Intra and inter-rater remote assessment of bradykinesia in Parkinson's disease / Evaluación remota de la bradicinesia en la enfermedad de Parkinson mediante análisis intra e inter evaluadores

Introduction: Reliable assessment of individuals with Parkinson's disease (PD) is essential for providing adequate treatment. Clinical assessment is a complex and time-consuming task, especially for bradykinesia, since its evaluation can be influenced by the degree of experience of the examiner, patient collaboration and individual bias. Improvement of the clinical evaluation can be obtained by considering assessments from several professionals. However, this is only true when inter and intra-rater agreement are high. Recently, the Movement Disorder Society highlighted, during the COVID-19 pandemic, the need to develop and validate technologies for remote assessment of the motor status of people with PD. Thus, this study introduces an objective strategy for the remote evaluation of bradykinesia using multi-specialist analysis. Methods: Twelve volunteers with PD participated and these were asked to execute finger tapping, hand opening/closing and pronation/supination movements. Each task was recorded and rated by fourteen PD health experts for each patient. The scores were assessed on an individual basis. Intra and inter-rater agreement and correlation were estimated. Results: The results showed that agreements and correlations between experienced examiners were high with low variability. In addition, group analysis was noted as possessing the potential to solve individual inconsistency bias. Conclusion: Furthermore, this study demonstrated the need for a group with prior training and experience, along with indicating the importance for the development of a clinical protocol that can use telemedicine for the evaluation of individuals with PD, as well as the inclusion of a specialized mediating group. In Addition, this research helps to the development of a valid remote assessment of bradykinesia.(AU)

Introducción: La evaluación confiable de las personas con la enfermedad de Parkinson (EP) es esencial para lograr con un tratamiento adecuado. La evaluación clínica es una tarea compleja y que requiere mucho tiempo, especialmente para la bradicinesia, ya que su evaluación puede verse influenciada por el grado de experiencia del examinador, la colaboración del paciente y el sesgo individual. La mejora de la evaluación clínica se puede obtener considerando las evaluaciones de varios profesionales. Sin embargo, esto solo es más preciso cuando el convenio intra e inter evaluadores es alto. Recientemente, la Sociedad de Trastornos del Movimiento destacó, durante la pandemia COVID-19, la necesidad de desarrollar y validar tecnologías para la evaluación remota del estado motor de las personas con EP. Por lo tanto, este estudio presenta una estrategia objetiva para la evaluación remota de la bradicinesia mediante un análisis multi evaluadores. Métodos: Participaron 12 voluntarios con EP y se les pidió que ejecutaran movimientos de golpeteo de dedos de las manos, movimientos con las manos y pronación-supinación de las manos. Cada ejecución del movimiento fue registrado y calificado por 14 expertos en salud. Las puntuaciones se evaluaron de forma individual. Se estimó el convenio y la correlación intra e inter evaluadores. Resultados: Los resultados mostraron que los convenios y las correlaciones inter evaluadores experimentados son altos con baja variabilidad. Además, se observó que el análisis de grupo posee el potencial de resolver el sesgo de inconsistencia individual. Conclusiones: De esta forma, este estudio demostró la necesidad de un grupo con formación y experiencia previa, señalando la importancia para el desarrollo de un protocolo clínico que utiliza la telemedicina para la evaluación de personas con EP y como la inclusión de un grupo mediador especializado. En realidad, esta investigación propone una evaluación remota eficaz de la bradicinesia.(AU)

Intra and inter-rater remote assessment of bradykinesia in Parkinson's disease.

INTRODUCTION: Reliable assessment of individuals with Parkinson's disease (PD) is essential for providing adequate treatment. Clinical assessment is a complex and time-consuming task, especially for bradykinesia, since its evaluation can be influenced by the degree of experience of the examiner, patient collaboration and individual bias. Improvement of the clinical evaluation can be obtained by considering assessments from several professionals. However, this is only true when inter and intra-rater agreement are high. Recently, the Movement Disorder Society highlighted, during the COVID-19 pandemic, the need to develop and validate technologies for remote assessment of the motor status of people with PD. Thus, this study introduces an objective strategy for the remote evaluation of bradykinesia using multi-specialist analysis. METHODS: Twelve volunteers with PD participated and these were asked to execute finger tapping, hand opening/closing and pronation/supination movements. Each task was recorded and rated by fourteen PD health experts for each patient. The scores were assessed on an individual basis. Intra and inter-rater agreement and correlation were estimated. RESULTS: The results showed that agreements and correlations between experienced examiners were high with low variability. In addition, group analysis was noted as possessing the potential to solve individual inconsistency bias. CONCLUSION: Furthermore, this study demonstrated the need for a group with prior training and experience, along with indicating the importance for the development of a clinical protocol that can use telemedicine for the evaluation of individuals with PD, as well as the inclusion of a specialized mediating group. In Addition, this research helps to the development of a valid remote assessment of bradykinesia.

Intra and inter-rater remote assessment of bradykinesia in Parkinson's disease.

INTRODUCTION: Reliable assessment of individuals with Parkinson's disease (PD) is essential for providing adequate treatment. Clinical assessment is a complex and time-consuming task, especially for bradykinesia, since its evaluation can be influenced by the degree of experience of the examiner, patient collaboration and individual bias. Improvement of the clinical evaluation can be obtained by considering assessments from several professionals. However, this is only true when inter and intra-rater agreement are high. Recently, the Movement Disorder Society highlighted, during the COVID-19 pandemic, the need to develop and validate technologies for remote assessment of the motor status of people with PD. Thus, this study introduces an objective strategy for the remote evaluation of bradykinesia using multi-specialist analysis. METHODS: Twelve volunteers with PD participated and these were asked to execute finger tapping, hand opening/closing and pronation/supination movements. Each task was recorded and rated by fourteen PD health experts for each patient. The scores were assessed on an individual basis. Intra and inter-rater agreement and correlation were estimated. RESULTS: The results showed that agreements and correlations between experienced examiners were high with low variability. In addition, group analysis was noted as possessing the potential to solve individual inconsistency bias. CONCLUSION: Furthermore, this study demonstrated the need for a group with prior training and experience, along with indicating the importance for the development of a clinical protocol that can use telemedicine for the evaluation of individuals with PD, as well as the inclusion of a specialized mediating group. In Addition, this research helps to the development of a valid remote assessment of bradykinesia.

Efectividad del trabajo de resistencia y de cicloergómetro a alta velocidad sobre la bradicinesia en la enfermedad de Parkinson: revisión sistemática / Effectiveness of endurance exercises and high-speed cycling on bradykinesia in Parkinson's disease: A systematic review

Antecedentes y objetivo Los ejercicios de resistencia y de cicloergómetro a alta intensidad se han utilizado en los últimos años para tratar la bradicinesia en la enfermedad de Parkinson (EP). El objetivo es determinar la efectividad del ejercicio de resistencia y de cicloergómetro a alta intensidad para disminuir la bradicinesia en pacientes con EP. Sujetos y métodos Se realizó una búsqueda hasta el año 2020 en las bases de datos PubMed, Web of Science, Medline, Cochrane Library, Google Scholar y ScienceDirect. Para evaluar la calidad metodológica y validez interna de los estudios se utilizó la escala PEDro. Resultados Se incluyeron 10 estudios en nuestra revisión. Cinco estudios llevaron a cabo un trabajo con cicloergómetro de alta intensidad cuya duración fue de una a cinco semanas, mejorando la bradicinesia cuatro de ellos, siendo tres de manera significativa. Cuatro estudios realizaron un trabajo con resistencia (desde nueve semanas hasta 24 meses) mejorando todos la bradicinesia, siendo significativos tres de ellos. Un estudio realizó un trabajo de resistencia y cicloergómetro demostrando mejorar la bradicinesia tras 12 semanas de tratamiento. Conclusión Aunque los dos tratamientos son beneficiosos para mejorar la bradicinesia en EP con severidades leves-moderadas, en un periodo mínimo de una semana, el tratamiento con cicloergómetro a alta velocidad tiene mejoras significativas, mientras que el trabajo con resistencia lo hace a partir de nueve semanas, siendo necesarios más estudios con mejores evidencias (AU)

Background and objective Endurance and high-intensity stationary cycling exercises have been used in recent years to treat bradykinesia in Parkinson's disease (PD). The aim is to determine the effectiveness of endurance and high-intensity stationary cycling in reducing bradykinesia in people with PD. Subjects and methods A search was conducted up to 2020 in the PubMed, Web of Science, Medline, Cochrane Library, Google Scholar and ScienceDirect databases. The PEDro scale was used to assess the methodological quality and internal validity of the studies. Results 10 studies were included in our review. Five studies carried out high intensity stationary cycling workouts with a duration of 1 to 5 weeks, 4 of them showed improved bradykinesia, 3 of them significantly. Four studies carried out endurance exercises (from 9 weeks to 24 months) all cases of bradykinesia improved, 3 significantly. One study looked at endurance exercises and stationary cycling showing, an improvement in bradykinesia after 12 weeks of treatment. Conclusion Although both treatments are beneficial for improving bradykinesia in PD of mild-moderate severity, in a minimum period of one week, treatment with high-speed stationary cycling shows significant improvements, while endurance exercises do so from 9 weeks onwards. Further studies with better evidence are needed (AU)

Análisis del patrón de la marcha en mujeres con fibromialgia. Revisión sistemática / Walking Motor Pattern Analysis in women with Fibromyalgia. A systematic Review

Objetivo: El objetivo de esta revisión fue recopilar información sobre los artículos publicados hasta la actualidad que se centren en el análisis del patrón de la marcha realizados en una población con fibromialgia, una enfermedad reumatológica con una serie de síntomas asociados que produce en los pacientes que la sufren limitaciones funcionales y alteraciones en el patrón motor que afectan en su rutina diaria y su calidad de vida.Método: Para ello se realizó una búsqueda en la base de datos PubMed, donde un total de 13 artículos fueron finalmente seleccionados tras aplicar una serie de criterios de inclusión y de exclusión. El método PRISMA fue aplicado en la elaboración de esta revisión, obteniendo los datos por el planteamiento PICOS. El nivel de evidencia de los artículos incluidos fue determinado por el Dutch Institute for Healtcare Improvement. Resultados: Los resultados evidenciaron que los pacientes con fibromialgia sufren alteraciones en el patrón motor que se traducen fundamentalmente en una reducción en la velocidad, cadencia y longitud de zancada principalmente. Otras variables como la frecuencia de zancada, el balanceo y las fases de apoyo también mostraron alteraciones respecto a sujetos sanos.Conclusiones: Las alteraciones que mostraron los resultados analizados fueron causadas por síntomas característicos de la fibromialgia como la fatiga, el dolor o la falta de actividad física, y hacen que aumente considerablemente el riesgo de sufrir caídas y lesiones. En base a estas evidencias, se subraya la importancia que tiene el análisis del patrón de la marcha desde un punto de vista clínico, tanto de los resultados significativos como de los no significativos, como valoración complementaria de los pacientes con esta enfermedad y para adecuar las terapias y tratamientos basados en actividad física que se implementen en pacientes con fibromialgia.(AU)

Objective: The main aim of this review was to collect information in the current literature about motor walking pattern analyses performed in people suffering from fibromyalgia, a rheumatologic disorder whose associated symptoms produce several consequences such as functional limitations and alterations in the motor walking pattern that affect their daily life routine and quality of life.Method: To this end, an electronic search was made in the PubMed database, and a total of 13 articles were finally selected after applying a series of inclusion and exclusion criteria. The PRISMA methodology was applied to perform this review Data collections was obtained according to the PICOS approach. The level of evidence for the included articles was established by the Dutch Institute for Healthcare Improvement.Results: The results obtained evidenced that fibromyalgia patients suffer alterations in the walking motor pattern that mainly translate into a reduction in speed, cadence and stride length. Other variables such as stride frequency swing and support phases also showed alterations with regard to healthy control subjects.Conclusions: The impairments showed by these results analysed were caused by symptoms characteristic of fibromyalgia such as fatigue, pain, or lack of physical activity. Thus, patients suffering from this syndrome considerably increase their risk of falls and injuries. Based on this evidence, both significant and non-significant walking motor patterns analysis could become a useful tool from a clinical point of view as a complementary assessment of fibromyalgia patients. Furthermore, this analysis may provide objective and thorough information in order to adapt therapies and treatments based on physical activity implemented in patients with fibromyalgia.(AU)

Main determinants of physical activity levels in individuals with Parkinson's disease / Fatores determinantes do nível de atividade física de indivíduos com doença de Parkinson

ABSTRACT This study analyzed the relationship between patient characteristics, factors associated with Parkinson’s disease (PD), and physical activity level of individuals affected by the disease. Forty-six volunteers with mild-to-moderate idiopathic PD were assessed using sections II/III of the Unified Parkinson’s Disease Rating Scale and their motor functions were classified according to the modified Hoehn and Yahr (HY) scale. Data such as age, disease duration, the Human Activity Profile (HAP), the Fatigue Severity Scale were collected. Lower limb bradykinesia and clinical subtypes of PD were defined. Two models that explained 76% of the variance of the HAP were used. The first comprised age, ability to perform activities of daily living (ADL), and the HY scale; the second comprised age, ability to perform ADL, and lower limb bradykinesia. Possible modifiable factors such as the ability to perform ADL and lower limb bradykinesia were identified as predictors of physical activity level of individuals with PD.

RESUMO Este estudo analisou a relação entre características dos pacientes, fatores associados com a doença de Parkinson (DP) e nível de atividade física de indivíduos afetados pela doença. Quarenta e seis voluntários com DP leve a moderada foram avaliados usando a Escala de Avaliação Unificada da Doença de Parkinson (UPDRS), e classificados de acordo com a Escala de Hoehn e Yahr modificada (HY). Dados como idade, duração da doença, Perfil de Atividade Humana (PAH), Escala da Severidade da Fatiga (FSS) foram coletados. Bradicinesia de membros inferiores e subtipos clínicos foram definidos. Dois modelos que explicaram 76% da variância do PAH foram observados. O primeiro compreende idade, habilidade de realizar Atividades de Vida Diária (AVD) e a escala de HY modificada; e o segundo compreende idade, habilidade de realizar AVD, e bradicinesia. Fatores modificáveis como a habilidade de realizar AVD e bradicinesia foram identificados como preditores do nível de atividade física de indivíduos com DP.

Parámetros cinemáticos en la prueba de Tapping en pacientes con enfermedad de Parkinson / Cinematic parameters in the Tapping test in patients with Parkinson's disease

Motor slowness is the most characteristic motor deficit in Parkinson Disease (PD). The tapping test is a timed motor performance task which has been widely used in evaluation of PD. We study kinematics parameters of tapping test in PD and health control. Methods: Subjects consisted on 12 patients (2 women) with Parkinson's disease (PD) and 6 healthy control subjects (2 women). The mean age 63 +/- 9.7years PD and 64.8 +/- 13.3 years control. Duration of disease was 5.8 +/- 4.1 years. All patients were on levodopa medication. Procedures: All participants performed repetitive Hand/Arm movements between two points placed 25 cm apart horizontally for 20 successive taps ("as fast as possible"). The test was performed independently for each hand. Parkinson patients performed under the best ON condition. We assessed patients clinically using the motor section of the Unified Parkinson Disease Rating Scale (UPDRS). Informed consent was obtained. Apparatus: One standard video camera positioned perpendicularly from two target points recorded movement and referential xy system. A light reflective marker was attached to middle finger. The middle finger marker was manually digitized at a rate of 30 Hz using Kinematics Analysis software. Statistical analysis Kuskal-wallis one way analysis of variance, r spearman correlation. A p value < 0.05 was considered statistically significant. Results: Median Velocity in normal control was 94 +/- 11 cm/s and in PD was 67 +/- 15 cm/s (p < 0.001). Maximal velocity in normal control was 198 +/- 20 cm/s and in PD was 143 +/- 33 cm/s (p < 0.001). Median acceleration in normal control was 1630 +/- 331 cm/s2 in PD was 966 +/- 285 cm/s2 (p < 0.001). Median Movement amplitude in Y plane; in normal control was 28 +/- 5 cm and in PD was 21 +/- 8 cm (p < 0.01). Median Movement amplitude in Y plane correlated significantly with bradykinesia summary score (r = -0.59, p < 0.001)...

La bradicinecia es el déficit motor más característico de la enfermedad de Parkinson (EP), generalmente diagnosticado bajo diversos estudios como la prueba de tapping -ampliamente utilizada para determinar la enfermedad-, donde se mide la repetición de una tarea específica en un tiempo determinado. En el siguiente trabajo se estudiaron los parámetros cinemáticos del tapping en EP y controles. El estudio se realizó en 12 pacientes con EP con una edad media de 64,6 +/- 9,4 años -con duración promedio de la EP de 5,8 +/- 4,1 años. Todos los casos estaban en tratamiento con levodopa. Además, se estudiaron 7 controles en personas con una edad media de 64,8 +/- 12,8 años. Se les solicitó a todos que con los dedos de la mano tocaran en forma secuencial dos puntos separados por 25 cm. En el dedo medio se instaló una marca refractaria a la luz, utilizada como referencia para determinar la posición de la mano. El movimiento fue filmado mediante una cámara de video estándar con una velocidad de 30 cuadros por segundo. Los pacientes fueron evaluados clínicamente usando la escala unificada para la valoración de la enfermedad de Parkinson en su sección motora parte III (UPDRS-III). El análisis cinemático se realizó mediante un software especialmente diseñado para determinar la posición espacial de la marca en relación al sistema de referencia cartesiano. El análisis estadístico se realizó con Kurskal-Wallis test y correlaciones de Spearman. Se consideró significación estadística con p < 0,05. Resultados: La velocidad media en el control normal fue de 94 +/- 11 cm/seg y en la EP fue de 67 +/- 15 cm/seg (p <0,001). La velocidad máxima en el control normal fue de 198 +/- 20 cm /seg y en la EP fue de 143 +/- 33 cm/seg (p < 0,001). En el control de aceleración media normal fue 1.630 +/- 331 cm/seg² en la EP fue 966 +/- 285 cm/seg² (p < 0,001). Movimiento amplitud media en el plano Y, en el control normal fue de 28 +/- 5 cm y en la EP fue de 21 +/- 8 cm (p < 0,01)...