Water-based vs. non-water-based physiotherapy for rehabilitation of postural deformities in Parkinson's disease: A randomized controlled pilot study

Objective: Our aim was to evaluate the feasibility of a hydrotherapy treatment in patients with Parkinson\u2019s disease and the effectiveness of this treatment on balance parameters in comparison to a traditional landbased physical therapy. Design: A randomized single-blind controlled trial. Setting: Outpatients. Subjects: Thirty-four patients with Parkinson\u2019s disease in Hoehn-Yahr stage 2.5\u20133. Intervention: Group 1 hydrotherapy treatment, group 2 land-based rehabilitation treatment. The two groups underwent the same rehabilitation period (60 minutes of treatment, five days a week for two months). Main measures: The primary outcome measures were the centre of the pressure sway area recorded with open and closed eyes, using a stabilometric platform. Secondary outcome measures were Unified Parkinson\u2019s Disease Rating Scale II and III, Timed Up and Go Test, Berg Balance Scale, Activities-specific Balance Confidence Scale, Falls Efficacy Scale, Falls diary and Parkinson\u2019s Disease Questionnaire-39. Results: Hydrotherapy treatment proved to be feasible and safe. Patients in both groups had a significant improvement in all outcome variables. There was a better improvement in patients who underwent hydrotherapy than in patients treated with land-based therapy in the centre of pressure sway area closed eyes (mean SD change: 45.4 SD64.9 vs. 6.9 SD45.3, p = 0.05), Berg Balance Scale (51.2 SD3.1 vs. 6.0 SD3.1, p = 0.005), Activities-specific Balance Confidence Scale (16.8 SD10.6 vs. 4.1 SD5.4, p = 0.0001), Falls Efficacy Scale ( 125.9 SD4.8 vs. 121.9 SD1.4, p = 0.003), Parkinson\u2019s Disease Quetionnaire-39 ( 1218.4 SD12.9 vs. 128.0 SD7.0, p = 0.006) and falls diary ( 122.4 SD2.2 vs. 120.4 SD0.5, p = 0.001)

Overground robot assisted gait trainer for the treatment of drug-resistant freezing of gait in Parkinson disease

Freezing of Gait (FOG) is a frequent and disabling feature of Parkinson disease (PD). Gait rehabilitation assisted by electromechanical devices, such as training on treadmill associated with sensory cues or assisted by gait orthosis have been shown to improve FOG. Overground robot assisted gait training (RGT) has been recently tested in patients with PD with improvement of several gait parameters. We here evaluated the effectiveness of RGT on FOG severity and gait abnormalities in PD patients. Eighteen patients with FOG resistant to dopaminergic medications were treated with 15 sessions of RGT and underwent an extensive clinical evaluation before and after treatment. The main outcome measures were FOG questionnaire (FOGQ) global score and specific tasks for gait assessment, namely 10 meter walking test (10 MWT), Timed Up and Go test (TUG) and 360\ub0 narrow turns (360 NT). Balance was also evaluated through Fear of Falling Efficacy Scale (FFES), assessing self perceived stability and Berg Balance Scale (BBS), for objective examination. After treatment, FOGQ score was significantly reduced (P=0.023). We also found a significant reduction of time needed to complete TUG, 10 MWT, and 360 NT (P=0.009, 0.004 and 0.04, respectively). By contrast the number of steps and the number of freezing episodes recorded at each gait task did not change. FFES and BBS scores also improved, with positive repercussions on performance on daily activity and quality of life. Our results indicate that RGT is a useful strategy for the treatment of drug refractory FOG

Investigating the brain mechanisms of externally cued sit-to-stand movement in Parkinson's disease

Background: One of the more challenging daily-life actions for Parkinson’s disease patients is starting to stand from a sitting position. Parkinson’s patients are known to have difficulty with self-initiated movements and benefit from external cues. However, the brain processes underlying external cueing as an aid remain unknown. The advent of mobile EEG now enables the investigation of these processes in dynamic sit-to-stand movements.Objective: To identify cortical correlates of the mechanisms underlying auditory cued sit-to-stand movement in Parkinson’s disease.Methods: 22 Parkinson’s disease patients and 24 healthy age-matched participants performed self- initiated and externally cued sit-to-stand movements while cortical activity was recorded through 32-channel mobile EEG.Results: Overall impaired integration of sensory and motor information can be seen in the Parkinson’s patients exhibiting less modulation in the theta band during movement compared to healthy age-matched controls. How Parkinson’s patients utilize external cueing of sit-to-stand movements can be seen in larger high beta power over sensorimotor brain areas compared to healthy controls, signaling sensory integration supporting the maintenance of motor output. This appears to require changes in cognitive processing allocation of cognitive resources to update the motor plan, reflected in frontal theta power increases in Parkinson’s patients when cued.Conclusion: These findings provide the first neural evidence for why and how cueing improves motor function in sit-to-stand movement in Parkinson’s disease. The Parkinson’s patients’ neural correlates indicate that cueing induces greater activation of motor cortical areas supporting the maintenance of a more stable motor output, but involves the use of cognitive resources to update the motor plan