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.

Comparing postural balance among older adults and Parkinson's disease patients

ABSTRACT The objective of this study was to compare postural balance among healthy older adults and Parkinson's disease (PD) patients during one-legged stance balance. We recruited 36 individuals of both sexes and divided them into two groups: healthy older adults (HG), and individuals with PD (PG). All the participants were assessed through a single-leg balance test, with eyes open, during 30 seconds (30 seconds of rest across trials) on a force platform. Balance parameters were computed from mean across trials to quantify postural control: center of pressure (COP) area and mean velocity in both directions of movement, anterior-posterior and medial-lateral. Significant differences between-group were reported for area of COP (P=0.002) and mean velocity in anterior-posterior direction (P=0.037), where poor postural control was related to PD patients rather than to healthy individuals. One-legged stance balance was a sensitive task used to discriminate poor postural control in Parkinson individuals.

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.

Dual task performance: a comparison between healthy elderly individuals and those with Parkinson’s disease / Desempenho em duplas tarefas entre indivíduos saudáveis e com doença de Parkinson

Introduction The dual tasks (DT) is learned during the whole life and a prerequisite in functional performance in different activities of daily living. Healthy elderly have reduced ability to perform motor activities and cognitive tasks simultaneously, compared to young adults. Parkinson’s disease (PD) is the second most common neurodegenerative disease in the elderly and classic motor symptoms coexist with prejudice in cognitive domains. Objective To compare balance, gait and performance in dual tasks of individuals with Parkinson’s disease and healthy elderly. Material and method Transversal study consisted of 21 individuals with PD, classified between 1.5 to 3 in Hoehn and Yahr scale and 21 healthy individuals. To evaluate the performance on simple tasks and dual tasks the participants were submitted to five simple tasks (motor) and each was associated with a cognitive task, featuring a DT. To balance and gait evaluation was used the following instruments: Berg Balance Scale, Tinetti Scale and Dynamic Gait Index. Results In respect to gait and performance in dual tasks, there was a statistically significant difference with the worst performance for the group of individuals with PD. Conclusion It was found that the group of elderly people with PD has lower performance in the execution of concurrent tasks when compared with healthy elderly, so the DT can be introduced in rehabilitation programs to improve the performance of these patients. .

Introdução A dupla tarefa (DT) é aprendida durante toda a vida e é pré-requisito no desempenho funcional em diversas atividades de vida diária. Idosos saudáveis apresentam redução na capacidade de executar atividades motoras e tarefas cognitivas simultaneamente, em comparação a adultos jovens. A doença de Parkinson (DP) é a segunda doença neurodegenerativa mais comum em idosos e os sintomas motores clássicos coexistem com prejuízo nos domínios cognitivos. Objetivo Comparar o equilíbrio, a marcha e o desempenho em duplas tarefas de indivíduos com doença de Parkinson e idosos saudáveis. Material e método Estudo transversal, composto por 21 indivíduos com DP, classificados entre os estágios 1,5 e 3 na Escala de Hoehn e Yahr e 21 indivíduos saudáveis. Para avaliação do desempenho nas tarefas simples e duplas os participantes foram submetidos a cinco tarefas simples (motoras) e a cada uma delas foi associada uma tarefa cognitiva, caracterizando uma DT. Para avaliação do equilíbrio e da marcha foram utilizados os seguintes instrumentos: Escala de Equilíbrio de Berg, Escala de Tinetti, e Índice de Marcha Dinâmica. Resultados Não houve diferença estatisticamente significante quanto à pontuação dos grupos nas escalas de equilíbrio. Em relação à marcha e ao desempenho nas duplas tarefas, houve diferença estatisticamente significante com pior desempenho para o grupo de indivíduos com DP. Conclusões Verificou-se que o grupo de idosos com DP apresenta menor desempenho na execução de tarefas simultâneas quando comparados com idosos saudáveis, portanto a DT pode ser introduzida nos programas de reabilitação para melhorar o desempenho desses pacientes. .