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Rehabilitation Treatment of Gait in Patients with Parkinson's Disease with Freezing: A Comparison Between Two Physical Therapy Protocols Using Visual and Auditory Cues with or Without Treadmill Training

Department of Physical Therapy, Scientific Institute of Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy.
Movement Disorders (Impact Factor: 5.63). 06/2009; 24(8):1139-43. DOI: 10.1002/mds.22491
Source: PubMed

ABSTRACT Freezing is a disabling symptom in patients with Parkinson's disease. We investigated the effectiveness of a new rehabilitation strategy based on treadmill training associated with auditory and visual cues. Forty Parkinsonian patients with freezing were randomly assigned to two groups: Group 1 underwent a rehabilitation program based on treadmill training associated with auditory and visual cues, while Group 2 followed a rehabilitation protocol using cues and not associated with treadmill. Functional evaluation was based on the Unified Parkinson's Disease Rating Scale Motor Section (UPDRS III), Freezing of Gait Questionnaire (FOGQ), 6-minute walking test (6MWT), gait speed, and stride cycle. Patients in both the groups had significant improvements in all variables considered by the end of the rehabilitation program (all P = 0.0001). Patients treated with the protocol including treadmill, had more improvement than patients in Group 2 in most functional indicators (P = 0.007, P = 0.0004, P = 0.0126, and P = 0.0263 for FOGQ, 6MWT, gait speed, stride cycle, respectively). The most striking result was obtained for 6MWT, with a mean increase of 130 m in Group 1 compared with 57 m in Group 2. Our results suggest that treadmill training associated with auditory and visual cues might give better results than more conventional treatments. Treadmill training probably acts as a supplementary external cue.

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    • "Regular exercises associated with medical therapy have been effective in providing the quality of life (Hirayama, Gobbi, Gobbi, & Stella, 2008; White, Wagenaar, & Ellis, 2006), the components of physical capacity (Hirsch, Toole, Maitland, & Rider, 2003; Skidmore, Patterson, Shulman, Sorkin, & Macko, 2008); the functional mobility (Frazzitta, Maestri, Uccellini, Bertotti, & Abelli, 2009; Gobbi, Barbieri , Vitorio, Pereira, & Teixeira-Arroyo, 2011, Pereira et al., 2012), and the spatial-temporal parameters of gait (Scandalis, Bosak, Berliner, Heiman, & Wells, 2001; Vitório et al., 2011). However, there are few studies about the effect of exercise on cognitive functions in patients with PD. "
    [Show description] [Hide description]
    DESCRIPTION: This study investigated the effect of a multimodal exercise program on executive functions and memory in people with Parkinson’s disease, taking into account disease severity and gender. Twenty-three patients with Parkinson’s disease (PD) were evaluated before and after a 6-month exercise program to improve executive functions and memory. We observed the effects of the intervention on executive functions (ability to abstract: p = .01), immediate memory (p = .04) and declarative episodic memory (p < .001). Women showed higher scores on declarative episodic memory (p = .03) than men, however there was no interaction between gender and the intervention. Regardless of sex and disease severity, these preliminary results indicate that the multimodal exercise seems to be effective in improving cognitive functions in patients with PD, suggesting that this program can be indicated as a preventive strategy to mitigate progressive cognitive deficits in the later stages of the disease.
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    • "Regular exercises associated with medical therapy have been effective in providing the quality of life (Hirayama, Gobbi, Gobbi, & Stella, 2008; White, Wagenaar, & Ellis, 2006), the components of physical capacity (Hirsch, Toole, Maitland, & Rider, 2003; Skidmore, Patterson, Shulman, Sorkin, & Macko, 2008); the functional mobility (Frazzitta, Maestri, Uccellini, Bertotti, & Abelli, 2009; Gobbi, Barbieri , Vitorio, Pereira, & Teixeira-Arroyo, 2011, Pereira et al., 2012), and the spatial-temporal parameters of gait (Scandalis, Bosak, Berliner, Heiman, & Wells, 2001; Vitório et al., 2011). However, there are few studies about the effect of exercise on cognitive functions in patients with PD. "
    [Show description] [Hide description]
    DESCRIPTION: This study investigated the effect of a multimodal exercise program on executive functions and memory in people with Parkinson’s disease, taking into account disease severity and gender. Twenty-three patients with Parkinson’s disease (PD) were evaluated before and after a 6-month exercise program to improve executive functions and memory. We observed the effects of the intervention on executive functions (ability to abstract: p = .01), immediate memory (p = .04) and declarative episodic memory (p < .001). Women showed higher scores on declarative episodic memory (p = .03) than men, however there was no interaction between gender and the intervention. Regardless of sex and disease severity, these preliminary results indicate that the multimodal exercise seems to be effective in improving cognitive functions in patients with PD, suggesting that this program can be indicated as a preventive strategy to mitigate progressive cognitive deficits in the later stages of the disease.
  • Source
    • "Regular exercises associated with medical therapy have been effective in providing the quality of life (Hirayama, Gobbi, Gobbi, & Stella, 2008; White, Wagenaar, & Ellis, 2006), the components of physical capacity (Hirsch, Toole, Maitland, & Rider, 2003; Skidmore, Patterson, Shulman, Sorkin, & Macko, 2008); the functional mobility (Frazzitta, Maestri, Uccellini, Bertotti, & Abelli, 2009; Gobbi, Barbieri , Vitorio, Pereira, & Teixeira-Arroyo, 2011, Pereira et al., 2012), and the spatial-temporal parameters of gait (Scandalis, Bosak, Berliner, Heiman, & Wells, 2001; Vitório et al., 2011). However, there are few studies about the effect of exercise on cognitive functions in patients with PD. "
    [Show description] [Hide description]
    DESCRIPTION: This study investigated the effect of a multimodal exercise program on executive functions and memory in people with Parkinson’s disease, taking into account disease severity and gender. Twenty-three patients with Parkinson’s disease (PD) were evaluated before and after a 6-month exercise program to improve executive functions and memory. We observed the effects of the intervention on executive functions (ability to abstract: p = .01), immediate memory (p = .04) and declarative episodic memory (p < .001). Women showed higher scores on declarative episodic memory (p = .03) than men, however there was no interaction between gender and the intervention. Regardless of sex and disease severity, these preliminary results indicate that the multimodal exercise seems to be effective in improving cognitive functions in patients with PD, suggesting that this program can be indicated as a preventive strategy to mitigate progressive cognitive deficits in the later stages of the disease.
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