Background and Purpose
Clinical experience suggests that many patients with functional motor disorders (FMD), despite reporting severe balance problems, typically do not fall frequently. This ...discrepancy may hint towards a functional component. Here, we explored the role of the Shoulder‐Touch test, which features a light touch on the patient's shoulders, to reveal a possible functional etiology of postural instability.
Methods
We enrolled consecutive outpatients with a definite diagnosis of FMD. Patients with Parkinson's disease (PD) or progressive supranuclear palsy (PSP) with postural instability served as controls. Each patient underwent a clinical evaluation including testing for postural instability using the retropulsion test. Patients with an abnormal retropulsion test (score ≥ 1) also received a light touch on their shoulders to explore the presence (S‐Touch+) or absence (S‐Touch−) of an incongruent, exaggerated postural response, defined as taking three or more steps to recover or a fall if not caught by the examiner.
Results
From a total sample of 52 FMD patients, 48 patients were recruited. Twenty‐five patients (52%) had an abnormal retropulsion test. Twelve of these 25 patients (48%) had an S‐Touch+, either because of need to take two or more steps (n = 4) or a fall if not caught by the examiner (n = 8). None of the 23 PD/PSP patients manifested S‐Touch+. The sensitivity of the S‐Touch test was 48%, whereas its specificity was 100%.
Conclusion
The S‐Touch test has a high specificity, albeit with a modest sensitivity, to reveal a functional etiology of postural instability in persons with FMD.
Axial postural abnormalities and pain are two main determinants of poor quality of life in patients with Parkinson’s disease (PD). Indeed, a detailed characterization of pain and other non-motor ...symptoms in patients with PAs has not been provided yet. The aim of this study is to assess the phenomenology of pain and other non-motor symptoms in PD patients with Pisa syndrome and camptocormia compared to PD patients without axial postural abnormality. Forty-five PD participants were equally distributed in three groups: patients with Pisa syndrome (PS), patients with Camptocormia (CC), and patients without postural abnormalities (PD). Pain characteristics were assessed by Kings Parkinson’s Pain Scale (KPPS), brief pain inventory (BPI), and numeric pain rating scale (NRS). All participants completed clinical assessments by non-motor symptom scale (NMSS), and movement disorder society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) parts II–III. Patients with and without axial postural abnormalities showed one or more types of pain, being fluctuation, nocturnal, chronic, and musculoskeletal the most frequently reported in Pisa Syndrome and camptocormia. PD group compared with PS and CC groups showed differences in the KPPS, NMSS, BPI pain severity and interference, and NRS total scores. No significant differences were found between PS group compared with CC group with exception of the NMSS total scores. PD patients with Pisa syndrome or camptocormia have a higher burden of musculoskeletal, chronic and fluctuation pain than PD patients without axial postural abnormalities, suggesting different etiologies of pain and possible different treatments.
Background
Functional motor disorders (FMDs) are highly disabling conditions associated with long-term disability, poor quality of life, and economic burden on health and social care. While ...multidisciplinary 5-days rehabilitation programs have been shown to reduce motor and non-motor symptoms, long-term management and monitoring in FMDs remain an unmet need.
Aim
To compare a 12-weeks telemedicine program against a 12-weeks self-management program after a 5-days rehabilitation program for improving motor, non-motor symptoms, quality of life, and perception of change in patients with FMDs.
Methods
The study population was 64 consecutive patients with a definite diagnosis of FMDs who underwent a 5-days in-person rehabilitation program followed by either a self-management (the first 32 patients) or a telemedicine program (the latter 32 patients). Validated measures of motor and non-motor symptoms such as fatigue and pain, quality of life, perception of change, gait, and postural control were recorded before (T0), after completion of rehabilitation (T1), and then again at 3 months (T2).
Results
Improvement at 3-month follow-up assessment of motor symptoms (
p
< 0.001), physical fatigue (
p
= 0.028), and self-rated change perception (
p
= 0.043) was greater in the telemedicine group. No different between-groups effect was found on other dimensions of fatigue, pain, physical and mental health, and gait and postural control.
Conclusions
Long-term management and expert monitoring of patients with FMDs via telemedicine may enhance long-term outcomes in motor symptoms and physical fatigue, with a positive long-term impact on self-rated health perception of change.
Introduction. Telerehabilitation enables patients to access remote rehabilitation services for patient-physiotherapist videoconferencing in their own homes. Home-based virtual reality (VR) balance ...training has been shown to reduce postural instability in patients with Parkinson’s disease (PD). The primary aim was to compare improvements in postural stability after remotely supervised in-home VR balance training and in-clinic sensory integration balance training (SIBT). Methods. In this multicenter study, 76 PD patients (modified Hoehn and Yahr stages 2.5–3) were randomly assigned to receive either in-home VR telerehabilitation (n=38) or in-clinic SIBT (n=38) in 21 sessions of 50 minutes each, 3 days/week for 7 consecutive weeks. VR telerehabilitation consisted of graded exergames using the Nintendo Wii Fit system; SIBT included exercises to improve postural stability. Patients were evaluated before treatment, after treatment, and at 1-month follow-up. Results. Analysis revealed significant between-group differences in improvement on the Berg Balance Scale for the VR telerehabilitation group (p=0.04) and significant Time × Group interactions in the Dynamic Gait Index (p=0.04) for the in-clinic group. Both groups showed differences in all outcome measures over time, except for fall frequency. Cost comparison yielded between-group differences in treatment and equipment costs. Conclusions. VR is a feasible alternative to in-clinic SIBT for reducing postural instability in PD patients having a caregiver.
•Functional motor disorders (FMD) are highly disabling neurological disorders.•Understanding postural deficits physiopathology in FMD is an unmet need.•A simple motor task with eyes closed can ...improve postural control in FMD.
Functional motor disorders (FMD) are highly disabling neurological conditions in which postural control deficits increase the risk of falls and disability in performing daily living activities. Scattered evidence suggests that such disturbances may depend on abnormal attentional focus and might improve with distraction.
How do motor and cognitive dual tasks performed under two different sensory conditions shape postural control in patients with FMD.
This posturographic study involved 30 patients with FMD (age, 45.20 ± 14.57 years) and 30 healthy controls (age, 41.20 ± 16.50 years). Postural parameters were measured with eyes open, and eyes closed in quiet stance (single task) and on a motor dual task (m-DT) and a calculation (cognitive) dual task (c-DT). The dual task effect (DTE, expressed in percentage) on motor and cognitive performance was calculated for sway area, length of Center of Pressure (CoP), and velocity of CoP displacement.
There was a statistically significant three-way interaction between task, condition, and group for the DTE on sway area (p = 0.03). The mean sway area DTE on the motor task in the eyes-closed condition was increased by 70.4 % in the healthy controls, while it was decreased by 1% in the patient group (p = 0.003). No significant three-way interaction was observed for the DTE on length of CoP and velocity of CoP displacement.
This study provides novel preliminary evidence for the benefit of a simple motor dual task in the eyes closed condition as a way to improve postural control in patients with FMD. These findings are relevant for the management of postural control disorders in patients with FMD.
Pain, one of the most frequent nonmotor symptoms of Parkinson disease (PD), is recognized as an important component of the illness that adversely affects patient quality of life. The aims of this ...review are to summarize the current knowledge on the clinical assessment and to provide a detailed overview of the evidence-based pharmacologic and nonpharmacologic approaches to treating pain. Results of a literature search include studies investigating pain/sensory abnormalities in PD. The effects of levodopa administration, deep brain stimulation (DBS), pallidotomy, spinal cord stimulation, rehabilitation, and complementary/alternative medicine are reviewed critically. PD patients have altered pain and sensory thresholds; levodopa and DBS improve pain and change sensory abnormalities toward normal levels through antinociceptive and/or modulatory effects that remain unknown. A wide range of nonpharmacologic approaches require further investigation. A multidisciplinary approach is fundamental in managing pain syndromes in PD.
The DUALITY trial recently showed that both integrated and consecutive dual-task training improve dual-task gait velocity, without increasing fall risks in patients with Parkinson's disease (PD). ...Gait velocity was the primary outcome; not reported, however, were important gait measures related to the risk of falling such as gait variability. In this secondary analysis, we compared the efficacy of the two training programs with respect to spatiotemporal outcome parameters.
121 PD patients (Hoehn and Yahr stage II-III while ON medication) were randomly assigned to either a consecutive group (n = 65) in which cognitive and gait tasks were trained separately, or an integrated group (n = 56) in which cognitive and gait tasks were trained simultaneously. Both groups received 24 in-home physiotherapy sessions for six consecutive weeks. Two baseline measurements were performed during a six-week control period prior to the interventions. Gait was evaluated under three different (and untrained) dual-task conditions immediately after the treatment period and at 12-week follow-up.
Both training modalities had a comparable effect on spatiotemporal gait parameters. A significant post-training increase in stride length (P < .001) and cadence (P < .001) was found under both the single and the dual-task conditions. These improvements were maintained at follow-up, although the effect was slightly reduced. No significant changes were found for gait variability under single and dual-task conditions.
We found both integrated and consecutive dual-task training to be safe and effective in improving several spatiotemporal gait parameters under trained and untrained dual-task conditions.
•Integrated and consecutive dual-task training in Parkinson's disease was evaluated.•Both training modalities resulted in similar gait improvements.•Dual-task training significantly increased stride length and cadence.•No significant changes were found for gait variability.
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