How does the treadmill affect gait in Parkinson’s disease?

[Abstract] Parkinson’s disease (PD) is clinically characterized by symptoms of akinesia, rigidity, and resting tremor, which are related to a dopaminergic deficiency of the nigrostriatal pathway. Disorders of gait are common symptoms of PD that affect the quality of life in these patients. One of the main focuses of physical rehabilitation in PD is to improve the gait deficits in the patients. In the last decade, a small number of studies have investigated the use of the treadmill for the rehabilitation of gait in PD patients. Although, the results of these studies are promising, the mechanisms underlying the therapeutic effect of the treadmill in PD are still largely unknown. This paper reviews 10 years of investigation of treadmill training in PD, focusing on the possible mechanisms involved in the therapeutic effect of the treadmill. Understanding these mechanisms may improve the prescription and design of physical therapy programs for PD patients.Ministerio de Ciencia e Innovación; PSI2008-03175Xunta de Galicia; 2009/00

Transcranial magnetic stimulation over dorsolateral prefrontal cortex in Parkinson’s disease

[Abstract] Objective Several studies have shown that repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) is effective in the treatment of depression in patients with Parkinson disease (PD). However, since research into the effect of this type of rTMS regime on motor function is limited, we studied the effect of rTMS over the DLPFC on the motor functions in PD patients. Methods Thirteen patients were randomly assigned into 2 groups, one receiving real-rTMS (90% of resting motor threshold, 10 Hz, 450 pulses-day for 10 consecutive days) over the DLPFC contralateral to the more affected side, and the other group receiving sham-rTMS. Assessment included a clinical motor evaluation using part III of the Unified Parkinson’s Disease Rating Scale (UPDRS), and several motor tasks. The UPDRS was applied before and after 10 days of rTMS. Finger tapping, reach movement, grip movement and gait were measured in each session before and after the rTMS over the 10 day period. Results Statistical analysis (ANOVA for repeated measures; group ∗ day ∗ side ∗ rTMS) only showed a significant effect for finger tapping, reach movement and gait for the factor day. No significant change was reported for the UPDRS in any group. Conclusions Application of rTMS over the DLPFC as a 10 day course had no significant effect on motor functions and clinical motor status, and the improvement in performance of motor tasks can be attributed to the effects of practice. Significance rTMS over the DLPFC did not lead to any motor improvement in PD patients

A therapeutic exercise program improves pain and physical dimension of health-related quality of life in young adults: a randomized controlled trial

Original Research[Abstract] Objective. The aim of this study was to evaluate the effects of an exercise therapy program on pain and physical dimension of health-related quality of life for young adults with musculoskeletal pain. Design. This is a randomized controlled single-blind trial. Fifty-seven subjects (58% women) were randomly assigned to experimental [n = 28, 21.4 (2.9) yrs] and control [n = 29, 21.0 (4.2) yrs] groups. The experimental group participated in a 9-wk stabilization exercise therapy program, 60 mins/wk, whereas the control group did not exercise, with a preintervention and postintervention assessment. Primary outcome was Physical Component Summary of SF-36. Secondary outcomes were Nordic Musculoskeletal Questionnaire, Visual Analogue Scale, Oswestry Disability Index, Neck Disability Index, and Trunk Flexor Endurance Test. The Shapiro-Wilk, independent t test or Mann-Whitney U test, X2, or Fisher's exact test were used for statistical analysis. Results. After intervention, the experimental group improved by 3.2 (4.5) points on the Physical Component Summary (P = 0.01), decreased prevalence of low back pain in the last month (P = 0.02) and cervical disability (P = 0.02), and increased flexor trunk endurance (P = 0.005). Conclusions. This study confirmed that a 9-wk progressive exercise therapy program can improve physical health and reduce the prevalence of cervical disability and low back pain in the last month in young adults with musculoskeletal pain. Musculoskeletal pain (MSP) is a significant health problem in society and has been shown to have a major impact on health-related quality of life, for both physical and mental health (MH),1–3 and this may be even more relevant in a young population. Most people who experience this type of pain go on to have recurrent episodes.3 The prevalence of MSP in younger people, such as university students, has increased significantly in the last decade because of different factors such as sedentary lifestyle with increased use of computers, low physical activity levels, poor sleeping habits, or psychosocial factors.4 The most common locations with symptoms include neck and shoulder regions, lumbar region, and simultaneously in multiple other regions.4 They may have a number of negative effects, including more generalized and chronic pain.1,2 Considering the increasingly higher prevalence of MSP in young adults and the predictive value that this pain has on suffering MSP as an adult, it seems appropriate to focus greater attention on early prevention at a young age. Exercise therapy has been investigated extensively, and there is evidence that it is effective for the prevention and treatment of low back and cervical pain.5,6 Although there is limited evidence regarding the specific content of exercises, their intensity, as well as the number, duration, and frequency of sessions; the accumulated evidence5–9 on the topic provides the best indications for which and how therapeutic exercises should be used. In the case of subjects with lower back pain (LBP), the most recommended exercises consist of coordination, relaxation, and resistance of the trunk muscles,7 as well as motor control or dynamic stabilization exercises and integrated activation of the global muscles.9 In turn, in subjects with neck pain, the recommended methods involve strengthening, resistance, stretching, and stabilization exercises.6,8 Despite the available evidence regarding the effects of exercise therapy on the prevention of MSP, we have found hardly any studies that apply this to young adults.10 However, we consider that more attention should be paid to this collective because of their imminent incorporation in the labor market, and the socio-economic consequences these symptoms may have for these future workers and their employers. Taking into consideration the increase in MSP in younger persons, the evidence supporting exercise therapy for its prevention in adults, and at the same time the lack of consensus regarding the specific characteristics of the intervention program, this study aims to evaluate the effect of a progressive, multimodal therapeutic exercise program on pain, physical health, disability, and trunk flexor muscle endurance in a group of young university adults

Mechanisms Involved in Treadmill Walking Improvements in Parkinson's Disease

[Abstract] Patients with Parkinson's disease (PD) improve gait after treadmill training and while they are walking over the treadmill. However, the mechanisms of these improvements have not been addressed. We designed a treadmill simulator without a belt that could move on a walkway in a constant speed, in order to explore the mechanism underlying treadmill walking improvements in PD. All subjects were tested in three different sessions (treadmill, simulatorassisted and simulatornot assisted). In each session, subjects first walked overground and then walked using the treadmill or simulator with the hands over the handrails (simulatorassisted) or with the hands free (simulatornot assisted). Step length, cadence, double support time, swing time, support time and the coefficient of variation (CV) of step time and double support time were recorded. Over the treadmill PD patients increased their step length and reduced significantly their cadence and CV of double support time in comparison with overground walking. In the simulatorassisted condition PD patients reduced significantly the CV of double support time in comparison with overground walking. With the simulatornot assisted both groups decreased their step length and increased their cadence and CV of double support time, compared with walking overground. These findings suggest that the step length improvement observed in PD patients, walking over a treadmill, is due to the proprioceptive information generated by the belt movement, since no improvement was reported when patients using a treadmill simulator.Ministerio de Ciencia e Innovación; PSI2008-03175Xunta de Galicia; 2009/00

Desarrollo de un programa de ejercicio terapéutico colaborativo, con perspectiva de género, en el grado de Fisioterapia

[Resumo] El movimiento, como agente físico aplicado con un fin terapéutico, es la base de la Cinesiterapia. Se constituye como un pilar fundamental dentro del curriculum del grado de Fisioterapia. Dentro de la asignatura “Cinesiterapia: bases del ejercicio terapéutico”, se enseña al alumnado a realizar programas de ejercicio terapéutico basados en la evidencia científica disponible, de forma grupal e individual. Con el objetivo de motivar al alumnado, y trabajar una perspectiva de género, se propone como actividad el diseño de programas de ejercicio terapéutico de forma grupal y colaborativa. El objetivo de esta experiencia es diseñar por grupos un programa de ejercicio terapéutico y favorecer un proceso de reflexión sobre las diferencias de género en la respuesta cardiovascular. Esta dinámica mejora la motivación de los estudiantes y su participación en el proceso de aprendizaje.[Abstract] Movement, as a physical agent applied with a therapeutic goal, is the basis of Kinesiotherapy. It is a fundamental pillar of the curriculum of Physiotherapy degree program. Within the subject “Kinesiotherapy: basis of therapeutic exercise”, the students learn how to design programs of therapeutic exercise based on the available scientific evidence. The design of therapeutic exercise programs is proposed, in order to motivate the students, and working on a gender perspective. It´s stablished as a grupal and collaborative activity. The outcome of this experience is designing in groups a therapeutic exercise program and a reflexion proccess about gender differences in the cardiovascular response. This dynamic implies the reflexion about the different cardiovascular responses and adaptations of women to exercise, and also how to desing justified activities for them. This activity improves motivation and participation of the students.http://hdl.handle.net/2183/2879

Spatiotemporal parameters of gait during treadmill and overground walking in Parkinson's disease

[Abstract] Despite the increasing number of studies that have examined the therapeutic effect of treadmill training programs in Parkinson's disease (PD), there has been little research to evaluate the modifications of gait induced by treadmill walking. We investigated spatiotemporal differences between treadmill and overground walking in patients with PD. PD patients significantly increased their step length and step height; and reduced their cadence, step width and step width variability on the treadmill in comparison with walking overground. PD patients are able to attenuate their short shuffling steps when walking on a treadmill.Ministerio de Ciencia e Innovación; DEP2011-2246

Realización de un dossier colaborativo sobre estiramientos en el grado de Fisioterapia

[Resumo] El movimiento, como agente físico aplicado con un fin terapéutico, es la base de la Cinesiterapia. Se constituye como un pilar fundamental dentro del curriculum del grado de Fisioterapia. Dentro de la asignatura “Cinesiterapia: bases del ejercicio terapéutico”, se desarrolla el aprendizaje de distintas técnicas basadas en la utilización del movimiento, como agente terapéutico. Para abordar la docencia práctica de la materia, se realiza un dossier con imágenes de la ejecución de estiramientos neuromusculares, de forma colaborativa. Esta metodología docente facilita la motivación del alumnado y su participación en el desarrollo de materiales nuevos de aprendizaje, construidos de forma grupal.[Abstract] Movement, as a physical agent applied with a therapeutic goal, is the basis of Kinesiotherapy. It is a fundamental pillar of the curriculum of Physiotherapy degree program. Within the subject “Kinesiotherapy: basis of therapeutic exercise”, the learning of different techniques based on the use of movement as a therapeutic agent is developed. In order to approach the practical training, the students and the university professors desing a collaborative dossier about execution of neuromuscular stretching techniques. This teaching methodology facilitates motivation and participation of the students in the development of new learning materials, built in group.http://hdl.handle.net/2183/2879

Gait pattern and cognitive performance during treadmill walking in Parkinson disease

[Abstract] Objective: The aim of this study was to explore whether attentional demands are involved in gait improvements in Parkinson disease (PD) patients when they walk on a treadmill. Design: Nineteen individuals with idiopathic PD and 19 age-matched healthy controls participated in this study. Participants walked on a treadmill and on overground under single task (walk only) and dual task (walk performing a simultaneous cognitive task) conditions. The dual-task paradigm was used to reveal the attention allocation behavior. Gait pattern and cognitive performance was measured. Results: The PD group showed reduced gait variability when walking on a treadmill in comparison with overground. However, this reduction did not deteriorate during the dual task. Moreover, there were no differences in the cognitive performance between treadmill and overground walking. Conclusions: This study does not support the proposition attentional resource allocation as a possible mechanism for the treadmill-associated gait improvements observed in PD.Ministerio de Ciencia e Innovación; DEP2011-2246

The effects of auditory startle and nonstartle stimuli on step initiation in Parkinson's disease

[Abstract] Background. Auditory external cues enhance step initiation in Parkinson's disease (PD) patients. We wanted to explore whether a startle reaction has a comparable effect on step initiation in PD. Methods. Thirteen PD patients and 13 aged-matched controls participated in this study. Electromyography pattern and onset toe-off time during a step initiation task were recorded in response to three different stimuli: a visual imperative stimulus; visual stimulus simultaneous with a nonstartle auditory stimulus and with a startle auditory stimulus. Results. In all subjects, onset of tibialis anterior was faster in the startle auditory condition, compared with the nonstartle auditory condition. However, in the patient group, there was no difference in onset of soleus and toe-off between the startle and nonstartle conditions. Conclusions. Startle reaction in PD patients demonstrates a disordered coupling between the anticipatory postural adjustments that initiate the weight shift and the movement to initiate toe-off during step initiation.Ministerio de Ciencia e Innovación; PSI2008-0317

Additive and Emergent Catalytic Properties of Dimeric Unnatural Amino Acid Derivatives: Aldol and Conjugate Additions

Different densely substituted L- and D-proline esters were prepared by asymmetric (3+2) cycloaddition reactions catalyzed by conveniently selected EhuPhos chiral ligands. The γ-nitro-2-alkoxycarbonyl pyrrolidines thus obtained in either their endo or exo forms were functionalized and coupled to yield the corresponding γ-dipeptides. The catalytic properties of these latter dimers were examined using aldol and conjugate additions as case studies. When aldol reactions were analyzed, an additive behavior in terms of stereocontrol was observed on going from the monomers to the dimers. In contrast, in the case of the conjugate additions between ketones and nitroalkenes, the monomers did not catalyze this reaction, whereas the different γ-dipeptides promoted the formation of the corresponding Michael adducts. Therefore, in this latter case emergent catalytic properties were observed for these novel γ-dipeptides based on unnatural proline derivatives. Under certain conditions stoichiometric amounts of ketone, acid and nitroalkene), formation of N-acyloxy-2-oxooctahydro-1H-indoles was observed.Financial support for this work was provided by the Spanish Ministerio de Ciencia e Innovación (MICINN-FEDER, Grants PID2019-104772GB-100 and RED2018-102387-T) and the Gobierno Vasco/Eusko Jaurlaritza (GV/EJ, Grant IT-1346-19). A.R.-O. thanks the Ministerio de Ciencia, Innovación y Universidades for her Ph.D. grant. M.d.G.R thanks the DIPC and UPV/EHU for her postdoctoral contract