The Physiology and Psychology of Exercise and Parkinson\u27s Disease

Parkinson’s disease is one of the most common degenerative neurological disorders and is currently lacking a cure. While physicians have long debated over the best treatment for Parkinson’s symptoms, treatments such as oral medication and deep brain stimulation have not yet shown to be a permanent solution to the disease. Recently, exercise has emerged as a contender in the fight against Parkinson’s and physicians and physiotherapists have been investigating the benefits of prescribing exercise programs to patients in an effort to slow progression of Parkinson’s symptoms. The following presents an analysis of the effects of exercise on Parkinson’s symptoms and whether or not the type of exercise prescribed is efficacious in the reduction in symptoms experienced by patients. This analysis involves weighing the physical and psychological benefits and risks of exercise intervention in individuals with Parkinson’s disease

Investigating the effect of rivastigmine on postural control in Parkinson's disease dementia

Objectifs : Comparer l’efficacité et l'aspect sécuritaire de la rivastigmine sous forme orale et transdermique destinée au traitement des symptômes liés aux instabilités posturales de patients atteints de la démence de la maladie de Parkinson (PDD) et qui sont des candidats pour un inhibiteur de l’acétylcholinestérase. La principale variable de l'étude était le changement de vitesse moyenne du centre de pression (CoP) en position debout après 6 mois de traitement. Les variables secondaires étaient les paramètres structuraux de posturographie dynamique, des échelles d’évaluation cliniques et les effets secondaires nécessitant une réduction de la dose. Méthodes: Des patients avec PDD ont été randomisé dans un ratio de 1 :1 impliquant une prise de rivastigmine orale ou transdermique avec des doses cibles de 6 mg deux fois par jour et 9,5 mg/10 cm2 par jour, respectivement. Les variables dépendantes ont été comparées au départ de l’étude et après 6 mois (comparaisons intra-groupes), de même qu'entre les groupes. Résultats: Dix-neuf patients ont complété l’étude (n=8 orale; n=11 transdermique). Des doses quotidiennes moyennes de 9,4 mg (± 1,5 mg) et 16,4 mg (± 3,6 mg) ont été administrées aux groupes oral et transdermique, respectivement. Le groupe transdermique a démontré une réduction significative de la vitesse moyenne du CoP de 15.8% (timbre: p=0,02; orale: réduction de 10,0%, p=0,16) lors de la condition d'équilibre la plus difficile (yeux fermés en maintenant l'équilibre sur une plateforme mobile synchronisée avec les déplacements du corps). Aucune différence n’a été trouvée entre les groupes (p=0,27). Concernant les paramètres structuraux, des améliorations significatives ont été observées au niveau de la durée moyenne des pics de stabilité de l'équilibre (timbre) et de la distance entre les pics de stabilité (orale) dans la condition d'équilibre la plus difficile. Aucun changement n’a été observé par rapport aux échelles cliniques. Six patients ont eu des effets secondaires mineurs nécessitant une réduction de dose (n=5 orale; n=1 transdermique). Conclusions: La rivastigmine pourrait améliorer certains éléments du contrôle postural de patients atteints de PDD, notamment la vitesse moyenne du CoP en position debout. Les bienfaits sont plus évidents sous les conditions qui challengent davantage l'équilibre.Objectives: To compare the efficacy and safety of oral and transdermal rivastigmine for postural instability in patients with Parkinson’s disease dementia (PDD) who were candidates for a cholinesterase inhibitor. The primary outcome was the change in mean velocity of the centre of pressure (CoP) after 6 months. Secondary outcomes included structural parameters of dynamic posturography, clinical rating scales and adverse events requiring dose reduction. Methods: Patients with PDD were randomized in a 1:1 ratio to oral or transdermal rivastigmine with target doses of 6 mg twice daily and 9.5 mg/10 cm2 daily, respectively. Outcomes were assessed at baseline and 6 months. Results were compared within and between groups. Results: Nineteen patients completed the study (n=8 oral, n=11 transdermal). Mean daily doses of 9.4 mg (± 1.5 mg) and 16.4 mg (± 3.6 mg) were achieved in the oral and transdermal groups, respectively. The transdermal group demonstrated a significant 15.8% decrease in mean velocity of CoP (patch: p <0.05; oral: 10.0% decrease, p=0.16) in the most difficult scenario (eyes closed with sway-referenced support). There was no difference between groups (p=0.27). For structural parameters, significant improvements were seen in the mean duration of peaks (patch) and inter-peak distance (oral) in the most difficult condition. No changes were observed in clinical rating scales. Six patients experienced non-serious adverse events requiring dose reduction (n= 5 oral; n=1 transdermal). Conclusions: Rivastigmine may improve certain elements of postural control, notably the mean velocity of CoP. Benefits appear to be more obvious under more taxing sensory conditions

Effect of Vestibular Adaptation Exercises on Chronic Motion Sensitivity

Dizziness is one of the most common complaints reported to primary care physicians. It is often associated with vestibular dysfunction and typically impacts postural stability. Motion sickness, or motion sensitivity, is stimulated by abnormal spatial orientation and is a common symptom related to dizziness and postural instability. The main cause of the motion sensitivity is aberrant sensory input from the visual, vestibular and somatosensory systems. The aim of this study was to measure the effect of vestibular adaptation exercises on postural stability in young healthy adults with subjective awareness of chronic motion sensitivity. Methods: Fifty healthy male and female participants between 20 to 40 years of age with chronic motion sensitivity were randomly assigned to either an experimental or control group. Postural stability measurements were taken at baseline and after 6 weeks using computerized dynamic posturography with immersion virtual reality. The experimental group performed daily vestibular adaptation exercises for 6 weeks. Results. There was no significant difference between the two groups at baseline in terms of mean age, height, weight, BMI or baseline postural stability scores (p\u3e0.05). Significant differences in mean postural stability scores were observed post intervention in both groups but larger improvements were detected in the experimental group (p=0.002). Conclusions: Minimal dosage of vestibular adaptation exercises improved postural stability in younger adults with chronic motion sensitivity. Additionally, familiarity of the testing environment during post-test measurements may have contributed to improvements in the control group over time; however, changes were greater in the experimental group

Effects of Neck Muscle Fatigue on the Vestibulo-Ocular Reflex

In order to maintain balance, the brain receives and processes input from multiple sensory systems including the visual, vestibular, and somatosensory systems. The information from these systems is sent to the brain where the information is then combined, organized and interpreted. This results in the output of reflexes (vestibulo-ocular reflex [VOR] and vestibulospinal reflex [VSR]). The VOR and the VSR work together with other motor systems to control gaze stability and control whole body equilibrium. Impairment in any of these sensory systems can result in dizziness, loss of balance, and visual instability. While the contributions of the visual, vestibular, and somatosensory systems on visual stability have been well described in the literature, contribution of cervical spine somatosensation on visual stability is not fully understood. The overall aim of the present work was to investigate whether impaired somatosensory information from the cervical spine, caused by neck muscle fatigue, directly influences dynamic visual stability in healthy young and healthy older participants. Results indicated that healthy young and healthy older participants who were fatigued had significantly poorer Dynamic Visual Acuity (DVA) than those who were not fatigued (P\u3c.05). In Conclusion, our research suggests that when assessing vestibular function in patients complaining of dizziness and/or visual disturbance with a history of neck trauma, one may speculate that VOR dysfunction could have a cervical origin due to somatosenory disturbance, which may lead to visual disturbances and dizziness

Effect of balance training on postural instability in patients with idiopathic Parkinson’s disease

Background. Postural instability (PI) is a disabling sign of Parkinson’s disease (PD) not easily amenable to treatment with medication. Objective. To evaluate the effects of balance training on PI in patients with PD. Methods. A total of 64 patients with PI were randomly assigned to the experimental group (n = 33) for balance training or to the control group (n = 31) for general physical exercises. Each patient received 21 treatment sessions of 50 minutes each. Patients were evaluated by a blinded rater before and after treatment as well as 1 month posttreatment using the Berg Balance Scale (BBS), ActivitiesSpecific Balance Confidence Scale (ABC), postural transfer test, self-destabilization of the center of foot pressure test, number of falls, Unified Parkinson’s Disease Rating Scale (UPDRS), modified Hoehn and Yahr (H&amp;Y) Staging Scale, and Geriatric Depression Scale (GDS). Results. At the end of treatment, the experimental group showed significant improvements in all outcome measures, except for the UPDRS and the H&amp;Y scale. Improvement was maintained at the 1-month follow-up in all outcome measures except for the GDS. No significant changes in performance were observed in the control group. Conclusions. A program of balance training can improve PI in patients with PD

Neurocognitive findings in adults who played youth football

Chronic Traumatic Encephalopathy (CTE) has been linked to contact sports, most notably boxing and American football, due to their propensity for repetitive head impacts. Concerns in the community for the safety of athletes in all contact sports has driven a significant amount of research into concussions, their long term effects, and strategies for treatment and prevention. Knowledge of long term brain health in response to neurotrauma is limited, a gap especially noticeable in the literature on non-catastrophic brain injuries sustained as a child. Concussion is a common injury that is often self-resolving with no lasting neurologic or cognitive deficits. Although repetitive brain trauma is hypothesized to be necessary and sufficient to lead to CTE, no human or animal models have definitively demonstrated the pathophysiologic connection or confirmed the mechanism of symptoms. The research to date has been case based, lacking prospective cohorts, with data complicated by convenience sampling. These factors limit the generalizability of conclusions. CTE is neuropathologically defined with variable symptoms; however, it is only diagnosable at postmortem autopsy making the etiology and prevalence difficult to understand. As more research is published to understand if there is an association between a neurocognitive degenerative disease and contact sports, the concentration is on professional athletes. Yet professional athletes do not represent the overwhelming majority of all contact sport participants. The proposed study will compare adults who participated in youth football, but not beyond the high school level, to a control group of adults who did not play contact sports. Evaluating their cognitive function with an online assessment, the Behavior Rating Inventory of Executive Function – Adult Version (BRIEF-A), data will be analyzed for signs of clinical cognitive impairment. The objective is to measure adults who represent the high percentage of youth football players who do not continue to the advanced levels. Data obtained from this study will help communities make informed decisions, and create the foundation for future studies on long term benefits and risks of contact sports for children

Comparing Balance Performance on Force Platform Measures in Individuals with Parkinson\u27s Disease and Healthy Adults

Introduction. Postural instability is a known contributing factor to balance dysfunction and increased fall risk in those with Parkinson’s disease (PD). Computerized posturography employing a force platform system provides objective, quantitative as- sessments of postural control impairments. This study examines balance performance as measured by force platform (FP) tests in persons with PD compared to age-matched healthy adults. Secondarily, we examine if these FP measures provide diagnostic and clinically meaningful information about the underlying balance impairments in the PD population. Methods. Participants—42 individuals with PD (Hoehn and Yahr stage 2.33 0.77) and 55 age-matched healthy adults—were assessed on three standardized balance measures on a computerized force platform system. Between groups, comparisons of FP performance were analyzed using independent t-test. Within the group, comparisons for the PD cohort were analyzed using ANOVA for comparing disease stage and Mann–Whitney U test for PD subtypes. Results. The PD cohort demonstrated significantly greater postural instability on the sensory organization test (SOT) measures (P 0.013, CI-95% 1.286 to 10.37) and slower movement velocity on the limits of stability (LOS) test (P 0.001, CI-95% 0.597 to 1.595) than the healthy cohort, suggesting that these tests were sensitive to detect sensory integration and voluntary postural control deficits in the PD cohort. Within the PD group, the SOT differentiated between H&Y stages 1–3. The motor control test (MCT) detected changes in reactive postural control mainly in later disease stages. All three FP tests distinguished between PD subtypes, with the Posture Gait Instability subtype demonstrating poorer balance performance than Tremor Dominant subtype. Conclusion. These findings suggest FP measures provide clinically meaningful, diagnostic information in the examination of balance impairments in individuals with PD. FP measures may inform clinicians regard sic balance deficits and guide them in designing targeted balance interventions to reduce fall risk in persons with PD

Rehabilitative devices for a top-down approach

In recent years, neurorehabilitation has moved from a "bottom-up" to a "top down" approach. This change has also involved the technological devices developed for motor and cognitive rehabilitation. It implies that during a task or during therapeutic exercises, new "top-down" approaches are being used to stimulate the brain in a more direct way to elicit plasticity-mediated motor re-learning. This is opposed to "Bottom up" approaches, which act at the physical level and attempt to bring about changes at the level of the central neural system. Areas covered: In the present unsystematic review, we present the most promising innovative technological devices that can effectively support rehabilitation based on a top-down approach, according to the most recent neuroscientific and neurocognitive findings. In particular, we explore if and how the use of new technological devices comprising serious exergames, virtual reality, robots, brain computer interfaces, rhythmic music and biofeedback devices might provide a top-down based approach. Expert commentary: Motor and cognitive systems are strongly harnessed in humans and thus cannot be separated in neurorehabilitation. Recently developed technologies in motor-cognitive rehabilitation might have a greater positive effect than conventional therapies

Cognitive and cognitive-motor interventions affecting physical functioning: A systematic review

Background Several types of cognitive or combined cognitive-motor intervention types that might influence physical functions have been proposed in the past: training of dual-tasking abilities, and improving cognitive function through behavioral interventions or the use of computer games. The objective of this systematic review was to examine the literature regarding the use of cognitive and cognitive-motor interventions to improve physical functioning in older adults or people with neurological impairments that are similar to cognitive impairments seen in aging. The aim was to identify potentially promising methods that might be used in future intervention type studies for older adults. Methods A systematic search was conducted for the Medline/Premedline, PsycINFO, CINAHL and EMBASE databases. The search was focused on older adults over the age of 65. To increase the number of articles for review, we also included those discussing adult patients with neurological impairments due to trauma, as these cognitive impairments are similar to those seen in the aging population. The search was restricted to English, German and French language literature without any limitation of publication date or restriction by study design. Cognitive or cognitive-motor interventions were defined as dual-tasking, virtual reality exercise, cognitive exercise, or a combination of these. Results 28 articles met our inclusion criteria. Three articles used an isolated cognitive rehabilitation intervention, seven articles used a dual-task intervention and 19 applied a computerized intervention. There is evidence to suggest that cognitive or motor-cognitive methods positively affects physical functioning, such as postural control, walking abilities and general functions of the upper and lower extremities, respectively. The majority of the included studies resulted in improvements of the assessed functional outcome measures. Conclusions The current evidence on the effectiveness of cognitive or motor-cognitive interventions to improve physical functioning in older adults or people with neurological impairments is limited. The heterogeneity of the studies published so far does not allow defining the training methodology with the greatest effectiveness. This review nevertheless provides important foundational information in order to encourage further development of novel cognitive or cognitive-motor interventions, preferably with a randomized control design. Future research that aims to examine the relation between improvements in cognitive skills and the translation to better performance on selected physical tasks should explicitly take the relation between the cognitive and physical skills into account.ISSN:1471-231