RESUMO
Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease, characterized by increasingly morbid motor dysfunction with advancing age. Recently, various antiparkinsonian agents and surgical intervention have been developed that, when used in combination, greatly promote sustained improvements in activities of daily living, leading to the establishment of a treatment algorithm. However, since all of these interventions are symptomatic therapies, it is difficult to resolve motor dysfunction completely. Recent evidence has revealed that exercise might enhance neuroplasticity and improve motor and cognitive behavioral impairment in PD. In this article, we reviewed recent therapeutic strategies for PD.
RESUMO
Gait disturbance is a serious problem in Parkinson's disease (PD). Exercise therapy is used to alleviate this complaint. We investigated the effects of a videotaped arm swinging-based home exercise program on gait in PD patients. The subjects included 25 outpatients aged between 55 and 77 years (average age 68.9 years) with PD in Hoehn and Yahr stages II-IV. We prepared a master video tape in which a trainer was shown to be performing an arm swinging exercise or steps in synchrony with a metronome. The exercise menu consisted of 4 parts : arm swinging in a seated position, arm swinging in an upright position without stepping, arm swinging with stepping, and walking on the floor or taking a walk. The patients performed the arm swinging exercise while watching a video tape everyday for a period of 3.4 weeks. Of the 25 patients, 22 completed the exercise program. Following the program, these patients showed significant improvements in their walking times for a 20m walk (10 m, return, 10 m) (before/after=29.6/24.3 sec, <i>p</i>=0.002) and in the step length (before/after=43.7/50.1 cm, <i>p</i><0.001). Frozen gait was a negative factor to complete the programs. Improvement of gait speed after the exercise was related with less frequency of cadence. Loss of arm swinging in PD may be associated with a disturbance in the internal rhythm formation process. Arm swinging exercises are one of the exercise methods that use rhythmic cues. This study suggests that a videotaped arm swinging-based home exercise therapy is effective in such patients.
RESUMO
We studied the functional limitations of the activities of daily living and the effect of treatment on 8 patients with thiamine deficiency neuropathy. Functional activities of daily living were evaluated using the functional independence measure whose scores were obtained before and after high-dose vitamin B1 therapy. In the pretreatment evaluation, the lowest mean score was that of in locomotion (stairs), followed by locomotion (walk-wheelchair), transfers (tub-shower), bathing, dressing the lower body, toileting, transfers (bed-chair-wheelchair), and transfers (toilet), in that order. This tendency was also observed after treatment. The most remarkable therapeutic efficacy was observed in locomotion (walk-wheelchair), followed by transfers (tub-shower), locomotion (stairs), dressing the lower body, and toileting, in that order. Every action reflects the motor ability of the lower extremities. Thiamine deficiency neuropathy should be assessed routinely not only by medical evaluation of clinical symptoms or laboratory studies but also by functional evaluation that reflects each patient's disability.
