Association between fatigue and MDS-UPDRS in individuals with Parkinson's disease: cross-sectional study.

BACKGROUND: Fatigue is significant in the context of Parkinson's disease (PD), considering that one-third of patients classify it as the most restricting symptom in their daily life activities (DLAs). The objective was to verify the relationship (association) between fatigue and non-motor and motor symptoms of PD. METHODS: A cross-sectional study which included 100 individuals with PD. Initially, demographic and clinical data (modified Hoehn and Yahr scale-HY, anxiety, and depression) were collected. To assess the non-motor and motor symptoms of PD, the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) was applied. Fatigue was evaluated using the Parkinson Fatigue Scale. RESULTS: A higher HY score, greater severity of non-motor aspects of DLAs and motor aspects of DLAs, more motor complications, and higher levels of anxiety as well as depression were observed in the "fatigue" group. Fatigue was associated with a lower daily equivalent levodopa dose (LEDD), a higher body mass index (BMI), anxiety, depression, and the presence of non-motor symptoms. CONCLUSION: Non-motor symptoms are more determining factors for fatigue than the motor condition itself, with an association between fatigue and higher BMI scores, increased anxiety and depression, lower LEDD, and greater severity of non-motor aspects of DLAs. Individuals in the "fatigue" group had higher HY scores, anxiety, and depression, worse non-motor and motor symptoms related to experiences of daily life, as well as motor complications.

A biomechanical analysis of turning during gait in individuals with different subtypes of Parkinson's disease.

BACKGROUND: Turning while walking is a complex component of locomotor capacity, which can be challenging in the daily lives of people with Parkinson's disease. The aim of the study was to compare biomechanical strategies during turning of gait in individuals with Parkinson's disease and its different clinical subtypes. METHODS: A cross-sectional study, comprising of 43 individuals with idiopathic Parkinson's disease, divided in subgroups: akineto-rigid, dominant tremor and mixed. Motor impairment was assessed using the Unified Parkinson's Disease Rating Scale. The gait biomechanical parameters (number of steps, step length, cadence, amplitude, velocity and radius of the turn) were analyzed during turning in a kinematics laboratory. In the statistical analysis, a comparison was made between subgroups, and correlations between biomechanical parameters. FINDINGS: There was no statistically significant difference between the subgroups. In the correlation analysis, notable correlations were found between the anticipatory step length and the following variables: number of steps (r = -0.418), step length while turning (r = 0.805), step length after turning (r = 0.644), average velocity (r = 0.830), average velocity while turning (r = 0.755), and maximum velocity (rho = 0.835). INTERPRETATION: The difficulties primarily occur during the anticipatory phase of the turn, which affects the entire task. The greater the length of the anticipatory step, the greater the length of the step taken to turn as well as the step taken after turning. And the greater the velocity, the greater the step length, and to fewer steps taken to perform the task.

Effectiveness of Neurofunctional Physical Therapy on the Quality of Sleep of Individuals with Parkinson's Disease: Case Series.

Objective Sleep disorders are disabling and highly prevalent comorbidities in Parkinson's disease (PD). This study's objective was to verify the effectiveness of neurofunctional physiotherapy in sleep quality, objectively and subjectively assessing it among individuals with PD. Methods A sample of individuals with PD was assessed before and after 32 physiotherapy sessions and three months later (follow-up). The following instruments were used: Pittsburgh Sleep Quality Index (PSQI); Epworth Sleepiness Scale (ESS); Parkinson's Disease Sleep Scale (PDSS), and actigraphy. Results Nineteen individuals aged 67.37 years old ( ± 8.03) on average were included. No differences were found in any of the variables measured by the actigraphy or the ESS. Improvement was found from pre- to post-intervention in terms of nocturnal movements (p = 0.04; d = 0.46) and total score (p = 0.03; d = 0.53) obtained on the PDSS. Improvement was also found in the PDSS sleep onset/maintenance domain (p = 0.001; d = 0.75) between pre-intervention and follow-up. The participants' total score obtained in the PSQI improved from pre- to post-intervention (p = 0.03; d = 0.44). Significant differences were found in nighttime sleep (p = 0.02; d = 0.51) and nocturnal movements (p = 0.02; d = 0.55), and in the PDSS total score (p = 0.04; d = 0.63) between pre- and post-intervention when only the poor sleepers subgroup (n = 13) was considered, while improvements were found in sleep onset/maintenance (p = 0.003; d = 0.91) between pre-intervention and follow-up. Discussion Neurofunctional physiotherapy was ineffective in improving objective parameters of sleep but was effective in improving the perception of sleep quality subjectively assessed among individuals with PD, especially those who perceived themselves to be poor sleepers.

Acute effects of transcranial direct current stimulation combined with physical therapy on the balance and gait in individuals with Parkinson's disease: A randomized controlled trial.

Application methods of transcranial direct current stimulation (tDCS) in Parkinson's disease (PD) are quite divergent making it difficult to define the clinical effectiveness of the tDCS on PD. Thus, the aim of this study was to verify the acute effects of tDCS when applied to different targets (Cz or C3-Cz-C4) combined to physical therapy to improve balance and gait in individuals with PD. A randomized controlled trial was conducted, with 50 individuals who were separated into four groups: 1) Real tDCS (Cz) + physical therapy, 2) Real tDCS (C3-Cz-C4) + physical therapy, 3) Sham tDCS + physical therapy and 4) Educational lecture + physical therapy. The current intensity was 2 mA, applied for 20 min. For the instrumental assessment of balance and gait, the 3D motion analysis system was used. For the biomechanical analysis of gait, three different conditions were performed: normal gait, dual task gait and obstacle gait. For balance analysis, the following positions were utilized: Romberg with eyes opened, Romberg with eyes closed, Tandem with eyes opened and Tandem with eyes closed. All evaluations were performed pre-intervention, post-intervention (immediately at the end of the intervention) and were followed-up on (24 h after the end of the intervention). No statistically significant differences were found for all gait and balance outcomes when considering the interaction between time (pre, post and follow-up assessments) versus group (Education, Sham, Cz and C3-Cz-C4). In conclusion, it was found that one session of tDCS, stimulating Cz or C3-Cz-C4 combined with physical therapy, was not effective in improving the balance and gait in people with PD as compared to sham tDCS or educational lecture plus physiotherapy.

Telehealth For Individuals with Parkinson's Disease During Covid-19 In Brazil: A Prospective Case Series.

Objective: To implement a telerehabilitation prevention, treatment, and follow-up physical therapy protocol for monitoring individuals with Parkinson's disease (PD) and to verify its effectiveness in minimizing the deleterious effects of the COVID-19 pandemic. Design: Prospective case series, involving 40 participants with mild to moderate PD recruited from a specialized neurorehabilitation group. The study was divided into four parts: (1) Phone calls to assess the feasibility of participating in remote physical therapy. (2) Social media training. (3) Baseline and post-intervention assessment for functional lower extremity strength, fear of falling, quality of life, depression, anxiety, activities of daily living, verbal fluency. (4) Intervention protocol consisting of 20 remote weekly physical therapy sessions, graphic material for physical and cognitive training, social activities, and education. Conclusion: The telerehabilitation protocol was viable and effective for patients with PD as an alternative to in-person treatment during the COVID-19 pandemic.

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.

Physiotherapy Versus Physiotherapy Plus Cognitive Training on Cognition and Quality of Life in Parkinson Disease: Randomized Clinical Trial.

OBJECTIVE: The aim of the study was to verify the effectiveness of physiotherapy associated with cognitive training to improve cognition and quality of life in individuals with Parkinson disease. DESIGN: This is a randomized clinical trial involving 58 individuals with mild to moderate Parkinson disease, randomly distributed into two groups: motor group and cognitive-motor group. Both groups were assessed for cognition and quality of life at the beginning of the study, at the end of the intervention protocols, and 3 mos after the end of the intervention. The following instruments were used to assess cognition and quality of life: Mini-Mental State Examination, Montreal Cognitive Assessment, Verbal fluency test, Rey Auditory Verbal Learning Test, Cognitive and perceptual assessment by pictures, Trail Making Test, Clock Drawing Executive Test, and Parkinson Disease Quality of Life Questionnaire. The motor group engaged in motor physiotherapy, whereas the cognitive-motor group underwent combined motor physiotherapy with cognitive training. RESULTS: The intragroup analysis revealed that both groups presented improved cognition (memory and visuospatial function domains) and quality of life after execution of the protocols, but without statistically significant intergroup differences. CONCLUSIONS: When comparing the intervention moments, the two treatment approaches used were effective for the outcomes: memory, visuospatial function, and quality of life in both groups.

Effectiveness of acute transcranial direct current stimulation on non-motor and motor symptoms in Parkinson's disease.

BACKGROUND: Transcranial direct current stimulation (tDCS) is an appropriate treatment for Parkinson's disease (PD). It offers promising results and is known to improve symptoms. Nevertheless, consistent parameters need to be established for research purposes. OBJECTIVE: To verify the effectiveness of acute tDCS on non-motor and motor symptoms in PD. METHODS: A double-blind, randomized and sham-controlled study, in which twenty individuals randomly underwent two (one real, one sham) stimulation sessions. The current was applied to the dorsolateral prefrontal cortex (DLPFC) for 20 min at 2 mA. Participants were assessed before and after the stimulation using the Trail Making Test (TMT), Verbal Fluency test, Stroop test, Timed Up and Go test and video gait analysis. In the statistical analysis, a two-way variance analysis of repeated measures was applied to the variables time, group and time vs. group interaction, using Sidak's post-hoc test. RESULTS: Statistically significant differences were found for TMT part B in both groups. For the Verbal Fluency test differences were found only within the group that received real stimulation. Additionally, both groups revealed improved reaction time in the congruent, incongruent and total phases of the Stroop test, but a significant difference in the Stroop effect was found only within the group that received real stimulation. CONCLUSION: The results confirm that improvements on cognitive tests are possible after a single session of DLPFC stimulation.

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.

Comparison of three physical therapy interventions with an emphasis on the gait of individuals with Parkinson's disease / Comparação de três intervenções fisioterapêuticas com ênfase na marcha de indivíduos com doença de Parkinson

Abstract Introduction: Gait impairments are one of the earliest signs reported by patients with Parkinson's disease (PD) and cause an increased number of falls and decreased quality of life among these patients. Objective: To compare the effectiveness of three physical therapy interventions using Rhythmic Cues (RC), Swiss Ball (SB) and Dual Task (DT), with an emphasis on gait treatment (step and stride length, duration and velocity), in individuals with PD. Methods: Quasi-randomized clinical trial addressing a sample composed of 45 individuals assigned to three groups. The individuals were assessed before and after the intervention protocol using the following: Modified Hoehn and Yahr Scale (HY), Unified Parkinson's Disease Rating Scale (UPDRS), Footprint analysis, Video Gait analysis, and Timed Up and Go Test (TUG). The groups were homogeneous concerning age, HY and UPDRS. Statistical analysis was performed using SPSS, version 20.0. Results: Statistically significant differences were found in all the variables analyzed in the RC and SB groups when compared in the pre- and post-intervention. With the exception of the TUG variable, the DT group presented statistically significant differences in all the remaining variables. Conclusion: The three interventions were effective for the outcomes under study, but the SB group presented the greatest magnitude of change (effect size), while the RC group presented the greatest improvement in the temporal gait variables (duration and velocity) and TUG.

Resumo Introdução: As alterações na marcha são um dos sinais relatados mais precocemente pelos pacientes com doença de Parkinson (DP), ocasionando aumento do número de quedas e redução da qualidade de vida desses indivíduos. Objetivo: Comparar a efetividade de três intervenções fisioterapêuticas utilizando Pistas Rítmicas (RC), Bola Suíça (SB) e Dupla Tarefa (DT) com ênfase no tratamento da marcha (tamanho do passo, da passada, tempo e velocidade) em indivíduos com DP. Métodos: Foi realizado estudo do tipo ensaio clínico quase randomizado, com casuística composta por 45 indivíduos, divididos nos três grupos. Os indivíduos foram avaliados antes e após o protocolo de intervenção pelos seguintes instrumentos: Escala de Hoehn & Yahr Modificada (HY), Escala Unificada de Avaliação da doença de Parkinson (UPDRS), Teste de impressão plantar (footprint), Análise de marcha por vídeo e Teste Timed Up and Go (TUG). Os grupos eram homogêneos em relação à idade, HY e UPDRS. Para análise estatística foi utilizado o programa SPSS 20. Resultados: Foram encontradas diferenças estatisticamente significantes em todas as variáveis analisadas no RC e SB quando comparados os valores pré e pós intervenção. No DT, as variáveis também apresentaram diferenças estatisticamente significantes, exceto o TUG. Conclusão: As três intervenções foram efetivas para os desfechos estudados, porém o grupo que apresentou maior magnitude de mudança (tamanho do efeito) foi o SB, enquanto o RC apresentou maior porcentagem de melhora nas variáveis temporais da marcha (tempo e velocidade), bem como no TUG.

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.