Effects of treadmill training on gait of elders with Parkinson's disease: a literature review / Efeitos do treinamento de marcha em esteira em idosos com doença de Parkinson: uma revisão da literatura

ABSTRACT Parkinson's disease is the second most common neurodegenerative disorder in old age. Aging process for elders with Parkinson's disease can induce gait disturbances with more functional disabilities than for elders without the disease. Treadmill training as a therapy has resulted in notable effects on the gait of patients with Parkinson's disease and may be a resource for geriatric neurological rehabilitation. This review aimed to study the effects on gait after treadmill training in elderly patients with Parkinson's disease. The search was performed in the databases PubMed®, LILACS, PEDro and EMBASE, with the following keywords: "Parkinson's disease", "elderly", "treadmill training" and "gait evaluation". The quality of the studies included was assessed by PEDro Scale. Eleven studies met the inclusion and exclusion criteria. Eight studies were randomized, and only one did a follow-up. One can observe in this review that treadmill training with or without weight support (at least 20 minutes, two to three times a week, with progressive increase of loads, for minimum of 6 weeks) in elderly patients with the Parkinson's disease was effective to improve gait. In addition, both were considered safe (since some studies described the use of belts, even in unsupported training) and can be associated with therapies complementary to gait, such as repetitive transcranial magnetic stimulation, visual cues or anodal transcranial direct current stimulation. Treadmill training in elderly patients with Parkinson's disease is an intervention that improves gait outcomes, but further studies are required for better proofs.

RESUMO A doença de Parkinson é o segundo distúrbio neurodegenerativo mais comum na velhice. O processo de envelhecimento de idosos com doença de Parkinson pode levar a distúrbios de marcha com mais incapacidades funcionais do que para idosos sem a doença. O treinamento em esteira como terapia pode resultar em efeitos notáveis na marcha de pacientes com Parkinson e ser um recurso para a reabilitação neurológica geriátrica. Esta revisão teve como objetivo estudar os efeitos da marcha após o treinamento em esteira na doença de Parkinson em idosos. A pesquisa foi realizada nas bases de dados PubMed®, LILACS, PEDro e EMBASE, com os seguintes descritores: "doença de Parkinson", "idosos", "treinamento em esteira" e "avaliação da marcha". A qualidade dos estudos incluídos foi avaliada pela escala de PEDro. Atenderam aos critérios de inclusão e exclusão 11 estudos. Oito estudos foram randomizados, e apenas um fez follow-up . Foi possível observar que treinamento em esteira com ou sem suporte de peso (por pelo menos 20 minutos, duas a três vezes por semana, com aumento progressivo de cargas, por, no mínimo, 6 semanas) em idosos com doença de Parkinson foi efetivo para melhorar a marcha. Além disso, ambos os treinamentos foram considerados seguros (pois alguns estudos relataram o uso de cintos, mesmo no treinamento sem suporte de peso) e podem ser associados a terapias complementares à marcha, como estimulação magnética transcraniana repetitiva, estímulos visuais ou estimulação transcraniana direta anódica. O treinamento em esteira em pacientes idosos com doença de Parkinson é uma intervenção que melhora os resultados da marcha, mas requer mais estudos para melhor comprovação.

Estudio piloto sobre la utilización de la Estimulación Rítmica Auditiva empleando tango para mejorar la marcha y la calidad de vida en pacientes con Enfermedad de Parkinson que experimentan trastornos de la marcha / PILOT STUDY OF THE USE OF RHYTHMIC AUDITORY STIMULATION USING ARGENTINE TANGO, IN ORDER TO IMPROVE GAIT DISORDERS AND QUALITY OF LIFE, IN PARKINSON´S DISEASE PATIENTS

La Estimulación Rítmica Auditiva (ERA) es una técnica que facilita la rehabilitación de movimientos que son intrínseca y biológicamente rítmicos, como la marcha. Utiliza los efectos fisiológicos del ritmo auditivo sobre el sistema motor y funciona como un estímulo de sincronización y como facilitador para lograr patrones de marchas fisiológicos. El objetivo de este estudio piloto fue comparar los parámetros de marcha y calidad de vida antes y después de la implementación de ERA en pacientes con Enfermedad de Parkinson (EP) que sufrían trastornos de la marcha. Para el estudio se reclutaron 10 pacientes con EP "clínicamente establecida o probable" según criterios diagnósticos internacionales de entre 60 y 85 años de edad, con trastornos de la marcha leves. El entrenamiento con ERA duró 6 semanas y utilizó piezas de tango para sincronizar la marcha a rentes niveles de cadencia. Los resultados muestran una mejoría significativa de la marcha y el equilibrio (escala de Tinetti) luego del entrenamiento con ERA, la cual fue acompañada por una tendencia a la mejoría de la calidad de vida (escala PDQ-39). Estos resultados sugieren que la ERA fue capaz de mejorar la marcha y esto se tradujo en mejorías funcionales. Se requieren estudios aleatorizados, ciego y controlados en un mayor número de pacientes para continuar estudiando la potencial eficacia de la ERA

Rhythmic Auditory Stimulation (RAS) is a technique that facilitates the rehabilitation of movements that are intrinsically and biologically rhythmic, such as gait. It uses the physiological effects of perceived rhythm on the motor system and functions as a synchronization stimulus and as a facilitator to improved gait patterns. The objective of this pilot study was to compare gait parameters and quality of life before and after the implementation of RAS in patients with Parkinson's Disease (PD) with gait difficulties. For the study, 10 patients with clinically established or probable PD according to international diagnostic criteria, between 60 and 85 years of age, who suffered from mild gait disorders were recruited. Training with RAS lasted 6 weeks and used tango pieces to synchronize gait to different levels of cadence. The results show a significant improvement in gait and balance (Tinetti scale) after training with RAS, which was accompanied by a tendency to improve the quality of life (PDQ-39 scale). These results suggest that RAS was able to improve gait, which translated into functional improvements. Randomized, blinded, controlled trials in a larger number of patients are required to further assess the potential efficacy of RAS.

Trastorno de la marcha en la enfermedad de Parkinson: freezing y perspectivas actuales / Freezing and gait disorders in Parkinson's disease

More than one third of patients with Parkinson disease experience freezing. It is characterized by the feeling that one's feet are "glued to the floor", and it is more common in the later stages of the disease. The causes of this gait disorder are not yet fully established, but it may lead patients to suffer falls and lose their independence. As a consequence, the development of therapeutic measures which can overcome freezing is of fundamental important for the autonomy of such individuals. There is no consensus in the literature on the most recommended therapeutic measures for the prevention or attenuation of freezing in gait. What seems to be defined are the phenomenological aspects of the disorder and good therapy, represented by the association between drug therapy and sensorial stimuli or motor coordination training geared towards the specificities to avoid motor difficulties of freezing, when triggering factors are present.

Aplicação do prognóstico de deambulação em crianças com paralisia cerebral descrito por Souza e Ferraretto / Application of the beambulation prognosis in children with cerebral paralysis, described by Souza and Ferraretto

A Paralisia Cerebral como é popularmente conhecida, proporciona as crianças alterações motoras, sensoriais, cognitivas que as fazem apresentar um desenvolvimento diferente das crianças normais. A pesquisa teve como finalidade comprovar a eficácia do prognóstico de deambulação para crianças com Paralisia Cerebral descrita por Souza e Ferraretto. O nosso objetivo foi identificar e comprovar através de pesquisas com crianças com Paralisia Cerebral da clínica de Fisioterapia da Unipar se os parâmetros são os indicadores mais fidedignos para se fazer um prognóstico de deambulação. O interesse por esse assunto surgiu uma vez que o profissional que trabalha com crianças com Paralisia Cerebral sempre enfrenta questões vindas dos pais que querem obter respostas mais precisas no que se refere ao prognóstico da criança principalmente sobre a deambulação e pela dificuldade em encontrar literatura sobre o assunto

Prolonged stretching: its effect on crouch gait of diplegic cerebral palsied children

The purpose of this study was to evaluate the effect of prolonged stretching for both calf muscles simultaneously, using wooden stretcher, on improving diplegic gait of cerebral palsied children. This study included fifteen diplegic cerebral palsied children from both sexes with age ranged from 6 to 8 [X6.2]. They were selected from out patient clinic of Faculty of Physical Therapy, Cairo university, on a basic criteria. Hoffman reflex/myogenic response [H/M] ratio and gait pattern were assessed before and after treatment. The treatment program included prolonged stretching using wooden stretcher in addition to traditional physical therapy modalities. It was conducted for 4 months, 4 times/week. At the end of study the results revealed significant reduction in H/M ratio which in turn resulted in functional improvement of diplegic walking pattern. This improvement could be attributed to the cumulative effect of stretching protocol and traditional physical therapy modalities