To assess the effects of postural rehabilitation (PR) on trunk asymmetry and balance, with and without Kinesio taping (KT) of the back muscles as additional treatment, in patients with Parkinson's ...disease (PD) who have postural disorders.
Single-blind, randomized controlled trial with 1-month follow-up.
Ambulatory care in referral center.
Patients (N=20) with PD showing postural abnormalities of the trunk, in the sagittal and/or coronal plane.
Four weeks of patient-tailored proprioceptive and tactile stimulation, combined with stretching and postural reeducation, was provided to 13 subjects (PR group), while 7 received no treatment (control group). Six of the 13 subjects receiving PR also had KT strips applied to their trunk muscles, according to the features of their postural abnormalities.
Berg Balance Scale, Timed Up and Go, and degrees of trunk bending in the sagittal and coronal planes were assessed at the enrollment (t0), 1 month later (t1), and 2 months later (t2).
At t1, all treated patients showed a significant improvement in trunk posture in both the sagittal (P=.002) and coronal planes (P=.01), compared with baseline. Moreover, they showed an improvement in measures of gait and balance (P<.01). Benefits persisted at t2 for all measures, except lateral trunk bend. No differences were found when comparing the PR and KT groups.
The combination of active posture correction and trunk movements, muscle stretching, and proprioceptive stimulation may usefully impact PD axial symptoms. Repeated training is advocated to avoid waning of the effect.
•This randomised controlled trial compared robot-assisted gait training (RAGT) to treadmill training (TT) for people with Parkinson's disease.•RAGT and TT improved overall gait capacity to the same ...extent.•RAGT was more effective than TT in improving freezing of gait (FOG).•RAGT reduced FOG more in dependent walkers than independent walkers.•Disability level was reduced in freezers more than in non-freezers.
Although gait disorders strongly contribute to perceived disability in people with Parkinson's disease, clinical trials have failed to identify which task-oriented gait training method can provide the best benefit. Freezing of gait remains one of the least investigated and most troublesome symptoms.
We aimed to compare the effects of robot-assisted gait training and treadmill training on endurance and gait capacity in people with Parkinson disease; the secondary aim was to compare the effect of the treatments in people with freezing and/or severe gait disability and assess changes in overall disease-related disability and quality of life.
Outpatients with Parkinson disease (Hoehn and Yahr stage≥2) were randomly assigned to receive 20 sessions of 45-min gait training assisted by an end-effector robotic device (G-EO System) or treadmill training. Outcome assessments were the 6-min walk test, Timed Up and Go test, Freezing of Gait Questionnaire, Unified Parkinson's Disease Rating Scales and Parkinson's Disease Quality of Life Questionnaire-39 administered before (T0) and after treatment (T1).
We included 96 individuals with Parkinson disease: 48 with robot-assisted gait training and 48 treadmill training. Both groups showed significant improvement in all outcomes. As compared with baseline, with robot-assisted gait training and treadmill training, endurance and gait capacity were enhanced by 18% and 12%, respectively, and motor symptoms and quality of life were improved by 17% and 15%. The maximum advantage was observed with the Freezing of Gait Questionnaire score, which decreased by 20% after either treatment. On post-hoc analysis, dependent walkers benefited more than independent walkers from any gait training, whereas freezers gained more from robot-assisted than treadmill training in terms of freezing reduction.
Repetitive intensive gait training is an effective treatment for people with Parkinson disease and can increase endurance and gait velocity, especially for those with severe walking disability. Advantages are greater with robot-assisted gait training than treadmill training for individuals with freezing of gait – related disability.
Background: “Ricominciare” is a single-center, prospective, pre-/post-intervention pilot study aimed at verifying the feasibility and safety of the ARC Intellicare (ARC) system (an artificial ...intelligence-powered and inertial motion unit-based mobile platform) in the home rehabilitation of people with disabilities due to respiratory or neurological diseases. Methods. People with Parkinson’s disease (pwPD) or post-COVID-19 condition (COV19) and an indication for exercise or home rehabilitation to optimize motor and respiratory function were enrolled. They underwent training for ARC usage and received an ARC unit to be used independently at home for 4 weeks, for 45 min 5 days/week sessions of respiratory and motor patient-tailored rehabilitation. ARC allows for exercise monitoring thanks to data from five IMU sensors, processed by an AI proprietary library to provide (i) patients with real-time feedback and (ii) therapists with information on patient adherence to the prescribed therapy. Usability (System Usability Scale, SUS), adherence, and adverse events were primary study outcomes. Modified Barthel Index (mBI), Barthel Dyspnea Index (BaDI), 2-Minute Walking Test (2MWT), Brief Fatigue Inventory (BFI), Beck Depression or Anxiety Inventory (BDI, BAI), and quality of life (EQ-5D) were also monitored pre- and post-treatment. Results. A total of 21 out of 23 eligible patients were enrolled and completed the study: 11 COV19 and 10 pwPD. The mean total SUS score was 77/100. The median patients’ adherence to exercise prescriptions was 80%. Clinical outcome measures (BaDI, 2MWT distance, BFI; BAI, BDI, and EQ-5D) improved significantly; no side effects were reported. Conclusion. ARC is usable and safe for home rehabilitation. Preliminary data suggest promising results on the effectiveness in subjects with post-COVID condition or Parkinson’s disease.
The COVID-19 pandemic has been a stress test for the population, especially for people with chronic disorders such as Parkinson’s disease (PD). In addition to public health restrictions that contrast ...with PD management recommendations, there were deep changes in health care delivery. This retrospective study evaluates the impact of COVID-19 on the clinical and functional evolution of a cohort of 221 PD patients consecutively referred to the Movement Disorders Center between 2018 and 2021. We analyzed the trend in motor and non-motor symptoms and functional status across years based on the Unified Parkinson’s Disease Rating Scale (UPDRS) and Non-Motor Symptom Scale (NMSS). We also compared the number of emerging complications, neurologic visits, and rehabilitation sessions per subject per year. In 2020, all primary endpoint measures worsened compared to 2019, without age, disease duration, or greater neurologic impairment explaining this outcome. Concurrently, the percentage of patients receiving neurologic visits or rehabilitation sessions reduced by 53% and 58%, respectively. The subgroup analysis of 167 subjects revealed that those who received at least one cycle of rehabilitation sessions in 2020 maintained their independence level. These findings lead to emphasizing the importance of regular monitoring and rehabilitation delivery in people with chronic neurological disorders.
(1) Background: Musculoskeletal conditions show increasing prevalence and high economic/human burden. Recovery for hip or knee surgery may require more than 26 weeks, while universally accepted ...rehabilitation guidelines are missing. Provided that multisensory-based training enhances motor learning, the study aims to verify if visuomotor training accelerates the recovery of lower limb motor function after orthopedic surgery. (2) Methods: Post-surgery subjects were randomly assigned to receive visuomotor training as an add-on to the conventional physical therapy (VTG), or receive the conventional therapy alone (CG). Subjects performed 40 one-hour training sessions in 8 weeks. The primary endpoint was the improvement in the Lower Extremity Functional Scale (LEFS) over the minimally clinical important difference (MCID) at 4 weeks post-randomization. The secondary endpoint included pain reduction. (3) Results: Eighteen patients were equally distributed into the VTG and CG groups. While LEFS and pain scores significantly improved in both groups, the VTG exceeded the LEFS MCID by 12 points and halved the pain value after the first 4 weeks of treatment, while the CG reached the endpoints only after treatment end (p = 0.0001). (4) Conclusions: Visuomotor training offers an innovative rehabilitation approach that accelerates the recovery of lower limb motor function in patients undergoing orthopedic surgery.
A healthy lifestyle plays a strategic role in the prevention of BC. The aim of our prospective study is to evaluate the effects of a lifestyle interventions program based on special exercise and ...nutrition education on weight, psycho-physical well-being, blood lipid and hormonal profile among BC patients who underwent primary surgery. From January 2014 to March 2017, a multidisciplinary group of oncologists, dieticians, physiatrists and an exercise specialist evaluated 98 adult BC female patients at baseline and at different time points. The patients had at least one of the following risk factors: BMI ≥ 25 kg/m2, high testosterone levels, high serum insulin levels or diagnosis of MS. Statistically significant differences are shown in terms of BMI variation with the lifestyle interventions program, as well as in waist circumference and blood glucose, insulin and testosterone levels. Moreover, a statistically significant difference was reported in variations of total Hospital Anxiety and Depression Scale (HADS) score, in the anxiety HADS score and improvement in joint pain. Our results suggested that promoting a healthy lifestyle in clinical practice reduces risk factors involved in BC recurrence and ensures psycho-physical well-being.
Postural abnormalities in Parkinson's disease (PD) form a spectrum of functional trunk misalignment, ranging from a "typical" parkinsonian stooped posture to progressively greater degrees of spine ...deviation.
To analyze the association between degree of postural abnormalities and disability and to determine cut-off values of trunk bending associated with limitations in activities of daily living (ADLs), motor impairment, falls, and back pain.
The study population was 283 PD patients with ≥5° of forward trunk bending (FTB), lateral trunk bending (LTB) or forward neck bending (FNB). The degrees were calculated using a wall goniometer (WG) and software-based measurements (SBM). Logistic regression models were used to identify the degree of bending associated with moderate/severe limitation in ADLs (Movement Disorders Society Unified PD Rating Scale MDS-UPDRS part II ≥17), moderate/severe motor impairment (MDS-UPDRS part III ≥33), history of falls (≥1), and moderate/severe back pain intensity (numeric rating scale ≥4). The optimal cut-off was identified using receiver operating characteristic (ROC) curves.
We found significant associations between modified Hoehn & Yahr stage, disease duration, sex, and limitation in ADLs, motor impairment, back pain intensity, and history of falls. Degree of trunk bending was associated only with motor impairment in LTB (odds ratio OR 1.12; 95% confidence interval CI, 1.03-1.22). ROC curves showed that patients with LTB of 10.5° (SBM, AUC 0.626) may have moderate/severe motor impairment.
The severity of trunk misalignment does not fully explain limitation in ADLs, motor impairment, falls, and back pain. Multiple factors possibly related to an aggressive PD phenotype may account for disability in PD patients with FTB, LTB, and FNB.
ABSTRACT
Introduction
The overall frequency of postural abnormalities (PA) in Parkinson's disease (PD) is unknown. We evaluated the overall prevalence of PA and assessed the association with ...demographic and clinical variables.
Methods
For this multicenter, cross‐sectional study, consecutive PD outpatients attending 7 tertiary Italian centers were enrolled. Patients were evaluated and compared for the presence of isolated PA such as camptocormia, Pisa syndrome, and anterocollis and for combined forms (ie, camptocormia + Pisa syndrome) together with demographic and clinical variables.
Results
Of the total 811 PD patients enrolled, 174 (21.5%; 95% confidence interval CI, 18.6%–24.3%) presented PA, 144 of which had isolated PA and 30 had combined PA. The prevalence of camptocormia was 11.2% (95% CI, 9%–13.3%), Pisa syndrome 8% (95% CI, 6.2%–9.9%), and anterocollis 6.5% (95% CI, 4.9%–8.3%). Patients with PA were more often male and older with longer disease duration, more advanced disease stage, more severe PD symptoms, a bradykinetic/rigid phenotype, and poorer quality of life. They were initially treated with levodopa, and more likely to be treated with a combination of levodopa and dopamine agonist, took a higher daily levodopa equivalent daily dose, and had more comorbidities. Falls and back pain were more frequent in PD patients with PA than in those without PA. Multiple logistic regression models confirmed an association between PA and male gender, older age, Hoehn and Yahr stage, and total Unified Parkinson's Disease Rating Scale score.
Conclusions
PA are frequent and disabling complications in PD, especially in the advanced disease stages.
Here, the authors present a low cost telerehabilitation system made up of a commercial red–green–blue depth (RGB-D) camera and a web-based platform. The authors goal is to monitor and assess subject ...movement providing acceptable and usable at-home remote rehabilitation services without the presence of a clinician. Clinical goals, defined by physiotherapists, are firstly translated into motion analysis features. A Takagi Sugeno fuzzy inference system (FIS) is then proposed to evaluate and combine these features into scores. In this stage, the ‘collaborative design’ paradigm is used in depth and complete manner: the contribution of the clinician is not limited only to the rules definition but enters in the core of the evaluation algorithm through the definition of the fuzzy rules. A case study on low back pain rehabilitation involving 40 subjects, 5 exercises, and 4 physiotherapists is then presented to the effectiveness of the proposed system. Results of the validation of the system aimed at the assessment of the reliability of the proposed approach show high correlations between clinician evaluation and FIS scores. In this scenario, due to the high correlation, each FIS could represent a virtual alter-ego of the physiotherapist which enable a real time and free second opinion.
PDF
