Tratamento manipulativo osteopático em paciente com síndrome da pessoa rígida e miastenia gravis: relato de caso / Osteopathic manipulative treatment in person with stiff person syndrome and myasthenia gravis: case report

Introdução: Síndrome da Pessoa Rígida (SPR) é uma doença neurológica autoimune rara caracterizada pela rigidez e espasmos musculares episódicos dolorosos, especialmente no tronco e extremidades do corpo, gerando comprometimento funcional importante. Existe uma lacuna de conhecimento sobre os possíveis efeitos do tratamento manipulativo osteopático (TMO) nos sintomas motores de pessoas com SPR. Objetivos: Descrever os efeitos do TMO na tontura, equilíbrio e amplitude de movimento (ADM) cervical em uma pessoa com a SPR e miastenia gravis. Método: Relato de caso baseado no TMO em uma mulher com SPR e miastenia grave. As seguintes avaliações foram utilizadas: Inventário de Brazilian Version of the Dizziness Handicap Inventory (DHI), Fall Efficacy Scale (FES I ­ Brazil), Timed Get Up and Go Test (TUG), Teste de Sentar e Levantar 5 vezes, goniometria dos movimentos da coluna cervical. Resultados: Nenhum resultado expressivo foi obtido pela FES-I (-1,8%) e DHI (0%). Para os testes funcionais (TUG e Sentado para de pé 5 vezes) observamos melhora de 5,8% e 6,7%, respectivamente, após o tratamento. A ADM cervical melhorou substancialmente em todos os movimentos avaliados (flexão: 60%, extensão: 28%, rotação direita: 33%, rotação esquerda:38%, inclinação lateral direita: 77%, inclinação lateral esquerda: 87%). Conclusão: O TMO proposto pareceu ser importante para melhora da ADM cervical no caso relatado. Medo de quedas, impacto da tontura na qualidade de vida e funcionalidade de membros inferiores não demonstrou melhoras após o TMO.

Introduction: Stiff Person Syndrome (SPS) is a rare neurological autoimmune disease characterized by stiffness and painful episodic muscle spasms, especially in the trunk and extremities of the body, causing significant functional impairment in affected individuals. There is a gap in knowledge about the possible effects of an osteopathic manipulative treatment (OMT) on the motor symptoms of people with SPS. Objectives: To describe the effects of an OMT on dizziness, balance deficit, and cervical range of motion (ROM) in a patient with SPS and myasthenia gravis. Methods: This is a case report on an OMT intervention in a woman with SPS and myasthenia gravis. The following assessments were used: Brazilian Version of the Dizziness Handicap Inventory (DHI), Fall Efficacy Scale (FES I ­ Brazil), Timed Get Up and Go Test (TUG), Stand Up Test 5 times, goniometry of cervical movements. Results: No expressive results were obtained for FES I ­ Brazil (-1.8%) and DHI (0%). For the functional tests (TUG and Sit and stand up 5x) we observed an improvement of 5.8% and 6.7%, respectively, after treatment. The cervical ROM improved substantially in all movements tested (flexion: 60%, extension: 28%, right rotation: 33%, left rotation: 38%, right side bending: 77%, left side bending: 87%). Conclusion: The proposed OMT appears to be important for the improvement of cervical ROM in this case. Fear of falls, impact of dizziness on quality of life, and lower limb functionality did not demonstrate meaningful improvements after the OMT.

Use of invertebrates to model chemically induced parkinsonism-symptoms.

The prevalence of neurological diseases is currently growing due to the combination of several factor, including poor lifestyle and environmental imbalance which enhance the contribution of genetic factors. Parkinson's disease (PD), a chronic and progressive neurological condition, is one of the most prevalent neurodegenerative human diseases. Development of models may help to understand its pathophysiology. This review focuses on studies using invertebrate models to investigate certain chemicals that generate parkinsonian-like symptoms models. Additionally, we report some preliminary results of our own research on a crustacean (the crab Ucides cordatus) and a solitary ascidian (Styela plicata), used after induction of parkinsonism with 6-hydroxydopamine and the pesticide rotenone, respectively. We also discuss the advantages, limits, and drawbacks of using invertebrate models to study PD. We suggest prospects and directions for future investigations of PD, based on invertebrate models.

Physical exercise influences astrocytes in the striatum of a Parkinson's disease male mouse model.

Physical exercise is considered an adjuvant treatment to Parkinson's disease (PD) patients, possibly reducing inflammatory responses in the brain. Studies have stated that physical exercise protects dopaminergic neurons in PD models produced by neurotoxins. However, few studies focused on immunohistochemically reacted astrocytes and morphometric analyses of these cells in a PD mouse model submitted to physical exercise. We investigated the effects of treadmill training on striatal astrocytes of a PD mouse model combining immunohistochemistry and western-blotting for glial fibrillary acidic protein (GFAP) with morphometric analyses. Male Swiss mice were divided into 4 groups: sedentary control (SEDCONT), exercise control (EXERCONT), sedentary Parkinson (SEDPD), and exercise Parkinson (EXERPD). Stereotaxic bilateral injections of 6-hydroxydopamine into the striatum were adopted for PD groups. Striatal astrocytes showed increased GFAP in EXERPD, and we observed a higher level of GFAP in EXERPD than SEDPD. The number of primary and secondary processes was similar in striatal astrocytes of control groups and EXERPD. The astrocyte primary processes of SEDPD were larger than those of EXERPD, EXERCONT and SEDCONT. Cell body diameters and areas showed no difference between groups. We concluded that physical exercise influences striatal astrocytes in exercised parkinsonian mice.

Association between mental health and physical activity levels in people with Parkinson's disease during the COVID-19 pandemic: an observational cross-sectional survey in Brazil.

Aims: (1) To evaluate mental health symptoms in people with Parkinson's (PwP) in self-isolation, before and during the COVID-19 pandemic, in Brazil; (2) to explore associations between mental health and physical activity levels. Methods: An observational cross-sectional survey using retrospective data. PwP from the Brazilian territory, both sexes, no age limit, in self-isolation due to COVID-19 pandemic, were invited to complete an online self-administered and validated questionnaire. Demographic data (sex, age, Brazilian state they lived in, levels of education, and household income), days in self-isolation, time of diagnosis, and symptoms that bothered most were reported. Self-reported levels of physical activity and mental health symptoms (depression, anxiety, fear, and thoughts of death), before and during the COVID-19 pandemic, were assessed. Results: The participants were 156 individuals with PD (64 ± 11 years), from both sexes (50% women; 50% men), resident in the 5 Brazilian regions. There was a worse on mental health symptoms over the time: anxiety [effect size = - 0.52; 95% CI (- 0.70; - 0.28); p < .001], fear [effect size = - 0.58; 95% CI (- 0.76; - 0.34); p < .001], and thoughts of death [effect size = - 0.43; 95% CI (- 072;-0.02); p = .001]. A lower physical activity level during the pandemic is related to increased probability of thoughts of death [crude OR = 1.84; 95% CI (0.98; 3.46); p = 0.05; adjusted OR = 2.98; 95% CI (- 0.01; 2.19); p = 0.05]. Anxiety, fear and depression were not associated with physical activity levels. Conclusions: Anxiety, fear and thoughts of death worsened during the COVID-19 pandemic in comparison with the period before COVID-19. Lower physical activity level during the pandemic was related to an increased probability of thoughts of death. Supplementary Information: The online version contains supplementary material available at 10.1007/s11332-021-00868-y.

Dance Rhythms Improve Motor Symptoms in Individuals with Parkinson's Disease: A Randomized Clinical Trial.

BACKGROUND: Evidence-based practices involving dance modalities found in binary (two-beat rhythm) or quaternary (four-beat rhythm) show that dance positively influences the motor aspects of disease.
Aim: This randomized clinical trial aimed to analyze the effect of two dance rhythm (binary and quaternary) on the balance, gait, and mobility in individuals with Parkinson's disease (PD).
Methods: Thirty-one individuals with PD were randomized into the binary group (n = 18) and the quaternary group (n = 13). Both groups participated in different dance rhythms lasting 12 weeks, twice a week, for 45 minutes.
Results: The binary group showed a significant difference in balance (p = 0.003), freezing of gait (p = 0.007), as well as in the motor aspects of MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), with emphasis on the total values with a score change of 3.23. In the quaternary group, significant differences were found in balance (p = 0.021) with a score change of -2.54 and in the motor aspects of the MDS-UPDRS Part III where the total values stood out with a change of 3.54.
Discussion: When comparing the possible effects of binary and quaternary rhythms on the motor symptoms of individuals with PD, it was demonstrated that binary rhythm improved balance, freezing gait, and UPDRSIII. As for the quaternary rhythm, the benefits were in balance and the UPDRSIII.
Conclusion: The binary and the quaternary rhythm dance protocols positively influenced the motor symptoms of individuals with PD after 12 weeks of intervention.

Effects of binary dance rhythm compared with quaternary dance rhythm in fatigue, sleep, and daily sleepiness of individuals with Parkinson's disease: A randomized clinical trial

Abstract Aim: People with Parkinson's disease constantly demonstrate low levels of physical activity, which is why dance has become increasingly important for the treatment of the disease. This study aimed to analyze the influence of binary and quaternary rhythm on fatigue, sleep, and daytime sleepiness in individuals with Parkinson's disease. Methods: 31 individuals participated in this randomized clinical trial with a mean age of 66.6 ± 10.2 years, 71% were male and 29% were female, allocated into two groups, binary and quaternary, where they participated in different dance interventions lasting 12 weeks. A questionnaire was applied including personal and clinical information; Mental State Mini-Examination (MMSE), Hoehn and Yahr (H&Y), Fatigue Severity Scale (FSS), Sleep Scale for Parkinson's Disease (PDSS), and Daytime Sleepiness Epworth Scale (ESS). Results: The groups that participated in binary rhythm classes showed improvement in sleep quality and daytime sleepiness after 12 weeks of intervention. However, no significant differences were found in the group that participated in the quaternary rhythm classes. Moreover, it was noted that the binary group managed to raise the heart rate during the 12 weeks of intervention, given that these results were not obtained in the quaternary group. Conclusion: The results showed the effectiveness of binary rhythm on non-motor symptoms and heart rate increase in individuals with Parkinson's disease. Thus, it is concluded that the binary rhythm was more effective than the quaternary rhythm.

Multidimensional Factors Can Explain the Clinical Worsening in People With Parkinson's Disease During the COVID-19 Pandemic: A Multicenter Cross-Sectional Trial.

Background: Self-reported clinical worsening by people with Parkinson's disease (PD) during social distancing may be aggravated in Brazil, where the e/tele-health system is precarious. Objectives: This study aims to investigate self-reported changes in motor and non-motor aspects during social distancing in people with PD living in Brazil and to investigate the factors that might explain these changes. Methods: In this multicenter cross-sectional trial, 478 people with a diagnosis of idiopathic PD (mean age = 67, SD = 9.5; 167 female) were recruited from 14 centers distributed throughout the five geographical regions of Brazil. The evaluators from each center applied a questionnaire by telephone, which included questions (previous and current period of social distancing) about the motor and non-motor experiences of daily living, quality of life, daily routine, and physical activity volume. Results: Self-reported clinical worsening in non-motor and motor aspects of daily life experiences (Movement Disorder Society-Unified PD Rating Scale-parts IB and II-emotional and mental health, and fear of falling) and in the quality of life was observed. Only 31% of the participants reported a guided home-based physical activity with distance supervision. Perceived changes in the quality of life, freezing of gait, decreased physical activity volume, daily routine, and fear of falling explained the self-reported clinical worsening (P < 0.05). Conclusions: Self-reported clinical worsening in people with PD living in Brazil during social distancing can also be aggravated by the precarious e/tele-health system, as perception of decreased physical activity volume and impoverishment in daily routine were some of the explanatory factors. Considering the multifaceted worsening, the implementation of a remote multi-professional support for these people is urgent.

Binary dance rhythm or Quaternary dance rhythm which has the greatest effect on non-motor symptoms of individuals with Parkinson's disease?

This study aimed to compare the effect of a binary and quaternary rhythm protocol on cognition, mental activity, daily life, and quality of life among individuals with Parkinson's Disease. A two-arm randomized clinical trial with 31 individuals diagnosed with Parkinson's disease, who were allocated to the binary group or quaternary group. Both groups underwent a 12-week intervention. The following variables were analyzed: personal and clinical information; MoCA; UPDRSI and II; PDQ-39. Both intervention groups improved cognition, mental activity, activities of daily living, and quality of life. In addition, there were intergroup differences in total UPDRSII, writing, and hygiene where the quaternary group was superior to the binary group. It concludes that the binary and quaternary rhythm positively influenced and presented similar effects on the complementary treatment of individuals with Parkinson's disease on the studied variables. Thus, it is believed that both interventions are possible and feasible for the health professionals involved in the area.

Physical activity of individuals with Parkinson's in social isolation before and during the pandemic COVID-19 / Atividade física de indivíduos com doença de Parkinson em isolamento social antes e durante a pandemia de COVID-19

The world has been hit by a pandemic caused by the new coronavirus (COVID-19), which has result-ed in government recommendations and measures including social isolation to reduce the spread of the disease. In view of these recommendations, there were drastic changes in lifestyle, impacting the physical and mental health of men and women. Thus, this study aimed to investigate the practice of physical activity, according to sex, in individuals with Parkinson's disease in social isolation before and during the COVID-19 pandemic.Cross-sectional observational study, based on an online question-naire validated for individuals with Parkinson's disease PAFPA/COVID19, in which 156 individuals of both sexes and degrees of the disease (I to V ) were allocated, with a mean age of 63.70 ± 11.00 years and from different Brazilian regions. Chi-square, Fisher's exact and binary logistic regression tests were used. It is observed that 92% of the participants were in social isolation, which caused nega-tive effects on the level of physical activity of the participants, even though most of them doing phys-ical activity online. In addition, it was found that those who participated in specific exercise programs for Parkinson's disease, are less likely to be insufficiently active, as well as individuals who receive online guidance. Although social isolation is a necessary measure to combat COVID-19, the results show a negative effect of this social isolation on the parameters of physical activity in this population in different regions of Brazil. This suggests that better strategies for health promotion in order to increase levels of physical activity at home are necessary to reduce the physical inactivity lifestyle dur-ing the pandemic, in order to prevent diseases associated with social isolation and physical inactivity

O mundo foi atingido por uma pandemia causada pelo novo coronavírus (COVID-19), que resultou em re-comendações e medidas governamentais, incluindo isolamento social para reduzir a disseminação da doença. Diante dessas recomendações, ocorreram mudanças drásticas no estilo de vida, impactando na saúde física e mental de homens e mulheres. Assim, este estudo teve como objetivo investigar a prática de atividade física, segundo o sexo, em indivíduos com doença de Parkinson em isolamento social antes e durante a pandemia de COVID-19. Estudo observacional transversal, baseado em questionário online validado para indivíduos com doença de Parkinson PAFPA/COVID19, no qual foram avaliados 156 indivíduos de ambos os sexos e graus da doença (I ao V ), com média de idade de 63,70 ± 11,00 anos e de diferentes regiões brasileiras. Foram utilizados os testes Qui-quadrado, exato de Fisher e a regressão logística binária. Observa-se que 92% dos participantes encontravam-se em isolamento social, o que causou repercussões negativas no nível de atividade física dos participantes, embora a maioria realizasse atividade física online. Além disso, verificou-se que aqueles que participaram de programas de exercícios específicos para a doença de Parkinson, tiveram menor probabilidade de serem insuficientemente ativos, assim como os indivíduos que recebem orientação online. Embora o isolamento social seja uma medida necessária para combater a COVID-19, os resultados mostram um efeito negativo desse isolamento social sobre os parâmetros de atividade física dessa população em dife-rentes regiões do Brasil. Isso sugere que melhores estratégias de promoção da saúde para aumentar os níveis de atividade física no domicílio são necessárias para reduzir o inatividade física durante a pandemia, a fim de prevenir doenças associadas ao isolamento social e inatividade física

Progressive muscle-strength protocol for the functionality of upper limbs and quality of life in individuals with Parkinson's disease: Pilot study.

The effects of physical-therapy intervention on the motor function of upper limbs and the quality of life in patients with Parkinson's disease (PD) are not fully understood. We evaluated the effects of a progressive muscle-strengthening protocol for upper limbs on the functionality and quality of life. Patients were divided into two groups: Intervention (n = 6) and Control (n = 7). Assessment tools used were: Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Questionnaire, Nine-Hole Peg Test (9HPT), Test d'Évaluation des Membres Supérieurs de Personnes Âgées (TEMPA), 10-Repetition Maximum (10-RM) and handgrip dynamometer, which were applied pre- and post-intervention, with follow-up for one month after the last training session. Only, the Intervention group (post-intervention) showed significant statistical differences, with the following outcomes: UPDRS III (p = 0.042); 9HPT, right (p = 0.028) and left side (p = 0.028); TEMPA for total right side (p = 0.028), left side (p = 0.028) and total bilateral tasks (p = 0.028); TEMPA task 2 - open a jar and take a spoonful of coffee (p = 0.028), task 3 - pick up a pitcher and pour water into a glass for right (p = 0.046) and left side (p = 0.028), task 5 - write on an envelope and stick on a stamp (p = 0.028), and task 6 - shuffle and deal playing cards (p = 0.028). We observed significant statistical differences between groups (post-intervention) for TEMPA task 6 (p = 0.032), total right side (p = 0.032), and total bilateral tasks (p = 0.032). An increase in the maximum load in the post-intervention stage, based on the 10-RM test, was observed on the right (p = 0.003) and left (p = 0.007) sides. Our results showed an improvement in upper-limb functionality in PD patients submitted to progressive muscle-strength training, although not in quality of life.

Measurement properties from the Brazilian Portuguese version of the QUIP-RS.

Parkinson's disease (PD) has numerous motor and non-motor symptoms. Among non-motor manifestations impulse control disorders (ICDs) stand out. ICDs include compulsions for gambling, shopping, eating, and sexual behavior, and "related disorders" such as hobbyism, simple motor activities, and dopamine dysregulation syndrome. There is no rating scale translated and adapted transculturally into Brazilian Portuguese language. Therefore, we cross-culturally adapted and investigated the measurement properties of the Brazilian version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale (QUIP-RS). Fifty-three patients participated in the study. Inter-evaluator and test-retest (patient and health professional) reliabilities (intraclass correlation coefficient) were all excellent (0.93, 0.93, and 0.99). The internal consistency was high (α = 0.92). The Minimal detectable change (MDC) value was 5.8 (patient) and 2.3 (health professional) points. There was a floor, but no ceiling, effect. In summary, the Brazilian version of the QUIP-RS has high reliability and content validity.

Feasibility of a Brazilian samba protocol for patients with Parkinson's disease: a clinical non-randomized study.

OBJECTIVE: To investigate the feasibility of a Brazilian samba protocol in individuals with Parkinson's disease. METHODS: Twenty participants, mean age of 66.4±10.7 years, diagnosed with idiopathic Parkinson 's disease, divided into: experimental group that received the intervention of Brazilian samba dance classes (10 individuals); and control group that maintained their routine activities (10 individuals). For data collection, a divided questionnaire was used: General Information; Disability stages scale; Balance and Quality of Life. RESULTS: During class implementation, there were no falls, as all dance activities adhered to the details of the protocol steps without any changes. On average, patients completed 82.7% of activities. After 12 weeks, the experimental group had improvements in the UPDRS global score, in daily activities, and on motor examination. There was also improvement in balance scores and in the mobility domain of the quality of life in the experimental group. CONCLUSION: The samba protocol seems to be feasible and safe for patients with PD. Moreover, it has pleasant characteristics and offers sufficient physical benefits for combination with drug treatment. There were also benefits in social relationships and as a possible rehabilitation tool in individuals with Parkinson's disease.

Feasibility of a Brazilian samba protocol for patients with Parkinson's disease: a clinical non-randomized study / Viabilidade de um protocolo de samba brasileiro em pacientes com doença de Parkinson: ensaio clínico não-randomizado

Abstract Background: New protocols applied in the rehabilitation of Parkinson's disease enable different action strategies for health professionals, as well as a new range of activities for these individuals. However, no valid samba protocol with activity prescription for this population was found in the literature. Objective: To investigate the feasibility of a Brazilian samba protocol in individuals with Parkinson's disease. Methods: Twenty participants, mean age of 66.4±10.7 years, diagnosed with idiopathic Parkinson 's disease, divided into: experimental group that received the intervention of Brazilian samba dance classes (10 individuals); and control group that maintained their routine activities (10 individuals). For data collection, a divided questionnaire was used: General Information; Disability stages scale; Balance and Quality of Life. Results: During class implementation, there were no falls, as all dance activities adhered to the details of the protocol steps without any changes. On average, patients completed 82.7% of activities. After 12 weeks, the experimental group had improvements in the UPDRS global score, in daily activities, and on motor examination. There was also improvement in balance scores and in the mobility domain of the quality of life in the experimental group. Conclusion: The samba protocol seems to be feasible and safe for patients with PD. Moreover, it has pleasant characteristics and offers sufficient physical benefits for combination with drug treatment. There were also benefits in social relationships and as a possible rehabilitation tool in individuals with Parkinson's disease.

Resumo Fundamentos: Novos protocolos aplicados na reabilitação da doença de Parkinson possibilitam diferentes estratégias de atuação para profissionais de saúde, além de um novo leque de atividades para estes indivíduos. Entretanto, não se encontrou na literatura qualquer protocolo de samba com prescrição de atividades validado para esta população. Objetivo: O objetivo foi verificar a viabilidade de um protocolo de samba brasileiro em indivíduos com doença de Parkinson. Métodos: Vinte participantes, com idade média de 66,4±10,7 anos, com diagnóstico de doença de Parkinson idiopática divididos em: grupo experimental que recebeu a intervenção das aulas de dança - samba brasileiro (10 indivíduos); e grupo controle que manteve as suas atividades rotineiras (10 indivíduos). Para a coleta dos dados foi utilizado um questionário dividido: Informações Gerais; Escala de estágios de Incapacidade; Equilíbrio e Qualidade de Vida. Resultados: Durante a realização das aulas, não houve quedas, todas as atividades de dança aderiram aos detalhes das etapas do protocolo, sem quaisquer alterações, e os pacientes completaram, em média, 82,7% das atividades. Após 12 semanas, o grupo experimental apresentou melhoras no escore global da escala UPDRS, em atividades de vida diária e no exame motor. Houve também melhora nos escores de equilíbrio e no domínio de mobilidade da qualidade de vida do grupo experimental. Conclusão: A utilização de um protocolo de samba para indivíduos com doença de Parkinson mostrou-se viável, por sua característica segura e prazerosa, e por apresentar benefícios físicos suficientes para combinação com o tratamento medicamentoso. Houve também benefícios nas relações sociais e como uma possível ferramenta de reabilitação em indivíduos com a doença de Parkinson.

Congelamento da marcha e de membros superiores na doença de Parkinson / Freezing of gait and upper limbs in Parkinson's disease

O fenômeno do congelamento é considerado um sintoma incapacitante para indivíduos acometidos pela doença de Parkinson, gerando impactos negativos na mobilidade, funcionalidade e qualidade de vida. O congelamento pode acometer membros inferiores (congelamento da marcha) e/ou membros superiores, sendo caracterizado por súbita incapacidade de iniciar ou manter a amplitude dos movimentos. A fisiopatologia do congelamento ainda não é compreendida, porém atribui-se às alterações em diferentes estruturas neuroanatômicas, tais como: núcleo pedúnculo-pontino, locus ceruleus, circuitaria dos núcleos da base, pedúnculo cerebelar e córtices cerebrais e sistema límbico. Fatores que contribuem para o surgimento do congelamento são: tempo de duração da doença, idade avançada, subtipo acinético-rígido da doença, ansiedade ou depressão, perfil de tratamento farmacológico. Sugere-se que o congelamento da marcha e dos membros superiores compartilhem das mesmas características espaço-temporais. A avaliação clínica do congelamento da marcha é melhor estabelecida quando comparada com a avaliação do congelamento dos membros superiores. Estratégias para minimizar o fenômeno do congelamento são descritas no presente artigo.

The phenomenon of freezing is a disabling symptom for subjects with Parkinson's disease, causing impairment in mobility, functionality and quality of life. Freezing may affect lower limbs (freezing of gait) or upper limbs, and is characterized by sudden inability to initiate or maintain range of motion. The pathophysiology of freezing is not yet understood, but it is attributed to changes in different neuroanatomical structures, such as: pedunculopontine nucleus, locus ceruleus, basal ganglia circuitry, pedunculocerebellar and cerebral cortices and limbic system. Factors that contribute to the appearance of freezing are: advanced age, akinetic-rigid subtype of the disease, anxiety or depression, pharmacological treatment strategies. It is suggested that the freezing of gait and upper limbs share the same spatiotemporal characteristics. The clinical evaluation of freezing of gait is better established when compared to the freezing of upper limbs. Strategies to minimize the phenomenon of freezing are described in this article.

Treadmill training and kinesiotherapy versus conventional physiotherapy in Parkinson's disease: a pragmatic study / Esteira e cinesioterapia versus fisioterapia convencional na doença de Parkinson: estudo pragmático / Entrenamiento en la cinta de correr y la cinesioterapia versus fisioterapia convencional en la enfermedad de Parkinson: estudio pragmático

Abstract Introduction: Physiotherapy has been identified in the literature as an important treatment for individuals with Parkinson's disease (PD) to improve functional capacity. Little is discussed about the physiotherapy practice environment for this population. Objective: To assess pragmatically the effects of two physiotherapy protocols: Conventional Physiotherapy (CP) and Treadmill Training and Kinesiotherapy (TTK) in PD patients. Method: Twenty-four PD patients classified from 1 to 3 on the Hoehn and Yahr scale were randomly distributed into two groups. In CP group (12 patients), exercises aimed to improve range of motion, bradykinesia, postural adjustments and gait. In TTK group (12 patients), exercises aimed to improve physical fitness, mobility and functional independence. The treatments were performed for 50 minutes, twice a week for 14 weeks. The following evaluations were performed before and after the interventions: Unified Parkinson's Disease Rating Scale (UPDRS); gait speed (GS); up stairs (US) and down stairs (DS) tests; timed get-up-and-go test (TUG) and 6-Minute Walk Distance Test (6-MWDT). Sociodemographic and clinical data were presented as descriptive analysis. Variables with normal and non-normal distributions were analyzed by specific statistical tests. Results: Intragroup analysis showed significant results for the TTK group (TUG, US, DS, GS, UPDRS total and UPDRS II) and for the CP group only UPDRS total. Intergroup analysis was favorable for the TTK group (TUG, US, DS, 6-MWDT). Conclusion: CP group improved the patients' general clinical status, while treadmill and kinesiotherapy improved the physical-functional and clinical aspects.

Resumo Introdução: A fisioterapia tem sido apontada na literatura como um importante tratamento para indivíduos com doença de Parkinson (DP) para melhorar a capacidade funcional. Pouco se discute sobre o ambiente da prática fisioterapêutica para essa população. Objetivo: Avaliar pragmaticamente os efeitos de dois protocolos fisioterapêuticos: Fisioterapia Convencional (FC) e Treinamento em Esteira e Cinesioterapia (TEC) em pacientes com DP. Método: Vinte e quatro pacientes com DP entre 1 e 3 da escala Hoehn e Yahr foram alocados aleatoriamente em dois grupos. No grupo FC (12 pacientes) foram aplicados exercícios visando melhorar a amplitude de movimento, bradicinesia, ajustes posturais e marcha. No grupo TEC (12 pacientes) foram aplicados exercícios visando melhorar a aptidão física, mobilidade e independência funcional. Os tratamentos foram conduzidos por 50 minutos, duas vezes por semana durante 14 semanas. Avaliações realizadas antes e após a intervenção: Unified Parkinson's Disease Rating Scale (UPDRS); velocidade da marcha (VM); subir escadas (SE) e descer escadas (DE); timed get up and go test (TUG) e Teste de Caminhada de 6 Minutos (TC6'). Dados sociodemográficos e clínicos apresentados como análise descritiva. Variáveis com distribuição normal e não-normal foram analisadas por testes estatísticos específicos. Resultados: Análise intragrupo mostrou resultado significativo para o grupo TEC (TUG, SE, DE, VM, UPDRS total e UPDRS II) e para o grupo FC apenas UPDRS total. Análise intergrupo foi favorável para o grupo TEC (TUG, SE, DE, TC6'). Conclusão: A FC melhorou o estado clínico geral dos pacientes, enquanto a esteira ergométrica e cinesioterapia melhoraram aspectos físico-funcionais e clínicos.

Resumen Introducción: La fisioterapia se ha señalado en la literatura como un importante tratamiento para las personas con enfermedad de Parkinson (EP) para mejorar la capacidad funcional. Poco se discute sobre el ambiente de la práctica fisioterapéutica para esa población. Objetivo: Evaluar pragmáticamente los efectos de dos programas de tratamiento fisioterapéutico: Fisioterapia Convencional (FC); Entrenamiento en la cinta de correr y la Cinesioterapia (ECCC) en pacientes con EP. Método: Veinticuatro pacientes con EP entre 1 y 3 de la escala Hoehn y Yahr, se asignaron al azar en dos grupos. En el grupo FC (12 pacientes) se aplicaron ejercicios para mejorar la amplitud de movimiento, bradicinesia, ajustes posturales y marcha. En el grupo ECCC (12 pacientes) se aplicaron ejercicios para mejorar la aptitud física, movilidad e independencia funcional. Los tratamientos se realizaron durante 50 minutos, dos veces por semana durante 14 semanas. Evaluaciones realizadas antes y después de la intervención: Unified Parkinson's Disease Rating Scale (UPDRS); velocidad de marcha (VM); subir escaleras (SE) y bajar escaleras (BE); timed get up and go test (TUG) y Prueba de Caminata de 6 Minutos (TC6'). Datos sociodemográficos y clínicos presentados como análisis descriptivo. Las variables con distribución normal y no normal se analizaron mediante pruebas estadísticas específicas. Resultados: El análisis intragrupo mostró un resultado significativo para el grupo ECCC (TUG, SE, BE, VM, UPDRS total y UPDRS II) y para el grupo FC sólo UPDRS total. El análisis intergrupo fue favorable para el grupo ECCC (TUG, SE, BE, TC6'). Conclusión: La FC mejoró el estado clínico general de los pacientes, mientras que la cinta de correr y la cinesioterapia mejoraron aspectos físico-funcionales y clínicos.

Determinants of the use of physiotherapy services among individuals with Parkinson's disease living in Brazil.

OBJECTIVES: To identify the factors affecting the use of physiotherapy services among individuals with Parkinson's disease (PD) living in Brazil. METHODS: Overall, 479 individuals with idiopathic PD, of both sexes, at any stage of the Hoehn & Yahr (HY) scale, and from seven capital cities in Brazil were recruited from 2014 to 2016. Multivariate logistic regression was the main statistical tool. For the construction of the logistic model, the association of the dependent variable "physiotherapy" with the independent sociodemographic/economic and clinical variables: age, education, family income, time of PD since onset, HY, the activities of daily living and motor subscales of the Unified Parkinson's Disease Rating Scale, cognitive aspects, depressive symptoms, fear of falling, freezing gait, history of falls, physical activity level, gait speed, walking performance and balance, were verified. RESULTS: The 479 individuals had an average age of 65.2 ± 11.0 years, 88% were in the HY I-III stages and 43.4% were under physiotherapy treatment. The analysis identified two determinant variables related to the use of the physiotherapy service: level of education (OR = 1.24) and walking performance (OR = 0.82). Decreased walking performance and a higher educational level increased the use of a physiotherapy service in individuals with PD living in Brazil. CONCLUSIONS: The present study shows that individuals with PD, residents from different regions of Brazil, have limited access to physiotherapy services. In addition, the Brazilian Public Health Care System, as well as local programs, need to target PD individuals with a low educational level to improve their access to physiotherapy services. Goals should aim towards the development of physical exercise programs to improve the patients' functional performance for a longer period.

Determinants of the use of physiotherapy services among individuals with Parkinson's disease living in Brazil / Determinantes do uso de serviço de fisioterapia entre indivíduos com doença de Parkinson que vivem no Brasil

ABSTRACT To identify the factors affecting the use of physiotherapy services among individuals with Parkinson's disease (PD) living in Brazil. Methods: Overall, 479 individuals with idiopathic PD, of both sexes, at any stage of the Hoehn & Yahr (HY) scale, and from seven capital cities in Brazil were recruited from 2014 to 2016. Multivariate logistic regression was the main statistical tool. For the construction of the logistic model, the association of the dependent variable "physiotherapy" with the independent sociodemographic/economic and clinical variables: age, education, family income, time of PD since onset, HY, the activities of daily living and motor subscales of the Unified Parkinson's Disease Rating Scale, cognitive aspects, depressive symptoms, fear of falling, freezing gait, history of falls, physical activity level, gait speed, walking performance and balance, were verified. Results: The 479 individuals had an average age of 65.2 ± 11.0 years, 88% were in the HY I-III stages and 43.4% were under physiotherapy treatment. The analysis identified two determinant variables related to the use of the physiotherapy service: level of education (OR = 1.24) and walking performance (OR = 0.82). Decreased walking performance and a higher educational level increased the use of a physiotherapy service in individuals with PD living in Brazil. Conclusions: The present study shows that individuals with PD, residents from different regions of Brazil, have limited access to physiotherapy services. In addition, the Brazilian Public Health Care System, as well as local programs, need to target PD individuals with a low educational level to improve their access to physiotherapy services. Goals should aim towards the development of physical exercise programs to improve the patients' functional performance for a longer period.

RESUMO Descrever a utilização do serviço de fisioterapia e identificar os fatores que determinam o uso desse serviço entre indivíduos com doença de Parkinson (DP) que vivem no Brasil. Métodos: No total, 479 indivíduos com DP idiopática, de ambos os sexos, em qualquer estágio da escala de Hoehn & Yahr (HY) e de sete capitais do Brasil foram recrutados durante 2014 a 2016. A análise de regressão logística multivariada foi a principal ferramenta de análise estatística. Para a construção do modelo logístico foi investigada a associação da variável dependente "fisioterapia" com variáveis independentes sociodemográficas, econômicas e clínicas: idade, educação, renda familiar, tempo de DP desde o início, HY, domínio motor e atividade de vida diária da Unified Parkinson´s Disease Rating Scale, aspectos cognitivos, sintomas depressivos, medo de queda, congelamento marcha, história de quedas, nível de atividade física, velocidade de marcha, capacidade de caminhar e equilíbrio. Resultados: 479 indivíduos apresentaram média de 65,2 ± 11,0 anos, 88% tiveram HY = I-III e 43,4% faziam fisioterapia para a DP. A análise identificou duas principais variáveis determinantes do uso da fisioterapia: educação (OR = 1,24) e capacidade de caminhada (OR = 0,82). A diminuição da capacidade de caminhar e maior nível educacional aumentam o uso da fisioterapia em indivíduos com doença de Parkinson vivendo no Brasil. Conclusões: O presente estudo mostra que indivíduos com DP, residentes de diferentes regiões do Brasil, têm acesso limitado aos serviços de fisioterapia. Além disso, o Sistema Brasileiro de Saúde Pública, bem como os programas locais, precisam atingir pessoas de DP com baixo nível educacional para melhorar seu acesso aos serviços de fisioterapia. Os objetivos devem ser para o desenvolvimento de programas de exercícios físicos para melhorar o desempenho funcional dos pacientes por um período mais longo.

Association of Oscillatory Ventilation during Cardiopulmonary Test to Clinical and Functional Variables of Chronic Heart Failure Patients.

OBJECTIVE: The aim of this study is to characterize the presence of exercise oscillatory ventilation (EOV) and to relate it with other cardiopulmonary exercise test (CET) responses and clinical variables. METHODS: Forty-six male patients (age: 53.1±13.6 years old; left ventricular ejection fraction [LVEF]: 30±8%) with heart failure were recruited to perform a maximal CET and to correlate the CET responses with clinical variables. The EOV was obtained according to Leite et al. criteria and VE/VCO2 > 34 and peak VO2 < 14 ml/kg/min were used to assess patients' severity. RESULTS: The EOV was observed in 16 of 24 patients who performed the CET, as well as VE/VCO2 > 34 and peak VO2 < 14 ml/kg/min in 14 and 10 patients, respectively. There was no difference in clinical and CET variables of the patients who presented EOV in CET when compared to non-EOV patients. Also, there was no difference in CET and clinical variables when comparing patients who presented EOV and had a VE/VCO2 slope > 34 to patients who just had one of these responses either. CONCLUSION: The present study showed that there was an incidence of patients with EOV and lower peak VO2 and higher VE/VCO2 slope values, but they showed no difference on other prognostic variables. As well, there was no influence of the presence of EOV on other parameters of CET in this population, suggesting that this variable may be an independent marker of worst prognosis in HF patients.

Association of oscillatory ventilation during cardiopulmonary test to clinical and functional variables of chronic heart failure patients

Abstract Objective: The aim of this study is to characterize the presence of exercise oscillatory ventilation (EOV) and to relate it with other cardiopulmonary exercise test (CET) responses and clinical variables. Methods: Forty-six male patients (age: 53.1±13.6 years old; left ventricular ejection fraction [LVEF]: 30±8%) with heart failure were recruited to perform a maximal CET and to correlate the CET responses with clinical variables. The EOV was obtained according to Leite et al. criteria and VE/VCO2 > 34 and peak VO2 < 14 ml/kg/min were used to assess patients' severity. Results: The EOV was observed in 16 of 24 patients who performed the CET, as well as VE/VCO2 > 34 and peak VO2 < 14 ml/kg/min in 14 and 10 patients, respectively. There was no difference in clinical and CET variables of the patients who presented EOV in CET when compared to non-EOV patients. Also, there was no difference in CET and clinical variables when comparing patients who presented EOV and had a VE/VCO2 slope > 34 to patients who just had one of these responses either. Conclusion: The present study showed that there was an incidence of patients with EOV and lower peak VO2 and higher VE/VCO2 slope values, but they showed no difference on other prognostic variables. As well, there was no influence of the presence of EOV on other parameters of CET in this population, suggesting that this variable may be an independent marker of worst prognosis in HF patients.