RESUMEN
Patients with advanced Parkinson's disease often suffer from severe gait and balance problems, impacting quality of live and persisting despite optimization of standard therapies. The aim of this review was to systematically review the efficacy of STN-DBS programming techniques in alleviating gait disturbances in patients with advanced PD. Searches were conducted in PubMed, Embase, and Lilacs databases, covering studies published until May 2024. The review identified 36 articles that explored five distinct STN-DBS techniques aimed at addressing gait and postural instability in Parkinson's patients: low-frequency stimulation, ventral STN stimulation for simultaneous substantia nigra activation, interleaving, asymmetric stimulation and a short pulse width study. Among these, 21 articles were included in the meta-analysis, which revealed significant heterogeneity among studies. Notably, low-frequency STN-DBS demonstrated positive outcomes in total UPDRS-III score and FOG-Q, especially when combined with dopaminergic therapy. The most favorable results were found for low-frequency STN stimulation. The descriptive analysis suggests that unconventional stimulation approaches may be viable for gait problems in patients who do not respond to standard therapies.
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Estimulación Encefálica Profunda , Trastornos Neurológicos de la Marcha , Enfermedad de Parkinson , Núcleo Subtalámico , Humanos , Estimulación Encefálica Profunda/métodos , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/terapia , Enfermedad de Parkinson/terapia , Enfermedad de Parkinson/complicaciones , Núcleo Subtalámico/fisiopatología , Resultado del TratamientoAsunto(s)
Estimulación Encefálica Profunda , Trastornos Neurológicos de la Marcha , Humanos , Estimulación Encefálica Profunda/métodos , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/terapia , Distonía/terapia , Trastornos Distónicos/terapia , Masculino , Femenino , AdultoRESUMEN
BACKGROUND: Gait disorders in patients with Parkinson's disease (PD) can become disabling with disease progression without effective treatment. OBJECTIVES: To investigate the efficacy of intermittent θ burst trans-spinal magnetic stimulation (TsMS) in PD patients with gait and balance disorders. METHODS: This was a randomized, parallel, double-blind, controlled trial. Active or sham TsMS was applied at third thoracic vertebra with 100% of the trans-spinal motor threshold, during 5 consecutive days. Participants were evaluated at baseline, immediately after last session, 1 and 4 weeks after last session. Primary outcome was Total Timed Up and Go (TUG) values comparing active versus sham phases 1 week after intervention. The secondary outcome measurements consisted of motor, gait and balance scales, and questionnaires for quality of life and cognition. RESULTS: Thirty-three patients were included, average age 68.5 (6.4) years in active group and 70.3 (6.3) years in sham group. In active group, Total TUG mean baseline was 107.18 (95% CI, 52.1-116.1), and 1 week after stimulation was 93.0 (95% CI, 50.7-135.3); sham group, Total TUG mean baseline was 101.2 (95% CI, 47.1-155.3) and 1 week after stimulation 75.2 (95% CI 34.0-116.4), P = 0.54. Similarly, intervention had no significant effects on secondary outcome measurements. During stimulation period, five patients presented with mild side effects (three in active group and two in sham group). DISCUSSION: TsMS did not significantly improve gait or balance analysis in patients with PD and gait disorders. The protocol was safe and well tolerated. © 2024 International Parkinson and Movement Disorder Society.
Asunto(s)
Trastornos Neurológicos de la Marcha , Enfermedad de Parkinson , Humanos , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/terapia , Enfermedad de Parkinson/fisiopatología , Masculino , Femenino , Anciano , Persona de Mediana Edad , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/terapia , Trastornos Neurológicos de la Marcha/fisiopatología , Método Doble Ciego , Equilibrio Postural/fisiología , Resultado del Tratamiento , Calidad de Vida , Estimulación de la Médula Espinal/métodos , Estimulación Magnética Transcraneal/métodos , Marcha/fisiología , Magnetoterapia/métodosRESUMEN
INTRODUCCIÓN: La rehabilitación robótica de la marcha, conocida como Robot-Assisted Gait Therapy, ha surgido como una alternativa innovadora a la rehabilitación convencional de la marcha. Esta terapia ofrece un enfoque de rehabilitación controlada, repetitiva e intensiva, permitiendo una evaluación objetiva del progreso de los pacientes. La rehabilitación de la marcha es especialmente relevante en pacientes con trastornos del sistema nervioso central, como la esclerosis múltiple, ictus o lesión medular. Estas condiciones pueden provocar una pérdida significativa de la capacidad motora y afectar la calidad de vida de los pacientes. Los exoesqueletos pueden ser utilizados en la rehabilitación de estos pacientes, buscando mejorar los patrones de marcha y mitigar los síntomas asociados. En resumen, la rehabilitación robótica de la marcha mediante exoesqueletos para las extremidades inferiores ofrece una opción terapéutica innovadora para mejorar la funcionalidad y la independencia en la marcha de los pacientes con trastornos del sistema nervioso central. Este informe busca proporcionar una evaluación completa de estos dispositivos en la rehabilitación de la marcha, centrándose en pacientes con esclerosis múltiple, ictus y lesión medular. OBJETIVOS: 1) Identificar, sintetizar, analizar y evaluar la evidencia científica disponible sobre la efectividad y seguridad de los exoesqueletos para la recuperación
INTRODUCTION: Robot-assisted gait training has emerged as an innovative alternative to conventional gait rehabilitation. The focus of this type of training is highly-controlled intensive repetitive rehabilitation, enabling objective evaluation of patient progress. Gait rehabilitation is key in patients with central nervous system damage such as that associated with multiple sclerosis, stroke, and spinal injury. These conditions can cause significant loss of motor function, and hence, impair patient quality of life. Exoskeletons may be used in the rehabilitation of these patients, seeking to improve gait patterns and ameliorate associated symptoms. In brief, robot-assisted gait rehabilitation using lower-extremity exoskeletons is an innovative treatment option for improving gait function and independence in patients with central nervous system damage. This report aims to provide a complete assessment of these gait rehabilitation devices, with a focus on patients with multiple sclerosis, stroke, or spinal injury. AIMS: 1) To identify, synthetise, analyse and evaluate the scientific evidence available concerning the efficacy/effectiveness and safety of exoskeletons for functional gait recovery in adult patients with central nervous system damage associated with multiple scl
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Humanos , Traumatismos de la Médula Espinal/fisiopatología , Accidente Cerebrovascular/fisiopatología , Trastornos Neurológicos de la Marcha/terapia , Dispositivo Exoesqueleto , Esclerosis Múltiple/fisiopatología , Evaluación en Salud/economía , Análisis Costo-Beneficio/economíaRESUMEN
Perturbation-based balance training (PBT) exposes individuals to a series of sudden upright balance perturbations to improve their reactive postural responses. In this study, we aimed to evaluate the effect of a short PBT program on body balance recovery following a perturbation in individuals with freezing of gait due to Parkinson's disease. Volunteers (mean age = 64 years, SD = 10.6) were pseudorandomly assigned either to a PBT (n = 9) or to a resistance training (RT, n = 10) group. PBT was implemented through balance perturbations varying in the kind, direction, side and magnitude of support base displacements. Both groups exercised with progressive difficulty/load activities twice a week for 4 weeks. Specific gains and generalization to dual-tasking and faster-than-trained support base displacements were evaluated 24 h after the end of the training, and retention was evaluated after 30 days of no training. Results showed that, compared with RT, PBT led to more stable postural responses in the 30-day retention evaluation, as indicated by decreased CoP displacement, velocity and time to direction reversal and reduced numbers of near-falls. We found no transfer either to a dual task or to a higher perturbation velocity. In conclusion, a training program based on diverse unpredictable balance perturbations improved the stability of reactive postural responses to those perturbations suffered during the training, without generalization to more challenging tasks.
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Trastornos Neurológicos de la Marcha , Enfermedad de Parkinson , Humanos , Persona de Mediana Edad , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/terapia , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/terapia , Equilibrio Postural/fisiología , Accidentes por Caídas , Marcha/fisiologíaRESUMEN
(1) Background: Stroke is one of the leading causes of disability. To identify the best treatment strategies for people with stroke (PwS), the aim of the current study was to compare the effects of training on a treadmill with functional electrical stimulation (TT-FES) with training on a treadmill (TT), and to analyze the effects of sequence of training on mobility and the parameters of walking ability. (2) Methods: Prospective, longitudinal, randomized and crossover study, in which 28 PwS were distributed into groups, namely the A-B Group (TT-FES followed by TT) and B-A Group (TT followed by TT-FES), using the foot drop stimulator, and were measured with functional tests. (3) Results: We found improved mobility, balance, non-paretic limb coordination, and endurance only in the group that started with TT-FES. However, sensorimotor function improved regardless of the order of training, and paretic limb coordination only improved in the B-A Group, but after TT-FES. These data indicate that the order of the protocols changed the results. (4) Conclusions: Although biomechanical evaluation methods were not used, which can be considered a limitation, our results showed that TT-FES was superior to isolated training on a treadmill with regard to balance, endurance capacity, and coordination of the non-paretic limb.
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Terapia por Estimulación Eléctrica , Trastornos Neurológicos de la Marcha , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Marcha/fisiología , Estudios Cruzados , Estudios Prospectivos , Terapia por Estimulación Eléctrica/métodos , Accidente Cerebrovascular/terapia , Estimulación Eléctrica , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/terapiaRESUMEN
ANTECEDENTES: En el marco de la metodología ad hoc para evaluar solicitudes de tecnologías sanitarias, aprobada mediante Resolución de Instituto de Evaluación de Tecnologías en Salud e Investigación N° 111 -IETSI-ESSALUD-2021 y ampliada mediante Resolución de Instituto de Evaluación de Tecnologías en Salud e Investigación N° 97-IETSI-ESSALUD2022, se ha elaborado el presente dictamen sobre la evaluación de la eficacia y seguridad del sistema robotizado para la rehabilitación de adultos con trastorno de la marcha debido a accidente cerebrovascular. ASPECTOS GENERALES: El accidente cerebrovascular (ACV) es una afección que se produce cuando se interrumpe el suministro de sangre al sistema nervioso central (cerebro, retina, columna espinal), lo que puede dañar las células cerebrales y provocar discapacidad o la muerte (Sacco et al., 2013). Existen dos tipos principales de ACV: el isquémico, que se produce cuando un coágulo o placa ateroesclerótica bloquea un vaso sanguíneo y deja sin oxígeno a alguna región del sistema nervioso central, y el hemorrágico, que se produce comúnmente tras una vasculopatía que causa una hemorragia (Campbell & Khatri, 2020). El ACV es una condición que afecta a las personas de todas las edades y géneros, siendo la segunda causa de muerte y tercera causa de discapacidad en todo el mundo (Feigin et al., 2021). Se estima que una de cada cuatro personas puede verse afectada por esta condición en algún momento de su vida (Feigin et al., 2018). Además, es especialmente frecuente en personas mayores de 65 años (Rajati et al., 2023). La prevención, la identificación temprana y el tratamiento adecuado son fundamentales para prevenir las complicaciones del ACV y mejorar los resultados del paciente. METODOLOGÍA: Se realizó una búsqueda bibliográfica exhaustiva con el objetivo de identificar la mejor evidencia sobre la evaluación de la eficacia y seguridad del sistema robotizado para la rehabilitación de adultos con trastorno de la marcha debido a accidente cerebrovascular. La búsqueda bibliográfica se llevó a cabo en las bases de datos PubMed, The Cochrane Library, Web of Science y LILACS. Además, se realizó una búsqueda manual en Google y dentro de las páginas web pertenecientes a grupos que realizan evaluaciones de tecnologías sanitarias (ETS) y guías de práctica clínica (GPC), incluyendo el Centro Nacional de Excelencia Tecnológica en Salud (CENETEC), National Institute for Health and Care Excellence (NICE), la Agency for Healthcare Research and Quality's (AH RQ), Scottish I ntercollegiate Guidelines Network (SIGN), The Guidelines International Network (GIN), National Health and Medical Research Council (NHMRC), Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA), Comissáo Nacional de Incorporacáo de Tecnologias no Sistema Único de Saúde (CONITEC), Instituto de Evaluación Tecnológica en Salud (IETS), Instituto de Efectividad Clínica y Sanitaria (IECS), Scottish Medicines Consortium (SMC), Canadian Agency for Drugs and Technologies in Health (CADTH), Instituto de Calidad y Eficiencia en la Atención de la Salud (IQWiG, por sus siglas en alemán), y Hauté Autorité de Santé (HAS). Asimismo, se realizó una búsqueda de GPC en las páginas web de las principales sociedades o instituciones especializadas en el manejo del accidente cerebrovascular o trastorno de la marcha, tales como: American Heart Association/American Stroke Association (AHA/ASA), European Stroke Organisation, Academy of Neurologic Physical Therapy (APTA). Finalmente, se realizó una búsqueda de estudios en curso aún no publicados en las páginas web de ClinicalTrials.gov y la International Clinical Trials Registry Platform. RESULTADOS: La búsqueda bibliográfica se realizó el 16 de marzo de 2023 y se identificaron cinco guías de práctica clínica (GPC) que contenían recomendaciones acerca del dispositivo en evaluación para la población objetivo (Haute Autorité de Santé, 2022; Hornby et al., 2020; National Institute for Health and Care Excellence, 2013; Teasell et al., 2020; Winstein et al., 2016). También se incluyeron cinco revisiones sistemáticas (RS) con metaanálisis (MA) que realizaron comparaciones directas de la intervención y comparador de la pregunta PICO planteada (Baronchelli et al., 2021; Calafiore et al., 2022; Loro et al., 2023; Mehrholz et al., 2020; Wang et al., 2021). Sin embargo, una de las RS evaluó como intervención la combinación del sistema robotizado y la fisioterapia, lo que limitó la evaluación del efecto aislado del sistema robotizado (Mehrholz et al., 2020). Durante la revisión de los ensayos clínicos aleatorizados (ECA) en la fase de texto completo, se encontró que la mayoría de ellos ya habían sido considerados en los análisis cualitativos y cuantitativos de las RS, por lo que se decidió no incluirlos en el análisis final. Además, se incluyó un protocolo de ECA (University Hospital Ostrava, 2022) en el que planea determinar el efecto de la rehabilitación de la marcha con Lokomat en comparación con la terapia convencional con un protocolo de tratamiento definido. CONCLUSIÓN: Por lo expuesto, el Instituto de Evaluación de Tecnologías en Salud e Investigación- 'ETS' no aprueba el uso del sistema robotizado para la rehabilitación de adultos con trastorno de la marcha debido a accidente cerebrovascular. Se recomienda a los especialistas que, en caso de identificar nueva evidencia que responda a la población de la PICO de interés, envíen sus propuestas para ser evaluadas en el marco de la Directiva N° 001-IETSI-ESSALUD-2018.
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Humanos , Robótica/métodos , Accidente Cerebrovascular/etiología , Trastornos Neurológicos de la Marcha/terapia , Análisis de la Marcha/métodos , Eficacia , Análisis Costo-BeneficioRESUMEN
BACKGROUND: Functional electrical stimulation (FES) applied to the paretic peroneal nerve has positive clinical effects on foot drop secondary to stroke. OBJECTIVE: To evaluate the effectiveness of FES applied to the paretic peroneal nerve on gait speed, active ankle dorsiflexion mobility, balance, and functional mobility. METHODS: Electronic databases were searched for articles published from inception to January 2020. We included randomized controlled trials or crossover trials focused on determining the effects of FES combined or not with other therapies in individuals with foot drop after stroke. Characteristics of studies, participants, comparison groups, interventions, and outcomes were extracted. Statistical heterogeneity was assessed with the I2 statistic. RESULTS: We included 14 studies providing data for 1115 participants. FES did not enhance gait speed as compared with conventional treatments (i.e., supervised/unsupervised exercises and regular activities at home). FES combined with supervised exercises (i.e., physiotherapy) was better than supervised exercises alone for improving gait speed. We found no effect of FES combined with unsupervised exercises and inconclusive effects when FES was combined with regular activities at home. When FES was compared with conventional treatments, it improved ankle dorsiflexion, balance and functional mobility, albeit with high heterogeneity for these last 2 outcomes. CONCLUSIONS: This meta-analysis revealed low quality of evidence for positive effects of FES on gait speed when combined with physiotherapy. FES can improve ankle dorsiflexion, balance, and functional mobility. However, considering the low quality of evidence and the high heterogeneity, these results must be interpreted carefully.
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Terapia por Estimulación Eléctrica , Trastornos Neurológicos de la Marcha , Modalidades de Fisioterapia , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/terapia , Humanos , Nervio Peroneo , Accidente Cerebrovascular/complicaciones , Velocidad al CaminarRESUMEN
Parkinson's disease is the second most common neurodegenerative disorder in old age. Aging process for elders with Parkinson's disease can induce gait disturbances with more functional disabilities than for elders without the disease. Treadmill training as a therapy has resulted in notable effects on the gait of patients with Parkinson's disease and may be a resource for geriatric neurological rehabilitation. This review aimed to study the effects on gait after treadmill training in elderly patients with Parkinson's disease. The search was performed in the databases PubMed®, LILACS, PEDro and EMBASE, with the following keywords: "Parkinson's disease", "elderly", "treadmill training" and "gait evaluation". The quality of the studies included was assessed by PEDro Scale. Eleven studies met the inclusion and exclusion criteria. Eight studies were randomized, and only one did a follow-up. One can observe in this review that treadmill training with or without weight support (at least 20 minutes, two to three times a week, with progressive increase of loads, for minimum of 6 weeks) in elderly patients with the Parkinson's disease was effective to improve gait. In addition, both were considered safe (since some studies described the use of belts, even in unsupported training) and can be associated with therapies complementary to gait, such as repetitive transcranial magnetic stimulation, visual cues or anodal transcranial direct current stimulation. Treadmill training in elderly patients with Parkinson's disease is an intervention that improves gait outcomes, but further studies are required for better proofs.
Asunto(s)
Prueba de Esfuerzo/métodos , Trastornos Neurológicos de la Marcha/terapia , Enfermedad de Parkinson/terapia , Anciano , Terapia por Ejercicio , Trastornos Neurológicos de la Marcha/etiología , Humanos , Resultado del TratamientoRESUMEN
Dopaminergic drugs partially alleviate gait problems in Parkinson's disease, but the effects are not sustained in the long-term. Particularly, the freezing of gait directly impacts patients' quality of life. Experimental epidural spinal cord stimulation (SCS) studies have suggested positive effects on locomotion among PD patients, but the effects of non-invasive stimulation have never been explored. Here, we investigated in a prospective, open-label, pilot study the efficacy and safety of non-invasive magnetic stimulation of the spinal cord in five patients with PD who experienced gait problems, including freezing of gait. A trial of transcutaneous magnetic SCS was performed at the level of the fifth thoracic vertebra. The primary outcome was the change in freezing of gait 7 days after stimulation. Secondary outcome measures included changes in gait speed and UPDRS part III. After non-invasive spinal cord stimulation, patients experienced a 22% improvement in freezing of gait (p = 0.040) and 17.4% improvement in the UPDRS part III (p = 0.042). Timed up and go times improved by 48.2%, although this did not reach statistical significance (p = 0.06). Patients' global impression of change was 'much improved' for four patients. Improvement in gait after stimulation was reversible, since it returned to baseline scores 4 weeks after stimulation. No severe side effects were recorded. This pilot study suggests that transcutaneous magnetic spinal cord stimulation is feasible and can potentially improve gait problems in PD, without severe adverse effects. Large scale phase II trials are needed to test this hypothesis.
Asunto(s)
Trastornos Neurológicos de la Marcha/terapia , Marcha/fisiología , Magnetoterapia/métodos , Enfermedad de Parkinson/terapia , Estimulación de la Médula Espinal/métodos , Anciano , Femenino , Trastornos Neurológicos de la Marcha/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/complicaciones , Proyectos Piloto , Estudios Prospectivos , Calidad de VidaRESUMEN
BACKGROUND: Current available therapies for Parkinson disease (PD) have strong limitations, and patients usually present with refractory symptoms despite all efforts. Deep brain stimulation (DBS), which has been used in PD patients for decades (since 1987), has best indications for symptoms like tremor, motor fluctuations, or dyskinesia. However, postural instability and gait disturbances (PIGD) have restricted benefits with DBS. In 2009, spinal cord stimulation (SCS), a well-established therapy for chronic pain, has emerged as a potential alternative therapy that may help control unresponsive symptoms such as bradykinesia, PIGD, and freezing of gait. METHODS: The main studies regarding SCS in PD are reviewed here from the first studies in animal models to the latest clinical trials. CONCLUSIONS: Despite promising findings, the heterogeneity of methodologies used and small samples in human studies pose a challenging problem to be addressed in order to have robust clinical evidence to support SCS as a viable PD treatment.
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Enfermedad de Parkinson/terapia , Estimulación de la Médula Espinal , Animales , Modelos Animales de Enfermedad , Trastornos Neurológicos de la Marcha/terapia , Humanos , Resultado del TratamientoRESUMEN
OBJECTIVE: Individuals with Parkinson's disease (PD) and freezing of gait (FOG) present peripheral and central sensitivity disturbances that impair motor performance. This study aimed to investigate long-term effects of plantar sensory stimulation on brain activity, brain connectivity, and gait velocity of individuals with PD and FOG. METHODS: Twenty-five participants were enrolled in this clinical trial (NCT02594540). Plantar sensory stimulation was delivered using the Automated Mechanical Peripheral Stimulation therapy (AMPS). Volunteers were randomly assigned to real or placebo AMPS groups and received eight sessions of treatment. The primary outcome was brain activity (task-based fMRI-active ankle dorsi-plantar flexion). Secondary outcomes were brain connectivity (resting state-RS fMRI) and gait velocity. fMRI was investigated on the left, right, and mid-sensory motor regions, left and right basal ganglia. RESULTS: No changes in brain activity were observed when task-based fMRI was analyzed. After real AMPS, RS functional connectivity between basal ganglia and sensory-related brain areas increased (insular and somatosensory cortices). Gait velocity also increased after real AMPS. A positive correlation was found between gait velocity and the increased connectivity between sensory, motor and supplementary motor cortices. CONCLUSION: Plantar sensory stimulation through AMPS was not able to modify brain activity. AMPS increased the RS brain connectivity mainly in areas related to sensory processing and sensorimotor integration. Plantar stimulation could be a way to improve plantar sensitivity and consequently ameliorate gait performance. However, the mechanisms behind the way AMPS influences brain pathways are still not completely known.
Asunto(s)
Pie , Vías Nerviosas/fisiopatología , Enfermedad de Parkinson/fisiopatología , Enfermedad de Parkinson/terapia , Estimulación Física/métodos , Anciano , Anciano de 80 o más Años , Ganglios Basales/fisiopatología , Método Doble Ciego , Femenino , Marcha , Trastornos Neurológicos de la Marcha/diagnóstico por imagen , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/terapia , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Corteza Motora/fisiopatología , Vías Nerviosas/diagnóstico por imagen , Enfermedad de Parkinson/diagnóstico por imagen , Resultado del TratamientoRESUMEN
ABSTRACT Parkinson's disease is the second most common neurodegenerative disorder in old age. Aging process for elders with Parkinson's disease can induce gait disturbances with more functional disabilities than for elders without the disease. Treadmill training as a therapy has resulted in notable effects on the gait of patients with Parkinson's disease and may be a resource for geriatric neurological rehabilitation. This review aimed to study the effects on gait after treadmill training in elderly patients with Parkinson's disease. The search was performed in the databases PubMed®, LILACS, PEDro and EMBASE, with the following keywords: "Parkinson's disease", "elderly", "treadmill training" and "gait evaluation". The quality of the studies included was assessed by PEDro Scale. Eleven studies met the inclusion and exclusion criteria. Eight studies were randomized, and only one did a follow-up. One can observe in this review that treadmill training with or without weight support (at least 20 minutes, two to three times a week, with progressive increase of loads, for minimum of 6 weeks) in elderly patients with the Parkinson's disease was effective to improve gait. In addition, both were considered safe (since some studies described the use of belts, even in unsupported training) and can be associated with therapies complementary to gait, such as repetitive transcranial magnetic stimulation, visual cues or anodal transcranial direct current stimulation. Treadmill training in elderly patients with Parkinson's disease is an intervention that improves gait outcomes, but further studies are required for better proofs.
RESUMO A doença de Parkinson é o segundo distúrbio neurodegenerativo mais comum na velhice. O processo de envelhecimento de idosos com doença de Parkinson pode levar a distúrbios de marcha com mais incapacidades funcionais do que para idosos sem a doença. O treinamento em esteira como terapia pode resultar em efeitos notáveis na marcha de pacientes com Parkinson e ser um recurso para a reabilitação neurológica geriátrica. Esta revisão teve como objetivo estudar os efeitos da marcha após o treinamento em esteira na doença de Parkinson em idosos. A pesquisa foi realizada nas bases de dados PubMed®, LILACS, PEDro e EMBASE, com os seguintes descritores: "doença de Parkinson", "idosos", "treinamento em esteira" e "avaliação da marcha". A qualidade dos estudos incluídos foi avaliada pela escala de PEDro. Atenderam aos critérios de inclusão e exclusão 11 estudos. Oito estudos foram randomizados, e apenas um fez follow-up . Foi possível observar que treinamento em esteira com ou sem suporte de peso (por pelo menos 20 minutos, duas a três vezes por semana, com aumento progressivo de cargas, por, no mínimo, 6 semanas) em idosos com doença de Parkinson foi efetivo para melhorar a marcha. Além disso, ambos os treinamentos foram considerados seguros (pois alguns estudos relataram o uso de cintos, mesmo no treinamento sem suporte de peso) e podem ser associados a terapias complementares à marcha, como estimulação magnética transcraniana repetitiva, estímulos visuais ou estimulação transcraniana direta anódica. O treinamento em esteira em pacientes idosos com doença de Parkinson é uma intervenção que melhora os resultados da marcha, mas requer mais estudos para melhor comprovação.
Asunto(s)
Humanos , Anciano , Enfermedad de Parkinson/terapia , Trastornos Neurológicos de la Marcha/terapia , Prueba de Esfuerzo/métodos , Resultado del Tratamiento , Trastornos Neurológicos de la Marcha/etiología , Terapia por EjercicioRESUMEN
BACKGROUND: Children with hemiparetic cerebral palsy are often characterized by reduced speed progression, shorter step length, and increased support base. These kinematic alterations result in inefficient gait. OBJECTIVE: To assess the immediate effects of treadmill training with additional lower limb loading on kinematic gait parameters in children with Cerebral Palsy (CP). METHODS: This cross-sectional, observational study, involved 20 children with hemiparetic CP that underwent single treadmill session with ankle loading. Kinematic gait data were collected by the Qualisys Motion Capture System during baseline (PRE), immediately after training (POST) and 5 minutes after post session (FOLLOW UP). RESULTS: The results demonstrated increase in knee (p = 0.001) and hip (p = 0.005) range of motion, maximum knee (p <.0.001) and hip (p =.001) flexion in swing and paretic foot height during swing (p <0.001) when PRE x POST were compared. CONCLUSION: Treadmill gait training with additional lower limb loading was a disturbance capable of modifying the locomotor strategy of these population. The increase in hip flexion during swing phase allowed higher paretic foot clearance which may favor the improvement of gait function.
Asunto(s)
Articulación del Tobillo/fisiología , Parálisis Cerebral/terapia , Prueba de Esfuerzo/métodos , Marcha/fisiología , Paresia/terapia , Soporte de Peso/fisiología , Parálisis Cerebral/diagnóstico , Parálisis Cerebral/fisiopatología , Niño , Preescolar , Estudios Transversales , Terapia por Ejercicio/métodos , Femenino , Estudios de Seguimiento , Trastornos Neurológicos de la Marcha/diagnóstico , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/terapia , Humanos , Masculino , Paresia/diagnóstico , Paresia/fisiopatología , Rango del Movimiento Articular/fisiología , Resultado del TratamientoRESUMEN
Freezing of gait (FoG) in Parkinson's disease (PD) is an incapacitating transient phenomenon, followed by continuous postural disorders. Spinal cord stimulation (SCS) is a promising intervention for FoG in patients with PD, however, its effects on distinct domains of postural control is not well known. The aim of this study is to assess the effects of SCS on FoG and distinct domains of postural control. Four patients with FoG were implanted with SCS systems in the upper thoracic spine. Anticipatory postural adjustment (APA), reactive postural responses, gait and FoG were biomechanically assessed. In general, the results showed that SCS improved FoG and APA. However, SCS failed to improve reactive postural responses. SCS seems to influence cortical motor circuits, involving the supplementary motor area. On the other hand, reactive posture control to external perturbation that mainly relies on neuronal circuitries involving the brainstem and spinal cord, is less influenced by SCS.
Asunto(s)
Trastornos Neurológicos de la Marcha/terapia , Enfermedad de Parkinson/terapia , Estimulación de la Médula Espinal/métodos , Médula Espinal/fisiopatología , Anciano , Brasil , Femenino , Marcha/fisiología , Trastornos Neurológicos de la Marcha/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Corteza Motora/fisiopatología , Enfermedad de Parkinson/fisiopatología , Equilibrio Postural/fisiologíaRESUMEN
La Estimulación Rítmica Auditiva (ERA) es una técnica que facilita la rehabilitación de movimientos que son intrínseca y biológicamente rítmicos, como la marcha. Utiliza los efectos fisiológicos del ritmo auditivo sobre el sistema motor y funciona como un estímulo de sincronización y como facilitador para lograr patrones de marchas fisiológicos. El objetivo de este estudio piloto fue comparar los parámetros de marcha y calidad de vida antes y después de la implementación de ERA en pacientes con Enfermedad de Parkinson (EP) que sufrían trastornos de la marcha. Para el estudio se reclutaron 10 pacientes con EP "clínicamente establecida o probable" según criterios diagnósticos internacionales de entre 60 y 85 años de edad, con trastornos de la marcha leves. El entrenamiento con ERA duró 6 semanas y utilizó piezas de tango para sincronizar la marcha a rentes niveles de cadencia. Los resultados muestran una mejoría significativa de la marcha y el equilibrio (escala de Tinetti) luego del entrenamiento con ERA, la cual fue acompañada por una tendencia a la mejoría de la calidad de vida (escala PDQ-39). Estos resultados sugieren que la ERA fue capaz de mejorar la marcha y esto se tradujo en mejorías funcionales. Se requieren estudios aleatorizados, ciego y controlados en un mayor número de pacientes para continuar estudiando la potencial eficacia de la ERA
Rhythmic Auditory Stimulation (RAS) is a technique that facilitates the rehabilitation of movements that are intrinsically and biologically rhythmic, such as gait. It uses the physiological effects of perceived rhythm on the motor system and functions as a synchronization stimulus and as a facilitator to improved gait patterns. The objective of this pilot study was to compare gait parameters and quality of life before and after the implementation of RAS in patients with Parkinson's Disease (PD) with gait difficulties. For the study, 10 patients with clinically established or probable PD according to international diagnostic criteria, between 60 and 85 years of age, who suffered from mild gait disorders were recruited. Training with RAS lasted 6 weeks and used tango pieces to synchronize gait to different levels of cadence. The results show a significant improvement in gait and balance (Tinetti scale) after training with RAS, which was accompanied by a tendency to improve the quality of life (PDQ-39 scale). These results suggest that RAS was able to improve gait, which translated into functional improvements. Randomized, blinded, controlled trials in a larger number of patients are required to further assess the potential efficacy of RAS.
Asunto(s)
Humanos , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedad de Parkinson/rehabilitación , Propiocepción , Calidad de Vida , Estimulación Acústica , Proyectos Piloto , Trastornos Neurológicos de la Marcha/terapia , MusicoterapiaRESUMEN
BACKGROUND: Deep brain stimulation and levodopatherapy ameliorate motor manifestations in Parkinson's disease, but their effects on axial signs are not sustained in the long term. OBJECTIVES: The objective of this study was to investigate the safety and efficacy of spinal cord stimulation on gait disturbance in advanced Parkinson's disease. METHODS: A total of 4 Parkinson's disease patients who experienced significant postural instability and gait disturbance years after chronic subthalamic stimulation were treated with spinal cord stimulation at 300 Hz. Timed-Up-GO and 20-meter-walk tests, UPDRS III, freezing of gait questionnaire, and quality-of-life scores were measured at 6 months and compared to baseline values. Blinded assessments to measure performance in the Timed-Up-GO and 20-meter-walk tests were carried out during sham stimulation at 300 Hz and 60 Hz. RESULTS: Patients treated with spinal cord stimulation had approximately 50% to 65% improvement in gait measurements and 35% to 45% in UPDRS III and quality-of-life scores. During blinded evaluations, significant improvements in the Timed-Up-GO and 20-meter-walk tests were only recorded at 300 Hz. CONCLUSION: Spinal cord stimulation at 300 Hz was well tolerated and led to a significant improvement in gait. © 2016 International Parkinson and Movement Disorder Society.
Asunto(s)
Trastornos Neurológicos de la Marcha/terapia , Evaluación de Resultado en la Atención de Salud , Enfermedad de Parkinson/terapia , Estimulación de la Médula Espinal/métodos , Anciano , Estimulación Encefálica Profunda , Femenino , Trastornos Neurológicos de la Marcha/etiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/complicaciones , Método Simple CiegoRESUMEN
More than one third of patients with Parkinson disease experience freezing. It is characterized by the feeling that one's feet are "glued to the floor", and it is more common in the later stages of the disease. The causes of this gait disorder are not yet fully established, but it may lead patients to suffer falls and lose their independence. As a consequence, the development of therapeutic measures which can overcome freezing is of fundamental important for the autonomy of such individuals. There is no consensus in the literature on the most recommended therapeutic measures for the prevention or attenuation of freezing in gait. What seems to be defined are the phenomenological aspects of the disorder and good therapy, represented by the association between drug therapy and sensorial stimuli or motor coordination training geared towards the specificities to avoid motor difficulties of freezing, when triggering factors are present.
Asunto(s)
Reacción Cataléptica de Congelación/fisiología , Trastornos Neurológicos de la Marcha/etiología , Enfermedad de Parkinson/complicaciones , Progresión de la Enfermedad , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/terapia , Humanos , Enfermedad de Parkinson/fisiopatología , Enfermedad de Parkinson/terapiaRESUMEN
More than one third of patients with Parkinson disease experience freezing. It is characterized by the feeling that one's feet are "glued to the floor", and it is more common in the later stages of the disease. The causes of this gait disorder are not yet fully established, but it may lead patients to suffer falls and lose their independence. As a consequence, the development of therapeutic measures which can overcome freezing is of fundamental important for the autonomy of such individuals. There is no consensus in the literature on the most recommended therapeutic measures for the prevention or attenuation of freezing in gait. What seems to be defined are the phenomenological aspects of the disorder and good therapy, represented by the association between drug therapy and sensorial stimuli or motor coordination training geared towards the specificities to avoid motor difficulties of freezing, when triggering factors are present.