The effect of subthalamic nucleus deep brain stimulation and dopaminergic treatment on dual-task manual dexterity in Parkinson's disease.

BACKGROUND AND PURPOSE: Dual-task manual dexterity is required to perform activities of daily living and is affected by cognitive functions. This study aimed to investigate the effects of two main treatment options, subthalamic nucleus deep brain stimulation (STN-DBS) and dopaminergic treatment (DT), on dual-task manual dexterity and cognitive functions of people with Parkinson's disease (PwPD). METHODS: Twenty-one PwPD were assessed in four different conditions as medication "on-off" and STN-DBS "on-off" in random order. Motor symptoms were measured with the Movement Disorder Society-Unified Parkinson Disease Rating Scale, motor section (MDS-UPDRS-III). Single and dual-task manual dexterity was assessed with the Nine-Hole Peg Test (NHPT) and cognitive functions were assessed with the Stroop Test (ST) and the Trail Making Test (TMT). RESULTS: Both DT and STN-DBS enhanced MDS-UPDRS-III, and the combination of DT and STN-DBS provided further improvement. Only STN-DBS enhanced dominant hand single-task NHPT scores. Non-dominant single-task NHPT scores and dual-task NHPT scores improved with both treatments alone; however, STN-DBS resulted in more improvement than DT. Dual-task interference, ST, and TMT scores improved with both treatments alone; however, combining DT and STN-DBS did not provide more improvement. CONCLUSION: DT, STN-DBS, and combining both treatments have different effects on motor symptoms, single and dual-task manual dexterity, dual-task interference, and cognitive functions. These results indicate that DT and STN-DBS may affect motor and cognitive functions via different mechanisms. Effects of DT and STN-DBS on manual dexterity may depend on the degree of cognitive involvement in manual dexterity tasks.

Effects of exercise and electrical stimulation on lumbar stabilization in asymptomatic subjects: a comparative study.

BACKGROUND AND OBJECTIVES: Segmental stabilization training and electrical stimulation are used as a treatment for patients with low back pain. There is limited information on the efficacy of two interventions in the literature. In this study, the efficacy of the two interventions on the multifidus muscle activation and fatigue, segmental stabilization training and electrical stimulation, were examined and compared. MATERIAL AND METHODS: Our sample consists of 30 asymptomatic individuals, randomly assigned to one of three groups: the group that was given segmental stabilization training, the group that was given electrical stimulation and the control group that received no treatment. The muscle activity and fatigability of the multifidus were recorded by the surface electromyography before and after the intervention. RESULTS: No difference is detected for any of the multifidus muscle activation and fatigue characteristics either within or between groups. CONCLUSION: Both techniques did not improve multifidus activation capacity. An effort at submaximal and maximal level affects and increases the activity of multifidus.

Comparison of functional exercise capacity, pulmonary function and respiratory muscle strength in patients with multiple sclerosis with different disability levels and healthy controls.

OBJECTIVE: To compare functional exercise capacity, pulmonary function and respiratory muscle strength in fully ambulatory patients with multiple sclerosis with different disability levels and healthy controls, and to elucidate the determinant factors of functional exercise capacity. METHODS: Forty-three fully ambulatory patients with multiple sclerosis and 30 healthy controls were included in the study. Patients were grouped according to Expanded Disability Status Scale (EDSS); Group I (EDSS 0-2), Group II (EDSS 2.5-4.5). Functional exercise capacity was evaluated using a six-minute walk test, and measurement of pulmonary function, and maximal inspiratory and expiratory pressures (MIP, MEP). The Pulmonary Index was used as a clinical predictor of respiratory dysfunction. RESULTS: Respiratory muscle strength was lower in multiple sclerosis groups compared with controls, but the difference in MIP and %MIP did not reach statistical significance in Group I. The six-minute walk test distance was significantly shorter and peak expiratory flow was lower in multiple sclerosis groups (p < 0.05). Of the variance in the six-minute walk test distance, 75% was explained by EDSS (R2 = 0.55, p < 0.001), difference in heart rate (R2 = 0.06, p = 0.007), age (R2 = 0.05, p = 0.009) and gender (R2 = 0.09, p = 0.003). CONCLUSION: Respiratory muscles are weakened, functional exercise capacity is reduced and pulmonary function is affected even in the early phase of multiple sclerosis. Ambulatory patients with multiple sclerosis who have a higher level of disability have lower pulmonary function, respiratory muscle strength and functional capacity than less disabled ones and controls. Neurological disability level, age, gender and heart rate difference on exertion are the determinants of functional exercise capacity.

Relationship between foot sensation and standing balance in patients with multiple sclerosis.

The aims of the present study were to investigate the relationship between the foot sensations and standing balance in patients with Multiple Sclerosis (MS) and find out the sensation, which best predicts balance. Twenty-seven patients with MS (Expanded Disability Status Scale 1-3.5) and 10 healthy volunteers were included. Threshold of light touch-pressure, duration of vibration, and distance of two-point discrimination of the foot sole were assessed. Duration of static one-leg standing balance was measured. Light touch-pressure, vibration, two-point discrimination sensations of the foot sole, and duration of one-leg standing balance were decreased in patients with MS compared with controls (p<0.05). Sensation of the foot sole was related with duration of one-leg standing balance in patients with MS. In the multiple regression analysis conducted in the 27 MS patients, 47.6% of the variance in the duration of one-leg standing balance was explained by two-point discrimination sensation of the heel (R(2)=0.359, p=0.001) and vibration sensation of the first metatarsal head (R(2)=0.118, p=0.029). As the cutaneous receptors sensitivity decreases in the foot sole the standing balance impairs in patients with MS. Two-point discrimination sensation of the heel and vibration sensation of the first metatarsal head region are the best predictors of the static standing balance in patients with MS. Other factors which could be possible to predict balance and effects of sensorial training of foot on balance should be investigated.