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1.
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
2.
BMC Neurol ; 19(1): 280, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718583

RESUMO

BACKGROUND: Parkinson's disease (PD) affects many physiological systems essential for balance control. Recent studies suggest that intensive and cognitively demanding physical exercise programs are capable of inducing plastic brain changes in PD. We have developed a highly challenging balance training (the HiBalance) program that emphasizes critical aspects of balance control through progressively introducing more challenging exercises which incorporates dual-tasking. Earlier studies have shown it to be effective in improving balance, gait and dual-tasking. The study design has thereafter been adjusted to link intervention-induced behavioral changes to brain morphology and function. Specifically, in this randomized controlled trial, we will determine the effects of the HiBalance program on balance, gait and cognition and relate this to task-evoked functional MRI (fMRI), as well as brain-derived neurotrophic factor (BDNF) in participants with mild-moderate PD. METHODS: One hundred participants with idiopathic PD, Hoehn & Yahr stage 2 or 3, ≥ 60 years of age, ≥ 21 on Montreal Cognitive Assessment will be recruited in successive waves and randomized into either the HiBalance program or to an active control group (the HiCommunication program, targeting speech and communication). Both interventions will be performed in small groups, twice a week with 1 h sessions for 10 weeks. In addition, a 1 h, once a week, home exercise program will also be performed. A double-blinded design will be used. At the pre- and post-assessments, participants will be assessed on balance (main outcome), gait, cognitive functions, physical activity, voice/speech function, BDNF in serum and fMRI (3 T Philips) during performance of motor-cognitive tasks. DISCUSSION: Since there is currently no cure for PD, findings of neuroplastic brain changes in response to exercise would revolutionize the way we treat PD, and, in turn, provide new hope to patients for a life with better health, greater independence and improved quality of life. TRIAL REGISTRATION: ClincalTrials.gov: NCT03213873, first posted July 11, 2017.


Assuntos
Terapia por Exercício/métodos , Plasticidade Neuronal , Doença de Parkinson/reabilitação , Projetos de Pesquisa , Idoso , Encéfalo/fisiopatologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Equilíbrio Postural/fisiologia , Qualidade de Vida
3.
Int Rev Neurobiol ; 147: 75-93, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31607363

RESUMO

Physical activity and exercise have become a central component of medical management of chronic illness, particular for the elderly who suffer from neurodegenerative disorders that impair their cognition and mobility. This chapter summarizes our recent research showing that a new generation of wearable technology can be adopted as diagnostic and rehabilitation tools for people living with Parkinson's disease. For example, wearable device-enabled 6-min walking test can be automated to eliminate human supervision and many other technical factors that confound the results with conventional testing. With reduced cost and increased test standardization, the technology can be adopted for population-based screening of cardiovascular fitness and gait rehabilitation training efficacy associated with many medical conditions. The Ambulosono platform for multidomain exercise intervention, in particular, has the potential to deliver lasting clinical benefits in slowing PD progression. The platform, through the integration of brisk walking with behavioral shaping strategies such as contingency reinforcement, anticipatory motor control and musical motivational stimulation, creates a home exercise regime that can transform monotonous walking into a pleasurable daily activity and habit.


Assuntos
Terapia por Exercício/métodos , Doença de Parkinson/diagnóstico , Doença de Parkinson/terapia , Dispositivos Eletrônicos Vestíveis , Humanos , Doença de Parkinson/reabilitação
4.
NeuroRehabilitation ; 45(2): 273-283, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31561398

RESUMO

BACKGROUND: While dance may improve motor features in Parkinson's disease (PD), it is not yet clear if the benefits extend to non-motor features. OBJECTIVE: To determine whether dance classes based on Dance for PD®, improve cognition, psychological symptoms and Quality of Life (QoL) in PD. METHODS: Participants were allocated to a Dance Group (DG; n = 17) or Control Group (CG: n = 16). Participants had early-stage PD (Hoehn & Yahr: DG = 1.6±0.7, CG = 1.5±0.8) with no cognitive impairment (Addenbrooke's score: DG = 93.2±3.6, CG = 92.6±4.3). The DG undertook a one-hour class, twice weekly for 12 weeks, while the CG had treatment as usual. Both groups were assessed for disease severity (MDS-UPDRS), cognition (NIH Toolbox® cognition battery, Trail Making Test), psychological symptoms (Hospital Anxiety and Depression Scale, MDS-UPDRS-I) and QoL (PDQ-39, MDS-UPDRS-II). RESULTS: Group comparison of pre-post change scores showed that selected cognitive skills (executive function and episodic memory), psychological symptoms (anxiety and depression) as well as QoL (PDQ-39 summary index) were significantly improved by the intervention (DG > CG, p's < 0.05, Cohen's d > 0.8). DISCUSSIONS AND CONCLUSION: Dance classes had a clear benefit on psychological symptoms, QoL and a limited cognitive benefit. Follow-up assessment is required to confirm the durability of these effects.


Assuntos
Terapia através da Dança/métodos , Doença de Parkinson/reabilitação , Idoso , Cognição , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida
5.
J Clin Neurosci ; 70: 47-54, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31526677

RESUMO

OBJECTIVE: This work aimed to assess effects of different exercise intervention on Parkinson's disease (PD) treatment via a network meta-analysis. METHODS: Eligible literatures were retrieved from three databases (PubMed, EMBASE and Cochrane Library) up to March 5, 2019 and screened based on established selection criteria. Afterwards, relevant data was extracted and heterogeneity tests were conducted to select appropriate effect models according to chi-square test and I2 statistics. Publication bias of included studies was also performed. Finally, the pairwise and network meta-analyses were carried out to evaluate the efficacy of different exercise training on PD management. RESULTS: Overall, 19 studies encompassing 920 PD patients were identified to explore effects of interventions such as dance, Qigong, tango, resistance training (RT), Taichi and yoga on PD in terms of six indicators including six-minute walk, gait velocity, UPDRS III, PD questionnaire-39 (PDQ-39), timed up and go (TUG) and Berg balance test (BBT). The direct meta-analysis revealed that RT and dance altered the gait velocity and PDR-39 indicator of PD patients. And there was a statistical difference in RT and Tango regarding UPDRS III. Besides, significant differences were also detected among multiple comparisons based on TUG and BBT, containing RT vs control, Tai Chi vs control and Tango vs control for TUG, and dance vs control for BBT. Finally, results of network meta-analysis implied that tango was a good exercise for PD patients according to six different outcome measures. CONCLUSION: Tango was an optimal and effective option for improving functional mobility of PD patients.


Assuntos
Dança , Terapia por Exercício/métodos , Doença de Parkinson/reabilitação , Humanos , Meta-Análise em Rede
6.
NeuroRehabilitation ; 45(2): 255-263, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498138

RESUMO

BACKGROUND: Studies have demonstrated that the combination of Nintendo Wii (NW) with Conventional Exercises (CE) was effective in the rehabilitation of patients with Parkinson's Disease (PD), but there are no studies comparing the effects of this combination on both techniques isolated. OBJECTIVE: To investigate if the effects of the combination of NW to CE are superior to isolated techniques in the rehabilitation of balance, gait, functional mobility and improvement of the quality of life of individuals with PD. METHODS: 45 patients with PD were divided into three groups, NW alone, CE alone and NW plus EC. The sessions occurred for 50 minutes, twice a week and evaluations administered before and after the 2-month intervention. RESULTS: Significant differences were found in the pre and post intervention analyzes of all the outcomes in the three groups, but there was no difference between the groups. The effect size was evaluated, in which the NW plus CE group had a greater magnitude of the therapeutic effect. CONCLUSION: The NW plus CE was statistically as effective as each intervention alone in the rehabilitation of patients with PD, however, the use of this combination provided a magnitude of the therapeutic effect superior to the other groups.


Assuntos
Terapia por Exercício/métodos , Reabilitação Neurológica/métodos , Doença de Parkinson/reabilitação , Ludoterapia/métodos , Jogos de Vídeo , Idoso , Feminino , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural , Qualidade de Vida , Método Simples-Cego
7.
NeuroRehabilitation ; 45(2): 285-290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498141

RESUMO

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disease due to dopamine deficiency in the basal ganglia, leading to motor symptoms such as bradykinesia, tremor, stiffness, and postural instability. This disease may also be associated with a broad spectrum of non-motor symptoms. More than 24% of patients with PD have one or more cognitive symptoms. OBJECTIVE: To evaluate the effects of computer-assisted cognitive rehabilitation (CACR) in Parkinson's disease (PD). METHODS: Sixty patients with PD were enrolled in this study and were randomly divided into control group (CG) and experimental group (EG). Each participant was evaluated at the beginning (T0) and at the end of training (T1). The CG underwent standard cognitive training (SCT) while EG performed CACR using the ERICA platform, aimed at improving several cognitive domains. In both the group, each training consisted of 3 sessions a week, each of these lasting sixty minutes, for eight weeks. RESULTS: Although both the groups had significant improvement after CR, we observed more significant changes in the EG, especially concerning attention, orientation and visual-spatial domains. CONCLUSIONS: Our data demonstrate that CACR is more effective than SCT in improving visual-spatial and executive deficits, in patients affected by PD.


Assuntos
Cognição , Função Executiva , Reabilitação Neurológica/métodos , Doença de Parkinson/reabilitação , Comportamento Espacial , Terapia Assistida por Computador/métodos , Atenção , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reabilitação Neurológica/instrumentação , Terapia Assistida por Computador/instrumentação
8.
IEEE Int Conf Rehabil Robot ; 2019: 1260-1265, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374802

RESUMO

Movement is accompanied by modulation of oscillatory activity in different ranges over the sensorimotor areas. This increase is more evident in normal subjects and less in patients with Parkinson's Disease (PD), a disorder associated with deficits in the formation of new motor skills. Here, we investigated whether such EEG changes improved in a group of PD patients, after two different treatments and whether this relates to performance. Subjects underwent either a session of 5 Hz repetitive Transcranial Magnetic Stimulation (rTMS) over the right posterior parietal cortex or a 4-week Multidisciplinary Intensive Rehabilitation Treatment (MIRT). We used a reaching task with visuo-motor adaptation to a rotated display in incremental 10° steps up to 60°. Retention of the learned rotation was tested before and after either intervention over two consecutive days. High-density EEG was recorded throughout the testing. We found that patients adapted their movements to the rotated display similarly to controls, although retention was poorer. Both rTMS and MIRT lead to improvement in retention of the learned rotation. Mean beta modulation levels changed significantly after MIRT and not after rTMS. These results suggest that rTMS produced local improvement reflected in enhanced short-term skill retention; on the other hand, MIRT determined changes across the contralateral sensorimotor area, reflected in beta EEG changes.


Assuntos
Aprendizagem/fisiologia , Doença de Parkinson/reabilitação , Estimulação Transcraniana por Corrente Contínua/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Medicina (Kaunas) ; 55(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31412676

RESUMO

Pilates may be a beneficial method of exercise for people with Parkinson's disease (PD). However, no studies have critically reviewed the scientific evidence in this regard. The purpose of this study was to conduct a systematic review and meta-analysis on the effectiveness of Pilates as a rehabilitation strategy for PD. A systematic search of the electronic databases PubMed, PEDro, Scopus, and SPORTDiscus was conducted to identify studies related to the effect of Pilates on PD. The search timeframe ranged from the inception of each database to March 2019. The search resulted in the identification of four randomized controlled trials (RCTs) and four non-RCT studies. The methodological quality of the investigations ranged from poor to fair. The descriptive analysis of the eight investigations showed that Pilates resulted in beneficial effects on fitness, balance and functional autonomy. A subsequent meta-analysis on the four RCTs indicated that Pilates was more effective than traditional training programmes in improving lower limb function. Pilates can be safely prescribed for people with mild-to-moderate PD. Preliminary evidence indicates that its practice could have a positive impact on fitness, balance and physical function. Its benefits on lower-body function appear to be superior to those of other conventional exercises. Future randomized studies with greater samples are needed to confirm these observations.


Assuntos
Técnicas de Exercício e de Movimento , Terapia por Exercício , Doença de Parkinson/reabilitação , Humanos
10.
NeuroRehabilitation ; 45(1): 125-134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31450520

RESUMO

BACKGROUND: Physical exercise combined with occupational therapy (OT) can lead to a global improvement in personal well-being. OBJECTIVE: To assess in PD patients: 1) if a rehabilitation program involving OT, Nordic walking (NW) and therapeutic touch (TT) yields motor/non-motor benefits; 2) if the time collocation of OT within the program influences results. METHODS: This is a pilot study on 17 PD patients undergoing a 10-week rehabilitation program consisting of OT, NW and TT. Patients were randomized to receive OT in the first [Group 1, n = 8] vs. last five weeks [Group 2, n = 9] of the program. Scales (MMSE, FAB, BDI, UPDRS II and III, PDQ39 and AES-S) and 6MWT, Gait speed and length were assessed at three time-points. RESULTS: Thirteen out of 17 patients were analyzed. 6MWT, Gait speed and length improved in time without between-group differences (p < 0.05) as did UPDRII, UPDRSIII, FAB and PDQ39 (p < 0.05). Baseline UPDRS II and III significantly determined Δ6MWT (adjusted R2 = 0.6738) and ΔGAIT speed (R2 = 0.6746) at multiple regression, while ΔGAIT length showed the best regression (adjusted R2 = 0.8247) with impact of age, gender and baseline PDQ39 (ADL and cognition dimensions). CONCLUSIONS: Multidisciplinary rehabilitation including OT can improve motor and non-motor conditions in PD patients. The OT time-collocation at beginning or end of the rehabilitation program does not significantly affect results.


Assuntos
Terapia por Exercício/métodos , Terapia Ocupacional/métodos , Doença de Parkinson/reabilitação , Toque Terapêutico/métodos , Velocidade de Caminhada , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Caminhada
11.
Turk J Med Sci ; 49(4): 999-1007, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31292107

RESUMO

Background/aim: Body weight-supported treadmill training (BWSTT) might have greater effects than conventional treadmill training (TT) in neurological diseases such as Parkinson's disease (PD). The aim of this study was to evaluate the effects of different percentages of BWSTT on gait, balance, quality of life, and fatigue in PD. Materials and methods: Thirty-five patients with moderate to advanced PD were randomized into three BWSTT groups according to the supported percentage of body weight: 0% BWSTT (control group; unsupported TT), 10% BWSTT, or 20% BWSTT. Five patients were excluded due to early discharge and 30 patients completed BWSTT sessions lasting 30 min, 5 days a week, for 6 weeks during their inpatient rehabilitation stay. The primary outcome was 6-min walk distance (6MWD). Secondary outcomes were Unified Parkinson's Disease Rating Scale (UPDRS), Berg Balance Scale (BBS), Nottingham Health Profile (NHP), Fatigue Impact Scale, and Fatigue Severity Scale scores. Measurements were performed before and after the training. Results: The unsupported TT group demonstrated no significant improvement in the outcome measures after a 6-week training except for BBS and NHP emotional subscores. Moreover, the NHP pain subscore increased in the unsupported TT group after training. The 10% and 20% supported BWSTT groups demonstrated significant improvements in 6MWD (P = 0.004 and P < 0.001, respectively), UPDRS - motor score (P = 0.012 and P = 0.005, respectively), NHP pain subscore (P = 0.003 and P = 0.002, respectively), and fatigue (P = 0.005 for both) after training. The 20% BWSTT provided the highest improvement in balance among the three groups (P < 0.001) and greater relief of fatigue than 10% BWSTT (P = 0.002). Conclusion: Six weeks of BWSTT improved walking distance and balance ability, relieved fatigue, and additionally reduced pain in patients with moderate to advanced PD.


Assuntos
Terapia por Exercício/métodos , Terapia por Exercício/estatística & dados numéricos , Doença de Parkinson/reabilitação , Idoso , Peso Corporal/fisiologia , Método Duplo-Cego , Teste de Esforço/métodos , Teste de Esforço/estatística & dados numéricos , Fadiga , Feminino , Marcha/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural/fisiologia
12.
Rev Med Chil ; 147(4): 465-469, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31344208

RESUMO

BACKGROUND: Multicomponent physical training in patients with Parkinson disease may improve their functional independence, especially in terms of gait speed and coordination. AIM: To assess the effects of an eight weeks multicomponent physical training program in patients with Parkinson disease. MATERIAL AND METHODS: Fourteen patients with Parkinson disease participated in a physical training program that lasted eight weeks. Three sessions lasting 60 minutes per week were carried out. Patients were assessed using the six minutes walk, timed up and go and the unipodal stance test. RESULTS: After the training period, significant improvements in the six minute walk test and timed up and go were observed. No significant changes were observed in the unipodal stance test. CONCLUSIONS: The eight weeks training program improved gait speed and functional status in these patients with Parkinson disease.


Assuntos
Terapia por Exercício/métodos , Marcha/fisiologia , Doença de Parkinson/fisiopatologia , Doença de Parkinson/reabilitação , Condicionamento Físico Humano/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica/fisiologia , Valores de Referência , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Teste de Caminhada
13.
Neurology ; 93(5): e485-e496, 2019 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-31278117

RESUMO

OBJECTIVE: We evaluated the efficacy of muscle-targeted nutritional support on the functional outcomes of multidisciplinary intensive rehabilitation treatment (MIRT) in patients with Parkinson disease (PD) or parkinsonism. METHODS: We conducted a pragmatic, bicentric, randomized (1:1), assessor-blind controlled trial (Protein, Leucine and Vitamin D Enhancing Rehabilitation [PRO-LEADER]; April 2017 to January 2018) in cognitively intact patients with PD or parkinsonism and undergoing a 30-day MIRT. Patients (n = 150) received a standard hospital diet with or without a whey protein-based nutritional supplement enriched with leucine and vitamin D twice daily. The primary efficacy endpoint was the increase in the distance walked during a 6-minute walking test (6MWT). Secondary endpoints were changes in 4-meter walking speed, Timed Up and Go test (TUG), Berg balance scale, handgrip strength, Self-assessment Parkinson's Disease Disability Scale, body weight, and skeletal muscle mass (SMM). RESULTS: Nutritional support resulted in greater increase in the distance walked during 6MWT (mean 69.6 meters [95% confidence interval (CI) 60.7-78.6]) than no support (51.8 meters [95% CI 37.0-66.7]): center-adjusted mean difference, 18.1 meters (95% CI 0.9-35.3) (p = 0.039). Further adjustment for changes in dopaminergic therapy and SMM yielded consistent results: mean difference, 18.0 meters (95% CI 0.7-35.2) (p = 0.043). A meaningful effect was also found for the following secondary endpoints: 4-meter walking speed (p = 0.032), TUG (p = 0.046), SMM, and SMM index (p = 0.029). Six patients discontinued the nutritional therapy due to mild side effects. CONCLUSION: The consumption of a whey protein-based nutritional formula enriched with leucine and vitamin D with MIRT improved lower extremity function and preserved muscle mass in patients with PD or parkinsonism.Clinicaltrials.gov IDENTIFIER: NCT03124277. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients with parkinsonism undergoing intensive rehabilitation, a whey protein-based nutritional formula enriched with leucine and vitamin D increased distance walked on the 6MWT.


Assuntos
Leucina/uso terapêutico , Músculo Esquelético , Apoio Nutricional/métodos , Doença de Parkinson/reabilitação , Desempenho Físico Funcional , Vitaminas/uso terapêutico , Proteínas do Soro do Leite/uso terapêutico , Idoso , Aminoácidos Essenciais/uso terapêutico , Peso Corporal , Colecalciferol/uso terapêutico , Proteínas na Dieta/uso terapêutico , Suplementos Nutricionais , Feminino , Alimentos Fortificados , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Transtornos Parkinsonianos/fisiopatologia , Transtornos Parkinsonianos/reabilitação , Resultado do Tratamento , Teste de Caminhada , Velocidade de Caminhada
14.
NeuroRehabilitation ; 44(4): 569-577, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256088

RESUMO

BACKGROUND: Randomized clinical trials (RCTs) used the Nintendo Wii (NW) in the treatment of Parkinson Disease, however, no meta-analysis was developed to determine the effects in these patients. OBJECTIVE: To analyze RCTs that investigated the effects of NW versus traditional physiotherapy on balance rehabilitation and quality of life of patients with PD. METHODS: Electronic research was conducted between December 2018 and January 2019 in the MEDLINE, PEDro, CENTRAL, LILACS and SciELO databases. The methodological quality was evaluated by the PEDro scale and the completeness of the description of the interventions by the TIDieR checklist. Weighted mean differences (WMD) and 95% confidence interval (CI) were calculated. RESULTS: Five studies were included and presented an average of 5.4 (1.5) on the PEDro scale and 6.7 (1.4) on the TIDieR. Compared to traditional physiotherapy, combined NW and traditional physiotherapy resulted in improvement in balance WMD 1.24 (95% CI: CI: 0.2 to 2.3 N = 72) and quality of life WMD- 8.9 (95% CI: -15.2 to -2.6 N = 56). CONCLUSION: combined NW and traditional physiotherapy was more effective on balance rehabilitation and quality of life of patients with PD, but the values demonstrated a poor methodological quality and a low level of completeness of the intervention descriptions.


Assuntos
Terapia por Exercício/métodos , Terapia por Exercício/psicologia , Doença de Parkinson/psicologia , Doença de Parkinson/reabilitação , Equilíbrio Postural/fisiologia , Jogos de Vídeo/psicologia , Humanos , Doença de Parkinson/fisiopatologia , Qualidade de Vida/psicologia , Resultado do Tratamento
15.
BMC Neurol ; 19(1): 143, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238908

RESUMO

BACKGROUND: Parkinson's disease (PD) is one of the most common neurodegenerative diseases. Patients suffer from a variety of motor and non-motor symptoms that severely affect their daily lives and quality of life. In many cases, a three-week inpatient Parkinson's complex treatment (MKP) can improve the overall condition and quality of life of patients in a short time. In the outpatient sector, however, there is often a lack of human resources and structures necessary for the interdisciplinary treatment of the disease. To support PD patients in continuing the physical exercises they learned from the MKP on a regular basis, a tablet-based training programme will be developed in which exercises can be adjusted to the patient's abilities. This programme is expected to increase quality of life and social participation, as well as delay the progression of the impairment. METHODS: a) Quasi-randomized, prospective longitudinal study (sequential study design). The intervention group receives a tablet-based training programme during and for 9 months after the MKP, and the control group receives treatment as usual. The evaluation is carried out by means of a written survey at three points in time (the beginning and end of the MKP and after 9 months). b) Qualitative analysis of interviews and focus groups in terms of feasibility and acceptance. c) Formative evaluation of the app and the administration panel. d) Evaluation of the implementation of the training programme by analysing the planned and performed physical activities, as well as evaluation of the phone calls between physiotherapists and patients. DISCUSSION: The tablet-based training programme can ensure continuous and long-term support for PD patients. They learn different self-management strategies during and after their MKP and are empowered to assume responsibility for carrying out regular physical activity on their own. Because common app stores have no scientifically evaluated apps for PD patients in the German language, the app can fill this gap and help PD patients receive high-quality care in the implementation of physically activating exercises regardless of their place of residence. In addition, the user-centred development of the app ensures that the app meets the specific needs of PD patients. TRIAL REGISTRATION: German Register of Clinical Trials, drks.de . Identifier: DRKS00014952. Registered on June 20th 2018. Date and version identifier April 25th 2019; version 1.


Assuntos
Computadores de Mão , Terapia por Exercício/métodos , Doença de Parkinson/reabilitação , Humanos , Estudos Longitudinais , Estudos Prospectivos , Qualidade de Vida , Projetos de Pesquisa , Inquéritos e Questionários
16.
NeuroRehabilitation ; 44(3): 433-443, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31177243

RESUMO

BACKGROUND: The use of the treadmill as a gait rehabilitation tool has provided novel options for treatment of gait impairments in Parkinson's Disease (PD). However, the neural mechanisms underlying these therapeutic effects in PD remain unknown and whether any therapeutic effects from treadmill training can be reproduced on overground walking. OBJECTIVE: To examine the immediate short-term effects of a single session of treadmill and overground walking on gait, spinal and corticospinal parameters in PD.METHODSPD participants (N = 15) were evaluated in two separate sessions under two walking conditions: walking over a treadmill and walking overground. Overground walking performance, the Soleus H-reflex, Reciprocal Ia-Inhibition, Intracortical Facilitation (ICF) and Short Intracortical Inhibition (SICI), were evaluated before and after each condition. RESULTS: Gait speed and stride length improved in post-treadmill compared with pre-treadmill. No significant changes in these gait parameters were found for the pre vs. post-overground condition. ICF values and Hmax/Mmax ratio decreased after, compared with before, the two walking conditions. CONCLUSIONS: Treadmill walking, but not overground walking, lead to an improvement in the stride length and gait speed in the PD patients without evidence of different modulation on spinal and corticospinal parameters.


Assuntos
Teste de Esforço/métodos , Exercício/fisiologia , Doença de Parkinson/fisiopatologia , Doença de Parkinson/reabilitação , Caminhada/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos/fisiologia , Terapia por Exercício/métodos , Feminino , Marcha/fisiologia , Reflexo H/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiologia , Doença de Parkinson/diagnóstico , Projetos Piloto , Velocidade de Caminhada/fisiologia
17.
J Neuroeng Rehabil ; 16(1): 68, 2019 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174570

RESUMO

BACKGROUND: Rhythmic Auditory Stimulation (RAS) can compensate for the loss of automatic and rhythmic movements in patients with idiopathic Parkinson's disease (PD). However, the neurophysiological mechanisms underlying the effects of RAS are still poorly understood. We aimed at identifying which mechanisms sustain gait improvement in a cohort of patients with PD who practiced RAS gait training. METHODS: We enrolled 50 patients with PD who were randomly assigned to two different modalities of treadmill gait training using GaitTrainer3 with and without RAS (non_RAS) during an 8-week training program. We measured clinical, kinematic, and electrophysiological effects of both the gait trainings. RESULTS: We found a greater improvement in Functional Gait Assessment (p < 0.001), Tinetti Falls Efficacy Scale (p < 0.001), Unified Parkinson Disease Rating Scale (p = 0.001), and overall gait quality index (p < 0.001) following RAS than non_RAS training. In addition, the RAS gait training induced a stronger EEG power increase within the sensorimotor rhythms related to specific periods of the gait cycle, and a greater improvement of fronto-centroparietal/temporal electrode connectivity than the non_RAS gait training. CONCLUSIONS: The findings of our study suggest that the usefulness of cueing strategies during gait training consists of a reshape of sensorimotor rhythms and fronto-centroparietal/temporal connectivity. Restoring the internal timing mechanisms that generate and control motor rhythmicity, thus improving gait performance, likely depends on a contribution of the cerebellum. Finally, identifying these mechanisms is crucial to create patient-tailored, RAS-based rehabilitative approaches in PD. TRIAL REGISTRATION: NCT03434496 . Registered 15 February 2018, retrospectively registered.


Assuntos
Estimulação Acústica/métodos , Terapia por Exercício/métodos , Música , Doença de Parkinson/reabilitação , Idoso , Fenômenos Biomecânicos , Encéfalo/fisiopatologia , Sinais (Psicologia) , Feminino , Marcha/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Modalidades de Fisioterapia , Caminhada/fisiologia
18.
Fisioter. Pesqui. (Online) ; 26(2): 112-119, abr.-jun. 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1012134

RESUMO

RESUMO O objetivo deste estudo piloto, realizado em um hospital universitário de referência em Pernambuco, foi avaliar os efeitos da prática mental associada à fisioterapia motora sobre a marcha e o risco de queda em pessoas com doença de Parkinson. A amostra da pesquisa foi composta por 18 sujeitos, de ambos os sexos, com doença de Parkinson idiopática, divididos em grupo experimental (8 indivíduos) e controle (10 indivíduos). Ambos os grupos realizaram 15 sessões de 40 minutos de fisioterapia motora, duas vezes por semana. No grupo de intervenção, a fisioterapia foi associada a prática mental (15 minutos). Em relação às variáveis de desfecho primário, o tempo de execução do timed up and go e do teste de caminhada de 10 metros reduziu, mas a diferença não foi significativa. Em relação à velocidade, cadência e escore do dynamic gait index, houve aumento após a intervenção no grupo experimental, com diferença significativa (p=0,02). O número de passos foi mantido em ambos os grupos. Os resultados sugerem que a prática mental associada à fisioterapia motora reduz o risco de quedas em comparação com a fisioterapia motora aplicada isoladamente.


RESUMEN El objetivo de este estudio piloto, realizado en un hospital universitario de referencia en Pernambuco, fue el de evaluar los efectos de la práctica mental asociada a la fisioterapia motora sobre la marcha y el riesgo de caída en personas con enfermedad de Parkinson. La muestra de la investigación fue compuesta por 18 sujetos, de ambos sexos, con enfermedad de Parkinson idiopática, divididos en grupo experimental (8 individuos) y de control (10 individuos). Ambos grupos realizaron 15 sesiones de 40 minutos de fisioterapia motora, dos veces por semana. En el grupo de intervención, la fisioterapia se asoció a la práctica mental (15 minutos). En cuanto a las variables de desenlace primario, el tiempo de ejecución del timed up and go y de la prueba de caminata de 10 metros se redujo, pero la diferencia no fue significativa. En cuanto a la velocidad, cadencia y puntaje del dynamic gait index, hubo aumento después de la intervención en el grupo experimental, con diferencia significativa (p= 0,02). El número de pasos se ha mantenido en ambos grupos. Los resultados sugieren que la práctica mental asociada a la fisioterapia motora reduce el riesgo de caídas en comparación con la fisioterapia motora aplicada aisladamente.


ABSTRACT The objective of this pilot study, carried out in a university hospital of reference in Pernambuco, was to assess the effects of mental practice associated with motor physical therapy on gait and the risk of falls in people with Parkinson's disease. The study sample consisted of 18 subjects, of both sexes, with idiopathic Parkinson's disease, divided into experimental group (8 individuals) and control group (10 individuals). Both groups performed fifteen 40-minute sessions of motor physical therapy twice a week. In the intervention group, physical therapy was associated with mental practice (15 minutes). Regarding the primary outcome variables, the duration of the timed up and go test and of the 10-meter walking test reduced, but the difference was not significant. Speed, cadence and dynamic gait index increased after the intervention in the experimental group, with a significant difference (p=0.02). The number of steps was maintained in both groups. The results suggest that the mental practice associated with motor physical therapy reduces the risk of falls compared with applied motor physical therapy alone.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doença de Parkinson/reabilitação , Modalidades de Fisioterapia , Processos Mentais , Acidentes por Quedas/prevenção & controle , Marcha
19.
J Sports Med Phys Fitness ; 59(10): 1756-1762, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31113177

RESUMO

BACKGROUND: The progression of Parkinson disease can lead to respiratory muscle weakness, reduced peak expiratory flow and quality of life (QoL). The aim was to evaluate the effects of strength training on levels of respiratory muscle strength, peak expiratory flow and QoL of elderly with Parkinson disease. METHODS: A total of 28 patients were randomized into one of two groups: the control group (CG) comprised 16 participants, and the strength training group (STG) comprised 12 participants. All subjects maintained the standard pharmacological treatment for Parkinson disease, and the intervention group participated in a 16-week strength training program. The primary outcome was the measurement of respiratory muscle strength. RESULTS: The STG showed improved values of maximum inspiratory pressures (36.11±11.82 to 52.94±24.17; P=0.01), maximum expiratory pressures (56.67±22.08 to 71.04±33.71; P=0.03) and QoL (41.75±20.33 to 34±20.92; P=0.0054); there was no significant difference in the peak expiratory flow (336.11±198.04 to 380±229.57; P=0.09). The CG showed significantly decreased values of peak expiratory flow (336.88±183.40 to 279.37±125.12, P=0.02) and non-significant changes in the other variables. CONCLUSIONS: Sixteen weeks of strength training improves the inspiratory and expiratory muscle strength and QoL of elderly with Parkinson disease. These findings suggest that strength training could be considered an adjunct therapeutic intervention for elderly with Parkinson disease.


Assuntos
Doença de Parkinson/fisiopatologia , Doença de Parkinson/reabilitação , Músculos Respiratórios/fisiopatologia , Idoso , Terapia por Exercício , Expiração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Doença de Parkinson/psicologia , Qualidade de Vida , Testes de Função Respiratória
20.
Int J Rehabil Res ; 42(3): 196-204, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31116118

RESUMO

The overall aim of the treatment in Parkinson's disease is to optimize functional independence, safety, well-being and thereby health-related quality of life. Tai Chi and Qigong are widely used exercises in Parkinson's disease, but there is insufficient evidence to support or refute the efficacy of Tai Chi and Qigong, especially on health-related quality of life in patients with Parkinson's disease. The aim of this study was to conduct a systematic review and a meta-analysis from the systematic reviews that evaluate the effectiveness of Tai Chi and Qigong on health-related quality of life in Parkinson's disease. A comprehensive literature search was conducted to identify the systematic reviews and meta-analyses by using Cochrane Library, MEDLINE, PubMed, etc., databases up to the end of November 2018. From 1504 articles, seven fulfilled the inclusion criteria and were included in our study. Five of the included systematic reviews were about Tai Chi, and two of them were about both Tai Chi and Qigong. According to our meta-analysis, there was no significant effect of Tai Chi and Qigong on health-related quality of life in patients with Parkinson's disease, when compared to the control group (standardized mean difference -0.166, 95% confidence interval -0.676 to 0.344; P = 0.523). In conclusion, our systematic review and meta-analysis showed no significant effect of Tai Chi and Qigong statistically on health-related quality of life in patients with Parkinson's disease, but the small effect size in our study favoured the potential benefit of Tai Chi and Qigong on health-related quality of life in Parkinson's disease.


Assuntos
Doença de Parkinson/psicologia , Qigong , Qualidade de Vida , Tai Ji , Humanos , Doença de Parkinson/reabilitação
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