The Efficacy of Exercise Programs for Parkinson's Disease: Tai Chi versus Combined Exercise

BACKGROUND AND PURPOSE: Exercise is recommended for every patient with Parkinson's disease (PD). The effectiveness of two different forms of exercise for PD, Tai Chi and combined stretching-strengthening exercise, was compared. METHODS: Patients with mild-to-moderate PD were recruited to join either the combined stretching-strengthening exercise group (n=7), the Tai Chi group (n=9), or the control (nonintervention) group (n=7). Exercise was performed three times a week over a period of 8 weeks. The Tai Chi exercise was led by certified instructors based on a Tai-Chi-for-arthritis program. The combined stretching-strengthening exercise comprised folk dancing, stepping, and elastic-band exercises. The subjects' functional fitness, parkinsonian symptoms, quality of life (QoL), and depression were evaluated. RESULTS: Both exercise groups yielded better results in their overall functional fitness after the intervention. However, no improvement with exercise was found for parkinsonian symptoms, as evaluated using the Unified Parkinson's Disease Rating Scale. With respect to the domains of QoL, the combined stretching-strengthening exercise group fared better in the social domain of QoL, and the Tai Chi group fared better in the emotional domain, while QoL and depression worsened in the control group. The postintervention QoL was improved relative to the control condition only for the Tai Chi group. Although the exercise interventions did not have any effect on depression, the control group was associated with a significant deterioration. CONCLUSIONS: Exercise improved the functional fitness and QoL of PD patients, with Tai Chi yielding better results in QoL and favorable results in functional fitness. These findings suggest that Tai Chi could be a good exercise strategy for patients with PD.

Characteristics and Prognosis of Pusher Syndrome in Stroke Patients

OBJECTIVE: To evaluate the incidence, associated neuropsychological symptoms, imaging feature and prognosis of pusher syndrome (PS). METHOD: One hundred-ninety-seven patients with unilateral acute stroke were enrolled. Patients were evaluated for the presence and severity of PS using a standardized scale for contraversive pushing, neurological examination, assessment of neuropsychological symptoms (neglect, anosognosia, aphasia, apraxia), activities of daily living (ADL) and neuroimaging studies (CT or MRI). ADL was measured with Korean version of modified Barthel index (K-MBI). RESULTS: PS was found in 10.7% (n=21) of the included patients. No significant differences were found between patients with and without PS in age, sex, handedness, initial K-MBI score, neuropsychologic symptoms, lesion size and cortical involvement. Thalamic lesion was strongly correlated with PS (p<0.05). PS had no independent influence on gain in ADL, but spent 4.8+/-1.7 weeks (p<0.05) more to reach the same final outcome level than did patients without PS. Average symptom duration of PS was 14.6+/-3.6 weeks. Initial severity of PS did not influence on gain in ADL and recovery period. CONCLUSION: PS did not affect final functional outcome, but slowed the process of recovery considerably. And thalamus seems to be fundamentally involved in control of upright body posture. Presence of PS is more important than severity of initial PS for prognosis.

Clinical Validity of Gugging Swallowing Screen for Acute Stroke Patients

OBJECTIVE: To assess the validity of Gugging Swallowing Screen (GUSS) that allows separate evaluations for non-fluid and fluid textures for aspiration risk of acute stroke patients. METHOD: Fifty-five acute stroke patients were assessed prospectively. For interrater reliability, 2 independent physicians evaluated 40 patients in two hours. For external validity, another group of 15 patients were tested by dysphagia therapist. The validity of the GUSS was established by videofluoroscopic swallowing study (VFSS). After GUSS, all patients were investigated by VFSS within 1 hour. To compare the results of VFSS, they were graded according to the Penetration Aspiration Scale (PAS). RESULTS: The cut-off value of GUSS was 14 points and 5 stage of PAS. GUSS reached 100% sensitivity, 61.1% specificity, and 100% negative predictive value when compared with VFSS by physician A (p<0.001). By physician B, GUSS (p<0.001) reached 100% sensitivity and 60.0% specificity, and 100% negative predictive value and 100%, 85.7%, 88.9%, 100%, in the 15 patient group (p<0.05). The kappa-value was 0.916 between physician A and B (p<0.05). CONCLUSION: This study proposes that GUSS is a reliable method in identifying stroke patients with aspiration risk. Such a graded assessment can provide less discomfort for those patients who can continue with their oral feeding for semisolid food while refraining from drinking fluids.

Computerized Analysis of Postural Instability in Parkinson's Disease

OBJECTIVE: To evaluate and quantify the postural instability in patients with Parkinson's disease (PD) using computerized posturography. METHOD: Twenty subjects with PD group (10 men, 10 women) and 20 control group (10 men, 10 women) were matched for age and sex. Average Hoehn-Yahr stage of PD group was 2.3+/-0.3. Sensory dysfunction, voluntary motor impairments and functional limitation were measured by determining the subject's response to reduced or altered sensory and voluntary motor control of balance. RESULTS: PD subjects demonstrated wider area of sway (degrees) under eye closed condition in modified sensory organization test and lower directional control (%) in right/left rhythmic weight shift (p<0.05). No significant difference was observed for sit to stand. Wider area of turn sway (degrees) and longer turn time (sec) during left step/quick turn were demonstrated in PD subjects (p<0.05). CONCLUSION: Computerized posturography shows that sensory dysfunction scores, voluntary motor impairment scores and functional limitation test scores were reduced in patients with PD.

Effects of Exercise Therapy on Natural Killer Cell Cytotoxic Activity in Breast Cancer Patients after Curative Surgery

OBJECTIVE: Exercise may contribute to alteration in cancer in many ways. The major cell in cellular immunity to defense against cancer cell is natural killer [NK] cell. So this study is aimed to investigate the effects of exercise on NK cell cytotoxic activity (NKCA) in breast cancer patients who underwent mastectomy. METHOD: Thirty-one breast cancer patients who had undergone curative surgery were randomly assigned to an exercise group (n=16) and a non-exercise group (n=15). Exercise therapy was consisted of aerobic activity such as bicycle ergometer for 30 minutes, twice a day, five times each week for 2 weeks. The venous blood samplings were obtained on postoperative days 1, 7 and 14. NKCA was assayed by cytotoxic response against K562 cells. The venous blood samplings were obtained on postoperative days 1, 7 and 14. NKCA was assayed by cytotoxic response against K562 cells. RESULT: The baseline study did not show any statistical difference between exercise group and non-exercise group. Mean NKCA of day 7 decreased in both groups compared with that at postoperative day 1 (p<0.05). At day 14, the difference of the mean NKCA between two groups was not significant, but the mean NKCA of the exercise group without metastasis demonstrated a significant increase compared with that of the non-exercise group without metastasis (p<0.05). CONCLUSION: This study suggested that early moderate exercise had a beneficial effect on the function of NK cells in early stage of breast cancer patients after curative surgery. A further study will be needed to evaluate long-term effect of exercise on NK cell.

Effects of Sitting Balance Using Visuo-perceptual Biofeedback Training in Stroke Patients

OBJECTIVE: This study was aimed to compare the effect of visuo-perceptual biofeedback sitting balance training using Balance Master in stroke patients with that of conventional sitting balance training. METHOD: The subjects were twenty-four stroke patients receiving rehabilitation therapy who could maintain sitting posture independently. These patients were randomly divided into a control and an experimental group. The ability of static postural balance control with the modified Clinical Test Sensory Interaction Balance (mCTSIB) and the weight bearing test was measured before and after the balance training. The ability of dynamic postural balance control was measured with the limit of stability (LOS) test and the rhythmic weight shift test. Motor assessment scale (MAS) and modified Barthel index (MBI) were also checked for measuring the effects. RESULT: There was significant improvement in both abilities of static and dynamic postural balance control in the experimental group that had visuo-perceptual biofeedback training using the Balance Master (p<0.05). MAS and MBI scores after the training showed a bigger increase in the experimental group than in the control group. CONCLUSION: The visuo-perceptual biofeedback sitting balance training using the Balance Master was considered to be more effective than the conventional training in the stroke patients.