Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover

Abstract

Introduction: The progressive modular rebalancing (PMR) system is a comprehensive rehabilitation approach derived from proprioceptive neuromuscular facilitation principles. PMR training encourages focus on trunk and proximal muscle function through direct perception, strength, and stretching exercises and emphasizes bi-articular muscle function in the improvement of gait performance. Sensory cueing, such as visual cues (VC), is one of the more established techniques for gait rehabilitation in PD. In this study, we propose PMR combined with VC for improving gait performance, balance, and trunk control during gait in patients with PD. Our assumption herein was that the effect of VC may add to improved motor performance induced by the PMR treatment. The primary aim of this study was to evaluate whether the PMR system plus VC was a more effective treatment option than standard physiotherapy in improving gait function in patients with PD. The secondary aim of the study was to evaluate the effect of this treatment on motor function severity. Design: Two-center, randomized, controlled, observer-blind, crossover study with a 4-month washout period. Participants: Forty individuals with idiopathic PD in Hoehn and Yahr stages 1–4. Intervention: Eight-week rehabilitation programs consisting of PMR plus VC (treatment A) and conventional physiotherapy (treatment B). Primary outcome measures: Spatiotemporal gait parameters, joint kinematics, and trunk kinematics. Secondary outcome measures: UPDRS-III scale scores. Results: The rehabilitation program was well-tolerated by individuals with PD and most participants showed improvements in gait variables and UPDRS-III scores with both treatments. However, patients who received PMR with VC showed better results in gait function with regard to gait performance (increased step length, gait speed, and joint kinematics), gait balance (increased step width and double support duration), and trunk control (increased trunk motion) than those receiving conventional physiotherapy. While crossover results revealed some differences in primary outcomes, only 37.5% of patients crossed over between the groups. As a result, our findings should be interpreted cautiously. Conclusions: The PMR plus VC program could be used to improve gait function and severity motor of motor deficit in individuals with PD. Clinical Trial Registration : www.ClinicalTrials.gov , identifier NCT03346265.

Boxing vs Sensory Exercise for Parkinson’s Disease: A Double-Blinded Randomized Controlled Trial

“…11,14,29,34,41,42 In comparison to sensory exercise, boxing did not have a lasting effect on disease severity. This is contrary to recent rehabilitation literature that have stated high-intensity exercise (e.g., treadmill training, 43 tandem cycling, 44 multidisciplinary intensive rehabilitation treatments, 45 and aerobic exercise 46 ) can greatly improve disease severity as well as potentially have a neuroprotective effect. One difference between these studies and the current one is that intensity was not quantified.…”

Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association

“…Thirteen high-quality and 16 moderate-quality studies examined the benefits of external cueing in individuals with PD. External cueing was defined for the purposes of this CPG as an external temporal or spatial stimuli , 151 including rhythmic auditory cueing, 93 , 146 , 152 , 154 visual cues, 111 , 148 , 150 , 155 verbal cues, or attentional cues. 170 , 171 These studies varied considerably regarding sample size, comparison group, outcomes measured, mode, frequency, duration, and type of external cueing.…”

Os efeitos da reabilitação baseada em exercícios sobre a marcha de pacientes com doença de Parkinson: uma revisão sistemática

“…A estratégia de busca rendeu 514 estudos das bases de dados de publicação, [19,21,23,30,37] incluíram participantes em estágio 4 (grave).…”

“…Por outro lado, verificou-se ainda em seis estudos os denominados programas de exercícios [18,20,22,30,34,41]. Em três estudos [20,22,34], notou-se a aplicação do treinamento de equilíbrio e marcha juntos, o treinamento de equilíbrio foi semelhante no que se refere a questão de melhorar o ajuste postural antecipatório dos participantes, já o treinamento de marcha foi realizado tanto em esteira, quanto em solo, com feedback [22] e também incorporando dupla tarefa [34]; nos outros três estudos [18,30,41] percebeu-se que os exercícios foram bastante diversificados, incorporavam movimentos de corpo inteiro e sequências motoras complexas [18], exercícios de percepção e fortalecimento [30], pistas visuais e auditivas [41]. Os parâmetros que apontaram melhoras foram: velocidade [18,20,22,30,34,41], comprimento da passada [22] e comprimento do passo [18,30,34].…”