Pain and Parkinson's disease: Current mechanism and management updates.

The aim of this comprehensive review was to provide an overview of pain in Parkinson's disease (PD) by identifying different clinical features and potential mechanisms, and presenting some data on the evaluation and management of pain in PD. PD is a multifocal degenerative and progressive disease, which could affect the pain process at multiple levels. Pain in PD has a multifactorial aetiology, with a dynamic process based on pain intensity, complexity of symptoms, pain pathophysiology and presence of comorbidities. In fact, pain in PD responds to the concept of multimorphic pain, which can evolve, in relation to the different factors, whether they are linked to disease and its management. Understanding the underlying mechanisms will help in guiding of treatment choices. Providing scientific support useful for clinicians and health professionals involved in management of PD, the aim of this review was to bringing practical suggestions and clinical perspectives on the development of a multimodal approach guided by a multidisciplinary clinical intervention through a combination of pharmacological and rehabilitative approaches, to manage pain to improve the quality of life on individuals with PD.

A Comprehensive Review of Pain Interference on Postural Control: From Experimental to Chronic Pain.

Motor control, movement impairment, and postural control recovery targeted in rehabilitation could be affected by pain. The main objective of this comprehensive review is to provide a synthesis of the effect of experimental and chronic pain on postural control throughout the available literature. After presenting the neurophysiological pathways of pain, we demonstrated that pain, preferentially localized in the lower back or in the leg induced postural control alteration. Although proprioceptive and cortical excitability seem modified with pain, spinal modulation assessment might provide a new understanding of the pain phenomenon related to postural control. The literature highlights that the motor control of trunk muscles in patient presenting with lower back pain could be dichotomized in two populations, where the first over-activates the trunk muscles, and the second under-activates the trunk muscles; both generate an increase in tissue loading. Taking all these findings into account will help clinician to provide adapted treatment for managing both pain and postural control.

The role of the vagus nerve in fibromyalgia syndrome.

Fibromyalgia (FM) syndrome is a common illness characterized by chronic widespread pain, sleep problems, fatigue, and cognitive difficulties. Dysfunctional neurotransmitter systems that influence the body's endogenous stress response systems are thought to underlie many of the major FM-related symptoms. A model of FM pathogenesis suggests biological and psychosocial variables interact to influence the genetic predisposition, but the precise mechanisms remain unclear. The Polyvagal Theory provides a theoretical framework from which to investigate potential biological mechanisms. The vagus nerve (VN) has anti-inflammatory properties via its afferent and efferent fibers. A low vagal tone (as assessed by low heart rate variability), has been observed in painful and inflammatory diseases, including FM, while the ventral branch of the VN is linked to emotional expression and social engagement. These anti-inflammatory and psychological (limbic system) properties of the VN may possess therapeutic potential in treating FM. This review paper summarizes the scientific literature regarding the potential role of the VN in transducing and/or therapeutically managing FM signs and symptoms.

Stabilometric analysis as a cognitive function predictor in adults over the age of 50: A cross-sectional study conducted in a Memory Clinic.

BACKGROUND: The aging process reduces adaptive balance responses. Two-thirds of older adults with cognitive problems suffer at least one fall every year, a rate three times higher than that observed in older adults without dementia. This cross-sectional study aims to analyze the relationship between balance and cognitive status in adults older than 50 years. METHODS: Individuals over the age of 50, who attended a Memory Clinic, were evaluated for balance changes using stabilometry, with analysis of the center of pressure (CoP). The following CoP parameters were assessed using an S-Plate pressure platform: 1) sway length, 2) sway area, and 3) anteroposterior and laterolateral sway (width, mean deviation, and speed). The individuals were evaluated with eyes open and closed for 30 s in each test. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive status. RESULTS: Eighty-seven subjects participated in the study. The average age was 67.8 years, 81.4% were female, and the average MoCA score was 19.8 points. Greater CoP oscillation was observed in the eyes closed condition, demonstrating greater postural imbalance. We found a significant and direct effect of MoCA score on the CoP area in the eyes open condition. CONCLUSION: The results suggest that stabilometric analysis may be a predictor of cognitive function.

Contribution of the sensory innervation of the spine in low back pain: review and clinical commentary.

Few validated tests allow a precise aetiological diagnosis of Low Back Pain (LBP), and the difficulty of clinical evaluations could be one of the reasons to explain the lack of effectiveness in the therapeutic management of chronic LBP. However, an implication of a sensory impairment in the control of sensorimotor circuits could be suggested. Interactive and specific responses between nociceptive nerve fibres and the paraspinal musculature motor control could have clinical implications, in particular through kinematic evaluation. Following an introduction to the link between the sensory innervation of the spine and pain, we then summarise the maladaptive movement in LBP at the kinematic and neuropathological level. A clinical objectification of these kinematic adaptations at the lumbar spine level, would clarify the aetiological diagnosis causes of chronic LBP, and so help optimising therapeutic strategies by proposing a relevant and precise clinical model of this painful condition.

Postural instability in Parkinson's disease: Review and bottom-up rehabilitative approaches.

The aims of this narrative review are to provide scientific support to characterize the postural instability commonly observed in Parkinson's disease (PD), and to emphasize how bottom-up rehabilitation programs stimulating the sole of the foot can improve postural stability in PD. Postural instability is a typical characteristic of individuals with PD, which increases the frequency of falls and may worsen their consequences. It thus seems relevant to diagnose these alterations as early as possible, in order to develop specific rehabilitative treatment. The association between sensitivity of the sole of the foot and postural instability in individuals with PD is linked to the key role of peripheral alterations of the sensorimotor system in balance and motor symptoms. By enhancing sensory feedback coming from the feet, bottom-up stimulation allows patients to improve their sensorimotor control. In clinical practice, health practitioners can use sensory stimulation to improve postural control. By improving postural stability, a decrease in fall risk can be achieved and the secondary impairments associated with falls prevented.

Effect of sensory stimulation applied under the great toe on postural ability in patients with fibromyalgia.

Fibromyalgia (FM) is a chronic pain syndrome, characterised by several symptoms. One of the most prevalent symptoms in FM is balance impairment that compromise the autonomy, function and performance status of patients.Purpose: The main objective of the present study was to evaluate the effect of sensory stimulation provided by the use of a low additional thickness of 0.8 mm placed under the great toes bilaterally on the centre of pressure (CoP) measures in patients with FM. It was hypothesised that postural ability would change with a low focal additional thickness used to compute these measures.Materials and Method: Twenty-four patients with FM voluntarily participated in this study. Postural performance during quiet standing was investigated through the CoP displacements recorded using a force-plate. Sensory stimulation was provided by a small additional thickness of 0.8 mm placed under the great toe bilaterally and two conditions were compared: additional thickness 0 (control) and 0.8 mm.Results: An improvement of body balance through spatial parameters with sensory cutaneous stimulation applied under the great toe bilaterally were observed in patients with FM. Our results showed a significant decrease of surface area and mean speed of CoP, associated to a significant decrease of variance of speed. An additional observation is that sagittal (Y) mean position of the CoP gets more anterior (+ 5 mm) relative to control condition.Conclusion: These findings brings new clinical perspectives in the development of intervention strategies in the management of patients with FM and balance disorders, completing validated therapeutic strategies.

The sensory role of the sole of the foot: Review and update on clinical perspectives.

The feet constitute an important sensory structure in the mechanisms of postural control. As a direct and often only interface between the body and the ground, the feet allow us to sense and interact with our environment. Sensory information provided by muscle and cutaneous afferents in the foot contribute to our ability to stand upright, and postural sway is necessary to detect both position and motion of the body in space. A decline in foot sole skin sensitivity occurs naturally with aging and as a result of neurological disorders, including different peripheral neuropathies, the commonest etiologies of which are diabetes mellitus or effects of chemotherapy. This decline in sensitivity is frequently associated with poorer postural control and increased risk of falls in these populations. The purpose of this comprehensive review is to summarize the evidence that supports a functional role of foot sole sensory tactile and muscular feedback in standing balance, and the postural consequences when this feedback is impaired with aging or disease. This brings new clinical perspectives on the development of intervention strategies to improve the quality of foot sole cutaneous feedback. It also seems to be a promising approach in the management of patients with balance disorders, with specific chronic pain syndromes, with neurologic diseases or those at risk of falling.

Effects of core strengthening on balance in university judo athletes.

BACKGROUND: Core strengthening prepares the body in an integral, safe and efficient way, favoring balance and postural control; physical abilities constantly demanded in sports, especially in body contact modalities, such as Judo. OBJECTIVE: This study investigated the effects of core strengthening on balance in university judo athletes. METHODS: Eighteen athletes from the University of Southern Santa Catarina (UNISUL) were randomly allocated into two groups: experimental (n = 9) and control (n = 9). Experimental group athletes were submitted to a core strengthening protocol (30-min sessions, twice a week for 5 consecutive weeks). Evaluations consisted of Stabilometic (center of pressure behavior parameters: total area in mm2, laterolateral and anteroposterior width in mm) and baropodometric analysis [peak pressure: obtained during a 30-s acquisition period and expressed by foot area, i.e., (a) forefoot (metatarsal heads and toes); and (b) hindfoot (calcaneus region, distal third of the foot)]. Right/left foot ratios were calculated as relative percentages and used for the analysis. The analyzes were performed at baseline and after 5 weeks of core strengthening. The athletes were evaluated in two situations: eyes-open and eyes-closed. RESULTS: Total right/left foot ratio pressure, right/left fore and hindfoot ratio pressure, as well as anteroposterior width measurements were statistically smaller in the experimental group. CONCLUSION: Although the results obtained showed that core strengthening presents certain benefits, these data alone are not enough to confirm its effects upon postural oscillation in university judo athletes.

Less Than One Millimeter Under the Great Toe is Enough to Change Balance Ability in Elite Women Handball Players.

Team handball is a complex intermittent sport game, which requires several motor abilities and effective postural control. Objective evaluation of stabilometric variables may be interesting to assess and improve functional parameters by postural control management. The purpose of the study was to evaluate the effects of a small additional thickness placed under the great toe (TUGT) on the Centre of Pressure (CoP) parameters in elite women handball players. Fourteen elite women handball players voluntarily participated in this study. Two conditions were compared: TUGT 0 (control) and TUGT 0.8 mm; four variables were computed from the CoP displacements. A paired T-test was performed for each variable. This study concludes that a low focal additional thickness placed under both great toes has an effect on the CoP measures used to assess postural control during an unperturbed stance. These results suggest that a low TUGT could contribute to a change in balance ability, and may be of clinical interest. This brings new perspectives in the management of athletes to prevent injury risk and optimize performance.

How can the stimulation of plantar cutaneous receptors improve postural control? Review and clinical commentary.

Postural control requires constant and subconscious postural sway to manage balance and achieve postural stability. These movements of regulation are based in particular on cutaneous plantar information. The foot constitutes a functional whole that participates in the mechanisms of postural control and regulation. It represents the direct interface between the body and the ground during quiet standing, and plantar cutaneous information contributes to postural control. Upright balance mechanically depends on the gravitational torque produced by the forces of gravity and reaction of the ground. In this context, the foot behaves like a sensory system for postural regulation whose objective is to maintain a state of stability within a changing and constraining environment. There is a relation between balance improvement and the facilitation of sensory feedback related to the activation of the plantar cutaneous mechanoreceptors. From a clinical point of view, the application of additional tactile cues may have therapeutic benefits in relation to fall prevention, or to improve specific types of chronic pain.

Low additional thickness under the toes could change upright balance of healthy subjects.

The purpose of the study was to evaluate the effect of an additional thickness placed under the toes (TUT) on the CoP measures and to determine the optimum thickness required to maximize the postural control performance. Four conditions were compared: TUT 0 (control), 0.8, 3, and 6mm and four variables were computed from the CoP displacements. These results suggest that the lowest TUT could contribute to changing balance control, and may have clinical interest. This brings perspectives in the management of patients with risk of falling or with chronic pain syndromes, complementing validated therapeutic strategies.