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2.
Sensors (Basel) ; 20(18)2020 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-32899946

RESUMO

Gait deterioration caused by prolonged walking represents one of the main consequences of multiple sclerosis (MS). This study aims at proposing quantitative indices to measure the gait deterioration effects. The experimental protocol consisted in a 6-min walking test and it involved nine patients with MS and twenty-six healthy subjects. Pathology severity was assessed through the Expanded Disability Status Scale. Seven inertial units were used to gather lower limb kinematics. Gait variability and asymmetry were assessed by coefficient of variation (CoV) and symmetry index (SI), respectively. The evolution of ROM (range of motion), CoV, and SI was computed analyzing data divided into six 60-s subgroups. Maximum difference among subgroups and the difference between the first minute and the remaining five were computed. The indices were analyzed for intra- and inter-day reliability and repeatability. Correlation with clinical scores was also evaluated. Good to excellent reliability was found for all indices. The computed standard deviations allowed us to affirm the good repeatability of the indices. The outcomes suggested walking-related fatigue leads to an always more variable kinematics in MS, in terms of changes in ROM, increase of variability and asymmetry. The hip asymmetry strongly correlated with the clinical disability.


Assuntos
Fadiga/fisiopatologia , Transtornos Neurológicos da Marcha/diagnóstico , Marcha/fisiologia , Esclerose Múltipla/diagnóstico , Índice de Gravidade de Doença , Caminhada/fisiologia , Adulto , Idoso , Fenômenos Biomecânicos/fisiologia , Estudos de Casos e Controles , Avaliação da Deficiência , Progressão da Doença , Teste de Esforço/métodos , Feminino , Transtornos Neurológicos da Marcha/etiologia , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/patologia , Esclerose Múltipla/fisiopatologia , Reprodutibilidade dos Testes , Projetos de Pesquisa , Fatores de Tempo
3.
Cochrane Database Syst Rev ; 9: CD013019, 2020 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-32970328

RESUMO

BACKGROUND: Motor imagery (MI) is defined as a mentally rehearsed task in which movement is imagined but is not performed. The approach includes repetitive imagined body movements or rehearsing imagined acts to improve motor performance. OBJECTIVES: To assess the treatment effects of MI for enhancing ability to walk among people following stroke. SEARCH METHODS: We searched the Cochrane Stroke Group registry, CENTRAL, MEDLINE, Embase and seven other databases. We also searched trial registries and reference lists. The last searches were conducted on 24 February 2020. SELECTION CRITERIA: Randomized controlled trials (RCTs) using MI alone or associated with action observation or physical practice to improve gait in individuals after stroke. The critical outcome was the ability to walk, assessed using either a continuous variable (walking speed) or a dichotomous variable (dependence on personal assistance). Important outcomes included walking endurance, motor function, functional mobility, and adverse events. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the trials according to pre-defined inclusion criteria, extracted the data, assessed the risk of bias, and applied the GRADE approach to evaluate the certainty of the evidence. The review authors contacted the study authors for clarification and missing data. MAIN RESULTS: We included 21 studies, involving a total of 762 participants. Participants were in the acute, subacute, or chronic stages of stroke, and had a mean age ranging from 50 to 78 years. All participants presented at least some gait deficit. All studies compared MI training versus other therapies. Most of the included studies used MI associated with physical practice in the experimental groups. The treatment time for the experimental groups ranged from two to eight weeks. There was a high risk of bias for at least one assessed domain in 20 of the 21 included studies. Regarding our critical outcome, there was very low-certainty evidence that MI was more beneficial for improving gait (walking speed) compared to other therapies at the end of the treatment (pooled standardized mean difference (SMD) 0.44; 95% confidence interval (CI) 0.06 to 0.81; P = 0.02; six studies; 191 participants; I² = 38%). We did not include the outcome of dependence on personal assistance in the meta-analysis, because only one study provided information regarding the number of participants that became dependent or independent after interventions. For our important outcomes, there was very low-certainty evidence that MI was no more beneficial than other interventions for improving motor function (pooled mean difference (MD) 2.24, 95% CI -1.20 to 5.69; P = 0.20; three studies; 130 participants; I² = 87%) and functional mobility at the end of the treatment (pooled SMD 0.55, 95% CI -0.45 to 1.56; P = 0.09; four studies; 116 participants; I² = 64.2%). No adverse events were observed in those studies that reported this outcome (seven studies). We were unable to pool data regarding walking endurance and all other outcomes at follow-up. AUTHORS' CONCLUSIONS: We found very low-certainty evidence regarding the short-term benefits of MI on walking speed in individuals who have had a stroke, compared to other therapies. Evidence was insufficient to estimate the effect of MI on the dependence on personal assistance and walking endurance. Compared with other therapies, the evidence indicates that MI does not improve motor function and functional mobility after stroke (very low-certainty evidence). Evidence was also insufficient to estimate the effect of MI on gait, motor function, and functional mobility after stroke compared to placebo or no intervention. Motor Imagery and other therapies used for gait rehabilitation after stroke do not appear to cause significant adverse events.


Assuntos
Transtornos Neurológicos da Marcha/reabilitação , Imagens, Psicoterapia/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Idoso , Viés , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Velocidade de Caminhada
4.
Ideggyogy Sz ; 73(7-08): 255-259, 2020 Jul 30.
Artigo em Húngaro | MEDLINE | ID: mdl-32750242

RESUMO

The evaluation of hand dexterity is an important marker for the success of DBS (deep brain stimulation) operation in patients with Parkinson's disease. In this study we applied a simple, semiquantitative optical dental plaque staining technique for the evaluation of the hand dexterity. Ten patient with Parkinson's disease were involved in the study. After dental students aided tooth brushing, bacterial dental deposits (plaque) were stained then photographed, and quantified under standard conditions before and after DBS surgery. Our results showed a significant decrease in dental plaque deposits after DBS operation. This simple technique seems to be a routinely applicable marker for the evaluation of the hand dexterity. Our future plans is repeating the previous experiement on a higher number of cases.


Assuntos
Estimulação Encefálica Profunda/métodos , Doença de Parkinson/fisiopatologia , Escovação Dentária , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Destreza Motora , Higiene Bucal , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(28): e20810, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664072

RESUMO

RATIONALE: The limb-girdle muscular dystrophies (LGMDs) are a heterogeneous group of disorders characterized by progressive proximal muscle weakness and have more than 30 different subtypes linked to specific gene loci, which manifest as highly overlapping and heterogeneous phenotypes. PATIENT CONCERNS: A 59-year-old male presented for evaluation of progressive muscle weakness since his late twenties. When he was 38 years old, he had muscle weakness in the upper extremities and had a waddling gait, hyper lordosis of lower back, and anterior pelvic tilt. His gait disturbance and muscle weakness slowly progressed. When he was 55 years old, he could not walk at all and had to use a wheelchair for ambulation. DIAGNOSIS: Next-generation sequencing using a custom target capture-based gene panel including specific genes responsible for muscular dystrophy was performed. As a result, the proband was genetically diagnosed as LGMD type 2B, carrying 2 compound heterozygous mutations (NM_003494.3:c.1663C>T, p.Arg555Trp; rs377735262 and NM_003494.3:c.2997G>T, p.Trp999Cys; rs28937581) of the DYSF gene. INTERVENTIONS: Physical and occupational therapy were prescribed properly for the first time Bracing and assistive devices were adapted specifically to the patient's deficiencies to preserve mobility and function and prevent contractures. OUTCOMES: The patient with LGMD has periodic assessments of physical and occupational therapy for the prevention and management of comorbidities. However, in the 3 years after the gene panel sequencing diagnoses, his weakness was slowly progress and the patient still could not walk. LESSONS: Gene panel sequencing allows for the correct recognition of different LGMD subtypes, improving timely treatment, management, and enrolment of molecularly diagnosed individuals in clinical trials.


Assuntos
Disferlina/genética , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Distrofia Muscular do Cíngulo dos Membros/genética , Braquetes/normas , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Distrofia Muscular do Cíngulo dos Membros/patologia , Distrofia Muscular do Cíngulo dos Membros/terapia , Mutação , Terapia Ocupacional/métodos , Administração dos Cuidados ao Paciente/métodos , Medicina Física e Reabilitação/métodos
7.
Rinsho Shinkeigaku ; 60(8): 543-548, 2020 Aug 07.
Artigo em Japonês | MEDLINE | ID: mdl-32641631

RESUMO

We describe an additional patient with spastic paraplegia 48 (SPG48). A 52-year-old woman with gradually increasing gait disturbance was admitted to our hospital. When she was 47 years old, acquaintances noted a shuffling gait. Gait worsening was evident at 48 years. Spastic gait was apparent at 50, and she required a walking stick at 54. Her elder brother had similar gait disturbance. No consanguinity was known. Neurologic examination at 52 disclosed spasticity and moderate weakness in the lower limbs. Spasticity and brisk reflexes in all limbs. Laboratory studies including HTLV-1 titer detected no abnormalities. MRI demonstrated mild corpus callosum narrowing and prominent anterior periventricular hyperintensities in fluid attenuation inversion recovery images. In limb muscles, electromyography (EMG) showed a chronic neurogenic pattern including reduced interference. Gene analysis identified compound homozygosity in exon 7 of adaptor-related protein complex 5 subunit zeta 1 (AP5Z1), including a novel frameshift mutation, c.1662_1672del;p.Glu554Hfs*15 in the patient, and a heterozygous missense mutation in asymptomatic family members, including her mother, two siblings, and a daughter. The frameshift mutation is considered a pathogenic variant according to American College of Medical Genetics and Genomics standards and guidelines. Based on clinical features, imaging findings and genetic abnormalities, we diagnosed this patient with SPG48. Mutations in AP5Z1, which encodes the ζ subunit of AP-5, underlie SPG48. The AP-5 adaptor protein complex, which is mutated in SPG48, binds to both spastizin and spatacsin. While hereditary spastic paraplegias generally are clinically and genetically heterogenous, SPG48, SPG11, and SPG15 are clinically similar.


Assuntos
Proteínas Adaptadoras de Transporte Vesicular/genética , Mutação da Fase de Leitura , Paraparesia Espástica/genética , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Corpo Caloso/diagnóstico por imagem , Corpo Caloso/patologia , Feminino , Transtornos Neurológicos da Marcha/etiologia , Genes Recessivos , Homozigoto , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paraparesia Espástica/complicações
9.
Int J Rehabil Res ; 43(3): 247-254, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32459669

RESUMO

This study aimed to determine the efficacy of using real-time visual feedback during overground walking training to improve walking function in patients with post-stroke hemiparesis. Twenty-four patients with post-stroke hemiparesis who were able to walk independently under less impact of synergy pattern on the affected lower limbs (Brunnstrom stage IV or V) were randomly assigned to either the experimental group or the control group. All subjects performed overground walking for 30 min, three times a week for 6 weeks, with real-time visual feedback (weight load to the affected lower limb) provided during training for subjects in the experimental group. Outcome measures comprised the timed up-and-go test and gait parameters (step length, stride length, single and double support times, step and stride length ratios, and single support time ratio). In between-group comparison, the changes between pre-test and post-test scores in all parameters were significantly greater in the experimental group than in the control group (P < 0.05), except for double support time and step length ratio. Furthermore, post-test values of all parameters were significantly more improved in the experimental group than in the control group (P < 0.05). Our findings suggest that real-time visual feedback may be an advantageous therapeutic adjunct to reinforce the effects of overground walking training in patients with post-stroke hemiparesis.


Assuntos
Transtornos Neurológicos da Marcha/fisiopatologia , Marcha , Paresia/terapia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/complicações , Retroalimentação Sensorial , Feminino , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/terapia , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Método Simples-Cego
10.
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
11.
Adv Exp Med Biol ; 1194: 173-180, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32468533

RESUMO

This article is about "kinesia paradoxa," a phenomenon presented in Parkinson's disease patients who generally suffer from bradykinesia and freezing of gait (FOG) but under certain circumstances exhibit a sudden, brief period of mobility. The objective of this paper was to identify the mechanisms causing this phenomenon, record possible brain circuits involved, and try to locate interconnections between these circuits. Moreover, we are proposing various modeling schemes in order to form the appropriate conditions for experimental design.


Assuntos
Encéfalo , Transtornos Neurológicos da Marcha , Doença de Parkinson , Encéfalo/fisiopatologia , Marcha , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Cinética , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Amplitude de Movimento Articular
12.
J Clin Neurosci ; 75: 55-61, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32234334

RESUMO

The aim of this study was to investigate the effects of action observation treatment (AOT) on gait ability in patients with subacute to convalescent stroke. Sixteen patients with subacute stroke were divided into a control group (n = 8) and AOT group (n = 8) when admitted to the convalescent ward. The control group received a conventional rehabilitation only. In addition to conventional rehabilitation, the AOT received AOT for 3 months (30 min per day 5 times per week). The AOT involved observing the action of another subject in a comfortable gait situation from the front, sides, and back via video and conducting the actual action. All participants were assessed during the main-assessment period, which included a baseline (i.e., when admitted to the convalescent ward) and 1, 2, and 3 months after baseline. The sub-assessment period at 2 and 3 months after baseline was conducted with participants who could walk independently. The main outcomes of the main-assessment and sub-assessment periods were Functional Ambulation Classification (FAC) and the 10-m walk test (10MWT), respectively. With respect to the FAC, we used a split plot design analysis of covariance to test the interaction between assessment time and group. There was no significant interaction between assessment time and group in FAC. However, a significant improvement of the 10MWT in the sub-assessment period was observed in the AOT group, but not the control group. Our results indicate that AOT may be an effective therapy for patients with subacute to convalescent stroke who can walk independently.


Assuntos
Transtornos Neurológicos da Marcha/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Adulto , Idoso , Feminino , Marcha , Transtornos Neurológicos da Marcha/etiologia , Humanos , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia
13.
Neurology ; 94(23): e2436-e2440, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32300063

RESUMO

OBJECTIVE: To develop a disease-specific staging system for CLN3 disease and to test the hypothesis that salient and discrete clinical features of CLN3 disease may be used to define disease stages by analyzed data from an 18-year-long natural history study. METHODS: A proposed staging system, the CLN3 Staging System (CLN3SS), was based on salient and clinically meaningful endpoints. The relationships between stage and age, stage and Unified Batten Disease Rating Scale (UBDRS) physical severity score, and stage and UBDRS capability impairment subscale scores were determined. We used t tests to determine whether the stages were significantly different from each other on the basis of age and scores. RESULTS: Data were analyzed from 322 evaluations in 108 individuals. There were significant differences among the stages based on age and severity scores. For individuals with longitudinal data, no individual reverted to a less severe stage over time. CONCLUSION: The CLN3SS is a disease-specific staging system that can be used to classify individuals into specific strata based on age and disease severity. The CLN3SS has potential applications in clinical trials for cohort stratification.


Assuntos
Lipofuscinoses Ceroides Neuronais/diagnóstico , Adolescente , Adulto , Criança , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Glicoproteínas de Membrana/deficiência , Chaperonas Moleculares , Lipofuscinoses Ceroides Neuronais/complicações , Prognóstico , Convulsões/etiologia , Índice de Gravidade de Doença , Transtornos da Visão/etiologia
14.
Georgian Med News ; (298): 119-122, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32141863

RESUMO

The aim of the research was to assess physical therapy effect using TRX equipment for patients after brain injuries, on balance and coordination. There were 30 respondents in this research. All of them with the easy level of brain injuries by using Glasgow coma scale. 10 females and 20 males, the age 19 - 64 years old, the average - 39,6±12,9 years. The coordination was assessed with no balance needed coordination scale by Schmitz. Balance using balance scale by Berg. The quality of life was assessed by using SF-36 questionnaire. Muscle strength by manual muscle strength scale by Lovett. Mathematical and statistical data analysis, using Microsoft Excel 2007 software package and SPSS 21.0. Data were statistically significant if p<0,05. The research lasted 15 days and consisted of daily training for 30-40 minutes. All respondents had two testing sessions, one before the first physical therapy with TRX class, and second after the last physical therapy with TRX class. Glasgow coma scale results showed that point ratio between the two groups was statistically insignificant (p>0,05). The mean of the study group points (14,7±0,45) was bigger than that of the control group (14,3±0,70). The muscle power results between two groups were statistically significant p<0,05 only in research group - 3,6±0,61 and 4,3±0,44, accordingly. Coordination assessment results showed that after physical therapy the results in the groups showed statistically significant improvement (p<0,05). The mean of the control group was 54,1±21,03, of the study group - 56,2±21,75. Quality of life and balance results for research subjects didn't change statistically significant, p>0,05. This brings to conclusion that TRX equipment is an important alternative to rehabilitation that improves patients' physical and emotional health after brain injuries.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/reabilitação , Terapia por Exercício/métodos , Transtornos Neurológicos da Marcha/reabilitação , Treinamento de Resistência/instrumentação , Adulto , Lesões Encefálicas Traumáticas/psicologia , Feminino , Transtornos Neurológicos da Marcha/etiologia , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Treinamento de Resistência/métodos , Inquéritos e Questionários , Adulto Jovem
16.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32144121

RESUMO

A previously healthy 9-year-old immigrant girl from Mexico was evaluated in the emergency department (ED) with one week of fatigue, fevers, rhinorrhea, and cough. She initially presented to her primary pediatrician, where a complete blood count revealed neutropenia, prompting referral to the ED. In the ED, she was found to be influenza A-positive. Because of dehydration, she received intravenous fluids and was admitted to the pediatric hospital medicine service. After 2 days, influenza symptoms improved, and oral intake increased. However, she was noted to have decreased bilateral lower-extremity strength, absent Achilles reflexes, decreased lower-extremity sensation and proprioception, a positive result on the Romberg sign, and abnormal heel-to-shin testing results. These findings prompted an urgent neurology consultation. After extensive imaging, laboratory evaluation, and further consultations, a diagnosis was established.


Assuntos
Anemia/etiologia , Transtornos Neurológicos da Marcha/etiologia , Influenza Humana/complicações , Debilidade Muscular/etiologia , Neutropenia/etiologia , Deficiência de Vitamina B 12/diagnóstico , Antivirais/uso terapêutico , Criança , Diagnóstico Diferencial , Fadiga/etiologia , Feminino , Febre/etiologia , Transtornos Neurológicos da Marcha/diagnóstico , Humanos , Influenza Humana/tratamento farmacológico , Oseltamivir/uso terapêutico , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico , Deficiência de Vitamina B 12/complicações , Vômito/etiologia
17.
Hum Mov Sci ; 70: 102591, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32217209

RESUMO

INTRODUCTION: Although it is known that individuals with Parkinson's disease (PD) have difficulties performing dual-task activities, most of the studies have verified the effect of dual tasks on gait using tasks that are uncommon to perform while walking. However, the realization of tasks involving gait that really represents the daily activities carried out by the participants, allow us to detect real fall risk situations of individuals with PD during their gait. OBJECTIVE: Our aim was to verify the influence of daily-life dual-tasks on gait spatiotemporal variables of the older adults with PD. METHODS: 20 older adults without PD and 20 older adults with PD participated in the study. Gait kinematic was analyzed under three different conditions: walking without dual task, walking carrying bags with weight, and walking talking on the cell phone. RESULTS: Older adults with PD presented lower speed (p = .001), cadence (p = .039), and shorter step length (p = .028) than older adults without PD during walking without dual tasks. When walking while carrying bags with weight, older adults with PD had a lower speed (p < .001), cadence (p = .015), shorter step length (p = .008), and greater double support time (p = .021) compared with older adults without PD. During walking while talking on the cell phone, older adults with PD walked with lower speed (p < .001), cadence (p = .013), shorter step length (p = .001) and swing time (p = .013), and increased double support time (p = .008) and support time (p = .014) in relation to older adults without PD. CONCLUSION: Daily-life dual tasks impair the spatiotemporal variables of gait in the older adults with PD, which was most evident during walking talking on the cell phone.


Assuntos
Atividades Cotidianas , Transtornos Neurológicos da Marcha/fisiopatologia , Doença de Parkinson/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Telefone Celular , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Caminhada , Suporte de Carga
18.
Zhonghua Yi Xue Za Zhi ; 100(3): 207-212, 2020 Jan 21.
Artigo em Chinês | MEDLINE | ID: mdl-32008288

RESUMO

Objective: To find more objective evidence and support for clinical classification of Parkinson's disease by means of tremor analysis in patients with early confirmed Parkinson's disease. Methods: A cross-sectional study was conducted to collect 65 patients with early Parkinson's disease treated in the Third Hospital of Peking University from January 2015 to December 2016. Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn-Yahr scale (H-Y scale), Mini-mental state examination (MMSE), Hamilton depression scale (HAMD) were recorded in all patients. According to the ratio of UPDRS rigidity score to tremor score, the patients were divided into tremor dominant (TD), postural instability/gait difficulty (PIGD) and mixed types. All patients were examined by tremor analysis and the results were analyzed and compared. Results: Among the 65 patients, the mean age of onset was (63±10) years, the course of disease was (14±8) months. Twenty-one patients were classified to TD group, 28 patients were classified to PIGD type, and 16 patients with mixed type. There was no significant difference in frequency and amplitude of tremor between the three groups (P>0.05), but the proportion of alternating contraction and harmonic resonance of active and antagonistic muscles in TD group was significantly higher (P<0.05). Twenty patients (71.4%) in TD group showed typical Parkinson's disease manifestations in tremor analysis. Only four patients (14.3%) in PIGD group showed the typical manifestations. More patients in PIGD group showed no clear main peak of tremor at rest. Some patients showed 6-8 Hz/sec peak frequency in posture position and simultaneous contraction of the active and antagonist muscles. These two manifestations occured simultaneously in mixed type patients, including 10 cases (62.5%) with typical Parkinson's disease manifestations. Conclusion: As an objective electrophysiological method to evaluate tremor type, tremor analysis can be used as an important assistant method for clinical classification of Parkinson's disease. It can provide information of the pathway of pathological loss in different types and give important hints in prognosis and treatment.


Assuntos
Transtornos Neurológicos da Marcha/fisiopatologia , Doença de Parkinson/classificação , Doença de Parkinson/fisiopatologia , Tremor/fisiopatologia , Idade de Início , Idoso , Estudos Transversais , Feminino , Marcha , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Tremor/etiologia
19.
PLoS One ; 15(2): e0229707, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32109255

RESUMO

Early onset, intensive and repetitive, gait training may improve outcome after stroke but for patients with severe limitations in walking, rehabilitation is a challenge. The Hybrid Assistive Limb (HAL) is a gait machine that captures voluntary actions and support gait motions. Previous studies of HAL indicate beneficial effects on walking, but these results need to be confirmed in blinded, randomized controlled studies. This study aimed to explore effects of incorporating gait training with HAL as part of an inpatient rehabilitation program after stroke. Thirty-two subacute stroke patients with severe limitations in walking were randomized to incorporated HAL training (4 days/week for 4 weeks) or conventional gait training only. Blinded assessments were carried out at baseline, after the intervention, and at 6 months post stroke. The primary outcome was walking independence according to the Functional Ambulation Categories. Secondary outcomes were the Fugl-Meyer Assessment, 2-Minute Walk Test, Berg Balance Scale, and the Barthel Index. No significant between-group differences were found regarding any primary or secondary outcomes. At 6 months, two thirds of all patients were independent in walking. Prediction of independent walking at 6 months was not influenced by treatment group, but by age (OR 0.848, CI 0.719-0.998, p = 0.048). This study found no difference between groups for any outcomes despite the extra resources required for the HAL training, but highlights the substantial improvements in walking seen when evidence-based rehabilitation is provided to patients, with severe limitations in walking in the subacute stage after stroke. In future studies potential subgroups of patients who will benefit the most from electromechanically-assisted gait training should be explored.


Assuntos
Transtornos Neurológicos da Marcha/reabilitação , Robótica , Reabilitação do Acidente Vascular Cerebral/instrumentação , Acidente Vascular Cerebral/complicações , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Resultado do Tratamento , Caminhada
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