1,721,083 research outputs found
Reduction of bradykinesia of finger movements by a single session of action observation in Parkinson disease.
No full textBackground. Action observation influences motor performance in healthy subjects and persons with motor impairments.
Objective. To understand the effects of action observation on the spontaneous rate of finger movements in patients with
Parkinson disease (PD). Methods. Participants, 20 with PD and 14 healthy controls, were randomly divided into 2 groups.
Those in the VIDEO group watched video clips showing repetitive finger movements paced at 3 Hz, whereas those in
the ACOUSTIC group listened to an acoustic cue paced at 3 Hz. All participants performed a finger sequence at their
spontaneous pace at different intervals (before, at the end of, 45 minutes after, and 2 days after training); 8 participants
with PD were recruited for a sham intervention, watching a 6-minute video representing a static hand. Finally, 10 patients
participated in the same protocol used for the VIDEO group but were tested in the on and off medication states. Results.
Both VIDEO and ACOUSTIC training increased the spontaneous rate in all participants. VIDEO intervention showed a
greater effect over time, improving the spontaneous rate and reducing the intertapping interval to a larger extent than
ACOUSTIC 45 minutes and 2 days after training. Action observation significantly influenced movement rate in on and
off conditions, but 45 minutes after training, the effect was still present only in the on condition. No effect was observed
after sham intervention. Conclusions. These findings suggest that the dopaminergic state contributes to the effects of action
observation, and this training may be a promising approach in the rehabilitation of bradykinesia in PD
Action Observation and Motor Imagery as a Treatment in Patients with Parkinson’s Disease
No full textAction observation (AO) and motor imagery (MI) has emerged as promising tool for physiotherapy intervention in Parkinson's disease (PD). This narrative review summarizes why, how, and when applying AO and MI training in individual with PD. We report the neural underpinning of AO and MI and their effects on motor learning. We examine the characteristics and the current evidence regarding the effectiveness of physiotherapy interventions and we provide suggestions about their implementation with technologies. Neurophysiological data suggest a substantial correct activation of brain networks underlying AO and MI in people with PD, although the occurrence of compensatory mechanisms has been documented. Regarding the efficacy of training, in general evidence indicates that both these techniques improve mobility and functional activities in PD. However, these findings should be interpreted with caution due to variety of the study designs, training characteristics, and the modalities in which AO and MI were applied. Finally, results on long-term effects are still uncertain. Several elements should be considered to optimize the use of AO and MI in clinical setting, such as the selection of the task, the imagery or the video perspectives, the modalities of training. However, a comprehensive individual assessment, including motor and cognitive abilities, is essential to select which between AO and MI suite the best to each PD patients. Much unrealized potential exists for the use AO and MI training to provide personalized intervention aimed at fostering motor learning in both the clinic and home setting
Interaction between vision and neck proprioception in the control of stance
No full textBalance control depends on the interaction of multiple
inputs originating from different sensory systems. Here,
we investigated the effect on quiet human stance of changing
the visual condition prior to a proprioceptive perturbation
produced by vibration of dorsal neck muscles. In complete
absence of visual references, the amplitude of the postural
responses to neck vibration (forward shift of the centre of
foot pressure) was the largest and became progressively
larger as a function of the repetition of administered stimuli.
The posture-destabilizing effect of vibration eyes-closed (EC)
and the build-up effect were reduced if vibration was preceded
by a period during which vision was allowed (EO).
Similarly, the small destabilizing effect of vibration EO was
increased if vibration was preceded by an EC period. The
fore-period must last more than 3 s in order to affect the
response to neck muscle vibration. The responsiveness to a
proprioceptive disturbing input does not immediately change
on adding or subtracting vision, but a finite time period must
elapse before the postural “set” defined by vision is fully
established. The findings underline the importance of time
when vision is used in re-weighting the excitability of the
postural control mechanisms
Evaluation of physical therapy in parkinsonian patients with freezing of gait: a pilot study
No full textObjective: Freezing of gait is a frequently disabling symptom in Parkinson's disease,
poorly responding to dopaminergic treatment. We investigated the short-term
effectiveness of a rehabilitation protocol in parkinsonian patients with freezing of gait.
Design: Prospective, uncontrolled pilot study with open label design.
Setting: Outpatient service for rehabilitation of neurological disorders.
Subjects: Twelve patients (8 male, 4 female; aged 59-78 years; Hoehn-Yahr stage:
2-3; mean disease duration: 14.2 +SD 4.1 years).
Interventions: Patients attended three (45 min) sessions every week, over a sixweek
period, of physical therapy focused to improve balance, postural control and
walking, and to learn new strategies for overcoming freezing of gait.
Main outcome measures: Patients were evaluated before (TO), at the end (Ti), and
one month after (T2) rehabilitation by means of clinical rating scales (Unified
Parkinson Disease Rating Scale - Motor Section; Freezing of Gait Questionnaire;
Parkinson Disease Quality of Life Score) and gait parameters (number of strides,
stride length and velocity) during a standardized walking test.
Results: The scores of Freezing of Gait Questionnaire and of Parkinson Disease
Quality of Life Questionnaire (but not of the Unified Parkinson Disease Rating Scale-
Motor Section) were significantly improved after treatment (Ti). Gait parameters
were significantly improved at Ti and T2.
Conclusions: We showed the potential short-term efficacy of a rehabilitative
approach to freezing of gait in Parkinson's disease. The positive outcome was
documented by clinical rating scales and objective gait evaluation. The rapid
reversibility of the clinical benefit suggests that further studies are needed to better
define the optimal frequency and duration of treatment
Rehabilitation for Parkinson's disease: Current outlook and future challenges
No full textRehabilitation is considered as an adjuvant to pharmacological and surgical treatments for Parkinson's disease (PD) to maximize functional ability and minimize secondary complications. Originally, approaches were based on empirical experience, but growing evidence suggests that exercise-dependent plasticity constitutes the main mechanism underlying the effects of physiotherapy. Exercise increases synaptic strength and influences neurotransmission, thus potentiating functional circuitry in PD. In addition, exercise is a pivotal element of motor learning. PD patients retain a sufficient capacity of motor learning, though learning rates and performance are reduced in comparison to normal controls. Recent meta-analyses demonstrated that rehabilitation could induce short-lasting, but clinically important benefits, particularly for gait and balance. However, the interventions are largely heterogeneous (stretching, muscle strengthening, balance, postural exercises, occupational therapy, cueing, treadmill training), and there is still no consensus about the optimal approach. Innovative techniques have been recently proposed: virtual reality and exergaming, motor imagery and action observation, robot-assisted physiotherapy and non-conventional therapies (e.g.: dance, martial arts). The rehabilitative program for PD should be "goal-based" (targeted to practicing and learning specific activities in the core areas), but a number of practice variables (intensity, specificity, complexity) need to be identified and the program should tailored to the individual patients' characteristics
Relationships between gait and emotion in Parkinson's disease: A narrative review
No full textBackground: Disturbance of gait is a key feature of Parkinson's disease (PD) and has a negative impact on quality of life. Deficits in cognition and sensorimotor processing impair the ability of people with PD to walk quickly, efficiently and safely. Recent evidence suggests that emotional disturbances may also affect gait in PD. Research question: We explored if there were relationships between walking ability, emotion and cognitive impairment in people with PD. Methods: The literature was firstly reviewed for unimpaired individuals. The recent experimental evidence for the influence of emotion on gait in people with PD was then explored. The contribution of affective disorders to continuous gait disorders was investigated, particularly for bradykinetic and hypokinetic gait. In addition, we investigated the influence of emotional processing on episodic gait disturbances, such as freezing of gait. Potential effects of pharmacological, surgical and physical therapy interventions were also considered. Results: Emerging evidence showed that emotional disturbances arising from affective disorders such as anxiety and depression, in addition to cognitive impairment, could contribute to gait disorders in some people with PD. An analysis of the literature indicated mixed evidence that improvements in affective disorders induced by physical therapy, pharmacological management or surgery improve locomotion in PD. Significance: When assessing and treating gait disorders in people with PD, it is important to take into the account non-motor symptoms such as anxiety, depression and cognitive impairment, in addition to the motor sequalae of this progressive neurological condition
Cervical dystonia affects aimed movements of non dystonic segments
No full textPatients with focal dystonia exhibit proprioception
abnormalities that can lead to kinematic deficits. Proprioceptive
abnormalities are present in both symptomatic and
asymptomatic body parts of dystonic patients. To ascertain
whether in patients with idiopathic cervical dystonia (CD)
movements performed with nondystonic segments display kinematic
abnormalities, we studied trajectory formation of out
and back arm reaching movements in 10 patients with CD
(before and 3 weeks after treatment with Botulinum toxin)
and in 10 age-matched controls. Before treatment, patients
with CD showed significant trajectory abnormalities when
compared with normal controls. Patients’ trajectories were
more curved with asymmetrical temporal velocity profiles as
well as increased hand path areas, and had longer reversal
lags between the out and back segments. Treatment with botulinum
toxin improved all the kinematic parameters. These
results suggest that in patients with CD, movements performed
with nondystonic segments are abnormal. The kinematic
abnormalities are likely to derive from long-standing
defective integration of the proprioceptive input, which, in
turn, causes general changes in the internal models of limb
dynamics. It is plausible that treatment with botulinum toxin
partially restores proprioceptive processing and thus, such internal
model
Action Observation and Motor Imagery: Innovative Cognitive Tools in the Rehabilitation of Parkinson’s Disease
Full text linkParkinson’s disease (PD) is characterized by a progressive impairment of motor skills with deterioration of autonomy in daily living activities. Physiotherapy is regarded as an adjuvant to pharmacological and neurosurgical treatment and may provide small and short-lasting clinical benefits in PD patients. However, the development of innovative rehabilitation approaches with greater long-term efficacy is a major unmet need. Motor imagery (MI) and action observation (AO) have been recently proposed as a promising rehabilitation tool. MI is the ability to imagine a movement without actual performance (or muscle activation). The same cortical-subcortical network active during motor execution is engaged in MI. The physiological basis of AO is represented by the activation of the “mirror neuron system.” Both MI and AO are involved in motor learning and can induce improvements of motor performance, possibly mediated by the development of plastic changes in the motor cortex. The review of available evidences indicated that MI ability and AO feasibility are substantially preserved in PD subjects. A few preliminary studies suggested the possibility of using MI and AO as parts of rehabilitation protocols for PD patients
kinesiotaping reduces pain and modulates sensory function in patients with focal dystonia: a randomized crossover pilot study.
No full textBackground. Pain is one of the most common and disabling “nonmotor” symptoms in patients with dystonia. No recent
study evaluated the pharmacological or physical therapy approaches to specifically treat dystonic pain symptoms. Objective.
To evaluate the effectiveness of KinesioTaping in patients with cervical dystonia (CD) and focal hand dystonia (FHD) on
self-reported pain (primary objective) and on sensory functions (secondary objective). Methods. Twenty-five dystonic
patients (14 with CD and 11 FHD) entered a randomized crossover pilot study. The patients were randomized to 14-
day treatment with KinesioTaping or ShamTaping over neck (in CD) or forearm muscles (in FHD), and after a 30-day
washout period, they received the other treatment. The main outcome measures were 3 visual analog scales (VASs)
for usual pain, worst pain, and pain relief. Disease severity changes were evaluated by means of the Toronto Western
Spasmodic Torticollis Rating Scale (CD) and the Writer’s Cramp Rating Scale (FHD). Furthermore, to investigate possible
KinesioTaping-induced effects on sensory functions, we evaluated the somatosensory temporal discrimination threshold.
Results. Treatment with KinesioTape induced a decrease in the subjective sensation of pain and a modification in the ability
of sensory discrimination, whereas ShamTaping had no effect. A significant, positive correlation was found in both groups
of patients between the improvement in the subjective sensation of pain and the reduction of somatosensory temporal
discrimination threshold values induced by KinesioTaping. Conclusions. These preliminary results suggest that KinesioTaping
may be useful in treating pain in patients with dystonia
Cervical Dystonia: Effect of botulinum toxin on trajectory formation
No full textObjective: To ascertain whether the abnormal processing of information
from muscle spindles present in asymptomatic muscles of patients with
focal dystonia impair trajectory formation and whether botulinum toxin
has restorative effects.
Method: Ten patients with cervical dystonia (CD) (age range:
35−65 years) were tested with a motor task before (baseline) and 3 weeks
after (Test) botulinum toxin injections in the overactive neck muscles. Ten
aged-matched normal controls were tested twice three weeks apart. During
the motor task, subjects performed out-and-back reaching movements on
a digitizing tablet from a central starting point to one of eight targets
displayed on a computer screen. Screen cursor was blanked and vision of
the limb was blocked to prevent corrections during movement.
Results: At baseline, hand-paths of controls were straight, with sharp
reversals and overlapping out-and-back strokes. In patients with CD hand
paths were more curved (p < 0.001) with increased area (p < 0.001) and
longer reversal lags (time between end of the out motion and the beginning
of the return, p < 0.0001) and increased asymmetry in the temporal velocity
profile (p < 0.001). Botulinum treatment improved head posture in all
patients. At test, hand-paths curvature, normalized areas, reversal lags and
symmetry indexes decreased in CD although without reaching the controls’
range.
Conclusion: Patients with CD, without clinically evident involvement
of the upper limbs, display defects in trajectory formation that partially
recover after treatment. Altogether, these findings suggest the presence
of abormal interjoint coordination. They support the hypothesis that CD
impairs the processing of proprioceptive input from upper limb. Treatment
with botulinum toxin is helpful in restoring sensory processes
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