Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.570
Filtrar
1.
Medicine (Baltimore) ; 100(6): e24631, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578580

RESUMO

RATIONALE: The Pisa syndrome (PS) is defined as a kind of reversible postural deformity which causes a lateral trunk flexion of 10 degrees or more. A prevalence of approximately 7.4% to 10.3% of patients with Parkinson disease (PD) also have PS. Though unbalanced function of the basal ganglia network and impaired visual-spatial functions including parietal cortices in PS is known, the pathophysiology of PS remains to be unclear. PATIENT CONCERNS: A 67-year-old male patient with PD visited our Rehabilitation outpatient department because of his trunk which involuntarily deviated to the left side when he stood up. DIAGNOSES: Based on the history, physical examination, X-ray images, Tc-99m brain TRODAT-1 single-photon emission computed tomography (SPECT), and regional cerebral perfusion Tc-99m ethyl cysteinate dimer SPECT, the patient was diagnosed with PD with PS. INTERVENTIONS: The patient refused our recommendation of admission for pharmaceutical treatment due to personal reasons and was only willing to accept physical training programs at our outpatient department. OUTCOMES: We arranged functional neuroimaging of the brain to survey possible neurologic deficits. The patient's images of ethyl cysteinate dimer SPECT and TRODAT SPECT showed abnormalities, including hypoperfusion and diminished dopamine transporter uptake, in the areas of the basal ganglia network and other brain regions. LESSONS: Based on previous literature and the imaging of our patient, we hypothesize that PS results from unbalanced function of the basal ganglia network and impaired visual-spatial functions of bilateral parietal cortices.


Assuntos
Doença de Parkinson/diagnóstico por imagem , Idoso , Humanos , Masculino , Neuroimagem , Compostos de Organotecnécio , Doença de Parkinson/reabilitação , Compostos Radiofarmacêuticos , Síndrome , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos
2.
Rev. neurol. (Ed. impr.) ; 71(12): 447-454, 16 dic., 2020. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-199338

RESUMO

INTRODUCCIÓN: El entrenamiento en tapiz rodante se considera una intervención eficaz para mejorar la capacidad de la marcha en pacientes con enfermedad de Parkinson (EP). Paralelamente, la realidad virtual se muestra como una intervención prometedora con diversas aplicaciones en el entorno médico hospitalario. OBJETIVO: Evaluar la viabilidad y la eficacia preliminar de la asistencia mecánica para la marcha combinada con la realidad virtual inmersiva en pacientes con EP. PACIENTES Y MÉTODOS: Este estudio piloto y de viabilidad siguió un diseño pre-post. La intervención consistió en 12 sesiones de 30 minutos, distribuidas regularmente durante cuatro semanas consecutivas. Los participantes deambularon sobre un tapiz rodante con un sistema de descarga del peso corporal establecido aproximadamente en el 20% del peso corporal y equipados con un casco de realidad virtual controlado por un joystick para cada mano. Las mediciones de viabilidad y tratamiento se recopilaron al inicio del estudio y después de cuatro semanas de intervención. RESULTADOS: De un total de 60 pacientes, se reclutó finalmente a 12 participantes. Nueve de ellos (75%) completaron el tratamiento, con una tasa de adhesión del 97%. Dos participantes abandonaron el estudio, uno debido a náuseas asociadas con la realidad virtual y otro por falta de motivación. Hubo diferencias significativas asociadas con un tamaño del efecto pequeño-mediano al comparar los valores pre y post para la distancia recorrida, velocidad de la marcha, equilibrio y calidad de vida. CONCLUSIONES: El estudio proporcionó evidencia preliminar que apoya la viabilidad de la combinación de un tapiz rodante antigravitatorio y un sistema de realidad virtual inmersivo para la rehabilitación de pacientes con EP


INTRODUCTION: Treadmill training is considered an effective intervention to improve gait ability in patients with Parkinson's disease (PD). In parallel, virtual reality shows promising intervention with several applications in the inpatient medical setting. AIM: To evaluate the feasibility and preliminary efficacy of mechanical gait assistance combined with immersive virtual reality in patients with PD. PATIENTS AND METHODS: This pilot and feasibility study followed a pre-post study design. The intervention consisted of 12 sessions of 30 minutes, distributed regularly over four consecutive weeks. Participants walked on a treadmill with a body-weight support system set at approximately 20% of body weight and equipped with a virtual reality helmet controlled by a two-handed joystick. Feasibility and intervention outcomes were collected at baseline and after four weeks of intervention. RESULTS: Twelve participants of 60 patients were finally enrolled. Nine of them (75%) completed the treatment intervention with an adherence rate of 97%. Two participants left the study, one of them due to sickness associated with virtual reality and another because of a lack of motivation. There were significant differences associated with small-medium effect sizes when comparing the pre and post values for walk distance, walk speed, balance, and quality of life. CONCLUSIONS: The present study provided preliminary evidence supporting the feasibility of the combination of antigravity treadmill and immersive virtual reality system for the rehabilitation of patients with PD


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doença de Parkinson/reabilitação , Transtornos Neurológicos da Marcha/reabilitação , Terapia de Exposição à Realidade Virtual/métodos , Teste de Esforço/métodos , Projetos Piloto , Transtornos Neurológicos da Marcha/fisiopatologia , Doença de Parkinson/fisiopatologia , Gravitação , Resultado do Tratamento , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Tempo , Estudos de Viabilidade
4.
Clin Rehabil ; 34(6): 837-844, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32362132

RESUMO

OBJECTIVE: (1) To determine associated factors of improved balance performance after a 10-week HiBalance intervention period, and (2) to determine effects of the programme on modifiable factors found above, considering both groups. DESIGN: Pre-posttest substudy founded on the outcomes evaluation of an effectiveness-implementation trial. PARTICIPANTS: Sixty-one participants were allocated the HiBalance training, while 56 were controls. INTERVENTION: Participants received a 10-week, two times weekly, progressive balance training, that is, HiBalance intervention, led by physical therapists. The intervention was group based and gradually incorporated dual-tasking over the training period. Participants also performed, unsupervised, a 1×/week home exercise programme. MAIN OUTCOME: The Mini-Balance Evaluation Systems Test (Mini-BESTest) assessed balance performance, and those having improved by ⩾2 points were classified as positive responders. Balance confidence was the secondary outcome. RESULTS: Fifty-three (87%) participants completed the intervention and 32 (60%) improved their balance scores by ⩾2 points in the intervention group, with 11 (24%) in the control group. The multivariable logistic regression analysis revealed two independently associated factors of improved balance, which included balance confidence (odds ratio (OR) = 0.95; 95% confidence interval (CI) = 0.90-0.99) and attendance of ⩾80% of training sessions (OR = 10.10; 95% CI = 1.71-59.60). The final model demonstrated good fit and acceptable discrimination (area under the curve = 0.84). Secondary analysis revealed a fair relationship (Rho = 0.30; P = 0.044) between improvements in balance confidence and balance performance in the intervention but not control group. CONCLUSION: Two personal factors were significantly associated with a higher likelihood of improvement in clinically measured balance performance. The HiBalance intervention appears to benefit those with lower balance confidence.


Assuntos
Terapia por Exercício , Doença de Parkinson/fisiopatologia , Doença de Parkinson/reabilitação , Equilíbrio Postural/fisiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Autoimagem , Resultado do Tratamento
5.
Clin Rehabil ; 34(6): 764-772, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32349543

RESUMO

OBJECTIVE: To explore the effects of an eight-week core stability program on balance ability in persons with Parkinson's disease. DESIGN: Randomized controlled trial. SETTING: A local Parkinson's association. SUBJECTS: A total of 44 participants with a clinical diagnosis of Parkinson's disease were randomly assigned to an experimental (n = 22) or control group (n = 22). INTERVENTION: The experimental group received 24 sessions of core training, while the control group received an intervention including active joint mobilization, muscle stretching, and motor coordination exercises. MAIN MEASURES: The primary outcome measure was dynamic balance evaluated using the Mini-Balance Evaluation Systems Test. Secondary outcomes included the balance confidence assessed with the Activities-specific Balance Confidence Scale and standing balance assessed by the maximal excursion of center of pressure during the Modified Clinical Test of Sensory Interaction on Balance and the Limits of Stability test. RESULTS: After treatment, a significant between-group improvement in dynamic balance was observed in the experimental group compared to the control group (change, 2.75 ± 1.80 vs 0.38 ± 2.15, P = 0.002). The experimental group also showed a significant improvement in confidence (change, 16.48 ± 16.21 vs 3.05 ± 13.53, P = 0.047) and maximal excursion of center of pressure in forward (change, 0.86 ± 1.89 cm vs 0.17 ± 0.26 cm, P = 0.048), left (change, 0.88 ± 2.63 cm vs 0.07 ± 0.48 cm, P = 0.010), and right (change, 1.63 ± 2.82 cm vs 0.05 ± 0.17 cm, P = 0.046) directions of limits of stability compared to the control group. CONCLUSION: A program based on core stability in comparison with non-specific exercise benefits dynamic balance and confidence and increases center of mass excursion in patients with Parkinson's disease.


Assuntos
Terapia por Exercício , Doença de Parkinson/reabilitação , Equilíbrio Postural/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Autoimagem , Método Simples-Cego , Tronco , Resultado do Tratamento
6.
Complement Ther Clin Pract ; 39: 101169, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32379638

RESUMO

Non-motor symptoms (NMS) including sleep disorders, anxiety, depression, fatigue, and cognitive decline can significantly impact quality of life in people with PD. Qigong exercise is a mind-body exercise that shows a wide range of benefits in various medical conditions. The purpose of this study was to investigate the effect of Qigong exercise on NMS with a focus on sleep quality. Seventeen participants completed a 12-week intervention of Qigong (n = 8) or sham Qigong (n = 9). Disease severity, anxiety and depression levels, fatigue, cognition, quality of life, and other NMS of the participants were evaluated prior to the intervention and at the end of the 12-week intervention. After the intervention, both Qigong and sham-Qigong group showed significant improvement in sleep quality (p < 0.05) and overall NMS (p < 0.05). No significant difference was found between groups. Qigong exercise has the potential as a rehabilitation method for people with PD, specifically alleviating NMS in PD. However, this finding needs to be carefully considered due to the small sample size and potentially low intervention fidelity of this study.


Assuntos
Doença de Parkinson/complicações , Doença de Parkinson/reabilitação , Qigong/métodos , Qigong/psicologia , Qualidade de Vida/psicologia , Transtornos do Sono-Vigília/terapia , Sono/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Projetos de Pesquisa , Transtornos do Sono-Vigília/etiologia
7.
BMC Neurol ; 20(1): 186, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-32404132

RESUMO

BACKGROUND: Parkinson's disease is one of the most frequent causes of disability among the older adults. It is a chronic-progressive neuro-degenerative disease, characterized by several motor disorders. Balance disorders are a symptom that involves the body axis and do not respond to dopaminergic therapy used in Parkinson's disease. Therefore, physiotherapy becomes an important intervention for the management of motor disorders. Originally, these rehabilitative approaches were based on empirical experiences, but several scientific evidences suggests that neuronal plasticity is exercise-dependent. In this context, robotic rehabilitation plays an important role because it allows to perform task-oriented exercises and to increase the number of repetitions and their intensity. This protocol study aims to evaluate the effectiveness of robotic-based intervention of the older adults with Parkinson's disease, designed to improve the gait and to reduce the risk of falling. METHODS: This study is a single-blinded randomized controlled trial. The primary outcomes are: risk of falling, gait performance and fear of falling measured through Performance-Oriented Mobility Assessment (POMA), instrumental gait analysis and Short Falls Efficacy Scale - International (FES-I), respectively. One hundred ninety-five patients with PD will be recruited and randomly divided into three groups, to receive a traditional rehabilitation program or a robotic rehabilitation using Tymo system or Walker View in addition to the traditional therapy. Assessments will be performed at baseline, at the end of treatment and 6 months, 1 year and 2 years from the end of the treatment. A 10-treatment session will be conducted, divided into 2 training sessions per week, for 5 weeks. The control group will perform traditional therapy sessions lasting 50 min. The technological intervention group will carry out 30 min of traditional therapy and 20 min of treatment with a robotic system. DISCUSSION: The final goals of the present study are to propose a new approach in the PD rehabilitation, focused on the use of robotic device, and to check the results not only at the end of the treatment but also in the long term. TRIAL REGISTRATION: NCT04087031, registration date September 12, 2019.


Assuntos
Terapia por Exercício/instrumentação , Doença de Parkinson/reabilitação , Robótica , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício/métodos , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/reabilitação , Humanos , Masculino , Doença de Parkinson/complicações , Equilíbrio Postural , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Transtornos das Sensações/etiologia , Transtornos das Sensações/reabilitação , Método Simples-Cego
8.
Am J Phys Med Rehabil ; 99(10): 917-924, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32304383

RESUMO

OBJECTIVE: The study aimed to evaluate the effect of virtual reality on balance, motor function, gait, and the ability to perform activities of daily living in patients with Parkinson disease. METHODS: We searched Cochran Central Register of Controlled Trials, Embase, PubMed, Wanfang Data, VIP Database, and China National Knowledge Infrastructure from their inception to June 2019. Two authors independently screened articles for inclusion, extracted data, and evaluated quality. RESULTS: Twelve randomized clinical trials involving 360 patients were included. It demonstrated that virtual reality can improve balance, measured by the Berg Balance Scale (fixed model weighted mean difference = 2.28, 95% CI = 1.39 to 3.16, P < 0.00001); strengthen motor function, assessed by the Timed Up and Go test (fixed model weighted mean difference = -1.66, 95% CI = -2.74 to 0.58, P = 0.003); enhance gait ability, assessed by the 10-Meter Walk Test Time (fixed model weighted mean difference = 0.13, 95% CI = 0.02 to 0.24, P = 0.02) in patients with Parkinson disease. It also showed that virtual reality can improve individuals' ability to perform activities of daily living, assessed by modified Barthel Index (fixed model weighted mean difference = 2.93, 95% CI = 0.8 to 5.06, P = 0.007). CONCLUSIONS: The findings suggest that virtual reality rehabilitation may be valuable in improving the balance, motor function, gait, and ability to perform activities of daily living in patients with Parkinson disease.


Assuntos
Atividades Cotidianas , Destreza Motora , Doença de Parkinson/fisiopatologia , Doença de Parkinson/reabilitação , Equilíbrio Postural , Realidade Virtual , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
NeuroRehabilitation ; 46(3): 311-320, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32250326

RESUMO

BACKGROUND: People with Parkinson disease (PD) have difficulty initiating internally generated movements. We have shown that computer-based cognitive training can improve movement initiation. However, little is known about the optimal duration of training. OBJECTIVES: To determine the optimal training duration for computer-based neurorehabilitation of internally represented movement initiation in people with PD. METHODS: Nineteen PD and twenty-one age-matched control participants, ages 50-85 years, were included in analysis of pre- and post-training evaluation and 30 training sessions. Computer training consisted of cued and un-cued movement trials. The presentation of a cue (a combination of numbers on either the right, left or both sides of the screen) indicated that participants should respond by typing the numbers. Successful cued trials were followed by un-cued trials consisting of a green filled circle. Participants re-enter the cued sequence, thus producing an internally represented (IR) movement. The training was adaptive. Outcome measures were reaction time and error rate, and cumulative sum (CUSUM) analysis was used to identify peak training improvement. RESULTS: Participants with PD were divided into impaired (IPD) and unimpaired (UPD) groups, based on mean control group pre-training performance. All three groups showed improved RT and error rates for IR trials; however, the IPD group demonstrated significantly greater improvement in reaction time. Training was most effective in participants with greater disease severity and duration. Peak day of training improvement for the IPD group was 8 days. CONCLUSION: Optimal training duration was relatively short and the IPD group demonstrated the most gain, indicating that cognitive training should be tailored to individual needs.


Assuntos
Reabilitação Neurológica/métodos , Doença de Parkinson/reabilitação , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
11.
Arch Phys Med Rehabil ; 101(7): 1212-1219, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32234414

RESUMO

OBJECTIVE: To investigate the effect of task prioritization on dual-task control in Parkinson disease (PD) associated with different postural impairments. DESIGN: Cross-sectional study. Participants were instructed to keep 2 interlocking rings apart and maintain balance in a tandem stance. Attention was focused on either stance stability (posture-focus strategy) or the interlocking rings (supraposture-focus strategy). SETTING: University research laboratory. PARTICIPANTS: Fifteen patients with PD and less postural impairment and 15 patients with PD and more postural impairment (N=30). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Postural sway, postural determinism (%DET), ankle co-contraction, and ring-touching time. RESULTS: In the less-impairment group, the supraposture-focus strategy provided smaller postural sway and postural %DET compared with the posture-focus strategy. In the more-impairment group, task prioritization showed lower effect on both postural sway and postural %DET. The supraposture-focus strategy led to less ankle co-contraction than the posture-focus strategy in the more-impairment group, but task prioritization did not affect ankle co-contraction in the less-impairment group. In both groups, the supraposture-focus strategy led to less ring-touching time than the posture-focus strategy. CONCLUSIONS: The supraposture-focus strategy provided better dual-task control than the posture-focus strategy in both PD groups. In the less-impairment group, the supraposture-focus strategy enhanced postural automaticity and postural stability. In the more-impairment group, the supraposture-focus strategy reduced ankle stiffness, owing to reduced muscle co-contraction.


Assuntos
Atenção , Terapia por Exercício/métodos , Doença de Parkinson/diagnóstico , Doença de Parkinson/reabilitação , Equilíbrio Postural/fisiologia , Idoso , Análise de Variância , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Postura/fisiologia , Desempenho Psicomotor , Índice de Gravidade de Doença , Análise e Desempenho de Tarefas
12.
Phys Ther ; 100(6): 933-945, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32157307

RESUMO

BACKGROUND: Virtual reality (VR) is a frequently used intervention for the rehabilitation of individuals with neurological disorders. PURPOSE: The aims of this review were to identify the short-term effect of VR on balance and to compare it with the effect of active interventions in individuals with Parkinson disease (PD). DATA SOURCES: Searches for relevant articles available in English were conducted using the MEDLINE (via PubMed), EMBASE, CENTRAL, CINAHL, PsycINFO, and Physiotherapy Evidence Database databases from inception until March 2019. STUDY SELECTION: All randomized controlled trials comparing the effect of training with VR and the effect of training without VR on balance in individuals with PD were included. DATA EXTRACTION: Two authors independently extracted data, assessed the methodological quality, and evaluated the evidence quality of the studies. DATA SYNTHESIS: Fourteen randomized controlled trials including 574 individuals were eligible for qualitative analyses, and 12 of the studies involving 481 individuals were identified as being eligible for meta-analyses. Compared with active interventions, the use of VR improved the Berg Balance Scale score (mean difference = 1.23; 95% CI = 0.15 to 2.31; I2 = 56%). The Dynamic Gait Index and Functional Gait Assessment results were also significant after the sensitivity analyses (mean difference = 0.69; 95% CI = 0.12 to 1.26; I2 = 0%). Both provided moderate statistical evidence. However, the Timed "Up & Go" Test and the Activities-Specific Balance Confidence Scale did not differ significantly. LIMITATIONS: Publication bias and diversity in the interventions were the main limitations. CONCLUSIONS: Existing moderate evidence of the effectiveness of VR with the Berg Balance Scale, Dynamic Gait Index, and Functional Gait Assessment for individuals with PD was promising. Although the differences did not reach the clinically important change threshold, VR was comparable to active interventions and could be considered an adjuvant therapy for balance rehabilitation in individuals with PD.


Assuntos
Doença de Parkinson/reabilitação , Equilíbrio Postural/fisiologia , Terapia de Exposição à Realidade Virtual/métodos , Análise de Dados , Análise da Marcha/métodos , Humanos , Doença de Parkinson/fisiopatologia , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Sensibilidade e Especificidade
13.
Clin Interv Aging ; 15: 87-95, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32158202

RESUMO

Purpose: Bradykinesia and muscle weaknesses are common symptoms of Parkinson's Disease (PD) and are associated with impaired functional performance, increased risk of falls, and reduced quality of life. Recent studies have pointed to progressive resistance training (PRT) as an effective method to control and reduce these symptoms, increasing possibilities to treat the disease. However, few studies have focused on assessing the PRT effects in the short-term. Therefore, the present study aimed to assess the short-term PRT effects on people with PD, in order to offer new parameters for a better understanding of its effects, so as an adequation and PRT use as a complementary therapy. Patients and Methods: Forty individuals diagnosed with PD from stage 1 to 3 on the Hoehn and Yahr scale took part on the study and were allocated into 2 groups; Training Group (TG) performed a 9-week RT program twice a week, and the Control Group (CG) attended disease lectures. Bradykinesia UPDRS subscale (BSS), knee extensors isokinetic strength, Ten Meters Walk Test (TMW), Timed Up&Go Test (TUG) and 30-Second Chair Stand (T30) were measured before and after the intervention period. Statistical significance was set at p ≤ 0.05. Results: Significant time was noted by the group interaction for all functional tests (TUG, T30, and TWM; all p < 0.01) and BSS (p < 0.01). Post hoc analyses revealed that these differences were driven by significant improvements in these dependent variables (all p < 0.01) while the CG remained unchanged (all p > 0.05). Moreover, TUG, T30, TWM, and BSS were significantly different between TG and CG in the post-training assessments (all p < 0.01). Isokinetic muscle strength was slightly increased in the TG (2.4%) and decreased in the CG (-2.2%), but statistical analyses did not reach significance for interaction but only a trend (p = 0.12). Conclusion: The results indicate that 9 weeks of PRT reduces bradykinesia and improves functional performance in patients with mild to moderate PD. These findings reinforce this mode of exercise as an important component of public health promotion programs for PD.


Assuntos
Doença de Parkinson/reabilitação , Treinamento de Resistência/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Humanos , Hipocinesia/reabilitação , Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Doença de Parkinson/fisiopatologia , Desempenho Físico Funcional , Modalidades de Fisioterapia , Qualidade de Vida , Índice de Gravidade de Doença , Fatores Sexuais
14.
Rev. neurol. (Ed. impr.) ; 70(5): 161-170, 1 mar., 2020. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-193285

RESUMO

INTRODUCCIÓN: La congelación de la marcha (CDM) es uno de los síntomas más graves asociados con la enfermedad de Parkinson (EP). El tratamiento fisioterapéutico podría ser una estrategia efectiva para su tratamiento, pero no se ha realizado ninguna revisión sistemática al respecto. OBJETIVO: Identificar las características, la calidad metodológica y los principales resultados de los estudios que han analizado los efectos de las intervenciones fisioterapéuticas en CDM hasta la fecha, mediante la realización de una revisión sistemática y un metaanálisis. PACIENTES Y MÉTODOS: Se realizaron búsquedas en cuatro bases de datos electrónicas para encontrar ensayos controlados aleatorizados que proporcionaran información con respecto a los efectos de cualquier tipo de tratamiento fisioterapéutico sobre la CDM. La calidad metodológica de las investigaciones se evaluó mediante la escala PEDro. RESULTADOS: Se identificaron 12 estudios para su inclusión en el análisis cualitativo y cuatro ensayos controlados aleatorizados se incluyeron en el metaanálisis final. La calidad de los ensayos fue generalmente buena. Las modalidades de fisioterapia que incluían señales fueron más efectivas para tratar la CDM que los enfoques de fisioterapia tradicionales. El metaanálisis indicó que las intervenciones fisioterapéuticas tuvieron un impacto significativamente mayor sobre la CDM que las comparaciones de control. CONCLUSIONES: El tratamiento fisioterapéutico, especialmente las modalidades que incluyen señales visuales y auditivas, debe prescribirse a los pacientes con EP con CDM. Se necesitan estudios futuros que incluyan pacientes con EP con deterioro cognitivo y herramientas de medición objetiva de la CDM para completar la evidencia científica existente


INTRODUCTION: Freezing of gait (FOG) is one of the most severe symptoms associated with Parkinson's disease (PD). Physiotherapy treatment could be an effective strategy for treating FOG, but no systematic review has been carried out in this regard. AIM:To identify the characteristics, methodological quality, and main outcomes of the studies that have analyzed the effects of physiotherapy interventions in FOG up to date, by performing a systematic review and a meta-analysis. PATIENTS AND METHODS: Four electronic databases were searched in order to find randomized controlled trials that provided information regarding the effects of any kind of physiotherapy treatment on FOG. The methodological quality of the included investigations was assessed by means of the PEDro scale. RESULTS: Twelve studies were identified for inclusion into the qualitative analysis, with four randomized controlled trials included in the final meta-analysis. The quality of the trials was generally good. Those physiotherapy modalities including cues were more effective for treating FOG than traditional physiotherapy approaches. The meta-analysis indicated that physiotherapy interventions had a significantly greater impact on FOG than control comparisons. CONCLUSIONS: Physiotherapy treatment, especially those modalities including visual and auditory cueing, should be prescribed to PD patients with FOG. Future studies including PD patients with cognitive impairment and FOG objective measurement tools are need to complete the existing scientific evidence


Assuntos
Humanos , Doença de Parkinson/reabilitação , Modalidades de Fisioterapia , Congelamento , Marcha , Medicina Baseada em Evidências , Ensaios Clínicos como Assunto
15.
Arq Neuropsiquiatr ; 78(1): 13-20, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32074191

RESUMO

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.


Assuntos
Terapia por Exercício/métodos , Musicoterapia/métodos , Doença de Parkinson/reabilitação , Atividades Cotidianas , Idoso , Brasil , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Qualidade de Vida , Fatores Socioeconômicos , Fatores de Tempo , Resultado do Tratamento
16.
Clin Rehabil ; 34(4): 533-544, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32070122

RESUMO

OBJECTIVE: To evaluate a group-based music intervention in patients with Parkinson's disease. DESIGN: Parallel group randomized controlled trial with qualitative triangulation. SETTING: Neurorehabilitation in primary care. SUBJECTS: Forty-six patients with Parkinson's disease were randomized into intervention group (n = 26), which received training with the music-based intervention, and control group (n = 20) without training. INTERVENTIONS: The intervention was delivered twice weekly for 12 weeks. MAIN MEASURES: Primary outcome was Timed-Up-and-Go subtracting serial 7's (dual-task ability). Secondary outcomes were cognition, balance, concerns about falling, freezing of gait, and quality of life. All outcomes were evaluated at baseline, post-intervention, and three months post-intervention. Focus groups and individual interviews were conducted with the intervention group and with the delivering physiotherapists. RESULTS: No between-group differences were observed for dual-task ability. Between-group differences were observed for Falls Efficacy Scale (mean difference (MD) = 6.5 points; 95% confidence interval (CI) = 3.0 to 10.0, P = 0.001) and for Parkinson Disease Questionnaire-39 items (MD = 8.3; 95% CI = 2.7 to 13.8, P = 0.005) when compared to the control group post-intervention, but these were not maintained at three months post-intervention. Three themes were derived from the interviews: Expectations versus Results, Perspectives on Treatment Contents, and Key Factors for Success. CONCLUSION: Patient-reported outcomes and interviews suggest that the group-based music intervention adds value to mood, alertness, and quality of life in patients with Parkinson's disease. The study does not support the efficacy in producing immediate or lasting gains in dual-tasking, cognition, balance, or freezing of gait.


Assuntos
Musicoterapia , Reabilitação Neurológica , Doença de Parkinson/reabilitação , Acidentes por Quedas , Idoso , Atenção , Feminino , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Modalidades de Fisioterapia , Equilíbrio Postural , Qualidade de Vida , Método Simples-Cego
17.
Physiotherapy ; 106: 36-42, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32026844

RESUMO

OBJECTIVE: To compare a 6-week virtual reality (VR) rehabilitation programme with a conventional rehabilitation programme in patients with Parkinson's disease. DESIGN: Prospective, single-blinded, randomised controlled trial. SETTING: Outpatients. PARTICIPANTS: Fifty-one patients with Parkinson's disease were assigned at random to a VR rehabilitation programme or a conventional rehabilitation programme. INTERVENTIONS: Both programmes ran for 6 consecutive weeks, with a 40-minute session three times per week. MAIN OUTCOME MEASURES: The Balance Berg Scale (BBS) was used to measure balance. Secondary outcome measures were: Dynamic Gait Index (DGI) to evaluate ability to adapt gait to complex walking tasks; Disabilities of the Arm, Shoulder and Hand (DASH) scale to measure performance of the upper limb; and Short Form 36 (SF-36) to evaluate quality of life. RESULTS: The VR rehabilitation programme led to an increase in BBS score {45.6 [standard deviation (SD) 7.9] vs 49.2 (SD 8.1), mean difference 3.6, 95% confidence interval (CI) 1.3 to 5.9; P=0.003}, DGI score [18.7 (SD 4.7) vs 20.2 (SD 4.2), mean difference 1.6, 95% CI 0.6 to 2.5; P=0.003] and SF-36 mental composite score [37.7 (SD 11.4) vs 43.5 (SD 9.2), mean difference 5.8, 95% CI 0.4 to 11.3; P=0.037], and a decrease in DASH scale score [29.6 (SD 17.5) vs 21.6 (SD 15.1), mean difference -7.9, 95% CI -13.7 to -2.2; P=0.009]. In contrast, the conventional rehabilitation programme only led to a decrease in DASH scale score [30.3 (SD 18.1) vs 25.1 (SD 15.8), mean difference -5.2, 95% CI -8.8 to -1.5; P=0.007]. CONCLUSION: These findings suggest that rehabilitation is useful in Parkinson's disease, and the VR rehabilitation programme was more effective in determining overall improvement than the conventional rehabilitation programme. CLINICAL TRIAL REGISTRATION NUMBER: NCT02807740.


Assuntos
Doença de Parkinson/reabilitação , Modalidades de Fisioterapia , Realidade Virtual , Idoso , Avaliação da Deficiência , Feminino , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Equilíbrio Postural , Estudos Prospectivos , Qualidade de Vida , Método Simples-Cego
18.
Med Clin North Am ; 104(2): 327-343, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32035572

RESUMO

Aging-associated anatomic and physiologic decline begins during the fourth decade of life and progresses over the ensuing decades sometimes to a state of frailty, with the decline amplified when there is deconditioning. Aging-related gait and balance disorders leading to an increased risk of falling can be compensated for with the use of exercise interventions, durable medical equipment, and environmental modifications. Caregiver training is an essential component of geriatric rehabilitation.


Assuntos
Acidentes por Quedas/prevenção & controle , Avaliação Geriátrica/métodos , Doença de Parkinson , Velocidade de Caminhada , Idoso , Cuidadores/educação , Humanos , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Doença de Parkinson/reabilitação
19.
Braz J Med Biol Res ; 53(2): e9171, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049101

RESUMO

Parkinson's disease cannot be cured but symptoms can be improved by making use of physical therapy. The objective of the study was to compare the effect of routine exercises and Tai Chi on physical and clinical performance in elderly people suffering from Parkinson's disease. Data from interviews, physical and clinical performance, and levodopa consumption of 500 patients with confirmed Parkinson's disease (severity level I to III) were collected and analyzed. Participants who received 80 min/day Tai Chi 3 times/week for 2 months were included in the Tai Chi (TC) group (n=250) and those who received 90 min/day routine exercise 3 times/week for 2 months were included in routine exercise (RE) group (n=250). Timed up-and-go, 50-foot speed walk, and functional reach were improved by Tai Chi and routine exercise (P<0.05 for all) but intensities of Tai Chi for improvement of such parameters was higher than routine exercise. Incidence of falls was decreased by both physical therapies (P<0.05 for all) but more for the TC group (P<0.0001, q=38.512). In the TC group, at the end of follow-up, 22 (9%) patients were successful in withdrawal of levodopa treatment. Also, the dose of levodopa was decreased in patients of the TC group who had to continue levodopa. Tai Chi had the potential to slow down the progression of symptoms of Parkinson's disease and delayed the introduction of levodopa (level of evidence: III).


Assuntos
Terapia por Exercício/métodos , Doença de Parkinson/reabilitação , Tai Ji/métodos , Acidentes por Quedas/prevenção & controle , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
20.
Gait Posture ; 77: 195-200, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32058283

RESUMO

BACKGROUND: Treadmill training may be used to improve gait rhythmicity in people with Parkinson's disease. Treadmills, however, alter dynamical stride time fluctuations in healthy adults in a manner that mimics pathologic states, indicating the stride-to-stride fluctuations that characterize healthy gait are constrained. It is unclear if treadmills similarly alter dynamic gait properties in Parkinson's disease. RESEARCH QUESTION: Do stride time fractal dynamics in individuals with Parkinson's disease differ between treadmill and overground walking? METHODS: Fifteen participants with Parkinson's disease and 15 healthy age-similar adults walked for 6 min in a conventional overground condition and on a treadmill while wearing inertial measurement units. Gait speed, stride times and stride time variability were measured. Fractal exponents (α) were computed with adaptive fractal analysis. Inferential statistics were analyzed with mixed model analyses of variance and post hoc simple effects tests. RESULTS: Mean gait speeds decreased and stride times increased on the treadmill but did not differ between the Parkinson's and control groups. Stride time variability was greater in the Parkinson's than control group in both conditions. Most relevant to our research question, stride time fractal exponents were greater on the treadmill (mean α = .910) than overground (mean α = .797) in individuals with Parkinson's disease, but not in healthy controls. SIGNIFICANCE: The fractal scaling exponent α emanating from stride time fluctuations during treadmill walking increased toward a 1/f signal of α = 1.0 that has been interpreted as an optimal structural variability for gait. The clinical implication is that treadmill training may promote more efficient walking dynamics in people with Parkinson's disease than conventional overground training.


Assuntos
Terapia por Exercício/métodos , Marcha/fisiologia , Doença de Parkinson/reabilitação , Idoso , Idoso de 80 Anos ou mais , Biometria , Estudos de Casos e Controles , Teste de Esforço , Feminino , Fractais , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...