Comparison between the effects of dual task performance [motor and cognitive] and visual cueing on gait parameters in parkinson's disease patients

The aims of this study were to investigate the effects of dual task performance on gait parameters in parkinson's disease. To find if the type of secondary task either motor or cognitive affects gait parameters more than the other. Furthermore, the effect of visual cues on the gait parameters was studied. Fifteen patients with idiopathic parkinson's disease participated in this study. Qualisys motion capture system was used to measure stride length [meter], walking speed [meter/second] and cadence [steps/minute] for each patient. Gait parameters were measured under the following conditions: 1] baseline, 2] with motor task, 3] with cognitive task and 4] with the use of visual cues. The results of this study showed a significant decrease in speed, cadence and stride length with motor and cognitive tasks. A non-significant difference was found between motor and cognitive tasks on the gait parameters studied. The use of visual cues resulted in a significant improvement in speed, cadence and stride length. These results imply that dual task performance compromises gait and therefore should be avoided for better gait functions. On the other hand the use of visual cuing should take part in the rehabilitaiion program to improve the gait pattern

Early morning versus early afternoon changes in fatigue and gait parameters in multiple sclerosis patients

Fatigue is a common symptom of multiple sclerosis patients even in the early phases of the disease process. Approximately 75% of multiple sclerosis patients experience gait problems. This study evaluated the within day variation in fatigue and gait performance in thirty multiple sclerosis patients with definite diagnosis. Patients; mean age was 43 +/- 6.5 years, mean disease duration was 7.4 +/- 4.6 and mean Expanded disability Status Scale was 3.7 +/- 1. Fatigue was assessed by fatigue severity scale that consists of nine items on seven point scale. Gait performance was assessed by gait speed, stride length and cadence which were measured by Qualisys motion capture system. The patients were assessed on two different time zones namely: Early morning and early afternoon. The results of this study revealed that the fatigue severity scale scores significantly increased while the gait parameters significantly decreased in the afternoon in relation to the morning. Negative significant correlation was found between fatigue severity scale and gait parameters. In addition positive correlation was noticed in diurnal variation of fatigue severity scale and gait performance. It can be concluded that as fatigue levels changes with time zones within the same day; being higher in the afternoon than in the morning, reflected on gait parameters which were also reduced in the afternoon than in the morning, so it is preferable to schedule MS treatment physiotherapy sessions early in the morning, as this guarantees maximum benefits for such patients

Effectiveness of neuromuscular rehabilitation in multiple sclerosis patients on balance and walking ability

Multiple sclerosis [MS] is a chronic, progressive neurological disease with a clinical course that may result in severe disability. It is characterized by movement, balance and walking impairment. In the past, physical therapy management of MS focused on passive treatment to avoid exacerbating fatigue or the disease process. Current research is demonstrating overwhelming benefits when MS patients perform exercise. The aim of this study was to investigate the effectiveness of neuromuscular rehabilitation program on MS patients with cerebello-pyramidal manifestations. Twenty five patients diagnosed as clinically definite MS were recruited from the out patient Department of Neurology, Kasr El-Aini hospital, Cairo University. They were 14 females and 11 males; their mean age was 41.6 +/- 7.9; mean duration of illness was 4.5 +/- 2.7 years and the mean Expanded Disability Status Scale [EDSS] was 4.9 +/- .912. Assessment was done in the morning before beginning the treatment program and after seven weeks of treatment. Six Spot Step Test is a quantitative assessment of lower extremity function, which is measured in the time domain by digital stop watch. Biodex stability system is an objective assessment of balance. The overall stability index was used as a measure of postural stability. Patients were assessed with bilateral stance at level 8 [most stable] over a period of 20 seconds. The neuromuscular rehabilitation program consisted of: rhythmic stabilization of proprioceptive neuromuscular facilitation [PNF], slow reversal of PNF, Frenkel's coordination exercises in supine, sitting and standing positions, static and dynamic balance training in crawling, kneeling and half kneeling positions, static and dynamic balance training by means of external postural perturbation, weight shift to both extremities and to the posterior part of feet while standing with feet together, in tandem stance, single limb support and Cawthorne-Cooksey exercises. Patients received the program three times per week for seven weeks. The results of this study showed the effectiveness of neuromuscular rehabilitation program in improving both the walking ability [p=.001] and balance [p=.001] in MS patients. Moreover weak non significant correlation was found between the tested variables and EDSS