The use of the Nintendo Wii has been considered a good alternative in the motor rehabilitation of individuals with Parkinson’s disease (PD), requiring simultaneous interaction to develop strategies for physical, visual, auditory, cognitive, psychological and social activities in the performing of virtual activities, resulting in improvement in functional performance and gait. The aim of this study was to analyze the effect of virtual sensorimotor activity on gait disorders in people with PD. Fifteen subjects with a clinical diagnosis of PD were submitted to the Unified Parkinson’s Disease Rating Scale (UPDRS III), Schwab and England Activities of Daily Living Scale (SE), Functional Independence Measure (FIM), and biomechanical gait analysis using digital images taken with a video camera before and after the treatment program. The activities with the Nintendo Wii virtual platform were standardized into three categories: aerobics, balance and Wii plus exercises. Participants carried out separate virtual exercises for 40 min, twice a week, for a total of 14 sessions. The program improved sensorimotor performance in PD gait, with an increase in stride length and gait speed, in addition to a reduction in motor impairment, especially in items of rigidity and flexibility of the lower limbs evaluated by UPDRS III, and greater functional independence, as evidenced in the SE and FIM scales. Improvements in items related to locomotion and stair climbing were also observed. The training was effective in motor recovery in chronic neurodegenerative diseases, showing improvement in motor performance and functional independence in individuals with PD.
More than one third of patients with Parkinson disease experience freezing. It is characterized by the feeling that one's feet are "glued to the floor", and it is more common in the later, siendo descrito por los pacientes como la sensación de tener los pies "pegados al suelo" 4 . Puede ser desencadenado al intentar iniciar y/o continuar la marcha, ante restricciones ambientales que exijan cambios en la velocidad, patrón o sentido del paso con o sin presencia de obstáculos o al caminar en espacios cerrados.Se observa particularmente en las etapas más avanzadas de la enfermedad y puede ocurrir espontáneamente al andar en espacios abiertos y al aire libre 1 . A pesar de que el FM presenta mayor frecuencia con la progresión de la enfermedad, Bloem et aI 5 pusieron en evidencia la presencia de congelamiento en fases precoces, con afectación de hasta 26% de pacientes con EP no tratados con levodopa (L-dopa). En las fases más avanzadas y con uso prolongado de levodopa, la prevalencia de congelamiento gira en torno de 20 a 60%.Las causas de FM todavía no son bien comprendidas. Existen varias hipótesis, tales como el congelamiento derivado de la incapacidad de generar una amplitud normal en la longitud del paso 6 , asimetría de la marcha, como evento único, o incluso problemas en el control motor de esos pacientes. La descoordinación y asimetría de la marcha, pero no aquella relacionada al desempeño motor en general, puede estar asociada al FM 1 . El FM presenta características distintas de aquellas que ocasionan otros síntomas parkisonianos, no consiguiéndose correlacionar la frecuencia de los episodios de freezing con los síntomas motores de la EP, tales como rigidez y bradicinesia, siendo la frecuencia del FM inversamente proporcional a la presencia del temblor 7,8 . Estos hechos refuerzan las complicaciones para la determinación de la fisiopatología del FM, siendo necesarias más investigaciones para el esclarecimiento de este trastorno 7 . Para completar este análisis, Factor et al 9 sugieren que la inestabilidad postural con
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