Transcranial direct current stimulation suggests not improving postural control during adapted tandem position in people with Parkinson's disease: A pilot study.

BACKGROUND: Balance impairments in people with Parkinson's disease (PD) demonstrated mainly in challenging postural tasks, such as increased body oscillation may be attributed to the deficits in the brain structures functionality involved in postural control (e.g., motor cortex, midbrain, and brainstem). Although promising results, the effect of transcranial direct current stimulation (tDCS) on postural control in people with PD is unclear, especially in objective measures such as the center of pressure (CoP) parameters. Thus, we analyzed the effects of a single session of tDCS on the CoP parameters during the adapted tandem position in people with PD. METHODS: Nineteen people with PD participated in this crossover, randomized, and double-blind study. Anodal tDCS was applied over the primary motor cortex in two conditions of stimulation (2 mA/active and sham) on two different days for 20 min immediately before the postural control evaluation. Participants remained standing in an adapted tandem position for the postural control assessment for 30 s (three trials). CoP parameters were acquired by a force plate. RESULTS: No significant differences were demonstrated between stimulation conditions (p-value range = 0.15-0.89). CONCLUSIONS: Our results suggested that a single session of tDCS with 2 mA does not improve the postural control of people with PD during adapted tandem.

Author Correction: Variability of crossing phase in older people with Parkinson's disease is dependent of obstacle height.

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Postural control after unexpected external perturbation: Effects of Parkinson's disease subtype.

Different clinical subtypes of Parkinson's disease (PD) have long been recognized. Recent studies have focused on two PD subtypes: Postural Instability and Gait Difficulty (PIGD) and Tremor Dominant (TD). PIGD patients have greater difficulties in postural control in relation to TD. However, knowledge about the differences in reactive adjustment mechanisms following a perturbation in TD and PIGD is limited. This study aimed to compare reactive postural adjustments under unexpected external perturbation in TD, PIGD, and control group (CG) subjects. Forty-five individuals (15 TD, 15 PIGD, and 15 CG) participated in this study. Postural perturbation was applied by the posterior displacement of the support surface in an unexpected condition. The velocity (15 cm/s) and displacement (5 cm/s) of perturbation were the same for all participants. Center of pressure (CoP) and center of mass (CoM) were analyzed for two reactive windows after the perturbation (0-200 ms and 200-700 ms). The Bonferroni post hoc test indicated a higher range of CoP in the PIGD when compared to the CG (p = 0.021). The PIGD demonstrated greater time to recover the stable posture compared to the TD (p = 0.017) and CG (p = 0.003). Furthermore, the TD showed higher AP-acceleration peak of CoM when compared to the PIGD (p = 0.048) and CG (p = 0.013), and greater AP-acceleration range of CoM in relation to the CG (p = 0.022). These findings suggest that PD patients present worse reactive postural control after perturbation compared to healthy older individuals. CoP and CoM parameters are sensitive to understand and detect the differences in reactive postural mechanisms in PD subtypes.

Variability of crossing phase in older people with Parkinson's disease is dependent of obstacle height.

Our aim was investigating variability in spatiotemporal parameters and kinetics of obstacle avoidance steps of different height obstacles in people with Parkinson's disease (PD) and healthy older people. Twenty-eight participants have included (15 PD - stage disease: 2.1 ± 0.4 pts) and 13 healthy older people (control group). Each subject performed 10 trials of the following tasks: low obstacle, intermediate obstacle and high obstacle. The presentation order was randomized by block for each condition and participant. The spatiotemporal parameters was collected by GAITRite. An optoelectronic system (Optotrak Northern Digital Inc.) with 100 Hz of frequency was used to collect obstacle parameters. The kinect parameters (propulsion impulse and braking impulse) were acquire through two force plates (AccuGait), with a frequency of acquisition 200 Hz. Intersteps variability was calculated throughout mean values, standard deviation and coefficient of variation of two obstacle avoidance steps for each trial. PD group presented greater variability than control group on vertical and horizontal distances to the obstacle. Obstacle height did not change kinect's parameters for both groups. The combination of task complexity (obstacle height) and disease impairments (gait alteration, loss of balance, etc) contributing for greater variability of Parkinson's group. Besides, low obstacle and high obstacle seem to exacerbate variability of distance between obstacle and foot.

A program of physical activity improves gait impairment in people with Alzheimer's disease

AIM: This study aimed to identify the effects of aging and Alzheimer's disease (AD) on gait parameters after a four-month period and to investigate the effects of a four-month program of physical activity, with emphasis on the cognitive components of gait during single and dual task, in people with AD. METHODS: Twenty-three people with AD, divided into the Training Group (TG; n=12; aged 79.17±7.62 years) and the Control Group (CG; n=11; aged 77.00±5.57 years), and eleven healthy older adults (Healthy Group - HG; aged 75.82±4.83 years) were included in this study. TG participated in a physical activity program for four months. The CG and HG were instructed not to participate in any kind of regular physical activity in this period. The physical activity program includes motor activities and cognitive tasks simultaneously. The participants attended a 1-h session three times a week. The kinematic parameters of gait were analyzed under two conditions, before and after a physical activity program: single and dual task. Deltas for all dependent variables between pre and post training were calculated. The deltas were compared using two-way ANOVAs with group (TG x CG and CG x HG) and task (single x dual task) as factors, with repeated measures for task. RESULTS: After the training period, the TG improved stride length, duration, velocity and cadence compared to the CG. CONCLUSION: Physical activity with emphasis on cognitive components promotes better reallocation of attention while walking in people with AD, improving attentional focus on the gait and thus resulting in a safer locomotive pattern.(AU)

Different types of additional somatosensory information do not promote immediate benefits on gait in patients with Parkinson's disease and older adults / Diferentes tipos de informação somatossensorial adicional não promovem benefícios imediatos no andar de pacientes com doença de Parkinson e idosos sadios / Diferentes tipos de información somatosensorial adicional no promueven beneficios inmediatos sobre la marcha en pacientes con enfermedad de Parkinson y los mayores saludables

Plantar cutaneous stimulation has been shown to improve gait in Parkinson's disease (PD), but the effects of different types of insoles have not been tested. We evaluated the immediate effect of different types of insoles on gait in PD patients and healthy older adults. Nineteen PD patients and nineteen healthy older adults performed and performed a walking task at their self-selected speed in three conditions: conventional insole, insole with a raised ridge around the foot perimeter, and insole with half-spheres. Plantar sensation was evaluated before and after the walking protocol. There were no differences between groups for plantar sensation before and after the walking task. PD patients demonstrated reduced stride length and stride velocity. There were no immediate benefits offered by the insoles on gait of either group. The increased plantar cutaneous stimulation does not promote immediate benefits on gait in PD patients and healthy older adults.

A estimulação cutânea plantar beneficia o andar de pacientes com doença de Parkinson (DP), mas os efeitos de diferentes tipos de palmilhas ainda não foram testados. Nós avaliamos o efeito imediato de diferentes tipos de palmilhas no andar de pacientes com DP e idosos saudáveis. Dezenove pacientes com DP e dezenove idosos sadios andaram em três condições: palmilha convencional, palmilha com borda na parte externa da superfície do pé e palmilha com semi-esferas. A sensibilidade plantar foi avaliada antes e após o protocolo do andar. Não foram encontradas diferenças entre os grupos para sensibilidade plantar antes e após a tarefa do andar. Os pacientes apresentaram reduzida velocidade e menor comprimento da passada. Não foram verificados benefícios imediatos das palmilhas no andar para os grupos. O aumento na estimulação cutânea plantar não promoveu benefícios imediatos no andar de pacientes com DP e controles.

La estimulación plantar beneficia el andar e de pacientes con enfermedad de Parkinson-(EP), pero los efectos de diferentes tipos de plantillas no fueron testados. Evaluamos el efecto inmediato de diferentes tipos de plantillas en el andar de pacientes con EP y en mayores saludables. Diecinueve pacientes con EP y diecinueve controles fueron evaluados en el andar en tres condiciones: plantilla convencional, plantilla con borde en la superficie exterior del pie e plantilla con semi-esferas. La sensibilidad plantar fue evaluada antes y después de lo andar. No hubo diferencias entre los grupos para la sensibilidad plantar antes y después de lo andar. Los pacientes mostraron velocidad reducida y menor longitud de la zancada. No hubo beneficios inmediatos de las plantillas en el andar para los grupos. El aumento en la estimulación plantar no promovió beneficios inmediatos en el andar para los grupos.

Efeitos do exercicio agudo sobre biomarcadores sericos de ratos diabeticos / The effects of acute exercise on serum biomarkers in diabetics rats / Efectos del ejercicio agudo sobre biomarcadores de suero em ratones diabeticos

INTRODUÇÃO: As respostas ao exercício agudo dos biomarcadores, como a fosfatase alcalina (FA) e a creatina quinase (CK) séricas têm sido pouco investigadas em ratos diabéticos. OBJETIVOS: Verificar os efeitos do exercício físico aeróbio agudo sobre as concentrações de CK e FA, bem como, avaliar o estado hídrico em ratos diabéticos experimentais. MATERIAIS E MÉTODOS Foram utilizados ratos Wistar machos, adultos jovens, distribuídos em dois grupos: diabéticos (DA) e controles (CA). O diabetes foi induzido por meio da administração de aloxana monoidratado Sigma(r) (32 mg/kg de peso corporal). Duas semanas após confirmação do diabetes, ambos os grupos foram submetidos a uma sessão aguda de natação por 30 min, com carga aeróbia (4,5 % do peso corporal). Foram avaliados: glicose, hematócrito, CK, FA, albumina e a cinética de lactato durante o exercício por meio de coletas 25 µL de sangue da cauda dos animais, nos minutos 0, 10, 20 e 30 de exercício. RESULTADOS: ANOVA de dois fatores para medidas repetidas e o teste post hoc de Tukey apontaram diminuição significativa dos valores de glicemia após o exercício para o grupo DA, aumento significativo de CK pós-exercício para o grupo DA, aumento significativo de hematócrito para ambos os grupos após exercício e manutenção da FA após exercício para o grupo DA. CONCLUSÃO: O exercício agudo aeróbio foi eficiente no controle dos níveis glicêmicos de ratos diabéticos. Entretanto, deve ser aplicado com cautela, pois induziu altos valores de CK, sugerindo possíveis lesões teciduais. .

INTRODUCTION: The responses to acute exercise on biomarkers, such as alkaline phosphatase (ALP) and creatine kinase (CK) serum levels have been little investigated in diabetic rats. OBJECTIVES: To investigate the effects of acute aerobic exercise on the concentrations of CK and ALP as well as evaluating the hydration status in diabetic rats. MATERIALS AND METHODS: Were used male Wistar rats, young adults, divided into two groups: diabetic (DA) and controls (CA). The diabetes was induced in the rats by administration of alloxan monohydrate Sigma(r) (32 mg/kg body weight). Two weeks after confirmation of diabetes, both groups were subjected to an acute swim session for 30 min, with aerobic load (4.5% body weight). Glucose, hematocrit, CK, ALP, albumin and lactate kinetics during exercise were evaluated by collecting 25µL of blood from the tail of the animals in minutes 0, 10, 20 and 30 of exercise. RESULTS: Two-way ANOVA for repeated measures and post hoc Tukey test showed significant decrease of glycemia after exercise for the DA group, significant increase in CK after exercise for the DA group, significant increase in hematocrit for both groups after exercise and maintenance of ALP after exercise for the DA group. CONCLUSION: The acute aerobic exercise was effective in controlling glucose levels in diabetic rats. However, it should be applied with caution, because it induced high CK values, suggesting possible tissue damage. .

INTRODUCCIÓN: Las respuestas al ejercicio agudo de los biomarcadores, como la fosfatasa alcalina (FA) y la creatina quinasa (CK) séricas han sido poco investigadas en ratones diabéticos. OBJETIVOS: Verificar los efectos del ejercicio físico aeróbico agudo sobre las concentraciones de CK y FA, bien como evaluar el estado hídrico en ratones diabéticos experimentales. MATERIALES Y MÉTODOS: Fueron utilizados ratones Wistar machos, adultos jóvenes, distribuidos en dos grupos: diabéticos (DA) y controles (CA). La diabetes fue inducida por medio de la administración de aloxana monohidratado Sigma(r) (32 mg/kg de peso corporal). Dos semanas después de la confirmación de la diabetes, ambos grupos fueron sometidos a una sesión aguda de natación por 30 minutos, con carga aeróbica (4,5% del peso corporal). Fueron evaluados: Glucosa, hematocrito, CK, FA, albumina y La cinética de lactato durante el ejercicio por medio de colectas de 25 µL de sangre de la cola de los animales, en los minutos 0, 10, 20 y 30 de ejercicio. RESULTADOS: ANOVA de dos factores para medidas repetidas y el test post hoc de Tukey apuntaron disminución significativa de los valores de glicemia después del ejercicio para el grupo DA, aumento significativo de CK después del ejercicio para el grupo DA, aumento significativo de hematocrito para ambos grupos después del ejercicio y mantenimiento de la FA después del ejercicio para el grupo DA. CONCLUSIÓN: El ejercicio agudo aeróbico fue eficiente en el control de los niveles glicémicos de ratones diabéticos. Entretanto, debe ser aplicado con cautela, pues indujo altos valores de CK, sugiriendo posibles lesiones tisulares. .

Systematic review of the effects of fatigue on spatiotemporal gait parameters.

PURPOSE: This systematic review aimed to assess changes on spatiotemporal gait parameters due to fatigue. MATERIAL AND METHOD: A search was carried out in literature published from 1950 to December 2010 and retrieved 771 articles using terms referring to walking and fatigue in the title, abstract or keywords. Two researchers assessed the selection and quality of each article independently. RESULTS: Seven studies were selected for this systematic review, two of which reported on the same data set. Several spatiotemporal parameters were reported to change with fatigue, but the few variables studied in multiple studies, gait speed and stride or step length and stride time, were affected only in single studies. Fatigue appears to modulate spatiotemporal gait parameters, but the effects of fatigue appear to be dependent on the muscles that were fatigued, and age that appears to be a moderator of the effects of fatigue on gait.

Revisão sistemática do efeito do envelhecimento no andar livre e adaptativo / Systematic review of the effect of aging on the free and adaptive gait

O envelhecimento parece comprometer o andar dos indivíduos. Entretanto, ainda não é claro quais são os efeitos do envelhecimento no andar. O objetivo deste estudo foi determinar as mudanças nos parâmetros cinemáticos, cinéticos e eletromiográficos do andar livre e adaptativo, em velocidade preferida, causadas pelo envelhecimento. A estratégia de busca inicial foi realizada para identificar os artigos que analisaram o andar livre e adaptativo. Foram utilizadas as bases de dados eletrônicas MEDLINE, PubMed, EMBASE, CINAHL, Sports Discus, DARE, PsychInfo, ERIC, AusportMed, AMI, Cochrane e PEDro. Vinte e três artigos foram revisados na íntegra. Idosos são mais lentos, têm menor comprimento do passo e maior duração de duplo suporte do que adultos jovens durante o andar livre e adaptativo. Ainda, eles apresentaram maiores demandas musculares, ocorrendo redistribuição da potência e do torque articular e aplicação de menor força na fase de propulsão e de absorção da massa corporal. Concluiu-se que idosos modificam os parâmetros cinemáticos, cinéticos e eletromiográficos do andar livre e adaptativo quando comparados a adultos jovens.

Aging seems to impair the walking. However, it is not clear the effects of aging on walking. The aim of this study was to determine changes in kinematic, kinetic and electromyographic parameters of the free and adaptive gait, in preferred velocity, caused by aging. The initial search strategy was performed to identify all articles that examined the free and adaptive gait. The electronic databases analyzed were: MEDLINE, PubMed, EMBASE, CINAHL, Sports Discus, DARE, PsychInfo, ERIC, AusportMed, AMI, Cochrane and PEDro. Twenty-three articles were reviewed in full. Elderly are slower, with shorter step length and longer double support duration than young adults during free and adaptive gait. Even, they showed higher muscular demands, with redistribution of joint power and torque and decreased force in the propulsion and absorption phases. It was concluded that elderly present altered kinematic, kinetic and electromyographic parameters of free and adaptive gait compared to young adults.