Dataset Information

Effects of exercise on gait and motor imagery in people with Parkinson disease and freezing of gait.

ABSTRACT:

Introduction

Exercise improves gait in Parkinson disease (PD), but whether exercise differentially affects people with PD with (freezers) and without freezing of gait (non-freezers) remains unclear. This study examines exercise's effects on gait performance, neural correlates related to these effects, and potential neural activation differences between freezers and non-freezers during motor imagery (MI) of gait.

Methods

Thirty-seven participants from a larger exercise intervention completed behavioral assessments and functional magnetic resonance imaging (fMRI) scans before and after a 12-week exercise intervention. Gait performance was characterized using gait velocity and stride length, and a region of interest (ROI) fMRI analysis examined task-based blood oxygen-level dependent (BOLD) signal changes of the somatomotor network (SMN) during MI of forward (IMG-FWD) and backward (IMG-BWD) gait.

Results

Velocity (F(1,34) = 55.04, p < 0.001) and stride length (F(1,34) = 77.58, p < 0.001) were significantly lower for backward versus forward walking in all participants. The ROI analysis showed freezers had lower BOLD signal compared to non-freezers in the cerebellum (F(1,32) = 7.01, p = 0.01), primary motor (left: F(1,32) = 7.09, p = 0.01; right: F(1,32) = 7.45, p = 0.01), and primary sensory (left: F(1,32) = 9.59, p = 0.004; right: F(1,32) = 8.18, p = 0.007) cortices during IMG-BWD only. The evidence suggests the exercise intervention did not affect gait or BOLD signal during MI.

Conclusion

While all participants had significantly slower and shorter backward velocity and stride length, respectively, the exercise intervention had no effect. Similarly, BOLD signal during MI did not change with exercise; however, freezers had significantly lower BOLD signal during IMG-BWD compared to non-freezers. This suggests potential decreased recruitment of the SMN during MI of gait in freezers.

SUBMITTER: Myers PS

PROVIDER: S-EPMC6120800 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Publications

Effects of exercise on gait and motor imagery in people with Parkinson disease and freezing of gait.

Myers Peter S PS McNeely Marie E ME Pickett Kristen A KA Duncan Ryan P RP Earhart Gammon M GM

Parkinsonism & related disorders 20180508

<h4>Introduction</h4>Exercise improves gait in Parkinson disease (PD), but whether exercise differentially affects people with PD with (freezers) and without freezing of gait (non-freezers) remains unclear. This study examines exercise's effects on gait performance, neural correlates related to these effects, and potential neural activation differences between freezers and non-freezers during motor imagery (MI) of gait.<h4>Methods</h4>Thirty-seven participants from a larger exercise intervention ...[more]

PMID: 29754837

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Project description:ObjectiveThe purpose of this study was to determine interrater and test-retest reliability of the Ziegler test to measure freezing of gait (FOG) severity in people with Parkinson disease. Secondary aims were to evaluate test validity and explore Ziegler test duration as a proxy FOG severity measure.MethodsPhysical therapists watched 36 videos of people with Parkinson disease and FOG perform the Ziegler test and rated FOG severity using the rating scale in real time. Two researchers rated 12 additional videos and repeated the ratings at least 1 week later. Interrater and test-retest reliability were calculated using intraclass correlation coefficients (ICCs). Bland-Altman plots were used to visualize agreement between the researchers for test-retest reliability. Correlations between the Ziegler scores, Ziegler test duration, and percentage of time frozen (based on video annotations) were determined using Pearson r.ResultsTwenty-four physical therapists participated. Overall, the Ziegler test showed good interrater (ICC2,1 = 0.80; 95% CI = 0.65-0.92) and excellent test-retest (ICC3,1 = 0.91; 95% CI = 0.82-0.96) reliability when used to measure FOG. It was also a valid measure, with a high correlation (r = 0.72) between the scores and percentage of time frozen. Ziegler test duration was moderately correlated (r = 0.67) with percentage of time frozen and may be considered a proxy FOG severity measure.ConclusionThe Ziegler test is a reliable and valid tool to measure FOG when used by physical therapists in real time. Ziegler test duration may be used as a proxy for measuring FOG severity.ImpactDespite FOG being a significant contributor to falls and poor mobility in people with Parkinson disease, current tools to assess FOG are either not suitably responsive or too resource intensive for use in clinical settings. The Ziegler test is a reliable and valid measure of FOG, suitable for clinical use, and may be used by physical therapists regardless of their level of clinical experience.

Project description:BackgroundCombining action observation (AO) and motor imagery (MI) training may induce greater brain activity in areas usually involved in Parkinson's disease (PD) and lead to greater behavioral and neurophysiological effects than when used separately.AimTo determine the effects of combining AO, MI, and gait training on balance and freezing of gait in individuals with PD.DesignThis is a single-blinded, randomized controlled clinical trial.SettingLaboratory of Intervention and Analysis of Movement (LIAM) from the Department of Physical Therapy of a Brazilian University.PopulationStudy sample consisted of individuals diagnosed with idiopathic PD by a neurologist specialized in movement disorders.Methods39 individuals with PD were divided into experimental (EG=21) and control groups (CG=18). EG performed 12 sessions of AO, MI, and gait training, whereas CG watched PD-related educational videos and performed 12 sessions of gait training. Balance (measured using the Mini Balance Evaluation Systems Test [MiniBESTest]) and freezing of gait (measured using the Freezing of Gait Questionnaire) were reassessed one day after the end of the intervention.ResultsWe did not observe significant intra- and intergroup differences in freezing of gait. For the EG, we observed a significant intragroup difference in the total score of MiniBESTest (F=5.2; P=0.02), and sensory orientation (F=4.5; P=0.04) and dynamic gait (F=3.6; P=0.03) domains. MiniBESTest domains were not different between groups.ConclusionsCombining AO, MI, and gait training was not more effective than isolated gait training for balance and freezing of gait in individuals with PD.Clinical rehabilitation impactMI training can moderate AO effects and enhance motor learning when both therapies are combined. Therefore, this approach may still have the potential to be included in the treatment of PD. New studies should investigate whether the factors that influence these results are related to the protocol's sensitivity in changing the evaluated parameters or to the time and intensity of AO and MI training.

Project description:IntroductionAccording to people with Parkinson's disease (PD), gait impairments are the most disabling motor symptoms of PD. Recently, motor imagery (MI) has gained notoriety as a gait training technique due to the flexibility of its use, however, it has not been demonstrated that causes a superior effect when included in physiotherapy. This study aims to determine if gait training combined with MI has a greater effect on the gait of people with PD than just gait training.MethodsThe GAITimagery is designed as a double-blind, randomized control trial, including a convenience sample in 2 parallel groups (1:1) with two interventions of 2 sessions per week during 6-week and 8-week follow-up. The initial recruitment will be 88 participants with idiopathic PD and unimpaired cognition state, who will be randomly divided into two groups: GAITimagery (GiG) or the active control Gait group (GaG). Both will perform the same gait exercises but only GiG will include MI training. Gait speed is the primary outcome, while Maximum gait speed (m/s) and Gait speed variability are the secondary results. The tertiary outcomes are related to Quality of life, Daily life activities, Freezing of gait, Balance, Mobility, and Gait performance measures to psychometrics and biomechanics instruments. All results will be measured at baseline (t0), post-training (t1), and follow-up assessment (t2) 8 weeks after finished physiotherapy programs.DiscussionThe GAITimagery program standardizes the application of MI exercises related to the improvement of parkinsonian gait at the same time that monitoring the vividness referred by the participants session by session. The effectiveness of this MI-exclusive program includes subjective and objective measurement tools to detect minimal changes after training. This still-to-be-finish study will support the therapeutic decisions on whether or not to allocate session time to imagery exercises depending on the effect size achieved and the comparison with a control gait training.

Dataset Information

Effects of exercise on gait and motor imagery in people with Parkinson disease and freezing of gait.

Introduction

Methods

Results

Conclusion

Publications

Effects of exercise on gait and motor imagery in people with Parkinson disease and freezing of gait.

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