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17 Rehabilitation improves dyskinesias in Parkinsonian patients: A pilot study comparing two different rehabilitative treatments
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Abstracts / Basal Ganglia 2 (2012) 257–265
Background: In the last decade, the relationship between cognitive function and gait performances has received increasing attention. The present study aimed to describe the gait pattern in patients affected by Parkinson’s disease (PD) with or without mild cognitive impairment (MCI+, MCI ). We also sought to find an association between gait pattern and specific cognitive profiles. Methods: Forty-three patients with PD (19 MCI+ and 24 MCI ) and 20 age- and gender-matched healthy subjects (HS) were enrolled. We compared the gait pattern among MCI+ vs MCI vs HS in the following conditions: (1) normal gait; (2) motor dual task; (3) cognitive dual task, by means of a gait analysis system. In PD patients, gait patterns were evaluated in both off and on state. Memory, executive and visuospatial domains were evaluated with an extensive neuropsychological battery. Results: Compared with MCI and HS, MCI+ PD patients displayed reduced step length and swing time and impairment of measures of dynamic stability, which were only partially reverted by levodopa. We also found that dual task conditions affected several walking parameters in MCI+ PD at off and on state with respect to MCI and HS . Factor analysis revealed two independent factors, namely pace and stability. The latter was strongly and directly correlated with the visuospatial domain. Conclusions: Dysfunctions on specific gait parameters, which are poorly responsive to levodopa and highly sensitive to dual tasks, are associated with MCI in PD patients. Importantly, visuospatial impairment is strongly associated with the development of instability and more generally with the progression of PD. http://dx.doi.org/10.1016/j.baga.2012.04.017
17 Rehabilitation improves dyskinesias in Parkinsonian patients: A pilot study comparing two different rehabilitative treatments Giuseppe Frazzitta a, Gabriella Bertotti a, Giulio Riboldazzi c, Elisa Pelosin d, Micaela Morelli e,f, Pietro Balbi a, Natalia Boveri a, Cristoforo Comi g, Marinella Turla h, Roberta Rovescala a, Guido Felicetti a, Roberto Maestri b a Department of Neurorehabilitation, Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy, b Department of Biomedical Engineering, Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy, c Center for Parkinson’s Disease, Macchi Foundation, Varese and Department of Rehabilitation, ‘‘Le Terrazze’’ Hospital, Cunardo, Italy, d Department of Neurosciences, University of Genoa, Italy, e Department of Toxicology, Centre of Excellence for Neurobiology of Dependence, University of Cagliari, Cagliari, Italy, f CNR Institute for Neuroscience, Section of Cagliari, Italy, g Department of Neurology, University of the Eastern Piedmont, Novara, Italy, h Department of Neurology, Valle Camonica Hospital, Esine, Italy Background: The present study was devised: (a) to test whether an intensive multidisciplinary rehabilitation treatment (60 h) for Parkinsonian patients is effective in improving dyskinesia and motor performance compared to a control group undergoing a non-intensive non multidisciplinary rehabilitation treatment (30 h) and (b) to verify whether rehabilitation may lead to a reduction in levodopa dosage. Methods: Forty Parkinsonian patients suffering from dyskinesias were admitted to study: 20 for an intensive (group-1) and 20 for a standard treatment (group-2). The rating scales used for the clinical evaluation were: Unified Parkinson’s Disease Rating Scales (UPDRS) II, III, IV, Parkinson’s disease disability scale (PDDS), Abnormal Involuntary Movement Scale (AIMS).
Results: All outcome measurements improved in both groups of patients, but patients group-1 presented better results: UPDRS II was reduced by 33% in group-1 and by 22% in group-2, UPDRS III 29% vs. 22%, UPDRS IV 74% vs. 10%, PDDS 18% vs. 12%, and AIMS 71% vs. 8%. A different behaviour was observed for levodopa dosage at baseline and after treatment: dosage decreased by an average value of 210 mg (p < 0.0001) in group-1 and was virtually unchanged (30 mg reduction, p = 0.08) in group-2. Conclusion: Our findings suggest that a rehabilitation protocol should be considered as a valid non-invasive therapeutic support for patients who show dyskinesias and that there are better results when the treatment is intensive. http://dx.doi.org/10.1016/j.baga.2012.04.018
18 Short- and long-term efficacy of intensive rehabilitation treatment on balance and gait in Parkinsonian patients: A pilot study with a 1-year follow-up G. Frazzitta a, G. Bertotti a, P. Balbi a, D. Uccellini b, N. Boveri a, R. Rovescala a, R. Maestri a a Department of Neurorehabilitation, Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy, b Department of Neurology, Tradate Hospital, Varese, Italy Background: Parkinson’s disease (PD) is a neurodegenerative disorder in which gait and balance disturbances are relevant symptoms that respond poorly to pharmacological treatment. Recent studies demonstrated that physical exercise improves balance and gait but the persistence over time of beneficial effects and the optimal content of exercise intervention remain open questions. The aim of this study was to investigate whether a multidisciplinary intensive rehabilitation treatment (IRT) is effective in improving balance and gait and whether improvements persist at a 1-year follow-up. Methods: We studied 20 PD patients (age: 71 ± 7 years) who underwent an IRT (4 weeks, three daily sessions of one hour each, 5 days a week). Outcome measures were UPDRS items for balance, falls and walk, Berg Balance Scale, 6-min walking test, Timed Up and Go Test, and Comfortable-Fast gait speeds. Patients were evaluated at admission, at the end of treatment, and at a 1-year follow-up. Pharmacological therapy was unchanged during IRT and at followup. Results: All outcome measures improved significantly at the end of IRT. At follow-up, UPDRS_walk and Comfortable-Fast gait speeds still maintained better values with respect to admission (p = 0.009, p = 0.03 and p = 0.02, respectively), while the remaining scales did not differ significantly. Conclusions: Our results demonstrate that the IRT was effective in improving balance and gait and that the improvement in gait performances was maintained also after 1 year. These results point out that Parkinsonian patients, despite the degenerative nature of the disease, have the potential to improve balance and gait, and maintain the result over time. http://dx.doi.org/10.1016/j.baga.2012.04.019
19 Working on asymmetry in Parkinson’s disease: A double-blind, randomized, controlled rehabilitation trial L. Ricciardi a,b, D. Ricciardi c, F. Lena d, M. Petracca a, S. Barricella d, N. Modugno d, G. Zuccalà c, A.R. Bentivoglio a, A. Fasano a,e a Istituto di Neurologia, Università Cattolica del Sacro Cuore, Roma, Italy, b Department of Neuroscience, University of Messina, Italy,
Abstracts / Basal Ganglia 2 (2012) 257–265
Background: In the last decade, the relationship between cognitive function and gait performances has received increasing attention. The present study aimed to describe the gait pattern in patients affected by Parkinson’s disease (PD) with or without mild cognitive impairment (MCI+, MCI ). We also sought to find an association between gait pattern and specific cognitive profiles. Methods: Forty-three patients with PD (19 MCI+ and 24 MCI ) and 20 age- and gender-matched healthy subjects (HS) were enrolled. We compared the gait pattern among MCI+ vs MCI vs HS in the following conditions: (1) normal gait; (2) motor dual task; (3) cognitive dual task, by means of a gait analysis system. In PD patients, gait patterns were evaluated in both off and on state. Memory, executive and visuospatial domains were evaluated with an extensive neuropsychological battery. Results: Compared with MCI and HS, MCI+ PD patients displayed reduced step length and swing time and impairment of measures of dynamic stability, which were only partially reverted by levodopa. We also found that dual task conditions affected several walking parameters in MCI+ PD at off and on state with respect to MCI and HS . Factor analysis revealed two independent factors, namely pace and stability. The latter was strongly and directly correlated with the visuospatial domain. Conclusions: Dysfunctions on specific gait parameters, which are poorly responsive to levodopa and highly sensitive to dual tasks, are associated with MCI in PD patients. Importantly, visuospatial impairment is strongly associated with the development of instability and more generally with the progression of PD. http://dx.doi.org/10.1016/j.baga.2012.04.017
17 Rehabilitation improves dyskinesias in Parkinsonian patients: A pilot study comparing two different rehabilitative treatments Giuseppe Frazzitta a, Gabriella Bertotti a, Giulio Riboldazzi c, Elisa Pelosin d, Micaela Morelli e,f, Pietro Balbi a, Natalia Boveri a, Cristoforo Comi g, Marinella Turla h, Roberta Rovescala a, Guido Felicetti a, Roberto Maestri b a Department of Neurorehabilitation, Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy, b Department of Biomedical Engineering, Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy, c Center for Parkinson’s Disease, Macchi Foundation, Varese and Department of Rehabilitation, ‘‘Le Terrazze’’ Hospital, Cunardo, Italy, d Department of Neurosciences, University of Genoa, Italy, e Department of Toxicology, Centre of Excellence for Neurobiology of Dependence, University of Cagliari, Cagliari, Italy, f CNR Institute for Neuroscience, Section of Cagliari, Italy, g Department of Neurology, University of the Eastern Piedmont, Novara, Italy, h Department of Neurology, Valle Camonica Hospital, Esine, Italy Background: The present study was devised: (a) to test whether an intensive multidisciplinary rehabilitation treatment (60 h) for Parkinsonian patients is effective in improving dyskinesia and motor performance compared to a control group undergoing a non-intensive non multidisciplinary rehabilitation treatment (30 h) and (b) to verify whether rehabilitation may lead to a reduction in levodopa dosage. Methods: Forty Parkinsonian patients suffering from dyskinesias were admitted to study: 20 for an intensive (group-1) and 20 for a standard treatment (group-2). The rating scales used for the clinical evaluation were: Unified Parkinson’s Disease Rating Scales (UPDRS) II, III, IV, Parkinson’s disease disability scale (PDDS), Abnormal Involuntary Movement Scale (AIMS).
Results: All outcome measurements improved in both groups of patients, but patients group-1 presented better results: UPDRS II was reduced by 33% in group-1 and by 22% in group-2, UPDRS III 29% vs. 22%, UPDRS IV 74% vs. 10%, PDDS 18% vs. 12%, and AIMS 71% vs. 8%. A different behaviour was observed for levodopa dosage at baseline and after treatment: dosage decreased by an average value of 210 mg (p < 0.0001) in group-1 and was virtually unchanged (30 mg reduction, p = 0.08) in group-2. Conclusion: Our findings suggest that a rehabilitation protocol should be considered as a valid non-invasive therapeutic support for patients who show dyskinesias and that there are better results when the treatment is intensive. http://dx.doi.org/10.1016/j.baga.2012.04.018
18 Short- and long-term efficacy of intensive rehabilitation treatment on balance and gait in Parkinsonian patients: A pilot study with a 1-year follow-up G. Frazzitta a, G. Bertotti a, P. Balbi a, D. Uccellini b, N. Boveri a, R. Rovescala a, R. Maestri a a Department of Neurorehabilitation, Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy, b Department of Neurology, Tradate Hospital, Varese, Italy Background: Parkinson’s disease (PD) is a neurodegenerative disorder in which gait and balance disturbances are relevant symptoms that respond poorly to pharmacological treatment. Recent studies demonstrated that physical exercise improves balance and gait but the persistence over time of beneficial effects and the optimal content of exercise intervention remain open questions. The aim of this study was to investigate whether a multidisciplinary intensive rehabilitation treatment (IRT) is effective in improving balance and gait and whether improvements persist at a 1-year follow-up. Methods: We studied 20 PD patients (age: 71 ± 7 years) who underwent an IRT (4 weeks, three daily sessions of one hour each, 5 days a week). Outcome measures were UPDRS items for balance, falls and walk, Berg Balance Scale, 6-min walking test, Timed Up and Go Test, and Comfortable-Fast gait speeds. Patients were evaluated at admission, at the end of treatment, and at a 1-year follow-up. Pharmacological therapy was unchanged during IRT and at followup. Results: All outcome measures improved significantly at the end of IRT. At follow-up, UPDRS_walk and Comfortable-Fast gait speeds still maintained better values with respect to admission (p = 0.009, p = 0.03 and p = 0.02, respectively), while the remaining scales did not differ significantly. Conclusions: Our results demonstrate that the IRT was effective in improving balance and gait and that the improvement in gait performances was maintained also after 1 year. These results point out that Parkinsonian patients, despite the degenerative nature of the disease, have the potential to improve balance and gait, and maintain the result over time. http://dx.doi.org/10.1016/j.baga.2012.04.019
19 Working on asymmetry in Parkinson’s disease: A double-blind, randomized, controlled rehabilitation trial L. Ricciardi a,b, D. Ricciardi c, F. Lena d, M. Petracca a, S. Barricella d, N. Modugno d, G. Zuccalà c, A.R. Bentivoglio a, A. Fasano a,e a Istituto di Neurologia, Università Cattolica del Sacro Cuore, Roma, Italy, b Department of Neuroscience, University of Messina, Italy,