Functional improvement related to enrolment in a Parkinson’s disease rehabilitation program

2020 ◽  
Vol 47 (4) ◽  
pp. 405-414
Author(s):  
Beverley Chow ◽  
Florin Feloiu ◽  
Assunta Berardocco ◽  
David Ceglie ◽  
Shanker Nesathurai
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Neurodegenerative Disorder ◽  
Motor Impairment ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Functional Improvement ◽  
Gait Velocity ◽  
Timed Up And Go ◽  
Multidisciplinary Program

BACKGROUND: Parkinson’s disease (PD) is a progressive neurodegenerative disorder with manifestations such as tremors, rigidity and bradykinesia. OBJECTIVE: The objective of this study was to evaluate the efficacy of outpatient multidisciplinary rehabilitation. METHODS: 179 patients participated in the six-week program. The following outcomes were measured: Timed Up and Go (TUG), sit to stand five times (STSx5) and in 30 seconds (STS30), six minute walk distance (6MWD) and gait velocity (6MWV), MOCA, bilateral grip strength, 360-degree turn (360 R, 360 L) and bilateral nine hole peg test. Pre- and post- data was analyzed via paired t-tests. Multiple regression was used to determine age- or gender-affected outcomes. RESULTS: Patients showed a statistically significant improvement (p < 0.05) in all outcomes. Mean TUG improved by 1.63 seconds (s), STSx5 by 4.19s, STS30 by 2.37 repetitions, 6MWD by 66.8 metres, 6MWV by 0.15 m/s, MOCA by 1.50 points, 360 R by 1.17s, 360 L by 1.60s, Grip R by 0.78 kg, Grip L by 0.95 kg, 9HP R by 1.71s and 9HP L by 1.58s. Gender had no influence. Age was a statistically significant predictor in STSx5 and 6MW. CONCLUSIONS: An outpatient multidisciplinary program successfully decreased motor impairment and increased overall functional independence in PD.

scholarly journals RISING FROM THE FLOOR IN PERSONS WITH PARKINSON’S DISEASE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S474-S475
Author(s):  
Dennis W Klima ◽  
Jeremy Stewart ◽  
Frank Freijomil ◽  
Mary DiBartolo
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Physical Performance ◽  
Performance Measure ◽  
Community Dwelling ◽  
Gait Velocity ◽  
Performance Tests ◽  
Motor Patterns ◽  
Timed Up And Go ◽  
Cross Sectional

Abstract While considerable research has targeted gait, balance and preventing falls in individuals with Parkinson’s disease (PD), less in known about the ability to rise from the floor in this population. The aims of this study were to 1) Examine the relationship between locomotion and physical performance tests and the timed supine to stand performance measure and to 2) Identify both the time required and predominant motor patterns utilized by persons with PD to complete to floor rise transition. A cross-sectional design was utilized. Twenty community-dwelling older adults with PD (mean age 74.8+/-9.5 years; 13 men) performed a standardized floor rise test and locomotion tests in a structured task circuit. Subject demographic and anthropometric data were also collected. Statistical analyses included descriptive statistics and Pearson Product Moment correlations. Fifteen subjects (75%) demonstrated the crouch kneel pattern and fourteen (70%) used an all-4’s strategy to rise to stand. The mean time to rise from the floor was 14.9 (+/- 7.6) seconds and slower than published norms for persons without PD. Nine subjects required the use of a chair to perform floor recovery. Supine to stand performance time was significantly correlated with the: Dynamic Gait Index (r= - 0.66; p&lt;0.002), Five Times Sit to Stand Test (r=0.78; p&lt;0.001), Timed Up and Go Test (r=0.74; p&lt;0.001), and gait velocity (r= -0.77; p&lt;0.001). Rising from the floor demonstrates concurrent validity with locomotion and physical performance tests. Floor recovery techniques can be incorporated in fall prevention initiatives in conjunction with PD symptom management.

Predictors of Functional Improvements After Therapeutic Yoga Intervention for People with Parkinson’s Disease

2019 ◽  
Vol 30 (1) ◽  
pp. 9-18
Author(s):  
Em V. Adams ◽  
Marieke Van Puymbroeck ◽  
Alysha Walter ◽  
Brent L. Hawkins ◽  
Arlene A. Schmid ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Predictive Factors ◽  
Secondary Data ◽  
Management Training ◽  
Functional Improvement ◽  
Gait Velocity ◽  
Future Research ◽  
Yoga Therapy ◽  
Yoga Intervention

Abstract Parkinson’s disease (PD) affects nearly 10 million people worldwide, leading to decreased mobility and balance and potential loss of independence. Yoga has been associated with improved function for people with PD, but the predictive factors for improved functional outcomes as a result of yoga participation remain unexamined. The objective of this secondary data analysis was to identify predictive factors of functional improvement for people with PD after an 8-week yoga intervention. Stepwise multiple linear regression was used to identify significant predictors of improvement in balance, fall control, PD symptoms, and activity constraints. Lower cognitive functioning was predictive of improvement in perceived control over falls, body responsiveness was predictive of improvement in PD-specific symptoms, and gait velocity was predictive of improvement in balance and activity constraints. Future research is warranted to evaluate the use of screeners to predict who is the best fit for yoga therapy. Additional research is needed to evaluate the need to include cognitive self-management training concurrent with yoga therapy.

Effects of mechanical stimulation of the feet on gait and cardiovascular autonomic control in Parkinson's disease

2014 ◽  
Vol 116 (5) ◽  
pp. 495-503 ◽  
Author(s):  
Franca Barbic ◽  
Manuela Galli ◽  
Laura Dalla Vecchia ◽  
Margherita Canesi ◽  
Veronica Cimolin ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Three Dimensional ◽  
Motor Impairment ◽  
Rotation Velocity ◽  
Step Length ◽  
Autonomic Control ◽  
Gait Velocity ◽  
Central Processing ◽  
Cardiovascular Autonomic Control

Motor impairment in Parkinson's disease (PD) is partly due to defective central processing of lower limb afferents. Concomitant alterations in cardiovascular autonomic control leading to orthostatic hypotension may worsen motor ability. We evaluated whether mechanical activation of feet sensory afferents could improve gait and modify the response of cardiovascular autonomic control to stressors in 16 patients (age 66 ± 2 yr) with idiopathic PD (Hoehn & Yhar scale 2–3) on their usual therapy. Eight subjects ( group A) were randomized to undergo skin pressure (0.58 ± 0.04 kg/mm2) stimulation at the hallux tip and first metatarsal joint (effective stimulation; ES) of both feet. Eight remaining patients ( group B) underwent sham stimulation (SS) followed by ES. Three-dimensional movement analysis provided quantitative indexes of movement disability before (baseline) and 24 h after ES and SS. Spectral analysis of heart rate and blood pressure variability provided markers of cardiac sympatho-vagal (LF/HF) and vascular sympathetic (LFSAP) modulations. Markers were measured at rest and during 75° head-up tilt, before and 24 h after ES and SS. After ES, step length and gait velocity increased, upright rotation velocity was enhanced, and step number was decreased. After ES, LFSAP declined. The increase in LF/HF and LFSAP induced by tilt was greater than before feet stimulation. No changes in gait and autonomic parameters were observed after SS. Twenty-four hours after ES, patients with PD showed improved gait and increased cardiac and vascular sympathetic modulation during upright position compared with baseline. Conversely, SS was ineffective on both movement and autonomic parameters, indicating a site specificity effect of the stimulation.

Quantification of Motor Impairment in Parkinson's Disease Using an Instrumented Timed Up and Go Test

2013 ◽  
Vol 21 (4) ◽  
pp. 664-673 ◽  
Author(s):  
Luca Palmerini ◽  
Sabato Mellone ◽  
Guido Avanzolini ◽  
Franco Valzania ◽  
Lorenzo Chiari
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Motor Impairment ◽  
Timed Up And Go

scholarly journals Multidisciplinary intensive outpatient rehabilitation program for patients with moderate-to-advanced Parkinson’s disease

2021 ◽  
pp. 1-9
Author(s):  
Noa Cohen ◽  
Yael Manor ◽  
Yitzhak Green ◽  
Gail Tahel ◽  
Inbal Badichi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Outpatient Rehabilitation ◽  
Advanced Parkinson’S Disease ◽  
Intensive Outpatient ◽  
Positive Results

BACKGROUND: Intensive, multi-disciplinary, rehabilitation programs for patients with Parkinson’s disease (PWPs) have shown to be effective. However, most programs are based on in-patient service, which is expensive. OBJECTIVE: To demonstrate the feasibility of a multidisciplinary, intensive, outpatient rehabilitation program (MIOR) for moderate to advanced Parkinson’s Disease (H&Y≥2). METHOD: The MIOR program takes place at a community rehabilitation center (‘Ezra Le’Marpe’), 3 times a week, 5 hours, 8 weeks, and includes 20 PWPs in each cycle. The multi-disciplinary team includes physical, occupational, speech and hydro therapists. Additional activities include, social work groups, boxing, dancing and bridge. RESULTS: Data was collected retroactively for the first two years. Data analysis includes 158 patient files who completed the program (mean disease duration 10.1±6 and mean H&Y stage 2.8±0.67). Assessments were performed at the beginning and end of the intervention. Positive results were collected: improvement in number of falls (p <  0.0001), Functional Independence Measure (p <  0.0001), quality of life (p <  0.01), balance (p <  0.0001), upper limb function (p <  0.0001) and paragraph reading vocal intensity (p <  0.01). CONCLUSIONS: MIOR is a feasible program, showing positive results in moderate to advanced PWP’s, improving quality of life, daily function, and motor performance. The current outcomes demonstrate feasibility of MIOR in addition to medical treatment.

scholarly journals Functional and Cognitive Improvement After an Intensive Inpatient Multidisciplinary Rehabilitation Program in Mild to Severe Parkinson's Disease: A Retrospective and Observational Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Mario Meloni ◽  
Francesca Lea Saibene ◽  
Sonia Di Tella ◽  
Monica Di Cesare ◽  
Francesca Borgnis ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Observational Study ◽  
Functional Disability ◽  
Rating Scale ◽  
Neurodegenerative Disorder ◽  
Rehabilitation Program ◽  
Semantic Fluency ◽  
Multidisciplinary Rehabilitation ◽  
Cognitive Improvement

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor (resting tremor, rigidity, bradykinesia, postural instability, and gait disturbances) and nonmotor symptoms (cognitive, neuropsychiatric, and autonomic problems). In recent years, several studies demonstrated that neurorehabilitation therapy is an effective treatment in addition to pharmacological personalized interventions in persons with PD (PwPD). The main aim of this study was to explore the short-term changes in functional, cognitive, and geriatric domains after a multidimensional rehabilitation program in PwPD (as primary condition) in mild–moderate (M-Ms) to severe (Ss) stages. Our second aim was to compare the effects of multidimensional rehabilitation in M-Ms versus Ss of PD. Twenty-four PwPD in M-Ms to Ss [age (mean ± SD) = 76.25 ± 9.42 years; male/female = 10/14; Hoehn and Yahr (median; IQR) = 4.00; 1.75] were included in a retrospective, observational study. Motor, cognitive, functional, and neuropsychiatric aspects were collected in admission (T0) and in discharge (T1). PwPD were involved in a person-tailored (to individual's needs), inpatient, intensive (5–7 days per week), multidisciplinary (combining cognitive, physical, occupational, and speech therapies), comprehensive, and rehabilitative program. According to Movement Disorders Society Unified Parkinson's Disease Rating Scale III cutoff, PwPD were classified in M-Ms or Ss (M-Ms ≤59; Ss &gt;59); 87.50% of our sample reported significant reduction of functional disability at Barthel Index (p &lt; 0.001). A significant improvement in Token test (p = 0.021), semantic fluency (p = 0.036), Rey's Figure-Copy (p &lt; 0.001), and Raven's Colored Progressive Matrices (p = 0.004) was observed. The pain intensity perception (p &lt; 0.001) and the risk of developing pressure ulcers (p &lt; 0.001) as assessed, respectively, by the Numeric Rating Scale and by the Norton Scale were improved. With regard to the second aim, in M-Ms group, we found a positive correlation between the number of neuromotor sessions and the change in functional disability and language comprehension; in the Ss group, on the other hand, despite a higher number of hospitalization days, the total number of completed sessions was positively associated with the change in visuoconstructional abilities. Our findings suggest that an intensive, inpatient, and multidisciplinary rehabilitation program may improve functional abilities, some strategic cognitive functions, and geriatric aspects in PwPD with mild–moderate motor impairment.

scholarly journals Autonomic Function in Patients With Parkinson’s Disease: From Rest to Exercise

2021 ◽  
Vol 12 ◽  
Author(s):  
Jeann L. Sabino-Carvalho ◽  
James P. Fisher ◽  
Lauro C. Vianna
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Neurodegenerative Disorder ◽  
Motor Impairment ◽  
Exercise Intolerance ◽  
Motor Nucleus ◽  
Motor Impairments ◽  
Dorsal Motor Nucleus ◽  
Clinically Significant ◽  
Underlying Mechanisms

Parkinson’s disease (PD) is a common neurodegenerative disorder classically characterized by symptoms of motor impairment (e.g., tremor and rigidity), but also presenting with important non-motor impairments. There is evidence for the reduced activity of both the parasympathetic and sympathetic limbs of the autonomic nervous system at rest in PD. Moreover, inappropriate autonomic adjustments accompany exercise, which can lead to inadequate hemodynamic responses, the failure to match the metabolic demands of working skeletal muscle and exercise intolerance. The underlying mechanisms remain unclear, but relevant alterations in several discrete central regions (e.g., dorsal motor nucleus of the vagus nerve, intermediolateral cell column) have been identified. Herein, we critically evaluate the clinically significant and complex associations between the autonomic dysfunction, fatigue and exercise capacity in PD.

scholarly journals Alpha-Synuclein as a Biomarker of Parkinson’s Disease: Good, but Not Good Enough

2021 ◽  
Vol 13 ◽  
Author(s):  
Upasana Ganguly ◽  
Sukhpal Singh ◽  
Soumya Pal ◽  
Suvarna Prasad ◽  
Bimal K. Agrawal ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Movement Disorders ◽  
Neurodegenerative Disorder ◽  
Early Stage ◽  
Motor Impairment ◽  
The Elderly ◽  
Alpha Synuclein ◽  
Cross Sectional ◽  
Peripheral Tissues

Parkinson’s disease (PD) is the second most common neurodegenerative disorder of the elderly, presenting primarily with symptoms of motor impairment. The disease is diagnosed most commonly by clinical examination with a great degree of accuracy in specialized centers. However, in some cases, non-classical presentations occur when it may be difficult to distinguish the disease from other types of degenerative or non-degenerative movement disorders with overlapping symptoms. The diagnostic difficulty may also arise in patients at the early stage of PD. Thus, a biomarker could help clinicians circumvent such problems and help them monitor the improvement in disease pathology during anti-parkinsonian drug trials. This review first provides a brief overview of PD, emphasizing, in the process, the important role of α-synuclein in the pathogenesis of the disease. Various attempts made by the researchers to develop imaging, genetic, and various biochemical biomarkers for PD are then briefly reviewed to point out the absence of a definitive biomarker for this disorder. In view of the overwhelming importance of α-synuclein in the pathogenesis, a detailed analysis is then made of various studies to establish the biomarker potential of this protein in PD; these studies measured total α-synuclein, oligomeric, and post-translationally modified forms of α-synuclein in cerebrospinal fluid, blood (plasma, serum, erythrocytes, and circulating neuron-specific extracellular vesicles) and saliva in combination with certain other proteins. Multiple studies also examined the accumulation of α-synuclein in various forms in PD in the neural elements in the gut, submandibular glands, skin, and the retina. The measurements of the levels of certain forms of α-synuclein in some of these body fluids or their components or peripheral tissues hold a significant promise in establishing α-synuclein as a definitive biomarker for PD. However, many methodological issues related to detection and quantification of α-synuclein have to be resolved, and larger cross-sectional and follow-up studies with controls and patients of PD, parkinsonian disorders, and non-parkinsonian movement disorders are to be undertaken.

scholarly journals Caffeine and Parkinson’s Disease: Multiple Benefits and Emerging Mechanisms

2020 ◽  
Vol 14 ◽  
Author(s):  
Xiangpeng Ren ◽  
Jiang-Fan Chen
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Animal Studies ◽  
Neurodegenerative Disorder ◽  
Therapeutic Potential ◽  
Motor Impairment ◽  
Epidemiological Studies ◽  
Experimental Investigations ◽  
Caffeine Consumption ◽  
Dopaminergic Neurodegeneration

Parkinson’s disease (PD) is the second most common neurodegenerative disorder, characterized by dopaminergic neurodegeneration, motor impairment and non-motor symptoms. Epidemiological and experimental investigations into potential risk factors have firmly established that dietary factor caffeine, the most-widely consumed psychoactive substance, may exerts not only neuroprotective but a motor and non-motor (cognitive) benefits in PD. These multi-benefits of caffeine in PD are supported by convergence of epidemiological and animal evidence. At least six large prospective epidemiological studies have firmly established a relationship between increased caffeine consumption and decreased risk of developing PD. In addition, animal studies have also demonstrated that caffeine confers neuroprotection against dopaminergic neurodegeneration using PD models of mitochondrial toxins (MPTP, 6-OHDA, and rotenone) and expression of α-synuclein (α-Syn). While caffeine has complex pharmacological profiles, studies with genetic knockout mice have clearly revealed that caffeine’s action is largely mediated by the brain adenosine A2A receptor (A2AR) and confer neuroprotection by modulating neuroinflammation and excitotoxicity and mitochondrial function. Interestingly, recent studies have highlighted emerging new mechanisms including caffeine modulation of α-Syn degradation with enhanced autophagy and caffeine modulation of gut microbiota and gut-brain axis in PD models. Importantly, since the first clinical trial in 2003, United States FDA has finally approved clinical use of the A2AR antagonist istradefylline for the treatment of PD with OFF-time in Sept. 2019. To realize therapeutic potential of caffeine in PD, genetic study of caffeine and risk genes in human population may identify useful pharmacogenetic markers for predicting individual responses to caffeine in PD clinical trials and thus offer a unique opportunity for “personalized medicine” in PD.

scholarly journals The Relationship between Periodontal Disease and Motor Impairment in the Course of Parkinson’s Disease

2020 ◽  
Vol 74 ◽  
pp. 340-347
Author(s):  
Beata Ledwon ◽  
Andrzej Miskiewicz ◽  
Ewa Grabowska ◽  
Jan Kowalski ◽  
Renata Górska
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Acute Phase Proteins ◽  
Periodontal Diseases ◽  
Motor Impairment ◽  
Lower Number ◽  
Periodontal Treatment ◽  
Control Group ◽  
Study Group ◽  
Timed Up And Go

Introduction: The incidence of Parkinson’s disease and the severity of accompanying motor impairment increase significantly with age. The etiopathogenesis and progression of Parkinson’s disease at the molecular level is associated with the production of cytokines and acute phase proteins, which are also typical for inflammatory diseases, such as periodontitis and gingivitis. Objectives: The aim of the study was to assess the correlation between neurological parameters, the indices of periodontal status and systemic parameters of inflammation, as well as their change after treatment. Patients/Methods: The presented study is a retrospective analysis of data obtained from medical histories and patient charts. Charts of 93 patients diagnosed with Parkinson’s disease and periodontal diseases over the period 2015–2017 were selected. Sixty-one of these patients received periodontal treatment: professional scaling, root planning – SRP and periodontal pockets rinsing with 3% H2O2 and constituted a study group. Additionally, the patients were instructed to use a 0.2% chlorhexidine mouthwash. The other 32 patients, who were not periodontally treated, formed a control group. Both groups continued their anti-parkinsonian treatment. Results: The mean pocket depth at the baseline was 4.0 mm (SD 0.9 mm), mean bleeding index was 56.2%, and 63.9% of patients presented tooth mobility grade II or III. A significant correlation between periodontal and neurological parameters was observed at the baseline. After periodontal treatment, an improvement of both periodontal parameters and those related to the Parkinson’s disease was observed in the study group. Those periodontally treated exhibited lower number of anti-parkinsonian medicines, lower number of falls, as well as better results in10-m walk test and timed-up-and-go test, as compared to the control group. The improvement was observed both 3 and 9 months after the end of treatment.

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