Is fatigue associated with balance in Parkinson's disease?

Abstract Background: Fatigue is a disabling symptom in the spectrum of Parkinson's disease (PD), affecting from 30% to 70% of the persons. Even though it is a common symptom, with negative repercussions for PD individuals, its correlation with balance is not established. Aim: The aims of this study were to verify the correlation between fatigue and balance in individuals with PD and to compare balance in individuals with PD that presents low fatigue or high fatigue. Methods: This study included 37 individuals with PD, who were divided into two groups: low fatigue (n = 25) and high fatigue (n = 12). Fatigue was evaluated using the Parkinson's disease Fatigue Scale and a force platform was used to assess four balance tasks: bipedal, tandem with eyes open/closed, and tandem with the dual-task, in three parameters: (1) 95% confidence ellipse area of the center of pressure (COP) (2) mean velocity (3) root mean square of COP. To verify the correlation between fatigue and balance, the Spearman rank-order correlation coefficient was assessed. Comparison of medians between the groups was analyzed using the Mann-Whitney test. Results: There was no significant correlation between fatigue and balance. There was no difference between the groups with low and high fatigue. Conclusion: This study's findings, together with those reported in the literature, suggest there is no correlation between fatigue and balance, and even though individuals with PD report fatigue or experience situations of fatigue, they do not present greater posture instability than individuals with PD who do not report fatigue. Fatigue is a disabling symptom in the spectrum of Parkinson's disease (PD), affecting from

Punctual mechanical oscillation in modulation of muscular tonus in children with spasticity

Spasticity is a motor condition present in 75 to 88% of children with Cerebral Palsy (CP). One form of treatment is called punctual mechanical oscillation (PO). The current study aimed to study different protocols for the application of PO and the magnitude of their effects. In total, 7children with medical diagnosis of CP and ICD (International Classification of Diseases) were included. The first intervention protocol (Int1) consisted of the application of PO to the spastic muscle tendon and the second intervention protocol (Int2) to the muscle belly ofthe spastic antagonist muscle. For evaluation, the Modified Ashworth Scale (MAS) was used, while simultaneously capturing the mechanomyography (MMG) signals. Data were collected pre-intervention and 1 (Post1), 15 (Post15), 30 (Post30), 45 (Post45), and60 (Post60) minutes after the interventions. The MAS values (median ± interquartile range) post intervention were statistically lower when compared to the pre values in the 2 protocols studied; in Int1between Pre (2 ± 0) andPost15 (0 ± 1.75), Post30 (0 ± 1), Post45 (1 ± 1),and Post60 (1 ± 1), and in Int2only between Pre (2 ± 1) and Post1 (0 ± 1).The values found in the MMG in both its temporal and spectral domains did not follow a pattern (p>0.05). The comparison between the protocols did not demonstrate statistical differences in any characteristics (MAS, MMGMF, and MMGRMS). However, PO was shown to be a therapeutic resource that modulated spasticity for up to 60 minutes after its application, and PO could contribute as a tool to aid the treatment of spasticity.

Fatigue in Parkinsons disease: Brazilian validation of the modified fatigue impact scale / Fadiga na doença de Parkinson: validação brasileira da escala modificada de impacto da fadiga

ABSTRACT Background: The instruments that measure the impact of fatigue on physical, cognitive and psychosocial aspects has yet to be validated in Brazilian population with Parkinson's disease (PD). The aim of this study was to cross-culturally adapt and assess the psychometric properties of the Brazilian version of the Modified Fatigue Impact Scale (MFIS-PD/BR). Methods: Ninety PD individuals were recruited. The adaptation of the MFIS-PD was performed by translation and back translation methodology. Psychometric analysis was applied in order to perform the administration of the socio-clinical questionnaire, Mini-Mental State Examination (MMSE), Unified Parkinson's Disease Rating Scale (UPDRS Part I-IV), Hoehn-Yahr disability scale (HY), hospital anxiety and depression scale (HADS), Geriatric Depression Scale (GDS), fatigue severity scale (FSS), Parkinson Fatigue Scale (PFS-16), and MFIS-PD/BR with retest of the MFIS-PD/BR after 7 days. Results: The adaptation phase kept the same items of original MFIS-PD. The Cronbach's alpha for the MFIS-PD/BR was 0.878 when all responses items were scored. The test-retest intraclass correlation coefficients was above 0.80 (p<0.01) for the MFIS-PD/BR score, which was moderately correlated with the HADS, GDS, MDS-UPDRS score total and non-motor experiences of daily living, FSS and PFS-16. It was revealed the MFIS-PD/BR>29 points as cut-off point to indicate fatigued subjects with accuracy of 0.835 (p<0.001). Conclusions: The MFIS-PD/BR is valid and reproducible to use in assessing the fatigue symptom in Brazilian PD subjects.

RESUMO Introdução: Os instrumentos que mensuram o impacto da fadiga nos aspectos físicos, cognitivos e psicossociais ainda não foram validados na população brasileira com doença de Parkinson (DP). O objetivo deste estudo foi adaptar culturalmente e avaliar as propriedades psicométricas da versão brasileira da escala modificada de impacto da fadiga (MFIS-PD/BR). Métodos: Setenta indivíduos com DP foram recrutados. A adaptação do MFIS-PD foi realizada pela metodologia de tradução e retrotradução. Na análise psicométrica foi realizada a administração de questionário socioclínico, Miniexame do estado mental (Mini-Mental State Examination - MMSE), Escala Unificada de Avaliação da DP (Unified Parkinson's Disease Rating Scale - UPDRS Parte I-IV), escala de incapacidade Hoehn-Yahr (HY), escala hospitalar de ansiedade e depressão (Hospital Anxiety and Depression Scale - HADS), escala de depressão geriátrica (Geriatric Depression Scale - GDS), escala de gravidade da fadiga (Fatigue Severity Scale - FSS), escala de fadiga de Parkinson (Parkinson Fatigue Scale - PFS-16) e a MFIS-PD/BR com reteste após 7 dias. Resultados: A fase de adaptação manteve os mesmos itens do MFIS-PD original. O coeficiente alfa de Cronbach para o MFIS-PD/BR foi de 0,878 quando todos os itens das respostas foram pontuados. Os coeficientes de correlação intraclasse teste-reteste foram superiores a 0,80 (p<0,01) para o escore MFIS-PD/BR, que foi moderadamente correlacionado com o escore HADS, GDS, MDS-UPDRS, total e aspectos não-motores da vida diária, FSS e PFS-16. Foi revelado o ponto de corte do MFIS-PD/BR>29 pontos para indicar indivíduos fatigados com acurácia de 0,835 (p<0,001). Conclusões: O MFIS-PD/BR é válido e reprodutível para a avaliação do sintoma de fadiga em indivíduos brasileiros com DP.

Results of orthoses used on ambulatory patients with bilateral cerebral palsy / Resultados do uso de órteses em pacientes deambuladores com paralisia cerebral

ABSTRACT Objective: To investigate the impact of ankle-foot orthoses (AFO) on subjects diagnosed with bilateral cerebral palsy (CP) using the gait index and temporal data parameters. Methods: Twenty-four subjects, 14 male and 10 female, with a mean age of 11 (5-17 years old), underwent a comprehensive gait analysis under both barefoot (BF) and braced walking conditions. All children had been wearing the orthoses for at least 2 months before the gait analysis. Results: The overall values for the left and right Gait Profile Scores (GPS) did not show statistically significant variations when comparing the same individuals with and without orthoses. Gait velocity increased by 19.5% (p < 0.001), while the cadence decreased by 4% with use of orthosis, although it was not statistically significant (p > 0.05). The stride and the step lengths on both the right and left sides, however, resulted in statistically significant increases, when wearing AFO. Conclusion: AFO, prescribed for assistance by professionals without using gait data, did not significantly affect the gait index (GPS), but improved temporal data. The determination of quantitative clinical parameters for the prescription of orthotics in patients with bilateral CP, as well as orthotics that meet the specific requirements are points to be addressed in the future to obtain more significant effects. Level of evidence III, Case control study.

RESUMO Objetivo: Investigar o impacto das órteses suropodálicas (AFOs) utilizando índices da análise computadorizada da marcha (ACM) e dados de tempo e espaço, em indivíduos com diagnóstico de paralisia cerebral (PC) bilateral. Métodos: 24 indivíduos, 14 do sexo masculino e 10 do sexo feminino, com média de idade de 11 anos (5-17 anos), foram submetidos a uma análise da marcha, tanto na condição de andar descalço (AD) quanto com uso das órteses. Todas as crianças usavam as órteses há no mínimo 2 meses antes da ACM. Resultados: Os valores do perfil global da marcha (GPS) dos lados direito e esquerdo não apresentaram variações estatisticamente significativas quando os mesmos indivíduos foram comparados, com e sem órteses. Com o uso de órtese a velocidade da marcha aumentou 19,5% (p < 0,001), enquanto a cadência diminuiu 4%, embora não tenha sido estatisticamente significativa (p > 0,05). No entanto, com o uso da órtese, a passada e o comprimento do passo dos lados direito e esquerdo tiveram aumentos estatisticamente significativos. Conclusão: As AFOs, quando prescritas por profissionais sem o uso de dados da ACM, não alteraram significativamente o índice da marcha (GPS), mas melhoraram os dados de tempo e espaço. A determinação de parâmetros clínicos quantitativos para a prescrição de órteses em pacientes com PC bilateral, bem como órteses que atendam a requisitos específicos, são pontos a serem abordados no futuro, a fim de obter efeitos mais significativos. Nível de evidência III, Estudo de caso e controle.

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.

Brazilian version of the Multidimensional Fatigue Inventory for Parkinsons disease / Versão brasileira do Inventário Multidimensional de Fadiga na doença de Parkinson

Abstract Introduction: The multidimensional fatigue inventory (MFI) has not been applied in Brazilian Parkinson`s disease (PD) population due to the lack of validation. Objective: The aim of this study was to cross-culturally adapt, to validate, and investigate the psychometric properties of Brazilian version of the MFI in PD. Method: Idiopathic PD individuals (N = 90) were recruited. The MFI was translated into Brazilian Portuguese using established forward-backward translation procedures, and the psychometric properties were evaluated. All individuals were assessed by socio-clinical questionnaire, Mini-Mental State Examination (MMSE), Unified Parkinson's Disease Rating Scale (MDS-UPDRS Part I-IV), Hoehn-Yahr disability scale (HY), hospital anxiety and depression scale (HADS), fatigue severity scale (FSS), Parkinson Fatigue Scale (PFS-16) and MFI-PD/ BR with retest of the MFI-PD/BR after seven days. Results: The adaptation phase kept the same items of original MFI-PD. No data missing, floor nor ceiling effects were found. The overall Cronbach's alpha coefficient for the 20 items was 0.81, ranging from 0.73 to 0.81 for each of the five subscales. Bland and Altman analysis showed no systematic differences between assessments. The intraclass correlation coefficient test-retest was higher or equal 0.70 (p < 0.01) for the MFI-PD/BR score, which was moderately correlated with the HADS, MDS-UPDRS score (motor examination, motor and non-motor experiences of daily living and motor complications), FSS and PFS-16. It was revealed the MFI-PD/ BR > 55 points as cut-off point to indicate fatigued subjects with accuracy of 0.84 (p < 0.001). Conclusion: The MFI-PD/BR can be considered a valid and reproducible instrument for assessing PD-related fatigue.

Resumo Introdução: O inventário multidimensional da fadiga (MFI) não tem sido administrado em indivíduos brasileiros com doença de Parkinson (DP) devido à falta de validação. Objetivo: Adaptar transculturalmente, validar e investigar as propriedades psicométricas da versão brasileira do MFI na DP. Método: Foram recrutados indivíduos com DP (N=90). O MFI foi traduzido para o português falado no Brasil usando procedimentos de tradução e retrotradução e as propriedades psicométricas foram avaliadas. Todos os indivíduos foram avaliados por meio de um questionário sócio-clínico, mini-exame do estado mental (MEEM), escala modificada de avaliação na DP (MDS-UPDRS Parte I-IV), escala de incapacidade de Hoehn-Yahr (HY), escala de ansiedade e depressão (HADS), escala de gravidade de fadiga (FSS), escala de fadiga da DP (PFS-16) e MFI-DP/ BR com reteste do MFI-PD/BR em sete dias. Resultados: A adaptação manteve os mesmos itens do instrumento original do MFI-PD. Nenhum dado perdido, efeito chão ou teto foram encontrados. O coeficiente alpha de Cronbach de todos os 20 itens foram 0.81, variando entre 0.73 a 0.81 entre as cinco subescalas. A análise de Bland-Altman não demonstrou nenhuma diferença sistemática entre as avaliações. O coeficiente de correlação intraclasse teste-reteste foi maior ou igual a 0.70 (p < 0.01) para os escores do MFI-DP/BR com correlações moderadas com HADS, MDS-UPDRS escore (exame físico, experiências motoras e não motoras de atividades de vida diária e complicações motoras), FSS e PFS-16. Foi revelado MFI-DP/ BR > 55 pontos como ponto de corte para indicar indivíduos com fadiga com acurácia de 0.84 (p < 0.001). Conclusão: O MFI-DP/BR pode ser considerado um instrumento válido e reprodutível para avaliar fadiga na DP.

Efetividade da equoterapia na marcha de crianças com paralisia cerebral: revisão sistemática de ensaios clínicos / Effectiveness of equine assisted therapy in gait of children with cerebral palsy: systemactic review of clinical trials

A marcha das crianças com paralisia cerebral (PC) tem sido alvo de intervenções conservadoras como a Equoterapia. Entretanto, seus efeitos têm sido pouco sistematizados na literatura. Objetivo: Analisar a evidência da efetividade da Equoterapia na marcha de crianças com PC comparada às terapias conservadoras não invasivas de ensaios clínicos. Método: Trata-se de uma revisão sistemática com busca nas bases de dados Cinahl, Cochrane, Embase, Google Scholar, Lilacs, Lisa (ProQuest), PEDro, PsycINFO (APA), Pubmed e Scopus, sem fltros. Foram incluídos ensaios clínicos que compararam Equoterapia e terapias convencionais (terapias conservadoras não invasivas) versus terapias convencionais, que avaliaram parâmetros da marcha em crianças com diagnóstico de PC com idade ≤ 12 anos. Os estudos foram avaliados quanto à qualidade metodológica pela escala Physiotherapy Evidence Database Scale. Resultados: Dentre os 668 estudos identificados, seis ensaios clínicos foram selecionados. Destes, a amostra total foi de 283 crianças, sendo 151 crianças alocadas no grupo experimental (GE) (hipoterapia + terapia convencional) e 132 crianças, no grupo controle (GC) (terapia convencional). Quatro estudos apresentaram elevada qualidade metodológica e dois estudos, baixa qualidade. Em relação à melhora dos parâmetros da marcha, GE e GC melhoraram, no entanto o GE apresentou significante melhora na análise da dimensão e (andar-pular-correr) da medida da função motora grossa, redução da assimetria muscular durante a deambulação e aumento da velocidade da marcha. Conclusão: A revisão sistemática sugere que o tratamento com associação de hipoterapia e terapia convencional promove melhora da marcha de crianças com PC.

Gait in cerebral palsy (CP) has been the target of conservative interventions as hippotherapy. However, the effects of this therapy on the promotion and functional adaptation of gait have been little systematized in the literature. Objective: To analyze the evidence of the effectiveness of hippotherapy in the gait of children with CP comparing to noninvasive conservative therapies of clinical trials. Methods: A systematic review of clinical trials was performed with search indatabases Cinahl, Cochrane, Embase, Google Scholar, Lilacs, Lisa (ProQuest), PEDro, PsycINFO (APA), Pubmed and Scopus), with no flters. It was included clinical trials comparing hippotherapy plus conventional therapy (non-invasive conservative therapies) versus conventional therapy that assessed gait parameters in children with CP diagnosis and age ≤ 12 years old. The studies were examined as methodological quality by the Physiotherapy Evidence Database Scale. Results: Of the 668 studies identifed, six trials were selected. Of these, the total sample consisted of 283 children (151 children were allocated to the experimental group (hippotherapy) and 132 children, in the control group (conventional therapies). Four studies presented high methodological quality and two studies, low quality. Regarding the improvement of gait parameters, experimental group and control group improved, however, the experimental group presented signifcant improvement in the analysis of the E dimension (walk-jump-run) of the gross motor function measure instrument, reduction of muscular asymmetry during walking and increase in walking speed. Conclusion: The systematic review, suggests that the treatment with association of hippotherapy and conventional therapy promotes improvement of gait of children with CP.

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.