Aquatic Dual-Task Training and Its Relation to Motor Functions, Activities of Daily Living, and Quality of Life of Individuals With Parkinson's Disease: A Randomized Clinical Trial.

Objectives: Parkinson's disease (PD) is a neurodegenerative disorder that impacts the dopaminergic neurons of the substantia nigra, leading to motor and non-motor symptoms, as well as changes in activities of daily living (ADL) and quality of life (QoL). Aquatic physical exercises and dual-task physical exercises have been used to manage PD symptoms. The aim of this study was to investigate the effects of a dual-task aquatic exercise program on the ADL, motor symptoms, and QoL of individuals with PD. Methods: A randomized controlled trial with a parallel group design was employed, and participants were randomized into 2 groups: a control group and an experimental group. The intervention was a 10-week program consisting of twice-weekly 40-minute aquatic dual-task exercises. Pre-intervention evaluations of ADL, motor function, and QoL were conducted at baseline (AS1), immediately after the intervention (AS2), and 3 months post-intervention (follow-up-AS3). The Unified Parkinson's Disease Rating Scale (UPDRS) II and III sections and the Parkinson's Disease Questionnaire 39 (PDQ-39) were utilized for outcome measures. Results: A total of 25 individuals completed the study. The experimental group showed significant improvements in both the UPDRS II (ADL) and III (motor function) sections (P's < .05), but there was no significant difference in PDQ-39 scores. Additionally, significant differences were observed in the experimental group between the AS2 and AS3 time periods (P < .05) for both UPDRS II and III scores (P < .05). Conclusions: Aquatic dual-task training may be effective in improving both ADL and motor functions in individuals with PD. Furthermore, the combination of aquatic environment and dual-task exercises may represent a promising approach to maintaining and improving the functionality of individuals with PD.

Improvement of Balance, Motor Aspects, and Activities of Daily Living in Parkinson's Disease after a Sequential Multimodal Aquatic- and Land-Based Intervention Program.

Parkinson's disease (PD) is a neurodegenerative, with heterogeneous clinical conditions and motor changes that reduce functioning. Postural instability is one of the motor aspects of disease progression, with a potential increase in the risk of falls, consequently affecting the activities of daily living (ADL). The objective of this study was to verify the influence of a multimodal intervention program (MIP) sequentially applied in aquatic- (AEs) and land-based environments (LEs) on balance, postural control, motor activities, and ADL in people with PD. It is an interventional clinical study with patients in stages 1 to 4 in the Hoehn and Yahr scale, assessed with Berg Balance Scale (BBS), Mini-Balance Evaluation System Test (Mini-BESTest), Unified Parkinson's Disease Rating Scale (UPDRS) II and III, Dynamic Gait Index (DGI), and quiet stance (QS) analysis in a force platform. The MIP was conducted sequentially with aquatic- (AIs) and land-based interventions (LIs) for 12 weeks each, twice a week, each session lasting 1 hour, and a 12-week interval between interventions. The comparison analysis was made with Friedman ANOVA, and the multiple comparisons with Wilcoxon signed-rank, Bonferroni correction, and effect size (r). The sample comprised 18 people with PD (66.83 ± 11.74 years). The AI and the full intervention (FI) had a large effect according to BBS. With Mini-BESTest, the LI and FI had a large effect. According to UPDRS II, the MIP improved ADL after LI, with a medium effect, and the motor aspects of UPDRS III improved after LI and FI, with a large effect. DGI was not sensitive in the analyses, with a ceiling effect after FI. No differences were identified in QS analyses. This research identified improved balance, ADL, and motor aspects in people with PD after sequential MIP in AI and LI, indicating that land-based and aquatic interventions are complementary and advantageous to people with PD.

Effects of an Aquatic Physical Exercise Program on Ventilatory Parameters in People with Parkinson's Disease.

Problems in the respiratory system are the main cause of death in Parkinson's disease (PD). Ventilatory limitations can also be part of a vicious cycle involving physical-functional limitations (e.g., walking difficulties) and the patients' perception of fatigue. The objective of this study was to analyze the effects of an aquatic physical exercise intervention program on ventilatory parameters, perception of fatigue, and gait capacity in participants with PD. This quasi-experimental study had a single group with repeated measures in four assessments, proposing an aquatic physical exercise intervention program. The inclusion criteria encompassed being in levels 1 to 4 on the Hoehn and Yahr scale and having a medical certificate for the activities. Assessments took place at 3-month intervals between them-the first period was the control, the second following the intervention, and the third period was the follow-up. The intervention had 25 biweekly sessions over 3 months. A total of 13 people (71.3 ± 5.61 years old) participated in the intervention, without significant differences in the control period. Between the intervention assessments, they had statistically significant differences in MIP, MEP, FVC, Tiffeneau index, MVV, and fatigue. The study demonstrated that the aquatic physical exercise intervention was effective for ventilatory outcomes and fatigue in people with PD.

Multicomponent Aquatic Training (MAT) Program for People with Parkinson's Disease: A Protocol for a Controlled Study.

INTRODUCTION: The complications from Parkinson's disease (PD) are directly related to decreased muscle function, balance deficits, and independence loss. Practicing aquatic exercises can minimize these symptoms and slow disease progress. OBJECTIVE: To develop a Multicomponent Aquatic Training (MAT) protocol for people with PD between stages 1 and 4 of the Hoehn and Yahr scale. METHODS: The protocol is for a single blind controlled clinical trial. The sample will comprise of people with PD between stages 1 and 4 in Hoehn and Yahr scale, divided into a control group and MAT group (who will participate in the MAT). Musculoskeletal function, functional mobility, and balance will be the primary outcomes of interest, assessed with an isokinetic dynamometer, the Five-Times-Sit-to-Stand test (FTSST), the Timed "Up and Go" test (TUG), the 6-m gait speed test, the Berg Balance Scale (BBS), and a force platform. Quality of life (QOL), activities of daily living (ADL), and motor aspects will be the secondary outcome measures, assessed with the Parkinson's Disease Questionnaire (PDQ-39) and Unified Parkinson's Disease Rating Scale (UPDRS), sections II and III. The MAT will be 12 weeks long, with two 50-min sessions per week. The outcome measures will be assessed before and after the interventions. DISCUSSION: This study is expected to establish parameters to prescribe and monitor a MAT program for people with PD in stages 1 to 4 in the Hoehn and Yahr scale, respecting individual progress and assisting the professionals in their procedure with these people.

Parkinson's disease and multicomponent aquatic exercise: Effects on motor aspects, functional mobility, muscle function and aquatic motor skills.

OBJECTIVE: Analyze the effects of a multicomponent aquatic exercise program on motor aspects, functional mobility, muscle function and aquatic motor skills of people with PD. METHODS: Eighteen people with a PD diagnosis were assessed before and after a 12-week multicomponent aquatic exercise program, twice a week, with each session lasting 50 min. The terrestrial variables analyzed were motor aspects, through the Unified Parkinson Disease Rating Scale (UPDRS); functional mobility, through the Five Times Sit to Stand Test (FTSST); Peak Torque (PT) and Mean Power (MP) of hip, knee and ankle flexors and extensors, assessed using an isokinetic dynamometer. In water, aquatic motor skill levels were assessed by means of the Aquatic Functional Assessment Scale (AFAS). RESULTS: Significant improvements were found after the intervention in the following outcomes: motor aspects (p = 0.038, Δ = 5-61); MP of knee flexors at 90°/s on the most affected side (p = 0.026, Δ = 5.14), MP of knee extensors at 90°/s on the most affected side (p = 0.008, Δ = 8.69), MP of knee extensors at 120°/s on the most affected side (p = 0.005, Δ = 8.35), and AFAS in the domain of specialized therapeutic exercises (p = 0.014, Δ = 1.28). CONCLUSIONS: The completed multicomponent aquatic exercise program promoted changes in muscle function and terrestrial and aquatic functional outcomes in people with PD.

RESULTS OF ORTHOSES USED ON AMBULATORY PATIENTS WITH BILATERAL CEREBRAL PALSY.

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.

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.

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.

Influence of feet position on COP measures in post-stroke patients in quiet standing.

BACKGROUND: Foot placement is an important methodological parameter in experiments for analyzing the behavior of the center of pressure (CoP) duringquiet standing. In the case of stroke patients, this is a relevant issue, as the standardized position, usually adopted is not ecological. RESEACH QUESTION: Do between-limb synchronization, weight-bearing symmetry, and amplitude of the postural sway of post-stroke individuals differ between standardized and comfortable foot positions during quiet standing? METHODS: A total of 36 volunteers (20 with stroke and 16 healthy) stood barefoot, for 60 s, on two force plates with feet in a comfortable and standardized position (14° of external rotation and heels 17 cm apart). Three trials were performed in each position, and the average values obtained were analyzed. RESULTS: The comfortable position adopted by stroke individuals was characterized by heels kept 17 cm apart and with 21° of external rotation. None of the measures of the healthy group were influenced by feet position. In the stroke group, the lag to maximal between-feet correlation in the mediolateral direction (ML ρmax lag) was higher (0.45 s) and the weight-bearing symmetry was better in the comfortable (38%) than in the standardized conditions (0.19 s and 32%, respectively). Neither the other CoP measures nor the intra-subject variability was sensitive to feet position. SIGNIFICANCE: The assumption that standardization leads to reduced variability might not be valid to the post-stroke and healthy individuals age around 55 years. Therefore, adoption of a comfortable condition might be advantageous, once it allows for a more practical and realistic evaluation of postural control.

Reliability and minimum detectable change of the gait profile score for post-stroke patients.

The objectives of this work were (i) to determine Gait Profile Score (GPS) for hemiparetic stroke patients, (ii) to evaluate its reliability within and between sessions, and (iii) to establish its minimal detectable change (MDC). Seventeen hemiparetic patients (mean age 54.9±10.5years; 9 men and 8 women; 6 hemiparetic on the left side and 11 on the right side; mean time after stroke 6.1±3.5months) participated in 2 gait assessment sessions within an interval of 2-7 days. Intra-session reliability was obtained from the intraclass correlation coefficient (ICC) between the three strides of each session. Inter-session reliability was estimated by the ICC from the averages of that three strides. GPS value of non paretic lower limb (NPLL) (13.9±2.4°) was greater than that of paretic lower limb (PLL) (12.0±2.8°) and overall GPS (GPS_O) was 13.7±2.5°. The Gait Variable Scores (GVS), GPS and GPS_O exhibited intra-session ICC values between 0.70 and 0.99, suggesting high intra-day stability. Most of GVS exhibited excellent inter-session reliability (ICC between 0.81 and 0.93). Only hip rotation, hip abduction of PLL exhibited moderate reliability with ICC/MDC values of 0.57/10.0° and 0.71/3.1°, respectively. ICC/MDC values of GPS were 0.92/2.3° and 0.93/1.9° for PLL and NPLL, respectively. GPS_O exhibited excellent test-retest reliability (ICC=0.95) and MDC of 1.7°. Given its reliability, the GPS has proven to be a suitable tool for therapeutic assessment of hemiparetic patients after stroke.

Avaliação de pacientes com distrofia muscular de Duchenne em laboratório computadorizado de marcha através do índice de alteração da marcha / Evaluation of patients with Duchenne Muscular Dystrophy in Gait Analysis Laboratory using Gait Deviation Index

Objetivo: Aplicação e correlação do índice de alteração da marcha (GDI) com questionário de avaliação funcional (FAQ), escala de mobilidade funcional (FMS) e índice de Sutherland (IS) para pacientes com distrofia muscular de Duchenne (DMD). Métodos: Onze crianças com diagnóstico clínico de DMD, idade entre 6-11 anos, deambuladoras, participaram do estudo. O GDI foi correlacionado com o FAQ, FMS e IS, utilizando o coeficiente de correlação rho de Spearman-Rank. O GDI foi calculado com a cinemática dos membros inferiores coletada com seis câmeras Hawks da Motion Analysis Corporation. Resultados: O GDI médio obtido foi de 82,5 (± 13,5), sendo este valor menor do que o esperado para indivíduos sem patologias musculoesqueléticas (i.e. ≥ 100). O GDI apresentou correlação moderada com o FAQ e FMS (50/500m) e forte com IS (rho > 0,83, p ≤ 0,05). Conclusão: O GDI apresenta correlação com classificações, sejam elas clínicas (i.e. FMS), por estudo do movimento (i.e. IS) e com questionário de avaliação funcional (i.e. FAQ).

Objective: Aplication and correlation at Gait Deviation Index (GDI) and Functional Assessment Questionnaire (FAQ), Functional Mobility Scale (FMS) and Sutherland Index (SI) for patients with DMD. Methods: Eleven children with clinical diagnosis at Duchenne Muscular Dystrophy (DMD), between 6 and 11 years old, walkers, participated at study. The GDI was correlated with the FAQ, FMS and IS, using the rho coefficient of correlation of Spearman-Rank. To calculate the GDI, the kinematics were collected by six Hawks cameras (Motion Analysis Corporation). Results: The average GDI achieved was 82.5 (plus or minus 13.5), this value being lower than expected for individuals without musculoskeletal disorders (ie greater than or equal to 100). GDI showed moderate correlation with the FMS and FAQ (50/500m) and strong with IS (rho>0.83, p<= 0.05). Conclusion: The GDI shows correlation with clinical classifications (FMS), gait analysis classifications (IS) and questionnaries of function evaluation (FAQ).