Dataset Information

A Randomized, Controlled Trial of Exercise for Parkinsonian Individuals With Freezing of Gait.

ABSTRACT:

Background

Exercises with motor complexity induce neuroplasticity in individuals with Parkinson's disease (PD), but its effects on freezing of gait are unknown. The objective of this study was to verify if adapted resistance training with instability - exercises with motor complexity will be more effective than traditional motor rehabilitation - exercises without motor complexity in improving freezing-of-gait severity, outcomes linked to freezing of gait, and brain function.

Methods

Freezers were randomized either to the adapted resistance training with instability group (n = 17) or to the active control group (traditional motor rehabilitation, n = 15). Both training groups performed exercises 3 times a week for 12 weeks. The primary outcome was the New Freezing of Gait Questionnaire. Secondary outcomes were freezing of gait ratio (turning task), cognitive inhibition (Stroop-III test), motor signs (Unified Parkinson's Disease Rating Scale part-III [UPDRS-III]), quality of life (PD Questionnaire 39), anticipatory postural adjustment (leg-lifting task) and brain activation during a functional magnetic resonance imaging protocol of simulated anticipatory postural adjustment task. Outcomes were evaluated before and after interventions.

Results

Only adapted resistance training with instability improved all the outcomes (P < 0.05). Adapted resistance training with instability was more effective than traditional motor rehabilitation (in improving freezing-of-gait ratio, motor signs, quality of life, anticipatory postural adjustment amplitude, and brain activation; P < 0.05). Our results are clinically relevant because improvement in the New Freezing of Gait Questionnaire (-4.4 points) and UPDRS-III (-7.4 points) scores exceeded the minimally detectable change (traditional motor rehabilitation group data) and the moderate clinically important difference suggested for PD, respectively. The changes in mesencephalic locomotor region activation and in anticipatory postural adjustment amplitude explained the changes in New Freezing of Gait Questionnaire scores and in freezing-of-gait ratio following adapted resistance training with instability, respectively.

Conclusions

SUBMITTER: Silva-Batista C

PROVIDER: S-EPMC7722148 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Publications

A Randomized, Controlled Trial of Exercise for Parkinsonian Individuals With Freezing of Gait.

Silva-Batista Carla C de Lima-Pardini Andrea Cristina AC Nucci Mariana Penteado MP Coelho Daniel Boari DB Batista Alana A Piemonte Maria Elisa Pimentel MEP Barbosa Egberto Reis ER Teixeira Luis Augusto LA Corcos Daniel M DM Amaro Edson E Horak Fay B FB Ugrinowitsch Carlos C

Movement disorders : official journal of the Movement Disorder Society 20200618 9

<h4>Background</h4>Exercises with motor complexity induce neuroplasticity in individuals with Parkinson's disease (PD), but its effects on freezing of gait are unknown. The objective of this study was to verify if adapted resistance training with instability - exercises with motor complexity will be more effective than traditional motor rehabilitation - exercises without motor complexity in improving freezing-of-gait severity, outcomes linked to freezing of gait, and brain function.<h4>Methods</ ...[more]

PMID: 32557868

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Project description:Freezing of gait is one of the most debilitating symptoms in Parkinson's disease as it causes falls and reduces mobility and quality of life. The pedunculopontine nucleus is one of the major nuclei of the mesencephalic locomotor region and has neurons related to anticipatory postural adjustments preceding step initiation as well as to the step itself, thus it may be critical for coupling posture and gait to avoid freezing. Because freezing of gait and postural impairments have been related to frontal lesions and frontal dysfunction such as executive function, we hypothesized that freezing is associated with disrupted connectivity between midbrain locomotor regions and medial frontal cortex. We used diffusion tensor imaging to quantify structural connectivity of the pedunculopontine nucleus in patients with Parkinson's disease with freezing of gait, without freezing, and healthy age-matched controls. We also included behavioural tasks to gauge severity of freezing of gait, quantify gait metrics, and assess executive cognitive functions to determine whether between-group differences in executive dysfunction were related to pedunculopontine nucleus structural network connectivity. Using seed regions from the pedunculopontine nucleus, we were able to delineate white matter connections between the spinal cord, cerebellum, pedunculopontine nucleus, subcortical and frontal/prefrontal cortical regions. The current study is the first to demonstrate differences in structural connectivity of the identified locomotor pathway in patients with freezing of gait. We report reduced connectivity of the pedunculopontine nucleus with the cerebellum, thalamus and multiple regions of the frontal cortex. Moreover, these structural differences were observed solely in the right hemisphere of patients with freezing of gait. Finally, we show that the more left hemisphere-lateralized the pedunculopontine nucleus tract volume, the poorer the performance on cognitive tasks requiring the initiation of appropriate actions and/or the inhibition of inappropriate actions, specifically within patients with freezing. These results support the notion that freezing of gait is strongly related to structural deficits in the right hemisphere's locomotor network involving prefrontal cortical areas involved in executive inhibition function.

Project description:Parkinson's disease is a neurodegenerative disease characterized by gait dysfunction in the advanced stages of the disease. The unilateral 6-hydroxydopamine toxin-induced model is the most studied animal model of Parkinson's disease, which reproduces gait dysfunction after >68% dopamine loss in the substantia nigra pars compacta. The extent to which the neural activity in hemi-parkinsonian rats correlates to gait dysfunction and dopaminergic cell loss is not clear. In this article, we report the effects of unilateral dopamine depletion on cerebellar vermis activity using micro-electrocorticography during walking and freezing on a runway. Gait and neural activity were measured in 6-hydroxydopamine- and sham-lesioned rats aged between 4 and 5 months at 14, 21 and 28 days after infusion of 6-hydroxydopamine or control vehicle into the medial forebrain bundle (n = 20). Gait deficits in 6-hydroxydopamine rats were different from sham rats at 14 days (P < 0.05). Gait deficits in 6-hydroxydopamine rats improved at 21 and 28 days except for run speed, which decreased at 28 days (P = 0.018). No differences in gait deficits were observed in sham-lesioned rats at any time points. Hemi-parkinsonian rats showed hyperactivity in the cerebellar vermis at 21 days (P < 0.05), but not at 14 and 28 days, and the activity was reduced during freezing epochs in Lobules VIa, VIb and VIc (P < 0.05). These results suggest that dopaminergic cell loss causes pathological cerebellar activity at 21 days post-lesion and suggest that compensatory mechanisms from the intact hemisphere contribute to normalized cerebellar activity at 28 days. The decrease in cerebellar oscillatory activity during freezing may be indicative of neurological changes during freezing of gait in patients with Parkinson's disease making this region a potential location for biomarker detection. Although the unilateral 6-hydroxydopamine model presents gait deficits that parallel clinical presentations of Parkinson's disease, further studies in animal models of bilateral dopamine loss are needed to understand the role of the cerebellar vermis in Parkinson's disease.

Project description:BackgroundThere is a high prevalence of gait impairments in individuals with dementia (IWD). Gait impairments are associated with increased risk of falls, disability, and economic burden for health care systems. Only few studies have investigated the effectiveness of physical activity on gait performance in IWD, reporting promising but inconsistent results. Thus, this study aimed to investigate the effectiveness of a multimodal exercise program (MEP) on gait performance in IWD.MethodsIn this parallel-group randomized controlled trial, we enrolled 319 IWD of mild to moderate severity, living in care facilities, aged ≥ 65 years, and being able to walk at least 10 m. The control group (n = 118) received conventional treatment, whereas the intervention group (n = 201) additionally participated in a 16-week MEP specifically tailored to IWD. We examined the effects of the MEP on spatiotemporal gait parameters and dual task costs by using the gait analysis system GAITRite. Additionally, we compared characteristics between positive, non-, and negative responders, and investigated the impact of changes in underlying motor and cognitive performance in the intervention group by conducting multiple regression analyses.ResultsTwo-factor analyses of variance with repeated measurements did not reveal any statistically significant time*group effects on either spatiotemporal gait parameters or dual task costs. Differences in baseline gait performance, mobility, lower limb strength, and severity of cognitive impairments were observed between positive, non-, and negative responders. Positive responders were characterized by lower motor performance compared to negative and non-responders, while non-responders showed better cognitive performance than negative responders. Changes in lower limb strength and function, mobility, executive function, attention, and working memory explained up to 39.4% of the variance of changes in gait performance.ConclusionsThe effectiveness of a standardized MEP on gait performance in IWD was limited, probably due to insufficient intensity and amount of specific walking tasks as well as the large heterogeneity of the sample. However, additional analyses revealed prerequisites of individual characteristics and impacts of changes in underlying motor and cognitive performance. Considering such factors may improve the effectiveness of a physical activity intervention among IWD.Trial registrationDRKS00010538 (German Clinical Trial Register, date of registration: 01 June 2016, retrospectively registered, https://www.drks.de/drks_web/setLocale_EN.do ).

Dataset Information

A Randomized, Controlled Trial of Exercise for Parkinsonian Individuals With Freezing of Gait.

Background

Methods

Results

Conclusions

Publications

A Randomized, Controlled Trial of Exercise for Parkinsonian Individuals With Freezing of Gait.

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