The effect of body weight-supported overground gait training for patients with Parkinson’s disease: A retrospective case-control observational study

Objective To evaluate the effects of body weight-supported overground gait training (BWSOGT) on motor abilities, such as gait and balance, in patients with Parkinson’s disease (PD). Design Retrospective case-controlled observational study with a 4-week follow-up. Setting Inpatient rehabilitation. Participants We selected 37 of 68 patients with PD. Inclusion criteria were (1) Hoehn & Yahr stage II–IV, (2) no medication adjustment during the study period, (3) at least 1 week since last medication adjustment, and (4) ability to walk more than 10 meters on their own. Exclusion criteria were (1) cerebrovascular disease or other complications affecting movement, (2) difficulty in measurement, (3) early discharge, (4) medication change during the study, and (5) development of complications. Interventions Patients were divided into two groups. Patients in Group I underwent 20 minutes of BWSOGT with a mobile hoist in addition to the standard exercises; Group II performed 20 minutes of gait training in place of BWSOGT. In both groups, training was performed for a total of 15 times/4 weeks. Main outcome measure(s) Participants were evaluated using the Unified Parkinson’s Disease Rating Scale total, part II, and part III; 10-m walk test; velocity; stride length; 6-minute walk test; timed up and go test; Berg Balance Scale; and freezing of gait before and after the intervention. Results There were significant decreases in the Unified Parkinson’s Disease Rating Scale total, part II, and part III in both groups; however, 6-minute walk test, timed up and go test, and freezing of gait results only improved in Group I. Conclusions BWSOGT for patients with PD improves gait ability and dynamic balance more than standard gait training.

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The efficacy of cognitive-cycling dual-task training in patients with early-stage Parkinson’s disease: A pilot study

Neurorehabilitation ◽

10.3233/nre-203090 ◽

2020 ◽

Vol 47 (4) ◽

pp. 415-426

Author(s):

Hsiu-Chen Chang ◽

Chiung-Chu Chen ◽

Yi-Hsin Weng ◽

Wei-Da Chiou ◽

Ya-Ju Chang ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Performance ◽

Dual Task ◽

Rating Scale ◽

Early Stage ◽

Freezing Of Gait ◽

Timed Up And Go ◽

Gait Performance ◽

The Mean

BACKGROUND: Recent studies have suggested that cognitive-motor dual-task (DT) training might improve gait performance, locomotion automaticity, balance, and cognition in patients with Parkinson’s disease (PD). OBJECTIVE: We aimed to investigate the efficacy of cognitive-cycling DT training in patients with early-stage PD. METHODS: Participants were scheduled to perform cognitive tasks simultaneously with the cycling training twice per week for eight weeks for a total of 16 sessions during their on-states. Clinical assessments were conducted using the unified Parkinson’s disease rating scale (UPDRS), modified Hoehn and Yahr stage, Timed Up and Go (TUG) test, gait and cognitive performances under dual-task paradigm, the new freezing of gait questionnaire, Schwab and England Activities of Daily Living scale, 39-item Parkinson’s disease questionnaire, and cognitive performance. RESULTS: Thirteen eligible patients were enrolled in the study. The mean age was 60.64±5.32 years, and the mean disease duration was 7.02±3.23 years. Twelve PD patients completed 16 serial cognitive-cycling sessions for two months. After 16 sessions of training (T2), the UPDRS III scores improved significantly in both the off- and on-states, and TUG were significantly less than those at pretraining (T0). During both the single-task and the DT situations, gait performance and spatial memory cognitive performance significantly improved from T0 to T2. CONCLUSION: The present study demonstrated that cognitive-cycling DT training improves the motor functions, gait and cognitive performances of PD patients.

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German Translation and Validation of the “Freezing of Gait Questionnaire” in Patients with Parkinson’s Disease

Parkinson s Disease ◽

10.1155/2015/982058 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Anina Vogler ◽

Jorina Janssens ◽

Thomas Nyffeler ◽

Stephan Bohlhalter ◽

Tim Vanbellingen

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Convergent Validity ◽

Rating Scale ◽

Freezing Of Gait ◽

Divergent Validity ◽

Timed Up And Go ◽

Disease Rating ◽

Disease Questionnaire ◽

Movement Disorder Society

Background. Freezing of Gait (FOG) is a disabling parkinsonian symptom. The Freezing of Gait Questionnaire (FOG-Q) reliably detects FOG in patients with Parkinson’s disease (PD).Objectives. The aim of this study was to develop a German translated version of the FOG-Q and to assess its validity.Methods. The translation was accomplished using forward-backward-translation. The construct validity of the FOG-Q was examined in twenty-seven German native speaking PD patients. Convergent validity was assessed by correlating the FOG-Q with the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) II-III, the Parkinson Disease Questionnaire 39 (PDQ-39), and the Timed Up and Go Test (TUG). Divergent validity was assessed by correlating the FOG-Q with the MDS-UPDRS I. The internal consistency was measured using Cronbach’s alpha (Cα).Results. A good internal structure of the FOG-Q was found (Cα=0.83). Significant moderate correlations between the FOG-Q and the MDS-UPDRS item 2.13 (freezing) (rs=0.568,P=0.002) and between the FOG-Q and the PDQ-39 subscale mobility (rs=0.516,P=0.006) were found. The lack of correlation with the MDS-UPDRS I demonstrated good divergent validity.Conclusion. The German FOG-Q is a valid tool to assess FOG in German native speaking PD patients.

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Can fatigue predict walking capacity of patients with Parkinson’s disease?

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20190136 ◽

2020 ◽

Vol 78 (2) ◽

pp. 70-75

Author(s):

Davi Vilela CARVALHO ◽

Renata Maria Silva SANTOS ◽

Helen Cardoso de MAGALHÃES ◽

Mariana Soares de SOUZA ◽

Paulo Pereira CHRISTO ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Regression Analysis ◽

Linear Regression ◽

Linear Regression Analysis ◽

Walk Test ◽

Independent Factor ◽

Timed Up And Go ◽

Walking Capacity ◽

6 Minute Walk Test

ABSTRACT Although fatigue is an expressive symptom of Parkinson’s disease (PD), few studies have investigated the association between fatigue, mobility and walking capacity of these patients. Objective: To investigate whether fatigue is an independent factor associated with mobility and the walking capacity in patients with PD. Methods: Forty-eight patients with PD (22 with fatigue) were tested for mobility and their walking capacity: Timed Up and Go (TUG), 10-Meter Walk Test (10MWT) at usual and fastest speed, and 6-Minute Walk Test (6MWT). Fatigue was measured with Parkinson’s Fatigue Scale (PFS-16). Linear regression analysis was used to investigate if fatigue is an independent factor contributing to variance in mobility and walking capacity. Results: There was a positive correlation between PFS-16 and TUG (rs=0.385; p=0.007). There was a negative correlation between PFS-16 and 10MWT at comfortable (r=-0.385; p=0.007) and fast speeds (r=-0.396; p=0.005), and 6MWT (r=-0.472; p=0.001). Linear regression analysis revealed that fatigue did not explain the variance of TUG and 10MWT. PFS-16, age and section III of UPDRS explained 49.6% (adjusted R2; p<0.001) variance in the 6MWT, and fatigue was the most significant predictor (F=-32.1; p=0.022). Conclusions: Fatigue is an independent factor contributing to the distance covered during 6MWT in patients with PD. Our results highlight the importance of recognition and management of this symptom.

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EFFECTS OF VIRTUAL REALITY ON PARKINSONIAN GAIT: BLIND CONTROLLED RANDOMIZED CLINICAL TRIAL PROTOCOL

Manual Therapy Posturology & Rehabilitation Journal ◽

10.17784/mtprehabjournal.2017.15.524 ◽

2020 ◽

pp. 1-7

Author(s):

Gileno Edu Lameira de Melo ◽

Renata Calhes Franco de Moura ◽

Jamile Benite Palma Lopes ◽

Paulo Roberto Fonseca Junior ◽

Roberta Delasta Lazzari ◽

...

Keyword(s):

Parkinson’S Disease ◽

Clinical Trial ◽

Parkinson's Disease ◽

Virtual Reality ◽

Rating Scale ◽

Inertial Sensor ◽

Gait Training ◽

Treadmill Training ◽

Timed Up And Go ◽

Parametric Data

Background: Parkinson’s disease (PD) is a neurodegenerative condition that exerts a negative influence on postural control and mobility, predominantly among older adults, affecting mobility and increasing the risk of slipping, tripping and falls. Objectives: Determine the effectiveness of gait training with the aid of virtual reality on balance and gait in comparison to treadmill training and conventional gait training for subjects with PD. Methods/design: A prospective, randomized, controlled blind, clinical trial is proposed. The sample will comprise 45 individuals with Parkinson’s disease randomly allocated to three groups (Control: conventional gait training; Experimental I: treadmill training; and Experimental II: gait training involving virtual reality). Evaluations will be conducted on four occasions: 1) pre-intervention; 2) immediately after one session; 3) post-intervention; and 4) one month after last session. The evaluations will involve the Berg Balance Scale, Tinetti Test, Unified Parkinson’s Disease Rating Scale and Hoehn and Yahr Scale. The G-WALK (BTS) inertial sensor will be used for the evaluation of spatiotemporal gait variables, the Timed Up and Go test and the Six-Minute Walk Test. Training will involve 20-minute sessions held three times per week for four consecutive weeks. The results will be analyzed statistically by two-way ANOVA for the data with parametric distribution or Friedman’s two-way ANOVA for non-parametric data (α<0.05). Conclusion: The proposed study will compare gait conventional training, treadmill training and training with virtual reality with regard to improvements in gait and balance in patients with PD. The results will be published and will contribute evidence on the use of these interventions for individuals with PD.

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Effects of Onabotulinum Toxin A on Gait in Parkinson’s Disease Patients with Foot Dystonia

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.42 ◽

2021 ◽

pp. 1-6

Author(s):

Pei Huang ◽

Yuan-Yuan Li ◽

Jung E. Park ◽

Ping Huang ◽

Qin Xiao ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Botulinum Toxin ◽

Gait Analysis ◽

Rating Scale ◽

Analog Scale ◽

Toxin A ◽

Timed Up And Go ◽

Balance Test ◽

Onabotulinum Toxin A

ABSTRACT: We investigated the effects of botulinum toxin on gait in Parkinson’s disease (PD) patients with foot dystonia. Six patients underwent onabotulinum toxin A injection and were assessed by Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), visual analog scale (VAS) of pain, Timed Up and Go (TUG), Berg Balance Test (BBT), and 3D gait analysis at baseline, 1 month, and 3 months. BFMDRS (p = 0.002), VAS (p = 0.024), TUG (p = 0.028), and BBT (p = 0.034) were improved. Foot pressures at Toe 1 (p = 0.028) and Midfoot (p = 0.018) were reduced, indicating botulinum toxin’s effects in alleviating the dystonia severity and pain and improving foot pressures during walking in PD.

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Dance Rhythms Improve Motor Symptoms in Individuals with Parkinson’s Disease: A Randomized Clinical Trial

Journal of Dance Medicine & Science ◽

10.12678/1089-313x.031522a ◽

2021 ◽

Author(s):

Jéssica A. Moratelli ◽

Kettlyn H. Alexandre ◽

Leonessa Boing ◽

Alessandra Swarowsky ◽

Clynton L. Corrêa ◽

...

Keyword(s):

Parkinson’S Disease ◽

Clinical Trial ◽

Parkinson's Disease ◽

Randomized Clinical Trial ◽

Rating Scale ◽

Freezing Of Gait ◽

Motor Symptoms ◽

Score Change ◽

Significant Difference ◽

Binary Group

Background: Evidence-based practices involving dance modalities found in binary (two-beat rhythm) or quaternary (four-beat rhythm) show that dance positively influences the motor aspects of disease.Aim: This randomized clinical trial aimed to analyze the effect of two dance rhythm (binary and quaternary) on the balance, gait, and mobility in individuals with Parkinson’s disease (PD). Methods: Thirty-one individuals with PD were randomized into the binary group (n = 18) and the quaternary group (n = 13). Both groups participated in different dance rhythms lasting 12 weeks, twice a week, for 45 minutes. Results: The binary group showed a significant difference in balance (p = 0.003), freezing of gait (p = 0.007), as well as in the motor aspects of MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), with emphasis on the total values with a score change of 3.23. In the quaternary group, significant differences were found in balance (p = 0.021) with a score change of -2.54 and in the motor aspects of the MDS-UPDRS Part III where the total values stood out with a change of 3.54. Discussion: When comparing the possible effects of binary and quaternary rhythms on the motor symptoms of individuals with PD, it was demonstrated that binary rhythm improved balance, freezing gait, and UPDRSIII. As for the quaternary rhythm, the benefits were in balance and the UPDRSIII. Conclusion: The binary and the quaternary rhythm dance protocols positively influenced the motor symptoms of individuals with PD after 12 weeks of intervention.

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Temporal Characteristics of High-Frequency Lower-Limb Oscillation during Freezing of Gait in Parkinson’s Disease

Parkinson s Disease ◽

10.1155/2014/606427 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Don A. Yungher ◽

Tiffany R. Morris ◽

Valentina Dilda ◽

James M. Shine ◽

Sharon L. Naismith ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

High Frequency ◽

Freezing Of Gait ◽

Body Motion ◽

High Frequency Oscillation ◽

Frequency Oscillation ◽

Timed Up And Go ◽

Clinical Onset ◽

Acceleration Data

A cardinal feature of freezing of gait (FOG) is high frequency (3–8 Hz) oscillation of the legs, and this study aimed to quantify the temporal pattern of lower-body motion prior to and during FOG. Acceleration data was obtained from sensors attached to the back, thighs, shanks, and feet in 14 Parkinson’s disease patients performing timed-up-and-go tasks, and clinical assessment of FOG was performed by two experienced raters from video. A total of 23 isolated FOG events, defined as occurring at least 5 s after gait initiation and with no preceding FOG, were identified from the clinical ratings. The corresponding accelerometer records were analyzed within a 4 s window centered at the clinical onset of freezing. FOG-related high-frequency oscillation (an increase in power in the 3–8 Hz band >3 SD from baseline) followed a distal to proximal onset pattern, appearing at the feet, shanks, thighs, and then back over a period of 250 ms. Peak power tended to decrease as the focus of oscillation moved from feet to back. There was a consistent delay (mean 872 ms) between the onset of high frequency oscillation at the feet and clinical onset of FOG. We infer that FOG is characterized by high frequency oscillation at the feet, which progresses proximally and is mechanically damped at the torso.

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Intestinal Levodopa/Carbidopa Infusion as a Therapeutic Option for Unresponsive Freezing of Gait after Deep Brain Stimulation in Parkinson’s Disease

Parkinson s Disease ◽

10.1155/2020/1627264 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Belén González-Herrero ◽

Serge Jauma-Classen ◽

Roser Gómez-Llopico ◽

Gerard Plans ◽

Matilde Calopa

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Rating Scale ◽

Therapeutic Option ◽

Freezing Of Gait ◽

Disease Rating ◽

Deep Brain

Background. Treatment of freezing of gait (FOG) is always challenging because of its unpredictable nature and multifactorial physiopathology. Intestinal levodopa infusion has been proposed in recent years as a valuable option for its improvement. FOG in Parkinson’s disease (PD) can appear after deep brain stimulation in patients who never had gait symptoms. Objective. To study the effects of intestinal levodopa/carbidopa infusion in unresponsive-FOG that appears in PD patients treated with subthalamic nucleus deep brain stimulation. Methods. We retrospectively collected and analyzed demographic, clinical, and therapeutic data from five PD patients treated with subthalamic nucleus stimulation who developed unresponsive-FOG and received intestinal levodopa/carbidopa infusion as an alternative therapy. FOG was measured based on scores in item 14 of the Unified Parkinson’s Disease Rating Scale before and after intestinal levodopa infusion. Results. Administration of intestinal levodopa caused improvement of FOG in the “ON” state in four patients (80%) by 2 or more points in item 14 of the Unified Parkinson’s Disease Rating Scale. The improvement was maintained for at least 12 months. Conclusions. Intestinal levodopa infusion may be a valuable therapeutic option for unresponsive-FOG developed after subthalamic nucleus deep brain stimulation.

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Automated Stage Discrimination of Parkinson’s Disease

BIO Integration ◽

10.15212/bioi-2020-0006 ◽

2020 ◽

Vol 1 (2) ◽

pp. 55-63

Author(s):

Vered Aharonson ◽

Nabeel Seedat ◽

Simon Israeli-Korn ◽

Sharon Hassin-Baer ◽

Michiel Postema ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rating Scale ◽

Motor Fluctuation ◽

Step Length ◽

Disease Stage ◽

Physical Parameters ◽

Timed Up And Go ◽

Step Velocity ◽

Treatment Plans

Abstract Background: Treatment plans for Parkinson’s disease (PD) are based on a disease stage scale, which is generally determined using a manual, observational procedure. Automated, sensor-based discrimination saves labor and costs in clinical settings and may offer augmented stage determination accuracy. Previous automated devices were either cumbersome or costly and were not suitable for individuals who cannot walk without support.Methods: Since 2017, a device has been available that successfully detects PD and operates for people who cannot walk without support. In the present study, the suitability of this device for automated discrimination of PD stages was tested. The device consists of a walking frame fitted with sensors to simultaneously support walking and monitor patient gait. Sixty-five PD patients in Hoehn and Yahr (HY) stages 1 to 4 and 24 healthy controls were subjected to supported Timed Up and Go (TUG) tests, while using the walking frame. The walking trajectory, velocity, acceleration and force were recorded by the device throughout the tests. These physical parameters were converted into symptomatic spatiotemporal quantities that are conventionally used in PD gait assessment.Results: An analysis of variance (ANOVA) test extended by a confidence interval (CI) analysis indicated statistically significant separability between HY stages for the following spatiotemporal quantities: TUG time (p < 0.001), straight line walking time (p < 0.001), turning time (p < 0.001), and step count (p < 0.001). A negative correlation was obtained for mean step velocity (p < 0.001) and mean step length (p < 0.001). Moreover, correlations were established between these, as well as additional spatiotemporal quantities, and disease duration, L-dihydroxyphenylalanine-(L-DOPA) dose, motor fluctuation, dyskinesia and the mobile part of the Unified Parkinson Disease Rating Scale (UPDRS).Conclusions: We have proven that stage discrimination of PD can be automated, even to patients who cannot support themselves. A similar method might be successfully applied to other gait disorders.

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Functional Performance and Associations between Performance Tests and Neurological Assessment Differ in Men and Women with Parkinson’s Disease

Behavioural Neurology ◽

10.1155/2015/519801 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Kadri Medijainen ◽

Mati Pääsuke ◽

Aet Lukmann ◽

Pille Taba

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rating Scale ◽

Functional Performance ◽

Clinical Stage ◽

Performance Tests ◽

Neurological Assessment ◽

Timed Up And Go ◽

Men And Women ◽

Assessment Tests

Background. Neurological assessment of a patient with Parkinson’s disease (PD) is expected to reflect upon functional performance. As women are known to report more limitations even for same observed functional performance level, present study was designed to examine whether associations between neurological assessments and functional performance differ across genders.Methods. 14 men and 14 women with PD participated. Functional performance was assessed by measuring walking speeds on 10-meter walk test (10MWT) and by performing timed-up-and-go-test (TUG). Neurological assessment included Hoehn and Yahr Scale (HY), Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Schwab and England Activities of Daily Living Scale (S-E), and Mini Mental State Examination (MMSE).Results. In women with PD, Kendall’s tau-b correlation analyses revealed significant correlations between functional performance tests and neurological assessment measures, with the exception in MMSE. No corresponding associations were found for men, although they demonstrated better functional performance, as expected.Conclusion. Men in similar clinical stage of the PD perform better on functional tests than women. Disease severity reflects upon functional performance differently in men and women with PD. Results indicate that when interpreting the assessment results of both functional performance and neurological assessment tests, the gender of the patient should be taken into consideration.

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