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Short-term effects of vibration therapy on motor impairments in Parkinson’s disease

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Abstract

Recent studies have suggested that vibration therapy may have a positive influence on motor symptoms in individuals with Parkinson's disease (PD). However, quantitative evidence of these benefits is scarce, and the concept of "whole-body" vibration in these studies is vague. The objectives of the current study were to evaluate the influence of vibration on motor symptoms and functional measures in PD by delivering sound waves to the entire body. We delivered whole body sound wave vibration to 40 individuals with PD using a Physioacoustic Chair, a piece of equipment with speakers spaced throughout the chair permitting a series of programmed low frequency sound waves through the body. Using a parallel cross-over design we utilized the Unified Parkinson's Disease Rating Scale (UPDRS), quantitative gait assessments, and a grooved pegboard for upper limb control. Improvements were seen in all symptom, motor control and functional outcome measures at the time of assessment. Specifically, a significant decrease in rigidity, and tremor were shown, as well as a significant increase in step length and improved speed on the grooved pegboard task. Results of this initial investigation provide support for vibration therapy as a non-pharmacological treatment alternative. Long-term benefits of vibration therapy will require further research.

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... The following preventative programs incorporate various low frequency programmes into their recommendations i.e.: Physioacoustic chairs (Hairo, 2002;Punkanen, 2004;Kärkkäinen, & Mitsui, 2006;King, Almeida, & Ahonen, 2009;Zheng, Sakari, Cheng, Hietikko, Moilanen, Timonen, Fagerlund, Kärkkäinen, Alèn, & Cheng, 2009), vibroacoustic programme also known as Vibroacoustic Therapy (VAT) (Skille, Weekes, & Wigram, 1989;Rüütel, 2002;Rüütel, Ratnik, Tamm, & Zilensk, 2004;Bergström-Isacsson, Julu, & Witt-Engerström, 2007;Lundqvist, Andersson, & Viding, 2008), Somatron (Brodsky, 2000). Another treatment program is the Whole-body-vibration (Fontana, Richardson, & Stanton, 2005;Haas, Turbanski, Kessler, & Schmidtbleicher, 2006). ...
... Punkanen found that the physioacoustic chair helped clients become aware and in touch with their physical body. King, Almeida, and Ahonen (2009), researched the effect of vibration therapy with participants with Parkinson's disease. Through the use of a Unified Parkinson's Disease Rating Scale, a pressure sensitive mat, gait assessments were made. ...
... Researchers found the use of physioacoustic chair to have significant effects in decreasing rigidity and tremors with participants with Parkinson's disease. That is, following physioacoustic treatment there was a carry-over effect in the post-rest period (King, Almeida, & Ahonen, 2009). Similarly, the use of whole-body-vibration has been studied for its positive effects for people with Parkinson's disease (Haas, Turbanski, Kessler, & Schmidtbleicher, 2006). ...
Article
Full-text available
Low frequency sound has many applications to medicine but the efficacy and effectiveness of low frequency sound treatment in health prevention remains unclear. The purpose of this study was to explore the perspectives and potentials of physioacoustic chair’s low frequency sound treatment when applied to daily activities among a sample of music students, faculty and/or staff, and to examine how participants view the benefits of the intervention for their well-being, health and health-related activities. The results show that the physioacoustic low frequency treatment added to participants’ subjective well-being by increasing their physical and emotional relaxation level, decreasing pain and stress, and increasing emotional enrichment and concentration. The study served as a pilot, to confirm stakeholder interest and to inform the feasibility of a larger study.
... The following preventative programs incorporate various low frequency programmes into their recommendations i.e.: Physioacoustic chairs (Hairo, 2002;Punkanen, 2004;Kärkkäinen, & Mitsui, 2006;King, Almeida, & Ahonen, 2009;Zheng, Sakari, Cheng, Hietikko, Moilanen, Timonen, Fagerlund, Kärkkäinen, Alèn, & Cheng, 2009), vibroacoustic programme also known as Vibroacoustic Therapy (VAT) (Skille, Weekes, & Wigram, 1989;Rüütel, 2002;Rüütel, Ratnik, Tamm, & Zilensk, 2004;Bergström-Isacsson, Julu, & Witt-Engerström, 2007;Lundqvist, Andersson, & Viding, 2008), Somatron (Brodsky, 2000). Another treatment program is the Whole-body-vibration (Fontana, Richardson, & Stanton, 2005;Haas, Turbanski, Kessler, & Schmidtbleicher, 2006). ...
... Punkanen found that the physioacoustic chair helped clients become aware and in touch with their physical body. King, Almeida, and Ahonen (2009), researched the effect of vibration therapy with participants with Parkinson's disease. Through the use of a Unified Parkinson's Disease Rating Scale, a pressure sensitive mat, gait assessments were made. ...
... Researchers found the use of physioacoustic chair to have significant effects in decreasing rigidity and tremors with participants with Parkinson's disease. That is, following physioacoustic treatment there was a carry-over effect in the post-rest period (King, Almeida, & Ahonen, 2009). Similarly, the use of whole-body-vibration has been studied for its positive effects for people with Parkinson's disease (Haas, Turbanski, Kessler, & Schmidtbleicher, 2006). ...
Article
Full-text available
Low frequency sound has many applications to medicine but the efficacy and effectiveness of low frequency sound treatment in health prevention remains unclear. The purpose of this study was to explore the perspectives and potentials of physioacoustic chair's low frequency sound treatment when applied to daily activities among a sample of music students, faculty and/or staff, and to examine how participants view the benefits of the intervention for their well-being, health and health-related activities. The results show that the physioacoustic low frequency treatment added to participants' subjective well-being by increasing their physical and emotional relaxation level, decreasing pain and stress, and increasing emotional enrichment and concentration. The study served as a pilot, to confirm stakeholder interest and to inform the feasibility of a larger study.
... The interviewee expressed that 40Hz would be the frequency with which one could begin basic research. Returning the body to a state of homeostasis (as discussed by Benson, 1978) could perhaps explain the efficacy of VAT for patient groups such as Parkinson's disease (King, Almeida & Ahonen, 2009). ...
... Much research is currently being conducted in Canada into the effects of VAT for various target groups, and results from earlier studies on Parkinson's disease (King, Almeida, & Ahonen, 2009), and fibromyalgia (Naghdi, Ahonen, Macario, & Bartel, 2015) have shown positive results relating to VAT application. It was also suggested that future research should look towards work-related stress, exhaustion, and myalgic encephalomyelitis (EAR, Interview, 2014). ...
... Although case studies are valuable sources of information on the individuals or small group's reaction to the treatment, various forms of evidence should be presented. This has begun to change with the emergence of articles discussing the use of sound vibration for Parkinson's Disease, depression, Fibromyalgia Syndrome, blood circulation, bone metabolism, and functional capacity (King, Almeida, & Ahonen, 2009;Koike, Hoshitani, Tabata, Seki, Nishimura, & Kano, 2012;Naghdi, Ahonen, Macario, & Bartel, 2015;and Zheng et al., 2009) and with this emergence of new evidence, the foundations upon which future research can rest will be much more secure. Although case studies offer an interesting insight into the smallscale effects and individual variation known to emerge after VAT treatment, generalisability is somewhat lacking and in order to increase probability of collaboration possibilities in medical settings, effect sizes should be presented. ...
... Several previous studies have examined the sensorimotor effect of WBV for individuals with PD [15,[17][18][19][20][21][22][23][24][25][26][27]. Although treatment protocols were not identical among studies, lowfrequency and low-amplitude vibrational signals were commonly used for individuals with PD. ...
... Frequencies greater than 20 Hz have been reported to generate kinesthetic illusions which may interfere with potential treatment effects [28][29][30]. In the majority of the reported treatment sessions, 5 bouts of alternating vibration and rest were delivered with each component lasting 1 minute, for a total session duration of 10-minutes [19,22,23,25,26]. The treatment is delivered to a patient who is placed in a standing possition on the vibration platform with both knees in slight flexion. ...
... Most research has suggested that WBV results in comparable outcomes to that of conventional therapy to improve balance and functional mobility for individuals with PD [19,20,23,[25][26][27]. Two studies reported WBV has superior outcomes as compared to conventional therapy [15,24]. ...
Article
Full-text available
Introduction: Previous studies have shown that whole-body vibration (WBV) may have a potential impact on gait and balance in individuals with Parkinson's disease (PD). However, this body of work has proven inconclusive due to the diverse disease progression and broad age range associated with PD. The effects of WBV on proprioception, a sense frequently affected by PD, has rarely been studied. Objective: To investigate the short-term effect of WBV on proprioception and motor function for individual with moderate PD. Design: A single-blind randomized controlled trial. Setting. A hospital and a laboratory. Participants. 32 participants with moderate PD were recruited and randomly assigned into either the WBV or conventional therapy groups. Interventions. For the WBV group, each treatment session included five, one-minute bouts of whole-body vibration paired with one-minute rest (frequency: 6 Hz; amplitude: 3 mm). Each conventional therapy participant received balance and mobility training for 10 minutes. Main Outcome Measures. Outcome measures included proprioceptive sensitivity of the upper limb, position sense of the knee joint, Unified Parkinson's disease rating scale : motor section (UPDRS-motor), functional reach test (FRT), and the timed up and go test (TUG). Results: No statistically significant difference was found between groups. However, both groups showed a significant improvement in motor function after treatment, including UPDRS-motor (P = 0.04), less affected side of FRT (P = 0.019), and TUG (P = 0.006). Conclusions: Although the effect of WBV was not superior to the conventional therapy, it provided a passive and safe clinical intervention as an alternative treatment, especially for individuals with motor impairment or poor balance function.
... The interviewee expressed that 40Hz would be the frequency with which one could begin basic research. Returning the body to a state of homeostasis (as discussed by Benson, 1978) could perhaps explain the efficacy of VAT for patient groups such as Parkinson's disease (King, Almeida & Ahonen, 2009). ...
... Much research is currently being conducted in Canada into the effects of VAT for various target groups, and results from earlier studies on Parkinson's disease (King, Almeida, & Ahonen, 2009), and fibromyalgia have shown positive results relating to VAT application. It was also suggested that future research should look towards work-related stress, exhaustion, and myalgic en- ...
... Although case studies are valuable sources of information on the individuals or small group's reaction to the treatment, various forms of evidence should be presented. This has begun to change with the emergence of articles discussing the use of sound vibration for Parkinson's Disease, depression, Fibromyalgia Syndrome, blood circulation, bone metabolism, and functional capacity (King, Almeida, & Ahonen, 2009;Koike, Hoshitani, Tabata, Seki, Nishimura, & Kano, 2012;and Zheng et al., 2009) and with this emergence of new evidence, the foundations upon which future research can rest will be much more secure. Although case studies offer an interesting insight into the smallscale effects and individual variation known to emerge after VAT treatment, generalisability is somewhat lacking and in order to increase probability of collaboration possibilities in medical settings, effect sizes should be presented. ...
... Indeed, PD patients show reduced somatosensory gating in the spinal cord and the somatosensory cortex, which is correlated with impairments in motor control and an increase in beta oscillations. Interestingly, peripheral vibration has been extensively studied as a treatment for PD, suggesting a link between the modulation of afferent input and motor initiation (Arias et al., 2009;Chouza et al., 2011;Ebersbach et al., 2008;Haas et al., 2006;Kapur et al., 2012;King et al., 2009); however, the results have been inconsistent due to differences in the vibration protocol used, the muscles targeted, the behaviours being measured and the patient groups studied. Recent work from this lab suggests that high frequency peripheral vibration decreases RTs and movement time in PD patients and healthy controls (under submission). ...
... Indeed, electrophysiological evidence from primates suggests that proprioceptive information is represented within the basal ganglia and that the synchrony of neural activity in this brain region may modulate this gain control (Klockgether et al., 1995). Due to these findings vibration has been employed as a therapeutic intervention for PD, but the results have been inconsistent (Arias et al., 2009;Chouza et al., 2011;Ebersbach et al., 2008;Haas et al., 2006;Kapur et al., 2012;King et al., 2009). A better mechanistic understanding of how peripheral vibration could modulate movement could help refine and extend these studies to improve the clinical potential of peripheral vibration for symptom management in PD. ...
... However, much more work needs to be done to test this hypothesis especially as the exact pathways affected by DBS will depend on the site of stimulation. Modulating somatosensory precision, non-invasively in the periphery, may offer an alternative method for symptom management in PD for those who cannot receive DBS. Indeed, there has been a long history of using vibration to treat PD since Charcot's "Vibrating Chair" (Charcot, 1892), but the results have been mixed (Arias et al., 2009;Chouza et al., 2011;Ebersbach et al., 2008;Haas et al., 2006;Kapur et al., 2012;King et al., 2009). This is likely due to differences in the vibration protocols used, the muscles targeted, the behaviors being measured and the patient groups studied. ...
Conference Paper
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Prior to and during movement afferent input to the cortex is reduced (Cohen and Starr, 1987; Hughes et al., 2013; Hughes and Waszak, 2011; Starr and Cohen, 1985). This robust phenomenon of sensory attenuation has been proposed to distinguish between biologically salient external sensations and our highly predictable self-generated sensory input. However, a recent theoretical framework, active inference, posits that this sensory gating may actually represent a necessary mechanism for movement initiation. Brown et al (2013) hypothesise that sensory attenuation “is a necessary consequence of reducing the precision of sensory evidence during movement to allow the expression of proprioceptive predictions that incite movement” (Brown et al., 2013; K. Friston et al., 2011; Friston et al., 2010). This theory predicts that estimates of the gain, or precision (inverse uncertainty), surrounding the ascending afferent input to sensorimotor cortex must be reduced in order to allow movements to be initiated (Brown et al., 2013). The mechanism underlying this theory comes from applying the ideas of predictive coding and Bayesian inference, that have been readily used to describe perception in multiple sensory modalities, to the sensorimotor system. However, this theory is grounded in computational and theoretical work, which is lacking empirical evidence. In this PhD, I conducted a series of experiments using behavioural tasks and electroencephalography (EEG) in humans to test specific predictions from this overarching hypothesis. More specifically, I aimed to better characterise somatosensory attenuation, determine the neurophysiological correlate of sensory precision in the cortex and determine the consequences of modulating sensory precision on behaviour and cortical oscillatory activity. As well as offering new insights into how we control movements, this PhD offers novel avenues for understanding movement disorders, in particular Parkinson’s disease (PD), and generates a number of testable hypotheses for future clinical work.
... Research has shown whole-body vibration therapy to provide relief for Parkinson's symptoms such as low blood pressure, nausea, confusion, and further dyskinesia by influencing the abnormal neural rhythms associated with the disease (Ebersbach et al., 2008;Haas et al., 2006;King & Almeida, 2009;Turbanski et al., 2005). this has also been attributed to the established gate-control theory of pain. ...
... Results of a crossover study design conducted by King and Almeida (2009) showed significant improvements in both qualitative and quantitative assessments of tremors, bradykinesia, rigidity, and step length in gait. Similar improvements have also been found in balance problems resulting from PD (Ebersbach et al., 2008). ...
... Further investigation has also found improvements in postural stability but has noted that improved postural stability as a result of whole body vibration is not a good indicator of frequency of falls in PD patients (Turbanski et al., 2005). Overall, whole body vibration has been shown to improve PD symptoms assessed via the Unified Disease Parkinson's Rating Scale (UDPRS) (Ebersbach et al., 2008;Haas et al., 2006;King & Almeida, 2009;Turbanski et al., 2005). ...
Article
Full-text available
Introduction: Whole body vibration therapy (WBV) is an emerging treatment modality that is currently being applied to many age-related chronic conditions including balance and gait deficiencies, fibromyalgia, multiple sclerosis, cystic fibrosis, Parkinson's disease, and peripheral neuropathy. However, while many preliminary studies have demonstrated intriguing results for WBV as a therapy for several chronic conditions, WBV remains an enigma in the medical community, partially due to a lack of any comprehensive reviews of the literature. The purpose of this study is to provide a concise review of the theoretical basis for whole body vibration as well as its experimental clinical applications. Methods: 38 studies were included, which examined the application of WBV for six known conditions. Since few trials have been conducted, specific inclusion criteria based on study methodology were deemed to be inappropriate for this review. Results: This review shows conclusive results supporting the use of WBV therapy for improving balance and gait deficiencies as well as reducing pain symptoms associated with fibromyalgia, Parkinson's disease, and peripheral neuropathy. Inconclusive results were found for the effects of WBV therapy on cystic fibrosis and multiple sclerosis. Conclusions: WBV therapy appears to be an effective non-pharmaceutical treatment alternative for improving balance and gait deficiencies as well as symptoms associated with fibromyalgia, Parkinson's disease, and peripheral neuropathy. It may also be a good complimentary aspect of physical therapy protocols for some of these conditions. However, the effectiveness of WBV for treatment of cystic fibrosis and multiple sclerosis remains unknown.
... The system consists of a reclining chair equipped with several speakers and a computer that produces sound vibrations. When sitting in the chair, the legs, lower back, and upper back of the subject come into contact with the surface of the chair, exposing a large part of the body to vibrations of sinusoidal sound waves of varying frequencies (27-113 Hz) (King et al., 2009;Zheng et al., 2009). ...
... However, as neither of these studies had a control group, it cannot be ruled out that the observed improvements in muscular performance were due to practice and maturation effects. (Haas et al., 2006a;Haas et al., 2006b;King et al., 2009;Turbanski et al., 2005), one documented the effect of multiple sessions of WBV (Ebersbach et al., 2008) and the other reported the effects of single and multiple sessions of WBV (Arias et al., 2009 The improvements were observed in tremor, rigidity, bradykinesia, gait and posture, but not in cranial symptoms (Haas et al., 2006a). King et al. (2009) reported similar findings of improvements in rigidity and tremor using a physioacoustic system. ...
... (Haas et al., 2006a;Haas et al., 2006b;King et al., 2009;Turbanski et al., 2005), one documented the effect of multiple sessions of WBV (Ebersbach et al., 2008) and the other reported the effects of single and multiple sessions of WBV (Arias et al., 2009 The improvements were observed in tremor, rigidity, bradykinesia, gait and posture, but not in cranial symptoms (Haas et al., 2006a). King et al. (2009) reported similar findings of improvements in rigidity and tremor using a physioacoustic system. In a non-randomized controlled study, Turbanski et al. (2005) showed that WBV also had a positive effect on postural sway in tandem standing (i.e., one foot in front of the other), Chapter 1 81 but no effect in narrow based standing (i.e., feet placed together side-by-side). ...
... Within the brain, vibration hypothetically enhances flow of cerebrospinal fluid and speeds removal of metabolic waste [39]. Most research with VAT has not explored neural oscillatory effects but recent studies show [40][41][42][43][44] potential brain effects, especially through prolonged application of a single frequency (e.g., 40 Hz). ...
... They differentiate the motor circuit pathways more precisely in the basal ganglia and suggest their work may inspire innovative ways to improve the therapeutic efficacy of neuromodulation in PD. Several studies have used sound vibration as a neuromodulatory stimulant with PD patients [44,147]. One study applied 30 Hz and the other 40 Hz. ...
Article
Full-text available
This paper presents a narrative review of research literature to “map the landscape” of the mechanisms of the effect of sound vibration on humans including the physiological, neurological, and biochemical. It begins by narrowing music to sound and sound to vibration. The focus is on low frequency sound (up to 250 Hz) including infrasound (1–16 Hz). Types of application are described and include whole body vibration, vibroacoustics, and focal applications of vibration. Literature on mechanisms of response to vibration is categorized into hemodynamic, neurological, and musculoskeletal. Basic mechanisms of hemodynamic effects including stimulation of endothelial cells and vibropercussion; of neurological effects including protein kinases activation, nerve stimulation with a specific look at vibratory analgesia, and oscillatory coherence; of musculoskeletal effects including muscle stretch reflex, bone cell progenitor fate, vibration effects on bone ossification and resorption, and anabolic effects on spine and intervertebral discs. In every category research on clinical applications are described. The conclusion points to the complexity of the field of vibrational medicine and calls for specific comparative research on type of vibration delivery, amount of body or surface being stimulated, effect of specific frequencies and intensities to specific mechanisms, and to greater interdisciplinary cooperation and focus.
... Another possibility is that many exclusion criteria, such as severe cardiovascular diseases or joint replacement, would severely restrict the circle of potential users, since they are only allowed to train at a maximum frequency of 12 Hz. One assumption is the fact that King et al. [15] ...
... Changing medication, beginning additional therapies, or exercising at home during longterm studies [44] could also have contributed to the inconsistent results. Some studies investigated whole-body vibrations in the ON medication status [15,20,37,44], others in the OFF medication status [12,16], and only 1 study tested participants in both an ON and OFF medication status [35]. Haas et al. [12] described that L-Dopa medication causes dyskinesia Accepted Article greater periods of time, differences between short-term and long-term interventions need to be examined. ...
Article
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Background Because of discrepant published results, there is a need to systematically analyze the literature that has evaluated the effectiveness of harmonic (WBV) and randomized whole‐body vibration (rWBV) in patients with PD. Objective To evaluate the effectiveness of WBV/rWBV on motor symptoms, balance, gait and mobility in people with Parkinson's disease. Type meta‐analysis Literature Survey Established databases PubMed, EMBASE, CINAHL, Cochrane, Trip and PEDro, library of the Saarland University (SULB) and electronic library of journals (EZB) were scanned by using "Parkinson" and "vibration" as combined search terms, including publications from 1960 to November 2017. Methodology First, data were extracted from the full‐text version, including number of participants, severity of disease, medication status, study design, use of vibration treatment, duration of study, number of treatment sessions and trials per session, vibration frequency and amplitude, duration of trials and rest periods and pre‐ and post‐test data. Qualitative analysis was performed by using the PEDro score. Standardized mean differences (SMD) with 95% confidence intervals (CI) were used to verify the efficacy of WBV and rWBV on mobility, balance, gait and motor symptoms. Synthesis From 244 publications found in online databases, 17 eligible studies fulfilled eligibility criteria and were further analyzed qualitatively. Out of those, 7 studies attained moderate to high quality (mean PEDro score 4.6 points, standard deviation 2.9) and were then further analyzed quantitatively. A large variation, between no effects (SMD = .06, 95% CI = ‐.78 to .90) and weak effects (SMD = .46, 95% CI = ‐.51 to 1.43), was found for motor symptoms, balance, gait and mobility. Conclusions There is no clear evidence of a PD symptom‐reducing effect (motor symptoms, balance, gait and mobility) of whole‐body vibration compared with respective control conditions. Only a few studies found significant group differences for mobility and motor symptoms. Therefore, the overall effects of vibration therapy on PD remain somewhat inconsistent. Further high‐quality studies should determine the efficacy of WBV/rWBV. Level of evidence II This article is protected by copyright. All rights reserved.
... However, previous studies investigating novel tremor suppression strategies found a significant reduction with a sample size of 15 to 20 subjects 27,28,[30][31][32]37 . Two studies have investigated vibration therapy in Parkinson's disease 38,39 (PD), the second most prevalent cause of tremor 40 . Both studies were based on whole body vibration and reported a reduction in tremor amplitude of 25% and ~50%, respectively. ...
... However, the differences in protocol could account for this discrepancy. In this way, whole-body vibration stimulation approaches 38,39 hampers the interpretation of the results due to the complex mechanical interactions between body parts. We overcame this challenge, by only targeting arm tremor and using a support to standardize the task and minimize inter-individual variability. ...
Article
Full-text available
Essential tremor (ET) is a major cause of disability and is not effectively managed in half of the patients. We investigated whether mechanical vibration could reduce tremor in ET by selectively recruiting afferent pathways. We used piezoelectric actuators to deliver vibratory stimuli to the hand and forearm during long trials (4 min), while we monitored the tremor using inertial sensors. We analyzed the effect of four stimulation strategies, including different constant and variable vibration frequencies, in 18 ET patients. Although there was not a clear homogeneous response to vibration across patients and strategies, in most cases (50–72%) mechanical vibration was associated with an increase in the amplitude of their tremor. In contrast, the tremor was reduced in 5–22% of the patients, depending on the strategy. However, these results are hard to interpret given the intrinsic variability of the tremor: during equally long trials without vibration, the tremor changed significantly in 67% of the patients (increased in 45%; decreased in 22%). We conclude that mechanical vibration of the limb does not have a systematic effect on tremor in ET. Moreover, the observed intrinsic variability of the tremor should be taken into account when designing future experiments to assess tremor in ET and how it responds to any intervention.
... Evidence for vibration as an approach to treat symptoms of PD, as an adjunct to anti-Parkinsonian medications or deep brain stimulation (DBS), has been suggested as a novel approach to treat neural oscillations associated with PD [3][4][5]. Neural synchrony is critically dependant on dopamine levels of the basal ganglia, thalamus, and sensorimotor cortices [6][7][8]. Levy and colleagues have demonstrated that the over-activity of the subthalamic nucleas of the basal ganglia may cause it to be abnormally held at a 15-30 Hz oscillatory rhythm [9]. ...
... Therefore the effects of vibration on brain oscillation and dopamine may explain the clinical observations in studies demonstrating the improvement of PD symptoms after several forms of vibrations, including locally applied vibrations [21], whole-body vibrations [3], and physioacoustic low frequency vibrations [22][23][24]. Furthermore, a more recent study showed a short-term improvement in the Unified Parkinson's Disease Rating Scale (UPDRS) motor scores and in gait assessments in PD patients undergoing brief physioacoustic therapy [4]. ...
Article
Full-text available
Recent studies have suggested that vibration therapy may have a positive influence in treating motor symptoms of Parkinson’s disease (PD). However, quantitative evidence of the benefits of vibration utilized inconsistent methods of vibration delivery, and to date there has been no studies showing the long term benefit of higher frequency (40Hz) vibration in the PD population. The objective of this study was to demonstrate the efficacy of vibration administered via a physioacoustic therapy method (PAT) on motor symptoms of PD over a longer term, completed as a randomized placebo-controlled trial. Overall motor symptom severity measured by the Unified Parkinson’s Disease Rating Scale III showed significant improvements in the treatment group over 12 weeks. Specifically, all aspects of PD including tremor, rigidity, bradykinesia, and posture and gait measures improved. To our knowledge, this is the first study to quantitatively assess higher frequency 40-Hz vibration applied using the PAT method for potential long-term therapeutic effects on motor symptoms of PD. Keywords: Parkinson’s Disease; Physioacoustic Therapy; Vibration
... 5 Other studies using a technique called Vibroacoustic Therapy (VAT) have shown that vibration at specific frequencies improves certain symptoms. [6][7][8] We must also highlight the work of music therapy at the Neurological Rehabilitation Center for Biomedical Research in Music (CBRM), led by Michael Thaut, which is paving the way for the therapeutic use of sound. 9 Sound is characterized by many different parameters, such as the frequency, duration, and intensity. ...
... A combination of both properties for the experimental stimulation was therefore determined. About 14 Hz was selected as the binaural stimulation because our main target was to decrease the EEG power in the theta band (4)(5)(6)(7)(8). For this reason, we could not use this frequency (it could increase); thus, we acoustically stimulated in a different frequency, specifically at 14 Hz, which falls within the low beta band. ...
Article
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We applied rhythmic binaural sound to Parkinson's Disease (PD) patients to investigate its influence on several symptoms of this disease and on Electrophysiology (Electrocardiography and Electroencephalography (EEG)). We conducted a double-blind, randomized controlled study in which rhythmic binaural beats and control were administered over two randomized and counterbalanced sessions (within-subjects repeated-measures design). Patients ([Formula: see text], age [Formula: see text], stage I-III Hoehn & Yahr scale) participated in two sessions of sound stimulation for 10[Formula: see text]min separated by a minimum of 7 days. Data were collected immediately before and after both stimulations with the following results: (1) a decrease in theta activity, (2) a general decrease in Functional Connectivity (FC), and (3) an improvement in working memory performance. However, no significant changes were identified in the gait performance, heart rate or anxiety level of the patients. With regard to the control stimulation, we did not identify significant changes in the variables analyzed. The use of binaural-rhythm stimulation for PD, as designed in this study, seems to be an effective, portable, inexpensive and noninvasive method to modulate brain activity. This influence on brain activity did not induce changes in anxiety or gait parameters; however, it resulted in a normalization of EEG power (altered in PD), normalization of brain FC (also altered in PD) and working memory improvement (a normalizing effect). In summary, we consider that sound, particularly binaural-rhythmic sound, may be a co-assistant tool in the treatment of PD, however more research is needed to consider the use of this type of stimulation as an effective therapy.
... The researcher acknowledged that the music-only treatment also resulted in a vibration effect since it was played through the bed speakers. King et al. [78] studied 40 PD patients (20 slow/rigid, 20 tremor dominant) not withdrawn from their medication. All participants received RSS stimulation at 30 Hz in five series lasting one minute each separated by one-minute rest periods. ...
... Low frequency sound stimulation through vibrotactile devices is limited to above 27 Hz because transducers are less efficient at lower rate. Two previous RSS studies with PD used 30 Hz [78] and 40 Hz [77]. Assuming neural resonance response up to four multiples, the stimulus frequency [58] for optimal sound stimulation of PD could be 40 Hz, eliciting responses at 40, 80, 120, and 160 Hz, or 80 Hz with responses at 80, 160, 240, and 320 Hz. ...
Article
This paper addresses the importance of steady state brain oscillation for brain connectivity and cognition. Given that a healthy brain maintains particular levels of oscillatory activity, it argues that disturbances or dysrhythmias of this oscillatory activity can be implicated in common health conditions including Alzheimer’s disease, Parkinson’s Disease, pain, and depression. Literature is reviewed that shows that electric stimulation of the brain can contribute to regulation of neural oscillatory activity and the alleviation of related health conditions. It is then argued that specific frequencies of sound in their vibratory nature can serve as a means to brain stimulation through auditory and vibrotactile means and as such can contribute to regulation of oscillatory activity. The frequencies employed and found effective in electric stimulation are reviewed with the intent of guiding the selection of sound frequencies for vibroacoustic stimulation in the treatment of AD, PD, Pain, and depression.
... Interestingly, whole body vibration has been considered as a possible treatment for Parkinson's disease patients (albeit at much lower intensity and frequency than occupational exposures). A study by King et al. reported short term motor impairment improvements in participants exposed therapeutically to whole body vibration (136), although a placebo controlled trial by Arias et al. found no effect (137). ...
... It may be relevant that very low intensity and frequency whole body vibration exposure has been examined as a treatment for Parkinson's disease, with the hypothesized effect of improvements in proprioception and ease of movement (e.g. (136,192)). However, a trial that included a placebo found no benefit (137). ...
... The summary of eligible studies was reported in 35-minute karate exercise and 10-minute cooldown exercise for 6 to 12 weeks) and reported that even in a sitting position, exercise could reduce the resting tremor of individuals with PD [28]. In the study performed by King et al. [29], vibroacoustic therapy was used in 5 one-minute sessions. Improvements were observed in the motor control symptoms following the intervention. ...
... p < 0.01). Studies included in this meta-analysis used different types of exercises including whole-body exercise (Tango dancing [30]), lower body activity via cycling [15,20], exercises focused on hand movements [28,31,32] and whole-body activity induced by acoustic vibration [29]. In order to investigate the source of between-study heterogeneity, only studies in which exercises were done based on hand movements were included into the subgroup analysis. ...
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Background: Prior studies suggest that exercise may prevent movement disorders in Parkinson's disease (PD) patients. In this meta-analysis, the pooled effect of exercise on PD-induced tremor was investigated. Method: Relevant published studies (n = 7) were retrieved by searching major databases, including Scopus, Web of Science and PubMed from 1985 to November 2020. Studies were eligible if the effect of exercise on PD-induced tremor was studied and sufficient information for calculating the effect size was reported. Furthermore, non-English manuscripts and studies related to non-human species were excluded. The quality of studies was evaluated using the improved Newcastle-Ottawa scale (NOS). In this study, variables such as participant’s age and gender, type of exercise, intervention duration and tremor indices were extracted for each study. Between-study heterogeneity and publication bias were calculated using I-statistic and funnel plot, respectively. esults: Results showed that hand movement and cycling exercises were effective for reducing tremor amplitude or frequency. When all types of exercises (upper, lower or whole-body movement) were considered, an odds ratio (OR) greater than 1 was obtained (log(OR) = 2, 95% CI: 0.88–3.12), while between-study heterogeneity was high (I = 78%). By restricting the studies to hand-movement exercises, a lower odds ratio (log(OR) = 1, 95% CI: 0.24–1.77) with small between-study heterogeneity (I = 0.0%, p = 0.502) was obtained. Statistical analysis based on Egger’s and Begg’s tests revealed no significant publication bias. Conclusions: Outcomes of this study suggested that exercises as inexpensive, noninvasive and easy-to-implement strategies could be applied for PD patients alongside medical interventions for reducing tremors.
... The review study by Lam et al conducted to investigate the effect of whole body vibration on balance, mobility and falls in older adults concluded that vibration may be effective in improving relatively basic balance ability and mobility among older adults, particularly frailer ones (16). Also, the study by King et al carried out to assess the efficacy of vibration in motor performance of patients with Parkinson disease indicated an improvement in all symptoms, motor control at the time of assessment, and specifically, significant justifiable decrease in rigidity and tremor, and significant increase in gait speed (17). Moreover, in the study by Park et al conducted to survey the effect of whole body vibration on chronic knee osteoarthritis concluded that vibration reduced pain intensity and increased strength of the right quadriceps and dynamic balance performance, and vibration was superior only in pain reduction and similarly effective in strengthening of the quadriceps muscle and balance improvement (18). ...
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Introduction: The restless legs syndrome (RLS) is a neurological disorder in patients undergoing hemodialysis. This syndrome causes individual’s disturbed rest, discomfort, and stress, and secondarily to weakened functioning and disturbance in occupational activities and familial life. Objectives: The present study aimed at investigate the effect of vibration on the severity of the manifestation of symptoms of RLS in hemodialysis patients. Patients and Methods: This is an interventional before-after study conducted on 80 patients with RLS in hemodialysis wards of Yazd hospitals. The samples were selected randomly and intervention was performed on the patients as vibration for 10 minutes three times per week during 4 succeeding weeks. The questionnaire of severity of RLS was completed before the study and at the last day of intervention before and after vibration. The data were analyzed with SPSS 23 using descriptive statistics and paired t test (P<0.05). Results: Our findings showed that most patients were at the moderate level of severity of symptoms before (68.8%) and after (78.8%) intervention and there was a significant difference in the mean score of RLS between before (18.99) and after (12.82) intervention (P=0.001). Conclusion: Based on the results of this study, it can be concluded that vibration decreases the severity of symptoms of RLS in hemodialysis patients. Hence, it is recommended that vibration be used as a cost-effective and safe procedure to improve the symptoms of RLS in this group of patients.
... Research using vibroacoustic therapy products showed positive results as a means of health prevention and for improvement of well-being. Studies show positive results with improving sleep [15], relaxing people physically and emotionally [14], decreasing stress and anxiety [16], decreasing rigidity and tremors for people with Parkinson's disease [17] and/or helping individuals in managing pain [18] (to name a few). ...
Article
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We designed a vibrotactile vest with physiological monitoring that interacts with a vibroacoustic urban environment, The Humming Wall. We structured vibrotactile patterns and built a vibrotactile language to convey information and to interact towards and from the vibroacoustic environment in order to elicit sensations and encourage particular body movements. The patterns were structured to emulate calming and activating sensations and to guide or warn the vest wearer. In addition, actions such as swiping or knocking on the wall were replicated on the vest for the vest wearer, and participants could ‘feel’ (vibroacoustically) and hear their own heartbeats and breath rates at the wall. A field trial with 39 participants was conducted over a 5-week period in an urban park. Participants wearing the vest completed a set of defined tasks. We logged use and responses, videoed all activities and conducted interviews and questionnaires post-experiment. The results depicted the participants’ experience, engagement and impressions while wearing the vibrotactile vest and interacting with the wall. The findings show convincing, strong and positive responses to novel interactions between the responsive vibroacoustic environment and the vibrotactile vest. We found compelling evidence to support further exploration into vibrotactile and vibroacoustic solutions for improving health and well-being. The work presented demonstrates the capacity for health and well-being solutions with multiple use cases. Additionally, this work constitutes the first field trial with a vibrotactile wearable responding to and driving vibroacoustic displays with an interactive vibroacoustic environment.
... Research using vibroacoustic therapy products showed positive results for prevention of ill health and for improvement in well-being. Studies show positive results with improving sleep [23], relaxing people physically and emotionally [1], decreasing stress and anxiety [42], decreasing rigidity and tremors for people with Parkinson's disease [22] and/or helping individuals in managing pain [39] (to name a few). ...
Article
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We designed a vibrotactile vest and The Humming Wall, a vibroacoustic interactive furniture set in an urban environment to interact with each other. We developed the vibrotactile patterns in the vest as a form of vibrotactile language to convey information to the wearer. In addition, we designed a set of interactive movements on The Humming Wall that would trigger patterns on the vest and elicit sensations and encourage body movements onto the wearer’s body. We invited people to interact in pairs at The Humming Wall, with one at the wall and one wearing the vest (they later swapped roles). Actions by the one at the wall, such as swiping or knocking on the wall were repeated on the vest wearer’s body. In addition, participants could ‘feel’ (vibroacoustically) and hear their own heartbeats and breath rates at the wall. We conducted a field trial with 39 participants over a 5-week period. Participants wearing the vest (and their pair) completed a set of tasks. We logged use and responses, recorded all activities on video and conducted post-experiment interviews and questionnaires. The results depicted the participants’ experience, communication and connection while wearing the vibrotactile vest and interacting with the wall. The findings show convincing, strong and positive responses to novel interactions between the responsive vibroacoustic environment and the vibrotactile vest. This work constitutes the first field trial with people ‘working’ in pairs with a vibrotactile wearable responding to and driving vibroacoustic displays with an interactive vibroacoustic environment.
... Obviously, what most resemble the Fauteuil Trépidant today are the whole-body vibration devices that are marketed for exercise use, and which either delivers rhythmic or stochastic vibrations. Small pilot studies indicate improved muscle strength and dynamic balance following repeated whole-body vibration [6,7], but there is not sufficient evidence to claim that it is effective in Parkinson's disease [8,9]. ...
... The use of peripheral vibration to treat symptoms of movement disorders is not a novel concept and was first realized with Charcot's "Vibrating Chair" in 1892 (Charcot, 1892). Following this there have been a number of studies investigating the clinical efficacy of peripheral vibration, particularly of the whole body (Haas et al., 2006;Ebersbach et al., 2008;Arias et al., 2009;King et al., 2009;Chouza et al., 2011;Kapur et al., 2012); however, the results have been inconsistent due to differences in the vibration protocol used, the muscles targeted, the behaviors being measured and the patient groups studied. In particular, there have been limited studies that have shown an improvement in behavioral performance in healthy controls following vibration, which is likely due to healthy controls performing at ceiling on the behavioral tasks used. ...
Article
A recent theoretical account of motor control proposes that modulation of afferent information plays a role in affecting how readily we can move. Increasing the estimate of uncertainty surrounding the afferent input is a necessary step in being able to move. It has been proposed that an inability to modulate the gain of this sensory information underlies the cardinal symptoms of Parkinson's disease (PD). We aimed to test this theory by modulating the uncertainty of the proprioceptive signal using high frequency peripheral vibration, to determine the subsequent effect on motor performance.We investigated if this peripheral stimulus might modulate oscillatory activity over the sensorimotor cortex in order to understand the mechanism by which peripheral vibration can change motor performance.We found that 80Hz peripheral vibration applied to the right wrist of a total of 54healthy human participants reproducibly improved performance across 4 separate randomized experiments on a number of motor control tasks (nine hole‐peg task, box and block test, reaction time task and finger tapping).Improved performance on all motor tasks (except the amplitude of finger tapping) was also seen for a sample of 18PD patients ON medication.EEG data investigating the effect of vibration on oscillatory activity revealed a significant decrease in beta power(15‐30Hz) over the contralateral sensorimotor cortex at the onset and offset of 80Hz vibration.This finding is consistent with a novel theoretical account of motor initiation, namely that modulating uncertainty of the proprioceptive afferent signal improves motor performance potentially by gating the incoming sensory signal and allowing for top‐down proprioceptive predictions. This article is protected by copyright. All rights reserved.
... Two studies have investigated vibration therapy in Parkinson's disease 35,36 (PD), the second most prevalent cause of tremor 37 .Both studies were based on whole body vibration and reported a reduction in tremor amplitude of 25 % and ~50%, respectively. The apparent discrepancy between these results and ours could be interpreted as there being a difference in the response to mechanical vibration between tremor in ET and PD. ...
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Essential tremor (ET) is a major cause of disability and is not effectively managed in half of the patients. We investigated whether mechanical vibration could reduce tremor in ET by selectively recruiting afferent pathways. We used piezoelectric actuators to deliver vibratory stimuli to the hand and forearm during long trials (4 min), while we monitored the tremor using inertial sensors. We analyzed the effect of four stimulation strategies, including different constant and variable vibration frequencies, in 18 ET patients. Although there was not a clear homogeneous response to vibration across patients and strategies, in most cases (50-72%) mechanical vibration was associated with an increase in the amplitude of their tremor. In contrast, the tremor was reduced in 5-22% of the patients, depending on the strategy. However, these results are hard to interpret given the intrinsic variability of the tremor: during equally long trials without vibration, the tremor changed significantly in 67% of the patients (increased in 45%; decreased in 22%). We conclude that mechanical vibration of the limb does not have a systematic effect on tremor in ET. Moreover, the observed intrinsic variability of the tremor should be taken into account when designing future experiments to assess tremor in ET and how it responds to any intervention.
... reduction in pain, including fibromyalgia [6][7][8], decrease in muscle tension and spasms [9][10][11], and a reduction in the parameters of blood pressure, pulse rate and muscle oscillation [12]. Experiments with the method have produced an improvement in motor function in the treatment of patients with Parkinson's disease [13]. VA treatment has also been shown to have the potential to help maintain cognition and functional ability in patients with Alzheimer's disease [14]. ...
... The inverse association with low levels of occupational WBV exposure could be due to a causally protective effect against PD. Very-low-intensity and -frequency WBV has been examined as a possible treatment for PD, with the hypothesized effect of improvements in proprioception and ease of movement (19,20), although a trial that included a placebo found no benefit (21). Furthermore, even clear treatment benefits might not indicate a protective effect for premorbid exposure. ...
... reduction in pain [9][10][11][12], decrease in muscle tension and spasms [13,1,4,[14][15][16], reduction in the parameters of blood pressure, pulse rate and muscle oscillation [17]. In the treatment of Parkinson's disease, experiments with the method have produced an improvement in motor function [18,19]. According to the practice-based evidence of VA treatment VA treatment, positive changes in indicators of the perceived health condition and emotional state [20] and an improvement of physical self-awareness [21,22] can be expected. ...
Article
Vibroacoustic (VA) treatment was applied to patients with chronic spinal cord and brain injuries during rehabilitation. The study aimed to ascertain the suitability of short-term VA treatment for supporting a decrease in spasticity and pain and an improvement in health condition in the rehabilitation programme for patients with spinal cord and brain injuries. Hypotheses: 1) indicators of self-perceived spasticity and pain measured after VA treatment are lower than measurement results before treatment; 2) VA treatment can be used in rehabilitation programmes to support the improvement of self-perceived health condition. 53 patients aged 20-72 participated in the study. VA treatment of 40 Hz was conducted once a day for 23 minutes over four or five days. Self-report numerical rating scales were used to measure patients’ condition before and after VA treatment sessions. Research findings revealed significant change in the levels of spasticity, pain, physical discomfort, general health condition, fatigue and anxiety after VA treatment sessions compared to the measurements before the sessions. Reduction in spasticity and physical discomfort was not statistically significantly different after four- or five-day treatment, a decrease in pain and an improvement in perceived health condition were significantly higher after five days than after four days treatment.
... WBV has also been studied as an intervention for improved motor performance in the PD population [23][24][25][26][27]. Although the methods of applying WBV among these studies are variable, shortterm improvements in balance and motor function were documented after WBV. ...
... However, an improvement of gait was reported in these patients following the application of vibration to lower limb muscles (Novak and Novak, 2006; De Nunzio et al., 2010) and changes were attributed to the enhancement of proprioceptive feedback. On the other hand, King et al. (2009) investigated the effect of " whole-body " vibration (sound waves) in PD showing significant improvements in outcome measure including rigidity, tremor, and motor function (improved speed on the grooved pegboard task). Furthermore, alternative rehabilitative strategies aimed to modulate sensory processing and proprioceptive feedback by means of sensory retraining or retuning and learning-based sensorimotor re-education. ...
Article
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Movement disorders (MDs) are frequently associated with sensory abnormalities. In particular, proprioceptive deficits have been largely documented in both hypokinetic (Parkinson's disease) and hyperkinetic conditions (dystonia), suggesting a possible role in their pathophysiology. Proprioceptive feedback is a fundamental component of sensorimotor integration allowing effective planning and execution of voluntary movements. Rehabilitation has become an essential element in the management of patients with MDs, and there is a strong rationale to include proprioceptive training in rehabilitation protocols focused on mobility problems of the upper limbs. Proprioceptive training is aimed at improving the integration of proprioceptive signals using "task-intrinsic" or "augmented feedback." This perspective article reviews the available evidence on the effects of proprioceptive stimulation in improving upper limb mobility in patients with MDs and highlights the emerging innovative approaches targeted to maximizing the benefits of exercise by means of enhanced proprioception.
... King et al. 25 comprovaram que a TV exerce função sobre as alterações funcionais na DP, pois após uma única sessão de tratamento notou-se melhora na atividade funcional, redução da bradicinesia e da rigidez e consequentemente um ganho na velocidade do passo durante a marcha. A limitação funcional na DP pode interferir na geração da potência do músculo, reduzindo a realização das AVD, ou seja, após a realização da TV haverá um relaxamento da região muscular, contribuindo para execução das tarefas diárias 26 . ...
... Gamma rhythmicity can also be altered in many neurodegenerative disorders, where decreased gamma amplitudes at 40 Hz can be present in AD patients, and stimulation of interneurons with this exact frequency resulted in decreased levels of Aβ as well as increased microglial recruitment required to clear Aβ accumulation; striking reductions in Aβ levels were also observed in the visual cortex of pre-deposited Aβ mice (Iaccarino et al., 2016). Rhythmic Sensory Stimulus (RSS) in the form of pulsed vibrotactile whole body sound wave therapy at 30 Hz was shown to improve motor function in patients with PD specifically through step length, velocity, and decreases in tremor and rigidity (King et al., 2009). After exposing neural cells and nerve growth factor (NGF) to frequencies of 10-200 Hz, 40 Hz was found to be the most effective frequency resulting in observable neurite outgrowth three times the other frequencies in the range of 10-100 Hz (Koike et al., 2004). ...
Article
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Music therapy (MT) and other rhythmic-based interventions for the treatment of neurodegeneration (ND) have been successful in improving the quality of life of affected individuals. Music therapy and rhythm-based stimuli affect patients with Alzheimer’s disease (AD) and Parkinson’s disease (PD) respectively not only through cognitive channels and subjective qualifications but also through altered brain structures and neural systems. Often implicated in the pathogenesis and resulting symptoms of these diseases is the role of aberrant circadian rhythmicity (CR), namely disrupted sleep. Recent literature suggests that proper maintenance of this timekeeping framework may be beneficial for patients with neurodegenerative disorders and serve a neuroprotective role. While music therapy can improve the quality of life for neurodegenerative patients, longitudinal studies analyzing sleep patterns of affected individuals and possible mechanisms of intervention remain sparse. Furthermore, the role of music therapy in the context of circadian rhythmicity has not been adequately explored. By analyzing the links between circadian rhythmicity, neurodegeneration, and music therapy, a more comprehensive picture emerges, suggesting that possible uses of non-pharmacological circadian-based music therapy to target mechanisms involved in the pathogenesis of Alzheimer’s disease and Parkinson’s disease may enhance clinical treatment and potentially indicate neuroprotection as a preventative measure.
... Tactile cueing using shoulder taps does not provide sufficient evidence to assess improvement. Recent studies have, however, reported an improved Unified Parkinson's Disease Rating Scale (UPDRS) measures for tremor and rigidity after using whole body vibration [10]. Furthermore, an improved gait pattern along with postural stability has been reportedly achieved through the application of vibratory stimuli to trunk [11] and lumbar [12] regions of PD patients. ...
Article
Freezing of gait (FOG) is an episodic motor symptom that occurs in almost half of the patients having Parkinson’s Disease (PD). Levodopa and other dopaminergic drugs, although quite effective for tremors and bradykinesia (dyskinesia) are not so effective in case of postural instability and freezing of gait. This establishes a need for a non-pharmacological intervention. It has been well established in research that PD patients who experience FOG respond positively to sensory cueing. In this paper, a complete modular system has been developed that has both: (i) biofeedback in the form of vibrational cueing, synchronised with gait (hardware), as well as (ii) real-time monitoring, and graph generation for offline analysis (software). To realise this, a force sensor fitted shoe is constructed to analyse gait and provide vibrations in sync with phases of gait, for rehabilitation therapy. The assembly is monitored on LabVIEW, where (i) a 5-level force heat map and a 3D pressure map qualitatively shows the force experienced by force sensing resistors (FSR), (ii) an indicator for each vibrational motor shows its on/off state, and (iii) a live voltage vs. time graph (separate for each foot) is generated.
... We do not expect such changes in the waitlist group due to the absence of fine motor strengthening. Given the large effect size of 0.8 sd/mean seen in other PD studies using the GPT grooved pegboard test as main outcome (36,37), we anticipate that our sample size of 25 per group will allow us to determine a group difference of 15% decreased time using the dominant hand and to be comparable to published data (38). We will also perform exploratory analyses using regression modeling to assess whether (1) sex, age or disease severity and (2) cortical motor beta power changes are correlated with fine motor tests performance. ...
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Background Presently available medications and surgical treatments for Parkinson’s disease have limited effects on fine motor problems and often leave patients with significant fine motor disability. Standard of care occupational therapy (OT) yields low efficacy, potentially due to a lack of standard protocols. Neurologic Music Therapy (NMT) techniques, especially Rhythmic Auditory Stimulation which relies on interaction between rhythm and movement, have shown to be effective in PD gait rehabilitation possibly through their reliance on neural pathways that are not affected by PD. Therapeutic Instrumental Music Performance (TIMP) is one other NMT technique that holds promise but which mode of action and efficacy has not been investigated in PD yet. Methods One hundred PD participants will be randomly assigned to receive 15 sessions of either TIMP with rhythm or TIMP without rhythm, standard of care OT, or to be waitlisted (control) over 5 consecutive weeks. Brain oscillatory responses will be collected using magnetoencephalography during an auditory-motor task to understand the underlying mechanisms. The Grooved Pegboard, the UPDRS III finger tap and the finger-thumb opposition will be assessed to investigate clinical changes related to fine motor function. This project will also serve to confirm or refute our pilot data findings suggesting NMT relies on compensatory brain networks utilized by the PD brain to bypass the dysfunctional basal ganglia. DiscussionThis study aims to use standardized TIMP and OT research protocols for investigating the neuronal pathways utilized by each intervention and possibly study their efficacy with respect to fine motor rehabilitation via a randomized control trial in the PD population.
... Therefore, auxiliary therapies for resting tremor remain highly desirable. Whole body vibration such as vibrating chairs and platforms has been investigated as a potential means to reduce resting tremor, however, results have been inconsistent (Haas et al., 2006;King et al., 2009;Kapur et al., 2012;Gaßner et al., 2014).Regardless of efficacy, such interventions do not represent a practical solution for many individuals as they are immobile, expensive and not highly customizable. If effective at lessening resting tremor, wearable vibrotactile stimulation devices may represent an attractive solution to PD patients. ...
Article
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Background: Resting tremor is a cardinal symptom of Parkinson’s disease (PD) that contributes to the physical, emotional, and economic burden of the disease. Objective: The goal of this study was to investigate the safety, tolerability, and preliminary effectiveness of a novel wearable vibrotactile stimulation device on resting tremor in individuals with PD. Methods: Using a randomized cross-over design, subjects received two different vibrotactile stimulation paradigms (high amplitude patterned and low amplitude continuous) on two separate laboratory visits. On each visit, resting tremor was video recorded for 10 min at baseline and while the vibrotactile stimulation was applied. Tremor severity was scored by a blinded clinician. Results: Both vibration paradigms were well safe and well tolerated and resulted in a reduction in resting tremor severity with a moderate effect size ( n = 44, p < 0.001, r = 0.37–0.54). There was no significant difference between the two vibration paradigms ( p = 0.14). Conclusion: Short durations of vibrotactile stimulation delivered via wearable devices were safe and well tolerated and may attenuate resting tremor severity in individuals with PD. The sample size as well as the potential preliminary effectiveness revealed by two arms of the study could not eliminate the potential for a placebo effect.
... We reasoned that the haptic channel could represent a suitable and safer alternative for external cueing, based on these two premises: (1) vibratory stimulation is effective in transiently improving cardinal motor signs in PD, including step parameters [9][10][11][12]; (2) it does not require allocation of attention as auditory or visual cues to be effectively processed. Moreover, we reasoned that (3) a bilateral, alternating, rhythmic stimulation at the ankles can be tuned to a given frequency for cueing a personalized comfortable walking cadence, even in healthy subjects; (4) in case of unpredictable FOG, the patient (or the care giver) can even activate on demand the device by an easily accessible remote Bluetooth control (i.e., a smartphone); (5) finally, haptic stimuli applied on lower limbs might directly target the activity of spinal centers for locomotion that are particularly sensitive to proprioceptive and exteroceptive inputs [13,14], meanwhile being hardly responsive (if not very indirectly through polysynaptic circuitries) to auditory and visual cueing. ...
Article
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Background and objectiveIn a proof-of-concept study, we aimed to verify whether the wearable haptic anklets, a device that delivers personalized suprathreshold alternating exteroceptive stimulation at the anklets on demand, may improve the quality of walking, including the freezing of gate (FOG), in idiopathic Parkinson’s disease (PD) patients. The clinical relevance of the presented device as a walking pacemaker to compensate the disturbed locomotion through the generation of a more physiological internal walking rhythm should be verified in a dedicated clinical trial.Methods We tested 15 patients diagnosed as idiopathic PD, during their regular treatment regimen. Patients were evaluated during walking with the device switched on and off, personalized at their most comfortable cadence. Stride velocity, variance, and length, as well as FOG episode duration during walking or turning of 180°, were quantified by an optical high-performance motion capture VICON system.ResultsThe alternating, rhythmic, sensory stimulation significantly improved either walking velocity or reduced inter-stride variance. Effects were more variable on stride length. The significant reduction of FOG episodes’ duration correlated with clinical severity of scales rating gate and balance. No safety problems occurred.Conclusions The WEARHAP-PD device, whose Technology Readiness Level (TRL) is 6, significantly improved some walking abilities (walking velocity and stride variance) and reduced the duration of FOG episodes in idiopathic PD patients. Unlike the traditional auditory and visual explicit cues that require the user’s allocation of attention for correct functioning, the interaction of the patients with the surrounding environment was preserved, due to the likely implicit processing of haptic stimuli.
... Studies that delivered vibrations to a single muscle (Jöbges et al., 2002) the entire body (Haas et al., 2006) or via physioacoustic chair (King et al., 2009) have demonstrated some level of efficacy in reducing tremors in individuals with PD. These studies further suggest that vibrations applied to manipulate local sensory feedback to the muscles, which decrease tremor frequency. ...
Article
Full-text available
Parkinson's disease (PD) is characterized by motor and cognitive deficits that negatively impact on activities of daily living. While dopaminergic medications are used to attenuate motor symptoms, adjuvant therapies such as acoustic-based non-pharmacological interventions are used as a complement to standard drug treatments. At present, preliminary studies of acoustic-based interventions such as rhythmic-auditory stimulation (RAS) and vibroacoustic therapy (VAT) suggest two competing hypotheses: (1) RAS may recruit alternative motor networks that may bypass faulty spatiotemporal motor networks of movement in PD; or (2) the use of RAS enhances BG function through entrainment of beta oscillatory activities. In this mini review article, we discuss the mechanisms underlying the role of acoustic-based interventions and how it may serve to improve motor deficits such as gait impairments and tremors. We further provide suggestions for future work that may use a combination of RAS, VAT, and physical therapy to improve motor function in PD.
... Studies that delivered vibrations to a single muscle (Jöbges et al., 2002) the entire body (Haas et al., 2006) or via physioacoustic chair (King et al., 2009) have demonstrated some level of efficacy in reducing tremors in individuals with PD. These studies further suggest that vibrations applied to manipulate local sensory feedback to the muscles, which decrease tremor frequency. ...
Article
Full-text available
Parkinson’s disease (PD) is characterized by motor and cognitive deficits that negatively impact on activities of daily living. While dopaminergic medications are used to attenuate motor symptoms, adjuvant therapies such as acoustic-based non-pharmacological interventions are used as a complement to standard drug treatments. At present, preliminary studies of acoustic-based interventions such as rhythmic-auditory stimulation (RAS) and vibroacoustic therapy (VAT) suggest two competing hypotheses: (1) RAS may recruit alternative motor networks that may bypass faulty spatiotemporal motor networks of movement in PD; or (2) the use of RAS enhances BG function through entrainment of beta oscillatory activities. In this mini review article, we discuss the mechanisms underlying the role of acoustic-based interventions and how it may serve to improve motor deficits such as gait impairments and tremors. We further provide suggestions for future work that may use a combination of RAS, VAT, and physical therapy to improve motor function in PD.
... We do not expect such changes in the waitlist group due to the absence of fine motor strengthening. Given the large effect size of 0.8 sd/mean seen in other PD studies using the GPT grooved pegboard test as main outcome [35,36], we anticipate that our sample size of 25 per group will allow us to determine a group difference of 15% decreased time using the dominant hand and to be comparable to published data [37]. We will also perform exploratory analyses using regression modeling to assess whether (1) sex, age, or disease severity and (2) cortical motor beta power changes are correlated with fine motor tests performance. ...
Article
Full-text available
Background Presently available medications and surgical treatments for Parkinson’s disease have limited effects on fine motor problems and often leave patients with significant fine motor disability. Standard of care occupational therapy (OT) yields low efficacy, potentially due to a lack of standard protocols. Neurologic music therapy (NMT) techniques, especially rhythmic auditory stimulation which relies on interaction between rhythm and movement, have shown to be effective in PD gait rehabilitation possibly through their reliance on neural pathways that are not affected by PD. Therapeutic instrumental music performance (TIMP) is one other NMT technique that holds promise but which mode of action and efficacy has not been investigated in PD yet. Methods One hundred PD participants will be randomly assigned to receive 15 sessions of either TIMP with rhythm or TIMP without rhythm, standard of care OT, or to be waitlisted (control) over 5 consecutive weeks. Brain oscillatory responses will be collected using magnetoencephalography during an auditory-motor task to understand the underlying mechanisms. The Grooved Pegboard, the UPDRS III finger tap, and the finger-thumb opposition will be assessed to investigate clinical changes related to fine motor function. This project will also serve to confirm or refute our pilot data findings suggesting NMT relies on compensatory brain networks utilized by the PD brain to bypass the dysfunctional basal ganglia. Discussion This study aims to use standardized TIMP and OT research protocols for investigating the neuronal pathways utilized by each intervention and possibly study their efficacy with respect to fine motor rehabilitation via a randomized control trial in the PD population. Trial registration ClinicalTrials.gov NCT03049033 . Registered on September 29, 2020
... 54 Similarly, one can explore a vibratory stimulation as an alternative treatment strategy for the rest tremor reduction. Preliminary results of vibration therapy are reported, 47,58 but further in-depth study is needed to understand this better. This appears to be a promising direction to explore. ...
Article
Rest tremor is one of the most common and disabling symptoms of Parkinson’s disease (PD). The exact neural origin of rest tremor is still not clearly understood. Understanding the origin of rest tremor is important as it may aid in optimizing existing treatment strategies such as Deep Brain Stimulation or in developing new treatment strategies for rest tremor reduction. There are broadly two theories that are gaining prominence for rest tremor generation in PD. The first theory is the central oscillator theory that states that the rest tremor is triggered by an oscillatory source in the brain. The second theory is the feedback-induced instability theory that states that the rest tremor arises out of a feedback-induced instability in the sensorimotor loop. This paper analyzes validity of the two theories based on established clinical observations of Parkinsonian rest tremor by using representative simulation examples. Finally, based on our analysis, we propose two test-worthy experiments for further validation.
... Other vibratory stimulation techniques include whole-body vibration (WBV). WBV has been found to improve performance during upper body exercise (Marín et al., 2013) and to reduce motor symptoms in PD patients (Haas et al., 2006;Ebersbach et al., 2008;King et al., 2009). However, a recent meta-analysis suggests that the symptom-reducing effects are inconsistent (Dincher et al., 2019) and do not improve certain components of gait or balance (Lau et al., 2011). ...
Article
Full-text available
Background Abnormal synchronization of neuronal activity in dopaminergic circuits is related to motor impairment in Parkinson’s disease (PD). Vibrotactile coordinated reset (vCR) fingertip stimulation aims to counteract excessive synchronization and induce sustained unlearning of pathologic synaptic connectivity and neuronal synchrony. Here, we report two clinical feasibility studies that examine the effect of regular and noisy vCR stimulation on PD motor symptoms. Additionally, in one clinical study (study 1), we examine cortical beta band power changes in the sensorimotor cortex. Lastly, we compare these clinical results in relation to our computational findings.Methods Study 1 examines six PD patients receiving noisy vCR stimulation and their cortical beta power changes after 3 months of daily therapy. Motor evaluations and at-rest electroencephalographic (EEG) recordings were assessed off medication pre- and post-noisy vCR. Study 2 follows three patients for 6+ months, two of whom received daily regular vCR and one patient from study 1 who received daily noisy vCR. Motor evaluations were taken at baseline, and follow-up visits were done approximately every 3 months. Computationally, in a network of leaky integrate-and-fire (LIF) neurons with spike timing-dependent plasticity, we study the differences between regular and noisy vCR by using a stimulus model that reproduces experimentally observed central neuronal phase locking.ResultsClinically, in both studies, we observed significantly improved motor ability. EEG recordings observed from study 1 indicated a significant decrease in off-medication cortical sensorimotor high beta power (21—30 Hz) at rest after 3 months of daily noisy vCR therapy. Computationally, vCR and noisy vCR cause comparable parameter-robust long-lasting synaptic decoupling and neuronal desynchronization.Conclusion In these feasibility studies of eight PD patients, regular vCR and noisy vCR were well tolerated, produced no side effects, and delivered sustained cumulative improvement of motor performance, which is congruent with our computational findings. In study 1, reduction of high beta band power over the sensorimotor cortex may suggest noisy vCR is effectively modulating the beta band at the cortical level, which may play a role in improved motor ability. These encouraging therapeutic results enable us to properly plan a proof-of-concept study.
... Other vibratory stimulation techniques include whole-body vibration (WBV). WBV has been found to improve performance during upper body exercise (Marín et al., 2013) and to reduce motor symptoms in PD patients (Haas et al., 2006;Ebersbach et al., 2008;King et al., 2009). However, a recent meta-analysis suggests that the symptom-reducing effects are inconsistent (Dincher et al., 2019) and do not improve certain components of gait or balance (Lau et al., 2011). ...
Article
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Background: Abnormal synchronization of neuronal activity in dopaminergic circuits is related to motor impairment in Parkinson’s disease (PD). Vibrotactile coordinated reset (vCR) fingertip stimulation aims to counteract excessive synchronization and induce sustained unlearning of pathologic synaptic connectivity and neuronal synchrony. Here, we report two clinical feasibility studies that examine the effect of regular and noisy vCR stimulation on PD motor symptoms. Additionally, in one clinical study (study 1), we examine cortical beta band power changes in the sensorimotor cortex. Lastly, we compare these clinical results in relation to our computational findings. Methods: Study 1 examines six PD patients receiving noisy vCR stimulation and their cortical beta power changes after 3 months of daily therapy. Motor evaluations and at-rest electroencephalographic (EEG) recordings were assessed off medication pre- and post-noisy vCR. Study 2 follows three patients for 6+ months, two of whom received daily regular vCR and one patient from study 1 who received daily noisy vCR. Motor evaluations were taken at baseline, and follow-up visits were done approximately every 3 months. Computationally, in a network of leaky integrate-and-fire (LIF) neurons with spike timing-dependent plasticity, we study the differences between regular and noisy vCR by using a stimulus model that reproduces experimentally observed central neuronal phase locking. Results: Clinically, in both studies, we observed significantly improved motor ability. EEG recordings observed from study 1 indicated a significant decrease in off-medication cortical sensorimotor high beta power (21—30 Hz) at rest after 3 months of daily noisy vCR therapy. Computationally, vCR and noisy vCR cause comparable parameter-robust long-lasting synaptic decoupling and neuronal desynchronization. Conclusion: In these feasibility studies of eight PD patients, regular vCR and noisy vCR were well tolerated, produced no side effects, and delivered sustained cumulative improvement of motor performance, which is congruent with our computational findings. In study 1, reduction of high beta band power over the sensorimotor cortex may suggest noisy vCR is effectively modulating the beta band at the cortical level, which may play a role in improved motor ability. These encouraging therapeutic results enable us to properly plan a proof-of-concept study.
Book
PLEASE NOTICE: The European Physiotherapy Guideline for Parkinson’s disease can be downloaded at www.parkinsonnet.info/euguideline. The Guideline development was initiated and mainly sponsored by ParkinsonNet and the Royal Dutch Society for Physical Therapy. The Guideline Development Group represents professional physiotherapy associations from 19 European countries. People with Parkinson’s disease were involved in the Guideline development from the outset and have contributed throughout the process. Dr. Samyra Keus, who lead the development: “It was a unique and challenging collaboration, with a great product as result. The Guideline will be helpful to all involved in Parkinson care who, supporting evidence-based, patient centred care”. Therefore, the Guideline comes in four parts: • The Guideline, mainly for physiotherapists: background on Parkinson’s disease and health management, physiotherapy core areas and rationale and evidence for categories of interventions • Information for people with Parkinson’s: self-management support and how to get the best out of physiotherapy care • Information for clinicians: when to refer to physiotherapy and what to expect • Information to the development and scientific justification of the Guideline: insight in the barriers and facilitators of current care and details to measurement tools and the GRADE-based recommendations Currently the Guideline is available in English. Translations into German, Dutch and other languages are underway.
Article
Background: While the transdisciplinary-based rehabilitation provided ample evidence on improving impairment (body structure and functions) levels, the therapeutic effects on the international classification of functioning, disability, and health (ICF) domains are unknown in cerebral palsy (CP). Objective: To compare the effects of the community-based family-child-centered care (CFC) and conventional pediatric rehabilitation (CPR) on the physical, cognitive, sensory, and social integration domains in children and adolescents with CP. Methods: Twenty-six participants with CP (mean age = 9.37±5.24, 14 females) were assigned into either CPR or CFC groups. Clinical outcomes included gross motor function measure (GMFM-66), Pediatric Balance Scale (PBS), fine motor area of Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2), Functional Independence Measure (FIM) cognition area, Short Sensory Profile (sSP), COPM, Pediatrics Quality of Life (PedsQL) questionnaire, Short Falls Efficacy Scale (sFES), and Dynamic Postural Instability (DPI). An analysis of variance (ANOVA) and an analysis of covariance (ANCOVA) was conducted at P < 0.05. Results: ANOVA revealed the superior effects of CFC in GMFM-66, PBS, BOT-2, FIM, and PedsQL compared to CPR (P < 0.05). ANCOVA showed the superior effects of CFC in Z-axis of DPI than CPR (P < 0.05). Conclusions: Our results provide novel, promising clinical evidence that CFC was more effective than CPR at improving impairment, activity, as well as participation levels in participants with CP.
Article
Resumen Introducción Los trastornos neurológicos son una causa frecuente de discapacidad infantil. Las disfunciones neuromotrices se afrontan clínicamente en la actualidad mediante tratamientos ortopédicos, farmacológicos y fisioterápicos. Las vibraciones terapéuticas son estudiadas para conocer sus efectos tróficos y neuromoduladores. Objetivo Observar los cambios relacionados con el control postural en casos de disfunción neuromotriz infantil después de la aplicación de estímulos vibratorios ecológicos, medidos con una plataforma de fuerzas. Pacientes y métodos Estudio consecutivo no controlado. Quince sujetos con discapacidad motora y edad media 9 ± 3,4 años fueron valorados en bipedestación estática mediante la plataforma Wii Balance Board antes y después de una única dosis de amplificación mecanoceptiva (AM). Se analizaron variables del centro de presiones: posición media, excursión media, amplitud y recorrido. Resultados La posición media conjunta del centro de presiones pre-AM se encontraba más alejada del centro anatómico en el eje frontal que en el sagital de manera estadísticamente significativa (p = 0,041) y mostraron recorridos mediolaterales del centro de presiones significativamente más largos (p = 0,001) que los anteroposteriores. Post-AM hubo aumentos significativos para la variables excursión media total (p = 0,015), amplitud en eje frontal (p = 0,010), y recorrido tanto en el total (p = 0,005) como en los parciales de ambos ejes frontal (p = 0,006) y sagital (p = 0,004). A la observación, la posición sagital media conjunta se retrasó mientras que la posición frontal media conjunta se aproximó hacia el centro, con elevada correlación entre reubicación y excursión y entre amplitud y recorrido. Conclusión Los sujetos obtuvieron un reequilibrio postural tendente hacia la posteriorización y hacia el miembro inferior estimulado después de la AM.
Article
Resumen Introducción La causa más prevalente de discapacidad infantil es la parálisis cerebral. Se ha demostrado que la terapia vibratoria tiene efectos beneficiosos sobre el control postural, siendo una de las limitaciones en la parálisis cerebral infantil. Su valoración nos permite así orientar las intervenciones terapéuticas. El objetivo de este estudio fue determinar la eficacia terapéutica de las microvibraciones funcionales sobre la estabilidad y los apoyos en bipedestación. Material y método Aplicación durante 3 meses, a un niño de 6 años con tetraparesia distónica, de un protocolo de intervención mediante un dispositivo Mecanoamplificador un día a la semana mientras caminaba 15 min. Se realizó una valoración postural pre- y postintervención mediante una plataforma de fuerzas portátil Wii Balance Board. Resultados Se observaron modificaciones en indicadores de estabilidad postural que sugieren mejoras inmediatas y acumuladas. Conclusión La amplificación mecanoceptiva podría incorporarse como una terapia eficaz sobre el control postural deficitario en la parálisis cerebral.
Article
Aim: The aim of this study was to examine the effects of whole body vibration (WBV) training and conventional physical therapy on spatiotemporal gait parameters, functional mobility and activities of daily living (ADL) in children with cerebral palsy (CP). Methods: A pretest–posttest control group design was used. In this 3-week trial, 24 children with spastic CP were randomly selected to either continue their physical therapy or to receive WBV in addition to their physical therapy programme. Gait analyses, the Timed Up and Go (TUG) test and the Functional Independence Measure for Children (WeeFIM) were conducted before and after training. Results: For spatiotemporal gait parameters, this study found statistically significant differences in the WBV group’s walking speed (p = 0.002), step length of the affected side (p = 0.021) and step width (p = 0.007) pre- and post-training. Between the two groups, there was a statistically significant difference in step width (F = 5.326, p = 0.031) and significant improvements in the WBV group’s TUG scores (p = 0.039) compared with the control group. According to the results of WeeFIM, there were no significant differences between the two groups after training. Conclusions: Administration of WBV training to children with CP in conjunction with conventional physical therapy leads to improvements in functional mobility.
Thesis
Beim idiopathischen Parkinson Syndrom (IPS) gewinnen nicht-motorische Symptome in Forschung und Klinik zunehmend an Bedeutung. So findet sich in der Literatur vermehrt Evidenz, dass die Propriozeption bei Patienten mit IPS (PmIPS) gestört ist. Verschiedene klinische und neuroanatomische Studien weisen darauf hin, dass es beim IPS zu einer fehlerhaften sensomotorischen Integration von propriozeptiven Informationen in den Basalganglien kommt. Zudem gibt es Hinweise, dass die passiv-sensible Wahrnehmung von Propriozeption pathologisch verändert ist. Außerdem wird vermutet, dass durch propriozeptives Training eine Verbesserung der Parkinsonsymptomatik erreicht werden kann. Ein spezielles Trainingsprogramm, die LSVT-BIG-Therapie, bei der gezielt trainiert wird, Bewegungen mit einer großen Amplitude durchzuführen, konnte motorische Symptome und Mobilität beim IPS effektiv verbessern. In der vorliegenden Arbeit stellten wir folgende Hypothesen auf: Das IPS geht mit einer fehlerhaften sensomotorischen Integration von Propriozeption einher. Die afferente propriozeptive Wahrnehmung ist ebenfalls pathologisch verändert. Eine propriozeptive Rekalibrierung ist mithilfe der LSVT-BIG-Therapie möglich. Für die Überprüfung dieser Hypothesen schlossen wir 30 PmIPS und 15 gesunde Probanden in unsere Fall-Kontroll-Studie ein und führten eine Eingangsuntersuchung durch. 11 PmIPS absolvierten anschließend eine vierwöchige LSVT-BIG-Therapie. Die Folgeuntersuchungen fanden 4 und 8 Wochen nach der Eingangsuntersuchung statt. 78 Diese beinhalteten neuropsychologische Testungen, außerdem die Bestimmung der Lebensqualität, die Erhebung des motorischen Teils der Movement Disorder Society Unified Parkinson´s Disease Rating Scale (MDS-UPDRS III), Untersuchungen zur Feinmotorik, die Durchführung einer diagnostischen Transkraniellen Magnetstimulation (TMS) sowie Testverfahren zur Propriozeption, darunter sowohl Zeigeversuche, als auch die Bestimmung der Position einer Extremität, ohne visuelle Kontrolle. Die Ergebnisse zeigten, dass die IPS-Gruppe gegenüber der gesunden Kontrollgruppe signifikant größere Zeigefehler machte, wohingegen die Bestimmung der Position einer Extremität in beiden Gruppen vergleichbar präzise möglich war. Zusätzlich zeigte eine von sieben Messungen der Feinmotorik einen signifikanten Unterschied zwischen PmIPS und Kontrollen. Die Messungen der TMS erbrachten hingegen keine signifikant messbaren Unterschiede zwischen den Gruppen. In den Folgeuntersuchungen nach therapeutischer Intervention ergaben die Zeigeübungen eine signifikante Verbesserung der BIG-Gruppe im Zeitverlauf. Die Untersuchungen zu Feinmotorik und MDS-UPDRS III ergaben zwar eine tendenzielle Verbesserung durch die LSVT-BIG-Therapie, waren jedoch statistisch nicht signifikant. Die Lebensqualität der PmIPS in der BIG-Gruppe verbesserte sich signifikant nach Intervention. Die Ergebnisse sprechen für die Hypothese der fehlerhaften propriozeptiven Integration beim Morbus Parkinson. Dies zeigte sich für aktive sensomotorische Tasks, nicht hingegen in der passiv-sensiblen propriozeptiven Testung. Auch wenn weitere Studien mit größeren Kohorten benötigt werden, legt unsere Studie nahe, dass die LSVT-BIG-Therapie mit einer propriozeptiven Rekalibrierung einhergeht. Damit erklärt sich möglicherweise der nachhaltige Erfolg der Therapie.
Article
Objective To review the effects of whole body vibration for patients with Parkinson’s disease. Design Randomized clinical trials comparing whole body vibration with no vibration or conventional physical therapy for patients with Parkinson’s disease were searched up to July 31, 2019. Results Seven studies with 196 patients were included for quantitative analysis. No significant difference was found between groups in motor score of unified Parkinson’s disease rating scale (UPDRS-III) (WMD [weighted mean difference] = −1.75, 95% CI, −5.40 to 1.90, I ² = 45.8%), functional reach test (SMD [standardized mean difference] = 0.21, 95% CI, −0.29 to 0.71; I ² = 0%), and other balance tests (including Berg balance test and Tinetti score) (SMD = 0.39, 95% CI, −0.01 to 0.80; I ² = 0%). No statistical difference was detected in walking velocity as well (WMD = −0.05, 95% CI, −0.17 to 0.06; I ² = 0%). In contrast, the pooled analysis from four studies on the Time Up and Go test showed favorable results for whole body vibration (WMD = −1.59, 95% CI, −2.90 to −0.28, I ² = 0%). Conclusion Whole body vibration may not be beneficial over placebo or conventional physical therapy in overall motor function, balance, and walking velocity in patients with Parkinson’s disease. However, it might have positive effects on sit to stand transitions or turning.
Article
Objective Although Essential Tremor is one of the most common movement disorders, we do not currently know which muscles are most responsible for tremor. Determining this requires multiple steps, one of which is characterizing the distribution of tremor among the degrees of freedom (DOF) of the upper limb. Methods Upper-limb motion was recorded while 22 subjects with ET performed postural and kinetic tasks involving a variety of limb configurations. We calculated the mean distribution of tremor among the seven DOF from the shoulder to the wrist, as well as the effect of limb configuration, repetition, and subject characteristics (sex, tremor onset, duration, and severity) on the distribution. Results On average, kinetic tremor was greatest in forearm pronation-supination and wrist flexion-extension, intermediate in shoulder internal-external rotation and wrist radial-ulnar deviation and then shoulder flexion-extension and elbow flexion-extension, and least in shoulder abduction-adduction. The average distribution of postural tremor was similar except for forearm pronation-supination, which played a smaller role than in kinetic tremor. Limb configuration and subject characteristics did significantly affect tremor, but practically only in forearm pronation-supination and wrist flexion-extension. There were no significant differences between repetitions, indicating that the distribution was consistent over the duration of the experiment. Conclusions This paper presents a thorough characterization of tremor distribution from the shoulder to the wrist. Significance Understanding which DOF exhibit the most tremor may lead to more targeted peripheral tremor suppression.
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Objective Assess the effect of Whole-Body Vibration (WBV) therapy in functional balance status of Parkinson’s disease (PD) patients and compare this to conventional and combined therapy.IntroductionPD patients experience a decreased mobility, inactivity, and loss of independence as consequence of disturbances in gait, posture, and balance. Rehabilitation therapy is a non-pharmacological way of improving functionality. One of the most studied modalities is WBV, with multiple studies showing improvement in motor function. However, results in this manner are inconsistent.Methods Forty-five patients were enrolled in a non-randomized controlled trial and divided into three groups. Group 1 received conventional therapy (thermotherapy, stretching, strengthening, coordination and balance). Group 2 received WBV therapy, and group 3 patients underwent a combined therapy protocol. A total of 20 sessions (3 per week) were conducted, assessing Berg Balance Scale (BBS) before initial and after final session.ResultsThe 3 intervention groups showed significant improvement in BBS scores after concluding the 20-session trial compared to initial assessment. When comparing mean change in BBS score from initial to final assessment, the combined therapy group had a greater increase compared to conventional therapy, but no significant differences were observed comparing to WBV group. Mean change in BBS score showed no significant difference between conventional therapy and WBV therapy group.ConclusionsWBV therapy is a useful tool as co-adjuvant in conventional therapy. The combination of both therapies is a significant therapeutic alternative for the improvement of functional balance status in PD patients compared to conventional therapy alone.
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Due to advances in medical knowledge the population of older adults struggling with issues of aging like Alzheimer's disease (AD), Parkinson's disease (PD), and stroke is growing. There is a need for therapeutic interventions to provide adaptive strategies to sustain quality of life, decrease neurologic impairment, and maintain or slow cognitive decline and function due to degenerative neurologic diseases. Musical interventions with adults with cognitive impairments have received increased attention over the past few years, such as the value of personalized music listening in the iPod project for AD (1); music as a tool to decrease agitation and anxiety in dementia (2); and music to aid in episodic memory (3); Rhythmic Auditory Stimulation as rehabilitation for PD (4); and recently the potential of 40 Hz sensory brain stimulation with AD and PD (5, 6). These approaches indicate the expanding scope and efficacy of music therapy and the potential mechanisms involved. This paper explicates a four-level model of mechanisms of music response (7, 8) that may help understand current music therapy approaches and treatments and help focus future research. Each level will be illustrated with research and suggestions for research directions.
Chapter
This chapter introduces two case studies that exemplify how interactive visualisations were introduced to supplement an interactive vibroacoustic therapeutic intervention setup for adolescents diagnosed as profoundly disabled each having individual dysfunctional conditions. The hypothesis behind the research of multisensory stimuli intervention aligns with how humans can differ in needs, desires, and preferences and it is posited toward optimising selectable feedback stimuli within intervention targeting inclusive well-being. The studies were associated to a European funded research project (https://www.bristol.ac.uk/carehere) (with end-users overall being handicapped and/or elderly and/or undertaking rehabilitation) where the author coordinated Sweden partner research and user studies due to his research being catalyst and responsible for gaining the project. Both case studies took place in a school for special needs in Landskrona municipality, Sweden—they were conducted applied as a part of the day-to-day activities of the school rather than being laboratory-based.
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Despite optimal medical and surgical therapies for Parkinson's disease, patients develop progressive disability. The role of the physiotherapist is to maximise functional ability and minimise secondary complications through movement rehabilitation within a context of education and support for the whole person. What form of physiotherapy is most effective in the treatment of Parkinson's disease remains unclear. 1. To compare the efficacy and effectiveness of novel physiotherapy techniques versus 'standard' physiotherapy in patients with Parkinson's disease. Standard physiotherapy is defined as the type of therapy that the physiotherapist would usually use to treat Parkinson's disease. 2. To compare the efficacy and effectiveness of one physiotherapy technique versus a second form of physiotherapy. Relevant trials were identified by electronic searches of MEDLINE, EMBASE, CINAHL, ISI-SCI, AMED, MANTIS, REHABDATA, REHADAT, GEROLIT, Pascal, LILACS, MedCarib, JICST-EPlus, AIM, IMEMR, SIGLE, ISI-ISTP, DISSABS, Conference Papers Index, Aslib Index to Theses, the Cochrane Controlled Trials Register, the CentreWatch Clinical Trials listing service, the metaRegister of Controlled Trials, ClinicalTrials.gov, CRISP, PEDro, NIDRR and NRR; and examination of the reference lists of identified studies and other reviews. Only randomised controlled trials (RCT) were included. Data was abstracted independently by KD and CEH and differences settled by discussion. Seven trials were identified with 142 patients. All used small numbers of patients and the method of randomisation and concealment of allocation was poor or not statedin all of the trials. These methodological problems could potentially lead to bias from a number of sources. The methods of physiotherapy varied so widely that the data could not be combined. Considering the small number of patients examined, the methodological flaws in many of the studies and the possibility of publication bias, there is insufficient evidence to support or refute the efficacy of any given form of physiotherapy over another in Parkinson's disease. Another Cochrane review, Physiotherapy for patients with Parkinson's Disease, found that there was insufficient evidence to support or refute the efficacy of physiotherapy compared to no physiotherapy in Parkinson's disease. A wide range of physiotherapy approaches were used in these studies and a survey of UK physiotherapists confirmed that they also use an eclectic combination of techniques in the treatment of Parkinson's disease (Plant 1999). Therefore a consensus must be found as to 'best practice' physiotherapy for Parkinson's disease. The efficacy of 'standard' physiotherapy should be proved first before examining variations in physiotherapy methods. Therefore large well designed randomised controlled trials are needed to judge the effect of physiotherapy in Parkinson's disease. After this large RCTs are needed to demonstrate the most effective form of physiotherapy in Parkinson's disease. Outcome measures with particular relevance to patients, carers, physiotherapists and physicians should be chosen and the patients monitored for at least 6 months to determine the duration of any effect. The trials should be reported according to CONSORT guidelines (CONSORT 1996).
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There is a wealth of data suggesting that behavioural events are reflected in the basal ganglia through phasic changes in the discharge of individual neurones. Here we investigate whether events are also reflected in momentary changes in the degree of synchronization between neuronal elements. We simultaneously recorded local potentials (LPs) from the subthalamic nucleus (STN) and/or ipsilateral globus pallidus interna (GPi) or scalp EEG during voluntary movements of a hand-held joystick in six awake patients following neurosurgery for Parkinson's disease. Without medication the power within the STN and the coherence between the STN and the GPi were dominated by activity with a frequency of <30 Hz. This coupling was attenuated by movement. In the presence of exogenous dopaminergic stimulation, power within the STN and coherence between the STN and the GPi was dominated by activity at 70-85 Hz, which increased with movement. The movement-related changes in coherence between the STN and EEG showed a similar pattern of pharmacological dependence, as seen subcortically. Movement-related frequency-specific changes in synchronization occur in the basal ganglia and extend to involve subcortico-cortical motor loops. The dynamic organization of activities in the frequency domain might provide a means for temporal co-ordination within and across different processing streams in the basal ganglia. This organization is critically dependent on the level of dopaminergic activity.
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Local field potentials and pairs of neurones in the subthalamic nucleus (STN) of patients with Parkinson's disease show high-frequency oscillations (HFOs) at 15-30 Hz. This study explores how these HFOs are modulated by voluntary movements and by dopaminergic medication. We examined 15 patients undergoing implantation of bilateral deep brain stimulating electrodes using microelectrode recordings of pairs of STN neurones (eight patients) and macroelectrode recordings of local field potentials from the STN (14 patients). Synchronized HFOs between STN neurones were observed in 28 out of 37 pairs in five patients who had tremor in the operating room and none of 45 pairs in three patients who did not. In two of the three non-tremulous patients, HFOs in the frequency spectra of local field potentials were detected but were weaker than in those patients with tremor. Active movement suppressed synchronized HFOs in three out of five pairs of neurones, independent of changes in firing rate. HFOs observed in the local field potentials in nine out of 14 patients were reduced with voluntary movement in six of the eight patients tested. Dopaminergic medication decreased the incidence of synchronized HFOs in STN neurone pairs, reduced HFO synchrony in a pair of tremor cells concurrent with a reduction in firing rate and limb tremor, and decreased HFOs of local field potentials in the STN. These results demonstrate that HFO synchronization in the STN is reduced by voluntary movements and by exogenous dopaminergic medication. A mechanism for neuronal oscillatory synchronization in basal ganglia is proposed. It is suggested that the firing of STN neurones can be synchronized by 15-30 Hz cortical beta oscillatory activity, particularly when dopamine deficiency results in a higher background firing rate of STN neurones, and that this synchronization contributes to parkinsonian pathophysiology.
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It is well known that applying vibrations to men influences multiple physiological functions. The authors analysed post effects of whole-body-vibration (WBV) on motor symptoms in Parkinson's disease (PD). Sixty-eight persons with PD were randomly subdivided into one experimental and one control group. Motor symptoms were assessed by the UPDRS (Unified Parkinson's Disease Rating Scale) motor score. A cross-over design was used to control treatment effects. The treatment consisted of 5 series of whole-body-vibration taking 60 seconds each. On average a highly significant (p<0.01) improvement of 16.8% in the UPDRS motor score was found in the treatment group. Only marginal changes (p>0.05) were found in the control group. The cross-over procedure showed comparable treatment effects (14.7% improvement after treatment). With respect to different symptom clusters only small changes were found in limb akinesia and cranial symptoms. By contrast, tremor and rigidity scores were improved by 25% and 24%, respectively. According to the structure of symptom changes it is unlikely that these effects are explainable on peripheral sensory level, exclusively. With respect to the findings of other studies one can speculate about changes in activation of the supplementary motor area and in neurotransmitter functions.
Article
This article traces the early development of vibroacoustic therapy, and some of the theoretical basis for its use in a treatment procedure. It describes some of the initial work in the Scandinavian countries, gives examples of the type of problems that low frequency sound and music have been particularly effective in treating, and puts into perspective the use of music and sound as a physically effective means of treating people in comparison with the interactive forms of intervention commonly used by music therapists. Much of the case material described in the article (Norwegian and English) is anecdotal. In the latter section of this paper, current research is described.
Article
To clarify the involvement of the central nervous system in responses of organisms to noise and whole-body vibration, the activity of dopamine (DA) neuron systems was estimated by examining DA turnover rates in various discrete regions of the brains of rats exposed to noise (broad band, 102 dB) or whole-body vibration (20 Hz, 4G) for 90 min. Plasma corticosterone level (COR) was determined simultaneously as an index of stress-induced autonomic-nervous and endocrine functions. Noise and whole-body vibration increased both COR and DA turnover rates (shown by an increase of homovanillic acid (HVA) and/or HVA/DA ratio) in the frontal cortex (FC) and the nucleus accumbens (NAc). Only noise increased the DA turnover rate in the amygdala (AMY). Furthermore, strong positive correlations of the HVA/DA ratios in the FC and the NAc with COR were observed in rats exposed to noise or vibration. These results suggest that the responses of organisms to noise and whole-body vibration may be critically mediated by cerebral DA systems, in particular by the mesocortical DA system, indicating that change of DA in the AMY can be considered a specific response to noise.
Article
Schultz, Wolfram. Predictive reward signal of dopamine neurons. is called rewards, which elicit and reinforce approach behav-J. Neurophysiol. 80: 1–27, 1998. The effects of lesions, receptor ior. The functions of rewards were developed further during blocking, electrical self-stimulation, and drugs of abuse suggest the evolution of higher mammals to support more sophistithat midbrain dopamine systems are involved in processing reward cated forms of individual and social behavior. Thus biologiinformation and learning approach behavior. Most dopamine neucal and cognitive needs define the nature of rewards, and rons show phasic activations after primary liquid and food rewards and conditioned, reward-predicting visual and auditory stimuli. the availability of rewards determines some of the basic They show biphasic, activation-depression responses after stimuli parameters of the subject’s life conditions. that resemble reward-predicting stimuli or are novel or particularly Rewards come in various physical forms, are highly variable salient. However, only few phasic activations follow aversive stim-in time and depend on the particular environment of the subject. uli. Thus dopamine neurons label environmental stimuli with appe- Despite their importance, rewards do not influence the brain titive value, predict and detect rewards and signal alerting and motivating events. By failing to discriminate between different
Article
Despite optimal medical and surgical therapies for Parkinson's disease, patients develop progressive disability. The role of the physiotherapist is to maximise functional ability and minimise secondary complications through movement rehabilitation within a context of education and support for the whole person. To compare the efficacy and effectiveness of physiotherapy with placebo or no interventions in patients with Parkinson's disease. Relevant trials were identified by electronic searches of MEDLINE, EMBASE, CINAHL, ISI-SCI, AMED, MANTIS, REHABDATA, REHADAT, GEROLIT, Pascal, LILACS, MedCarib, JICST-EPlus, AIM, IMEMR, SIGLE, ISI-ISTP, DISSABS, Conference Papers Index, Aslib Index to Theses, the Cochrane Controlled Trials Register, the CentreWatch Clinical Trials listing service, the metaRegister of Controlled Trials, ClinicalTrials.gov, CRISP, PEDro, NIDRR and NRR; and examination of the reference lists of identified studies and other reviews. Only randomised controlled trials (RCT) were included, however those trials that allowed quasi-random methods of allocation were allowed. Data was abstracted independently by KD and DJ and differences settled by discussion. Eleven trials were identified with 280 patients. Eight trials did not have adequate placebo treatments, all used small numbers of patients and the method of randomisation and concealment of allocation was good in only four trials. These methodological problems could potentially lead to bias from a number of sources. Although ten of the trials claimed a positive effect from physiotherapy, few outcomes measured were statistically significant. Walking velocity was measured in four trials and increased significantly in two of them. Stride length was the only other outcome measured in more than one trial, it was significantly improved in two trials. Five other outcomes improved significantly in individual studies, but eight other outcomes did not improve significantly. Considering the methodological flaws in many of the studies, the small number of patients examined, and the possibility of publication bias, there is insufficient evidence to support or refute the efficacy of physiotherapy in Parkinson's disease. The studies illustrate that a wide range of approaches are being employed by physiotherapists to treat Parkinson's disease. This was confirmed by the UK survey of physiotherapists. There is a need to develop a consensus as to 'best-practice'. Large well designed placebo-controlled RCTs are then needed to demonstrate the efficacy and effectiveness of 'best practice' physiotherapy in Parkinson's disease. The stage of the disease at which the physiotherapy is given should be specified at the outset. Outcome measures with particular relevance to patients, carers, physiotherapists and physicians should be chosen and the patients monitored for at least six months to determine the duration of any beneficial effects. The trials should be reported according to CONSORT guidelines.
Article
Neurologists should take brain rhythms seriously. Classical neurophysiology has focused on the encoding of information through changes in the firing rate of neurones, the salience of a stimulus or initiation of a motor response being accompanied by increases or decreases in neuronal activity. Yet when networks of neurones interact the result is often rhythmic activity within defined frequency ranges that can engage in temporal synchronization and de‐synchronization. Neurologists are predisposed to consider all rhythmicity as pathological. After all, in our working lives we diagnose essential tremor and the tremor of Parkinson’s disease and many of our concepts of diseases such as epilepsy are bound up with ideas of widespread rhythmic synchronization of neural elements resulting in loss of consciousness and violent involuntary movement. Over recent years a more sophisticated appreciation of neural rhythmicity and temporal synchronization has emerged. Neurophysiologists can now record simultaneously from networks of neurones in cortical and sub‐cortical structures of humans and animals. We are beginning to understand that brain rhythms, their synchronization and de‐synchronization, form an important and possibly fundamental part of the orchestration of perception, motor action and conscious experience (Singer, 1993; Farmer, 1998) and that disruption of oscillation and/or temporal synchronization may be a fundamental mechanism of neurological disease. Levy and colleagues in this issue of Brain (Levy et al ., 2002) report the results of sophisticated micro‐ and macro‐electrode recordings from sub‐thalamic nucleus (STN) in conscious patients undergoing neurosurgical treatment for advanced Parkinson’s disease. Their data consists of action potentials recorded from micro‐electrodes and local field potentials recorded using macro‐electrodes. Using Fourier analysis they have identified the dominant frequencies of oscillatory activity in action potential spike trains and local field potentials. Application of coherence analysis to such data …
Article
Previous research on tremor pathophysiology showed that tremor can be affected, e.g. by electrical stimulation of the peripheral nerve, mechanical perturbation of the limb and by transcranial magnetic stimulation of the motor cortex. This report is focused on possible effects of muscle vibration (MV) on resting tremor in Parkinson's Disease (PD). Vibratory stimulation was applied to the tendons of M. extensor carpi radialis longus and M. flexor ulnaris in 27 subjects with moderate PD resting tremor. The following effects were observed: (1) tremor stopped or started time-locked to MV onset and offset, (2) tremor persisted during MV but its frequency pattern changed. These results are discussed with specific emphasis to effects of MV on spinal and supraspinal levels.
Article
The purpose of the present study was twofold: first to examine the influences of sex and handedness on manual performance on the Grooved Pegboard Test; and secondly to provide normative data for two versions (Place and Remove tasks) of the Grooved Pegboard Test, as previous work (Bryden & Roy, 1999) had suggested that the Remove task of the Grooved pegboard may provide a purer measure of motor speed of the two hands than the standard administration of the Grooved Pegboard Test. One hundred and fifty-three (47 males and 106 females) participants completed the Grooved Pegboard Test. Individuals performed the standard version of the Grooved Pegboard Test (Place task) and a novel version of the test (Remove task). In the standard version, participants were timed on their speed for placing the pegs, while in the novel version they were timed on their speed for removing the pegs. Results confirmed previously noted hand and sex differences in the Place task of the Grooved Pegboard Test, as well as the lack of effect of handedness on performance (Bornstein, 1995; Ruff & Parker, 1993). Significant performance differences between the hands were also noted for the Remove task. Findings also indicated that the Remove task was sensitive to sex and handedness effects.
Article
Low frequency rest tremor is one of the cardinal signs of Parkinson's disease and some of its animal models. Current physiological studies and models of the basal ganglia differ as to which aspects of neuronal activity are crucial to the pathophysiology of Parkinson's disease. There is evidence that neural oscillations and synchronization play a central role in the generation of the disease. However, parkinsonian tremor is not strictly correlated with the synchronous oscillations in the basal ganglia networks. Rather, abnormal basal ganglia output enforces abnormal thalamo-cortical processing leading to akinesia, the main negative symptom of Parkinson's disease. Parkinsonian tremor has probably evolved as a downstream compensatory mechanism.
Article
Parkinson's disease is a common neurodegenerative disorder that can cause significant disability and decreased quality of life. The cardinal physical signs of the disease are distal resting tremor, rigidity, bradykinesia, and asymmetric onset. Levodopa is the primary treatment for Parkinson's disease; however, its long-term use is limited by motor complications and drug-induced dyskinesia. Dopamine agonists are options for initial treatment and have been shown to delay the onset of motor complications. However, dopamine agonists are inferior to levodopa in controlling motor symptoms. After levodopa-related motor complications develop in advanced Parkinson's disease, it is beneficial to initiate adjuvant therapy with dopamine agonists, catechol O-methyltransferase inhibitors, or monoamine oxidase-B inhibitors. Deep brain stimulation of the subthalamic nucleus has been shown to ameliorate symptoms in patients with advanced disease. Depression, dementia, and psychosis are common psychiatric problems associated with Parkinson's disease. Psychosis is usually drug induced and can be managed initially by reducing antiparkinsonian medications. The judicious use of psychoactive agents may be necessary. Consultation with a subspecialist is often required.
Article
The basal ganglia have been implicated in timing control, yet the nature of timing disturbances in Parkinson's disease (PD) is poorly understood. We evaluated the influence of timing cues on spatiotemporal aspects of gait control and its variability, and the impact of dopaminergic treatment on timing. Three separate groups: 19 PD (OFF state); 24 PD (ON state); and 30 control participants were tested. Participants walked on a computerized carpet at four randomized and metronome-controlled rates: self-paced, 60, 80, or 100 steps/min. To our knowledge, this is the first study to demonstrate that medicated PD patients had poorer timing control than patients withdrawn from medication and healthy participants when modulating timing to an external stimulus. Increased step-to-step timing variability and deficits in mean temporal gait characteristics revealed that the medicated PD group (in contrast to nonmedicated PD group) performed least like healthy participants. This was observable in externally-cued conditions, but not during self-paced gait. Similar to previous research, step length contributed to overall slowness in PD, while temporal characteristics of gait did not. Interestingly, healthy participants increased stride length with each increase in cue rate, whereas both PD groups locked their step length regardless of temporal demand. Step-to-step variability differences between PD and healthy (e.g. step and double-support time measurements) may be indicative of specific basal ganglia involvement in temporal control of gait.
Article
Background: Despite drug and surgical therapies for Parkinson's disease, patients develop progressive disability. It has both motor and non-motor symptomatology, and their interaction with their environment can be very complex. The role of the occupational therapist is to support the patient and help them maintain their usual level of self-care, work and leisure activities for as long as possible. When it is no longer possible to maintain their usual activities, occupational therapists support individuals in changing and adapting their relationship with their physical and social environment to develop new valued activities and roles. Objectives: To compare the efficacy and effectiveness of occupational therapy with placebo or no interventions (control group) in patients with Parkinson's disease. Search strategy: Relevant trials were identified by electronic searches of MEDLINE (1966-April 2007), EMBASE (1974-2000), CINAHL (1982-April 2007), Psycinfo (1806-April 2007), Ovid OLDMEDLINE (1950-1965), ISI Web of Knowledge (1981-April 2007), National Library for Health (NLH) (April 2007), Nursing, Midwifery and Allied Health (NMAP) (April 2007), Intute: Medicine (December 2005), Proquest Nursing Journals (PNJ, 1986 - April 2007); rehabilitation databases: AMED (1985-April 2007), MANTIS (1880-2000), REHABDATA (1956-2000), REHADAT (2000), GEROLIT (1979-2000); English language databases of foreign language research and third world publications: Pascal (1984-2000), LILACS (1982- April 2007), MedCarib (17th Century-April 2007), JICST-EPlus (1985-2000), AIM (1993-April 2007), IMEMR (1984-April 2007), grey literature databases: SIGLE (1980-2000), ISI-ISTP (1982-April 2007), DISSABS (1999-2000), Conference Papers Index (CPI, 1982-2000) and Aslib Index to Theses (AIT, 1716- April 2006), The Cochrane Controlled Trials Register (Issue 2, 2007), the CenterWatch Clinical Trials listing service (April 2007), the metaRegister of Controlled Trials (mRCT, April 2007), Current controlled trials (CCT) (April 2007), ClinicalTrials.gov (April 2007), CRISP (1972-April 2007), PEDro (April 2007), NIDRR (April 2007) and NRR (April 2007) and the reference lists of identified studies and other reviews were examined. Selection criteria: Only randomised controlled trials (RCT) were included, however those trials that allowed quasi-random methods of allocation were allowed. Data collection and analysis: Data was abstracted independently by two authors and differences were settled by discussion. Main results: Two trials were identified with 84 patients in total. Although both trials reported a positive effect from occupational therapy, all of the improvements were small. The trials did not have adequate placebo treatments, used small numbers of patients and the method of randomisation and concealment of allocation was not specified in one trial. These methodological problems could potentially lead to bias from a number of sources reducing the strength of the studies further. Authors' conclusions: Considering the significant methodological flaws in the studies, the small number of patients examined, and the possibility of publication bias, there is insufficient evidence to support or refute the efficacy of occupational therapy in Parkinson's disease. There is now a consensus as to UK current and best practice in occupational therapy when treating people with Parkinson's disease. We now require large well designed placebo-controlled RCTs to demonstrate occupational therapy's effectiveness in Parkinson's disease. Outcome measures with particular relevance to patients, carers, occupational therapists and physicians should be chosen and the patients monitored for at least six months to determine the duration of benefit. The trials should be reported using CONSORT guidelines.
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