Faculty Bibliography

Background/UNASSIGNED:Freezing of gait (FOG) is one of the most disabling symptoms of Parkinson disease (PD). It has been found that different land-based rehabilitation approaches based on motor and cognitive strategies could be effective for treating FOG. At the same time, there are data about the efficacy of aquatic therapy (AT) in ameliorating this phenomenon. No 1 study has explored the combined effect of land plus AT in patients with PD who have FOG. Objective/UNASSIGNED:The objective was to investigate the effectiveness of a multidisciplinary, intensive, motor-cognitive rehabilitation treatment (MIRT) in improving FOG and whether the implementation with AT (MIRT-AT) adds further benefits. Design/UNASSIGNED:The design consisted of a single-blind, parallel group, 1:1 allocation ratio, randomized trial. Setting/UNASSIGNED:Department of Parkinson disease, Movement Disorders and Brain Injury Rehabilitation - "Moriggia-Pelascini" Hospital (Gravedona ed Uniti, Como-Italy) was used as the setting. Participants/UNASSIGNED:60 hospitalized patients with PD who had FOG in Hoehn & Yahr (H&Y) stage 2 or 5-3 were included. Intervention/UNASSIGNED:60 patients with PD + FOG were randomly assigned to 2 groups. 30 underwent a 4-week MIRT and 30 underwent a 4-week MIRT plus AT (MIRT-AT). Measurements/UNASSIGNED:The primary outcome measure was the Freezing of Gait Questionnaire (FOGQ); secondary outcome measures were total Unified Parkinson Disease Rating Scale (UPDRS), UPDRS II, UPDRS III, Berg Balance Scale (BBS), Timed Up and Go Test (TUG) and 6-Minute Walk Test (6MWT). These measures were assessed both at admission and discharge. Results/UNASSIGNED:Patients in the two groups had similar age, gender distribution, H&Y stage, and most-affected side. At baseline, no difference in outcome measures was observed between the two groups. After treatment, a significant time effect was observed for all variables in both groups. No significant time x-group interaction was observed. A between-group analysis showed non-significant differences between values at T1 and values at T0 for all variables. Limitations/UNASSIGNED:A limitation is that control group and follow-up are lacking. Conclusions/UNASSIGNED:We showed that a multidisciplinary, intensive, and goal-based rehabilitation treatment, such as MIRT, improve FOG in patients with PD. Even though AT could be considered as a useful approach for treating FOG, it does not add further benefits to this kind of motor-cognitive rehabilitation.

Objective: The object of the study was to evaluate the efficacy of Proprioceptive Focal Stimulation on Gait in middle-advanced Parkinson (PD) patients by a crossover, randomized, double Blind double dummy study using Equistasi®, a nano-technological device of the dimension of a plaster which generates High Frequency Vibration (FV). Background: The efficacy of Gait Analysis (GA) on evaluating gait modification on Parkinson's disease (PD) Patients is already well-known. Therefore, GA was recorded in a group of PD patients using Equistasi® device and its placebo. Methods: Forty PD patients on optimal therapy were enrolled in the study. Patients were randomly assigned to receive active or sham stimulation for 8 weeks and, following a wash-out period, switched to an additional 8-week period with the reverse intervention. GA was performed at baseline and at the end of both 8-weeks treatment periods Clinical state was monitored by MDUPDRS part III. Results: Active stimulation induced a significant improvement in Mean Velocity (Velocity), Stride Length (SL), Stance (STA), and Double Support (DST) percentage, both in left and right stride. The ANOVA analysis using H&Y stage as a factor, showed that DST and MDUPDRS III scores improved significantly more in the more severely affected subjects. Conclusions: The findings obtained in this randomized controlled study show the efficacy of mechanical focal vibration, as stimulation of the proprioceptive system, in PD and encourage further investigation. The effect of the device on more severe patients may open a new possibility to identify the most appropriate candidate for the management of gait disturbances and postural instability with FV delivered with Equistasi®.

People with Parkinson's disease (PD) have a deficit of facial expression. Previous studies indicate that hemispheric dominance for emotional processing can give rise to an asymmetric pattern of facial expression of emotion. In this study, we aimed to evaluate possible asymmetry in facial emotion expressivity in PD. Twenty PD patients and twenty healthy controls were video-recorded while posing the 6 basic emotions. The most expressive pictures were derived from the videos and chimeric faces were created. Nine healthy raters were asked to judge which of the two chimeras looked more expressive. Chosen responses, reaction times and confidence levels were the main outcome measures. We evaluated possible differences in these measures within each group and between groups (PD, healthy controls). We assessed possible correlations between a global facial laterality index (pooling all emotions together) as well as facial laterality indexes for each emotion and the body laterality index, accounting for the predominant side of limb bradykinesia in patients. There was no difference in outcome measures when evaluating the two hemifaces within PD patients and healthy controls or between the two groups (all Ps > 0.05). In PD patients there was a correlation between the global facial laterality index and the body laterality index (R = - 0.39, P = 0.01), suggesting that the most expressive hemiface corresponded to the less affected body side. The results of our study do not support the hypothesis of hemisphere predominance in regulating facial emotion expressions and provides novel information on altered facial emotion expression in PD.

OBJECTIVE:To examine the feasibility of a randomized controlled study design and to explore the benefits of a set dancing intervention compared with usual care. DESIGN:Randomized controlled design, with participants randomized to Irish set dance classes or a usual care group. SETTING:Community based. PARTICIPANTS:Individuals with idiopathic Parkinson disease (PD) (N=90). INTERVENTIONS:The dance group attended a 1.5-hour dancing class each week for 10 weeks and undertook a home dance program for 20 minutes, 3 times per week. The usual care group continued with their usual care and daily activities. MAIN OUTCOME MEASURES:The primary outcome was feasibility, determined by recruitment rates, success of randomization and allocation procedures, attrition, adherence, safety, willingness of participants to be randomized, resource availability, and cost. Secondary outcomes were motor function (motor section of the Unified Parkinson's Disease Rating Scale), quality of life (Parkinson's Disease Questionnaire-39), functional endurance (6-min walk test), and balance (mini-BESTest). RESULTS:Ninety participants were randomized (45 per group). There were no adverse effects or resource constraints. Although adherence to the dancing program was 93.5%, there was >40% attrition in each group. Postintervention, the dance group had greater nonsignificant gains in quality of life than the usual care group. There was a meaningful deterioration in endurance in the usual care group. There were no meaningful changes in other outcomes. The exit questionnaire showed participants enjoyed the classes and would like to continue participation. CONCLUSIONS:For people with mild to moderately severe PD, set dancing is feasible and enjoyable and may improve quality of life.

OBJECTIVE:To compare the efficacy of two physiotherapy protocols (water-based vs. non-water-based) on postural deformities of patients with Parkinson's disease. DESIGN/METHODS:A single blind, randomized controlled pilot study. SETTING/METHODS:Inpatient (Rehabilitative Department). PARTICIPANTS/METHODS:A total of 30 patients with idiopathic Parkinson's disease. INTERVENTIONS/METHODS:Participants were randomly assigned to one of two eight-week treatment groups: Water-based ( n = 15) or non-water-based physiotherapy exercises ( n = 15). OUTCOME MEASURES/METHODS:Changes in the degree of cervical and dorsal flexion and in the angle of lateral inclination of the trunk (evaluated by means of a posturographic system) were used as primary outcomes. Unified Parkinson Disease Rating Scale section III, Time Up and Go Test, Berg Balance Scale, Activities-specific Balance Confidence, Falls Efficacy Scale and the Parkinson's disease quality of life questionnaire (39 items) were the secondary outcomes. All outcomes were assessed at baseline, at the end of training and eight weeks after treatment. Patients were always tested at the time of their optimal antiparkinsonian medication ('on' phase). RESULTS:After the treatment, only Parkinson's disease subjects randomized to water-based treatment showed a significant improvement of trunk posture with a significant reduction of cervical flexion (water-based group: -65.2°; non-water-based group: +1.7°) and dorsal flexion (water-based group: -22.5°; non-water-based group: -6.5°) and lateral inclination of the trunk (water-based group: -2.3°; non-water-based group: +0.3°). Both groups presented significant improvements in the secondary clinical outcomes without between-group differences. CONCLUSION/CONCLUSIONS:Our results show that water-based physiotherapy was effective for improving postural deformities in patients with Parkinson's disease.

OBJECTIVES:To assess whether a specific land-based physical intervention with the inclusion of aquatic therapy is more effective than land-based rehabilitation alone for the treatment of balance dysfunction in patients with Parkinson disease (PD), immediately after therapy and at 6 months' follow-up. DESIGN:Randomized controlled study with 6-month follow-up. SETTING:A PD and brain injury rehabilitation department in a general hospital. PARTICIPANTS:Patients (N=34) with moderate-stage PD. INTERVENTION:Seventeen patients underwent a land-based rehabilitation protocol called multidisciplinary intensive rehabilitation treatment (MIRT), and 17 underwent MIRT plus aquatic therapy (MIRT-AT). MAIN OUTCOME MEASURES:The primary outcome measure was the Berg Balance Scale (BBS); secondary outcome measures were the Unified Parkinson Disease Rating Scale parts II and III (UPDRS II/III) and the Timed Up and Go (TUG) test. These measures were assessed in both groups at admission, at discharge, and after 6 months. RESULTS:BBS improved after treatment in both groups. Even though no statistically significant difference between groups was observed at each observation time, BBS scores at follow-up were significantly higher than at baseline in MIRT-AT patients. Both groups also showed an improvement in UPDRS II/III and TUG at the end of treatment compared with baseline, but these findings were lost at the 6-month follow-up. CONCLUSIONS:Aquatic therapy added to land-based rehabilitation could provide a contribution to the treatment of balance dysfunction in patients with moderate-stage PD.

OBJECTIVE:To evaluate the effects of aquatic exercise therapy on gait variability and disability compared with usual care for people with Parkinson disease (PD). DESIGN:Single-blind randomized controlled trial. SETTING:Community-based hydrotherapy pool. PARTICIPANTS:Individuals with PD (Hoehn-Yahr stages I-III) (N=21). INTERVENTIONS:Participants were randomly assigned to either an aquatic exercise therapy group (45min, twice a week for 6wk) or a group that received usual care. MAIN OUTCOME MEASURES:The primary outcome measure was gait variability as measured using a motion capture system. Secondary outcomes were quality of life measured on the Parkinson's Disease Questionnaire-39 and freezing of gait and motor disability quantified by the Unified Parkinson's Disease Rating Scale. Feasibility was evaluated by measuring safety, adverse events, and participant satisfaction. RESULTS:People in the aquatic therapy group and usual care group showed similar small improvements in gait variability. The aquatic therapy group showed greater improvements in disability than the usual care group (P<.01). No differences between groups or over time were identified for freezing of gait or quality of life. Aquatic therapy sessions were safe and enjoyable with no adverse events. CONCLUSIONS:Aquatic therapy appears feasible and safe for some people in the early stages of PD.

Although hydrotherapy is one of the physical therapies adopted to optimize gait rehabilitation in people with Parkinson disease, the quantitative measurement of gait-related outcomes has not been provided yet. This work aims to document the gait improvements in a group of parkinsonians after a hydrotherapy program through 2D and 3D underwater and on land gait analysis. Thirty-four parkinsonians and twenty-two controls were enrolled, divided into two different cohorts. In the first one, 2 groups of patients underwent underwater or land based walking training; controls underwent underwater walking training. Hence pre-treatment 2D underwater and on land gait analysis were performed, together with post-treatment on land gait analysis. Considering that current literature documented a reduced movement amplitude in parkinsonians across all lower limb joints in all movement planes, 3D underwater and on land gait analysis were performed on a second cohort of subjects (10 parkinsonians and 10 controls) who underwent underwater gait training. Baseline land 2D and 3D gait analysis in parkinsonians showed shorter stride length and slower speed than controls, in agreement with previous findings. Comparison between underwater and on land gait analysis showed reduction in stride length, cadence and speed on both parkinsonians and controls. Although patients who underwent underwater treatment exhibited significant changes on spatiotemporal parameters and sagittal plane lower limb kinematics, 3D gait analysis documented a significant (p<0.05) improvement in all movement planes. These data deserve attention for research directions promoting the optimal recovery and maintenance of walking ability.

BACKGROUND:Proprioceptive deficits have been largely documented in PD patients, thus external sensory signals (peripheral sensory feedback) are often used to compensate the abnormalities of proprioceptive integration. This pilot study aims to evaluate the feasibility and the effectiveness of a rehabilitation-training program, combined with the use of a sensory-motor orthotic in improving balance in a small sample of PD patients. METHODS:, where subjects performed an identical training program without wearing any kind of orthotics. In all, the training program lasted 10 sessions (5 days a week for 2 weeks) and the clinical and instrumental assessments were performed at baseline, immediately after the end of the training and 4 weeks after the rehabilitative program was stopped. RESULTS:All clinical outcome measures tested improved significantly at post and follow-up evaluations in both groups. Interestingly, at the end of the training, only the experimental group obtained a significant improvement in the functional reaching test (sway area - eyes closed) measured by means of stabilometric platform and this result was maintained in the follow-up evaluation. CONCLUSIONS:Our preliminary results suggested that the use of a sensory-motor orthotic, in combination with a tailored balance training, is feasible and it seems to positively impact on balance performance in Parkinson's disease. TRIAL REGISTRATION/BACKGROUND:EudraCT N. 003020-36 - 2013.