Does physiotherapy plus cognitive training improve balance in Parkinsons disease? Randomized clinical trial

Abstract Aims: Postural instability is intrinsically related to cognitive dysfunctions in Parkinson's disease (PD), which supports the importance of multimodal treatments. The purpose of this study was to investigate the effectiveness of adding cognitive training to motor physiotherapy in comparison with motor physiotherapy in the balance of individuals with PD. Methods: randomized clinical trial, where the individuals were randomized to two treatments: Physiotherapy Group (PG; n=29; M=12; HY= 2.5 [2-3]) executed balance training; Physiotherapy plus Cognitive Training Group (PCG; n=29; 10M; HY= 2.5 [1.5-3]), balance training plus a cognitive training at the end of the therapy. Evaluation instruments: Balance Evaluation Systems Test (BESTest); Unified Parkinson Disease Rating Scale (UPDRS). Results: The intragroup analysis revealed that both groups presented improved balance and UPDRS total score after execution of the protocols, but without statistically significant intergroup differences. The effect sizes were small for all the comparisons. Conclusion: There was no difference between the proposed treatments (PCG and PG). However, both interventions benefitted the individuals' balance and signs and symptoms of PD, when considered the time effect.

Efficacy of neurofunctional versus resistance training in improving gait and quality of life among patients with Parkinson's disease: a randomized clinical trial

Abstract AIMS to compare the efficacy of neurofunctional training versus resistance training in improving gait and quality of life among patients with PD METHODS This randomized controlled trial included 40 participants randomly assigned to two groups through random number table generator: resistance training (RT) (n=19) and neurofunctional training (NT) (n=21). The RT group performed resistance exercises emphasizing the lower limbs and trunk, while the NT group sessions were focused on gait, functional independence and balance training. Trained physical therapists supervised both groups. The training sessions lasted 60 minutes in each group and were performed twice a week, totalizing 24 sessions. The outcomes, gait and quality of life, were measured using video gait analysis and footprint analysis; and PDQL and PDQ-39 questionnaires, respectively RESULTS intra-group comparison revealed all gait variables (stride length, step length, number of steps, time of distance walked, gait speed and cadence) improved after the NT intervention with large effect size, while only stride length improved in the RT group with moderate effect size. The between group analyses means (Δ) shows that all the variables presented statistically significant differences in the NT group. Additionally, both groups showed significant improvements in quality of life. CONCLUSIONS The application of specific neurofunctional training, directed and enriched with sensorial resources, resulted in superior gait performance among individuals with PD when compared to those in the resistance training group; both treatments were efficacious in improving quality of life.

Comparison of three physical therapy interventions with an emphasis on the gait of individuals with Parkinson's disease / Comparação de três intervenções fisioterapêuticas com ênfase na marcha de indivíduos com doença de Parkinson

Abstract Introduction: Gait impairments are one of the earliest signs reported by patients with Parkinson's disease (PD) and cause an increased number of falls and decreased quality of life among these patients. Objective: To compare the effectiveness of three physical therapy interventions using Rhythmic Cues (RC), Swiss Ball (SB) and Dual Task (DT), with an emphasis on gait treatment (step and stride length, duration and velocity), in individuals with PD. Methods: Quasi-randomized clinical trial addressing a sample composed of 45 individuals assigned to three groups. The individuals were assessed before and after the intervention protocol using the following: Modified Hoehn and Yahr Scale (HY), Unified Parkinson's Disease Rating Scale (UPDRS), Footprint analysis, Video Gait analysis, and Timed Up and Go Test (TUG). The groups were homogeneous concerning age, HY and UPDRS. Statistical analysis was performed using SPSS, version 20.0. Results: Statistically significant differences were found in all the variables analyzed in the RC and SB groups when compared in the pre- and post-intervention. With the exception of the TUG variable, the DT group presented statistically significant differences in all the remaining variables. Conclusion: The three interventions were effective for the outcomes under study, but the SB group presented the greatest magnitude of change (effect size), while the RC group presented the greatest improvement in the temporal gait variables (duration and velocity) and TUG.

Resumo Introdução: As alterações na marcha são um dos sinais relatados mais precocemente pelos pacientes com doença de Parkinson (DP), ocasionando aumento do número de quedas e redução da qualidade de vida desses indivíduos. Objetivo: Comparar a efetividade de três intervenções fisioterapêuticas utilizando Pistas Rítmicas (RC), Bola Suíça (SB) e Dupla Tarefa (DT) com ênfase no tratamento da marcha (tamanho do passo, da passada, tempo e velocidade) em indivíduos com DP. Métodos: Foi realizado estudo do tipo ensaio clínico quase randomizado, com casuística composta por 45 indivíduos, divididos nos três grupos. Os indivíduos foram avaliados antes e após o protocolo de intervenção pelos seguintes instrumentos: Escala de Hoehn & Yahr Modificada (HY), Escala Unificada de Avaliação da doença de Parkinson (UPDRS), Teste de impressão plantar (footprint), Análise de marcha por vídeo e Teste Timed Up and Go (TUG). Os grupos eram homogêneos em relação à idade, HY e UPDRS. Para análise estatística foi utilizado o programa SPSS 20. Resultados: Foram encontradas diferenças estatisticamente significantes em todas as variáveis analisadas no RC e SB quando comparados os valores pré e pós intervenção. No DT, as variáveis também apresentaram diferenças estatisticamente significantes, exceto o TUG. Conclusão: As três intervenções foram efetivas para os desfechos estudados, porém o grupo que apresentou maior magnitude de mudança (tamanho do efeito) foi o SB, enquanto o RC apresentou maior porcentagem de melhora nas variáveis temporais da marcha (tempo e velocidade), bem como no TUG.

Desempenho cognitivo-perceptual de indivíduos com doença de Parkinson submetidos à fisioterapia / Cognitive-perceptual performance of subjects with Parkinson's disease submitted to physiotherapy

Objetivo: Verificar a efetividade da fisioterapia no sistema cognitivo-perceptual de indivíduos com doença de Parkinson (DP). Métodos: Trata-se de série de casos prospectiva, composta por 16 indivíduos com DP, entre os estágios 1,5 a 3 na escala de Hoehn e Yahr modificada (HY), avaliados antes, ao final e três meses pós-intervenção (follow up) utilizando-se os seguintes instrumentos: Escala Unificada para Avaliação da DP, Escala de Estadiamento HY modificada, Escala de Depressão Geriátrica (GDS), Mini-exame do estado mental (MEEM), Índice de Katz e duas ilustrações visomotoras. Receberam intervenção fisioterapêutica totalizando 20 sessões visando a melhora do sistema cognitivo-perceptual. Resultados: Foram encontradas diferenças estatisticamente significantes entre os valores pré e pós (P=0,03) e entre o pós e o follow up (P=0,03) para a execução das duas ilustrações visomotoras. Quanto aos demais desfechos não foram encontradas diferenças significantes. Conclusão: A intervenção realizada foi efetiva para o sistema perceptual em indivíduos com DP. Entretanto, não foram observadas diferenças estatisticamente significantes entre os valores dos três momentos de avaliação nas escalas MEEM, GDS e Índice de Katz.

Objective: To investigate the effectiveness of physiotherapy in the cognitive-perceptual system of individuals with Parkinson's disease. Methods: This is a prospective case series, consisting of 16 individuals with PD between stages 1.5 to 3 on the Hoehn and Yahr scale, assessed before, at the end, and later than three months after the intervention (follow up) using the following instruments: Unified Parkinson's Disease Rating Scale, Degree of Disability Scale of Hoehn and Yahr, Geriatric Depression Scale, Mini Mental Test, the Katz Index, and two visuomotor graphics. A physiotherapy intervention, totaling 20 sessions targeting the improvement of cognitive-perceptual system, was received. Results: Statistically significant differences were found between pre and post (P=0.03) and between post and follow up (P=0.03) for the implementation of the two visuomotor graphics. As for the other outcomes, no significant differences were found. Conclusion: The intervention was made effective for the perceptual system in individuals with PD. However, no statistically significant differences were found between the values of the three evaluation moments in the MMSE scale, GDS and Katz Index.