behavioral symptoms and particularly balance disorders contribute to the occurrence of falls in HD.

Freezing of gait (FOG) in Parkinson's disease patients-the contribution of Garcin and Melaragno.

Raymond Garcin, professor of neurology in Paris, France, and his Brazilian assistant, Professor Roberto Melaragno described in 1948 the phenomenon defined as "bégaiement de la mise en route du mouvement" in patients with Parkinson's disease. This was one of the first descriptions of freezing of gait (FOG) in the world.

Effects of explosive and impact exercises on gait parameters in elderly women / Efectos de los ejercicios explosivos y de impacto sobre los parámetros de la marcha en adultas mayores

Abstract Introduction: Several systematic reviews and meta-analyses have suggested that physical activity programs combining low impact exercises and resistance exercises help maintaining functional capacity in older adults. Objective: To analyze the effects of an aquatic training program involving both impact and explosive exercises on gait parameters of women aged 60 and above. Materials and methods: 60 physically active women (64.08±3.98 years) were divided into 2 groups: those training in a pool by performing series ofjumps, i.e., the experimental group (EG= 35), and the control group (CG=35). EG participants trained 3 times per week during 32 weeks in an hour per session basis. Body composition measurements, explosive strength, and gait parameters (in a 6 meters long track) were assessed using the center of pressure (COP) indicator before and after participating in the training program. Results: When comparing both groups, differences in explosive strength and power (EG vs. CG; p values=from 0.05 to 001) were observed, as well as changes in gait parameters related to the COP (EG vs. CG: p = 0.05-001), in particular EG participants had significant and positive changes. Conclusion: The aquatic training program described here produced an increase in muscle strength and muscle power, thus gait parameters were improved. Bearing this in mind, an improved availability of similar programs for older adults should be considered, since their participation in these programs could help them improve their functional capacity, and, thus, their quality of life.

Resumen Introducción. Varias revisiones sistemáticas y meta-análisis han sugerido que los programas de actividad física que combinan ejercicios de bajo impacto y de fuerza mantienen la capacidad funcional en adultos mayores. Objetivo. Analizar el efecto de un programa de entrenamiento acuático basado en movimientos explosivos y de impacto en los parámetros de la marcha en adultas mayores. Materiales y métodos. 60 mujeres físicamente activas (64.08±3.98 años) fueron divididas en dos grupos, uno control (CG=35) y otro de intervención (entrenamiento en piscina usando multisaltos) (IG=35). El IG entrenó por 32 semanas, 3 días a la semana, 1 hora por sesión. Se evaluó la composición corporal, la fuerza explosiva y los parámetros de la marcha sobre 6m de recorrido usando el centro de presión (COP) antes y después de participar en el programa. Resultados. Se presentaron diferencias en la fuerza explosiva y la potencia (EG vs. CG; p=0.05-001), así como cambios en los parámetros de la marcha relacionados al COP (EG vs. CG: p=0.05-001), con cambios significativos y positivos para EG. Conclusión. El programa de entrenamiento en agua con movimientos de impacto y explosivos induce ganancias en fuerza muscular y potencia, lo que mejora la capacidad de caminar. Teniendo en cuenta lo anterior, se debe considerar ofrecer una mejor disponibilidad de programas similares a esta población, ya que su participación en estos programas podría ayudarles a mejorar su capacidad funcional y, por tanto, su calidad de vida.

Síndrome de Hakim Adams: evaluación de la calidad de vida luego de la cirugía / Hakim Adams syndrome: assessment of quality of life after surgery

Introducción: el síndrome de Hakim Adams, o hidrocefalia normotensiva, es un cuadro progresivo que se caracteriza por presentar alteración de la marcha, trastornos esfinterianos y demencia, y que afecta principalmente a pacientes añosos. Si bien existen publicaciones sobre los resultados del tratamiento quirúrgico, estos trabajos suelen evaluar la mejoría sintomática pero no la calidad de vida de los pacientes. Objetivo: Conocer el impacto del tratamiento en pacientes con síndrome de Hakim Adams tratados con derivación de LCR. Material y Métodos: Realizamos un estudio retrospectivo de una serie de 8 pacientes. Se realizó una encuesta para la evaluación preoperatoria y postoperatoria; con un tiempo transcurrido no menor a 6 meses luego del procedimiento. Se utilizó la escala de Barthel para la funcionalidad, y una escala numérica simple para la calidad de vida. Resultados: Previo a la cirugía, 7 casos presentaban alteraciones de la marcha y/o problemas para deambular; 6 casos alteraciones esfinterianas; y 5 casos algún tipo de alteración neurocognitiva. Luego de la cirugía, todos los pacientes refirieron un cambio significativo en la calidad de vida; y también en la funcionalidad, logrando 6 pacientes una independencia absoluta. Conclusión: Aunque nuestra comunicación tiene las debilidades de una serie pequeña de casos analizados en forma retrospectiva, los resultados son concluyentes en cuanto a mejora en la calidad de vida y funcionalidad en el postoperatorio. Creemos que esta modalidad de evaluación puede ayudar a los pacientes y/o familiares de pacientes en el proceso de toma decisiones del tratamiento quirúrgico.

Introduction: the Hakim Adams’ syndrome is a chronic hydrocephalus of the elderly with normal or low CSF pressure that clinically have gait disturbances, urinary incontinence and dementia. Although there are some publications about the surgical results in terms of the relief of symptoms, they don’t usually evaluate the patients’ quality of life. Material and Methods: We are reporting a retrospective study of a series of 8 patients with diagnosis of Hakim Adams’ syndrome that was performed to assess the influence of CSF shunting on their quality of life. A survey was performed to record the preoperative status, with at least 6-months after surgery. Functional results were evaluated with Barthel’s scale; and the quality of life with a simple numeric scale. Results: Before surgery, 7 cases had gait disturbances; 6 cases had urinary incontinence; and 5 cases had neurocognitive impairment. Postoperatively, all patients reported a significative change in their quality of life, and also in the functional scale; 6 cases obtained total independence. Conclusion: Although our communication has the weakness of the small number of cases evaluated in a retrospective manner, the results are conclusive in terms of functionality improvement and quality of life. This kind of assessment may help to our patients and/or patients’ family in the decision making process of shunting procedures.

Vascular Parkinsonism: deconstructing a syndrome.

Progressive ambulatory impairment and abnormal white matter (WM) signal on neuroimaging come together under the diagnostic umbrella of vascular parkinsonism (VaP). A critical appraisal of the literature, however, suggests that (1) no abnormal structural imaging pattern is specific to VaP; (2) there is poor correlation between brain MRI hyperintensities and microangiopathic brain disease and parkinsonism from available clinicopathologic data; (3) pure parkinsonism from vascular injury ("definite" vascular parkinsonism) consistently results from ischemic or hemorrhagic strokes involving the SN and/or nigrostriatal pathway, but sparing the striatum itself, the cortex, and the intervening WM; and (4) many cases reported as VaP may represent pseudovascular parkinsonism (e.g., Parkinson's disease or another neurodegenerative parkinsonism, such as PSP with nonspecific neuroimaging signal abnormalities), vascular pseudoparkinsonism (e.g., akinetic mutism resulting from bilateral mesial frontal strokes or apathetic depression from bilateral striatal lacunar strokes), or pseudovascular pseudoparkinsonism (e.g., higher-level gait disorders, including normal-pressure hydrocephalus with transependimal exudate). These syndromic designations are preferable over VaP until pathology or validated biomarkers confirm the underlying nature and relevance of the leukoaraiosis. © 2015 International Parkinson and Movement Disorder Society.