Extensor and flexor muscle strength (peak torque) at 90°/s, 120°/s and 180°/s in Patients and Controls.

<p>Peak torque values are expressed in Newton Metre (N·m).</p><p>Extensor and flexor muscle strength (peak torque) at 90°/s, 120°/s and 180°/s in Patients and Controls.</p

Rehabilitation in progressive supranuclear palsy: Effectiveness of two multidisciplinary treatments

<div><p>Background</p><p>to date, there are no medical or surgical treatments for progressive supranuclear palsy (PSP). It is possible to speculate that patients with PSP could benefit from rehabilitative treatments designed for Parkinson’s disease, including the use of robot-assisted walking training.</p><p>Objective</p><p>to evaluate whether the use of the robotic device Lokomat® is superior in PSP patients to the use of treadmill with visual cues and auditory feedbacks (treadmill-plus) in the context of an aerobic, multidisciplinary, intensive, motor-cognitive and goal-based rehabilitation treatment (MIRT) conceived for Parkinsonian patients.</p><p>Methods</p><p>we enrolled twenty-four PSP patients. Twelve subjects underwent a 4-week MIRT exploiting the use of the treadmill-plus (MIRT group). Twelve subjects underwent the same treatment, but replacing the treadmill-plus with Lokomat® (MIRT-Lokomat group). Subjects were evaluated with clinical and functional scales at admission and discharge. The primary outcomes were the total PSP Rating Scale (PSPRS) score and its “limb” and “gait” sub-scores. Secondary outcomes were Berg Balance Scale (BBS), Six Minutes Walking test (6MWT) and the number of falls.</p><p>Results</p><p>total PSPRS, PSPRS-gait sub-score, BBS, 6MWT and number of falls improved significantly in both groups (p ≤ 0.003 all, except 6MWT, p = 0.032 and p = 0.018 in MIRT-Lokomat and MIRT group respectively). The PSPRS-limb sub-score improved significantly only in the MIRT group (p = 0.002). A significant difference between groups was observed only for total PSPRS, indicating a slightly better improvement for patients in the MIRT group (p = 0.047). No differences between groups were revealed for the other outcomes, indicating that the effect of rehabilitation was similar in both groups.</p><p>Conclusions</p><p>Lokomat<b>®</b> training, in comparison with treadmill-plus training, does not provide further benefits in PSP patients undergoing MIRT. Our findings suggest the usefulness of an aerobic, multidisciplinary, intensive, motor-cognitive and goal-based approach for the rehabilitation of patients suffering from such a complex disease as PSP.</p><p>Trial Registration</p><p>This trial was registered on ClinicalTrials.gov, <a href="https://clinicaltrials.gov/ct2/show/NCT02109393" target="_blank">NCT02109393</a>.</p></div

CONSORT flow diagram.

<p>CONSORT flow diagram.</p

Demographic and clinical data of patients and controls.

<p><i>Abbreviations</i>: <i>BMI (Boby Mass Index); UPDRS (Unified Parkinson's Disease Rating Scale); MMSE (Mini Mental State Examination)</i>.</p><p>Demographic and clinical data of patients and controls.</p

Extensor and flexor strength (peak torque) at 90°/s, 120°/s and 180°/s in PD patients predominately affected on the left and on the right side (Left PD and Right PD, respectively), and controls.

<p>Peak torque values are expressed in Newton Metre (N·m). P value is from the group comparison (Kruskal Wallis test).</p><p>Extensor and flexor strength (peak torque) at 90°/s, 120°/s and 180°/s in PD patients predominately affected on the left and on the right side (Left PD and Right PD, respectively), and controls.</p

Demographic and clinical characteristics of patients assigned to MIRT group and MIRT-Lokomat group.

<p>Reported p-values are computed by the Chi-square test for the variable Sex, by unpaired t-test for age, LED, weight, height, disease duration and by the Mann–Whitney U test for all the other variables. Data are reported as median (lower quartile, upper quartile) or mean±SD for non-normally and normally data respectively and as number (frequency percentage) for discrete variables.</p

Comparison between right affected and left affected PD patients.

<p><i>Abbreviations</i>: <i>BMI (Boby Mass Index); UPDRS (Unified Parkinson's Disease Rating Scale); MMSE (Mini Mental State Examination); PD (Parkinson’s disease)</i>.</p><p>Comparison between right affected and left affected PD patients.</p

Baseline and end of treatment values of outcome variables for both groups of patients.

<p>Reported p-values are computed by the Wilcoxon signed rank test. Data are reported as median (lower quartile, upper quartile).</p

Difference (discharge-admission) of the outcome variables for MIRT+Lokomat group and MIRT group and effect size.

<p>Reported p-values are computed by the Mann–Whitney U test.</p

Mechanical Energy Recovery during Walking in Patients with Parkinson Disease

<div><p>The mechanisms of mechanical energy recovery during gait have been thoroughly investigated in healthy subjects, but never described in patients with Parkinson disease (PD). The aim of this study was to investigate whether such mechanisms are preserved in PD patients despite an altered pattern of locomotion. We consecutively enrolled 23 PD patients (mean age 64±9 years) with bilateral symptoms (H&Y ≥II) if able to walk unassisted in medication-off condition (overnight suspension of all dopaminergic drugs). Ten healthy subjects (mean age 62±3 years) walked both at their ‘preferred’ and ‘slow’ speeds, to match the whole range of PD velocities. Kinematic data were recorded by means of an optoelectronic motion analyzer. For each stride we computed spatio-temporal parameters, time-course and range of motion (ROM) of hip, knee and ankle joint angles. We also measured kinetic (W_k), potential (W_p), total (W_totCM) energy variations and the energy recovery index (ER). Along with PD progression, we found a significant correlation of W_totCM and W_p with knee ROM and in particular with knee extension in terminal stance phase. W_k and ER were instead mainly related to gait velocity. In PD subjects, the reduction of knee ROM significantly diminished both W_p and W_totCM. Rehabilitation treatments should possibly integrate passive and active mobilization of knee to prevent a reduction of gait-related energetic components.</p></div