Effect of Muscle Vibration on Spatiotemporal Gait Parameters in Patients with Parkinson’s Disease

[Purpose] The purpose of this study was to investigate the effect of muscle vibration in the lower extremities in patients with Parkinson’s disease (PD) during walking. [Subjects] Nine patients with PD participated in this study and were tested with and without vibration (vibration at 60 Hz). [Methods] Eight oscillators of vibration were attached to the muscle bellies (tibialis anterior, gastrocnemius, biceps femoris, and rectus femoris) on both sides of the lower extremities with adhesive tape in this study. Spatiotemporal gait parameters were measured using a motion analysis system. [Results] Stride length and walking speed with vibration were significantly increased compared with those without vibration in PD patients. [Conclusion] These results suggest that the application of vibration to lower extremity muscles in patients with PD may improve the parkinsonian gait pattern.Key words: Parkinson’s disease, Muscle vibration, Spatiotemporal gait parameter     

Tai Chi and Parkinson’s disease (PD): A systematic overview of the scientific quality of the past systematic reviews

ObjectivesThe aim of the current study was to assess the scientific quality of the past systematic reviews regarding the application of Tai Chi in the management of Parkinson’s disease (PD) using a systematic overview.MethodsThe search of PubMed and PsycInfo in February 2018 identified k=10 relevant systematic reviews published in 2008–2017 with terms PD, Tai Chi, and review in titles or abstracts. The quality of reviews was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR2) and the quality of meta-analytic procedures was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsThe k=10 systematic reviews assessed various outcomes of Tai Chi in PD using a qualitative (k = 4) or a quantitative synthesis (meta-analysis; k = 6) of data from up to 14 primary studies published in English. The review strengths were the comprehensive search for literature, data coding, and data quality assessment. The review limitations were the high overlap in the primary data and the lack of either the review protocol, the list of excluded studies or the conflict of interest statement in the primary studies. The critical problems were that the qualitative data synthesis relied on the statistical significance of results in the primary studies with small sample sizes and that the computational details of meta-analysis were inadequately reported.ConclusionsThe past systematic reviews suggest that Tai Chi is a promising complementary treatment for PD. However, the quality of such past reviews is limited. Future systematic reviews can be improved by adequately reporting the methodological details and adhering to the guidelines for conducting such reviews. The clinical relevance of Tai Chi in terms of the magnitude and the longer-term durability of its outcomes should be tested in future RCTs with larger sample sizes.     

Effects of Exercise on Non-motor Symptoms in Parkinson’s Disease

Patients with Parkinson’s disease experience disabling non-motor symptoms, including autonomic dysfunction, cognitive decline, and sleep disorders. Pharmacologic treatments for these symptoms are often ineffective or have intolerable side effects. Therefore, non-pharmacologic interventions are an attractive alternative. Exercise in particular has the potential to alleviate the progressive impairment related to these non-motor symptoms. In this commentary, we explore available research that addresses the impact of exercise and physical activity on autonomic dysfunction, cognitive impairment, and sleep disorders in Parkinson’s disease and suggest areas in need of further study. Many gaps remain in our understanding of the most effective exercise intervention for these symptoms, the mechanisms underlying exercise-induced changes, and the best way to monitor response to therapy. However, available research suggests that exercise is a promising approach to improve non-motor symptoms in patients with Parkinson’s disease.     

Effects of Home Exercise on Physical Function and Activity in Home Care Patients with Parkinson’s Disease

[Purpose] The aim of this study was to clarify the effects of guidance in home exercise on physical function and the amount of activity in home care patients with Parkinson’s disease (PD). [Subjects and Methods] A 2-month home exercise intervention consisting of self-administered exercise by patients (self-exercise) and home visit exercise therapy guided by a physical therapist (home visit exercise) was conducted in 10 home care patients with PD to compare changes in physical function, activities of daily living, and postural status between before and after the intervention. [Results] A decreased number of chief complaints and alleviation of fear of falling were observed after the intervention. In terms of physical function, a significant increase in flexibility and muscle strength were observed, although no significant changes were found in activities of daily living, gait, and balance. Although there was no significant change in the total amount of daily physical activity, the analysis of daily posture changes revealed a significant reduction in the percentage of time spent lying down and a significant increase in the percentage of time spent sitting after the intervention. [Conclusion] Guidance in home exercise in home care patients with PD can be effective in making self-exercise a habit, improving range of motion and muscle strength, and reducing the time spent in a supine position.Key words: Exercise therapy, Home care patients with Parkinson’s disease, Physical activity     

The Effect of tDCS on Cognition and Neurologic Recovery of Rats with Alzheimer’s Disease

[Purpose] This study examined the effect of the application of transcranial direct current stimulation (tDCS) on neurologic recovery and cognitive function of rats with Alzheimer-like dementia induced by scopolamine injections. [Subjects] To create a cognition dysfunction model, intraperitoneal injection of scopolamine was given to Sprague-Dawley rats that subsequently received tDCS for 4 weeks. [Methods] Changes in motor behavior were evaluated by conducting an open field test. Acetylcholine content in the cerebral cortex and hippocampus was examined for a biochemical assessment. [Results] With respect to changes in motor behavior, group II showed the most meaningful difference after scopolamine injection, followed by group III. In the biochemical assessment, the results of the examination of acetylcholine content in the tissue of the cerebral cortex and the hippocampus on the 14th and 28th days, respectively, showed the most significant increase in group II, followed by group III. [Conclusion] The above findings confirm that tDCS application after the onset of cognitive dysfunction caused by Alzheimer’s disease leads to a positive effect on motor behavior and biochemical changes, and this effect is maintained over a specific period of time.Key words: tDCS, Neurologic recovery, Alzheimer’s disease     

Effects of Balance and Gait Training on the Recovery of the Motor Function in an Animal Model of Parkinson’s Disease

[Purpose] This study was conducted to investigate the effect of balance and gait training on the recovery of the motor function in a Parkinson’s disease animal models. [Subjects and Methods] A total of 40 mice were randomly classified into four groups with 10 in each group: Group I-Normal; Group II-Parkinson’s disease and no training; Group III-Parkinson’s disease and balance training was performed; and Group IV-Parkinson’s disease and gait training. Parkinson’s disease was induced by administration of MPTP to animals in Groups II–IV. Groups III and IV did training once a day, five days a week, for four weeks. Neurobehavioral evaluation was performed through the pole and open-field tests. Immunological evaluation was performed via TH (tyrosine hydroxylase) protein expression, using western blot analysis. [Results] In the result of the pole test, Groups III and IV showed significantly greater motor function recovery than to Group II. The results of the open-field test also showed that Groups III and IV had significantly greater motor function recovery than to Group II, and Group IV showed significantly greater motor function recovery than to Group III. Using western blot analysis, we determined that the expression of TH protein in the corpus striatum was greatest in group I, followed by Groups III and IV, and that Group II had the lowest TH protein expression in the corpus striatum. [Conclusion] The results of this study showed that balance and gait training were effective at recovering the motor functions of a Parkinson’s disease animal models induced by MPTP, and that gait training was more effective than balance training.Key words: Parkinson’s disease, Balance training, Gait training     

Influence of Functional Movement Rehabilitation on Quality of Life in People with Parkinson’s Disease

[Purpose] Parkinson’s disease is one of the most frequent diseases of the central nervous system. Thorough knowledge of reasons for movement defects may contribute to the ability to quality of life at a good level as far as motor abilities are concerned. The aim of the study was to evaluate the influence of functional movement rehabilitation on the degree of intensity of movement symptoms in Parkinson’s disease. [Subjects] The research was carried out in people diagnosed with stage III Parkinson’s disease, according to the Hoehn and Yahr scale classification. [Methods] In order to establish the clinical state of patients, parts I, II, and III of the Unified Parkinson’s Disease Rating Scale, the Schwab and England Activities of Daily Living scale, and the quality of life in Parkinson’s disease questionnaire were applied. The intervention group took part in 60 minutes of functional movement rehabilitation twice a week for a period of 15 weeks. The main emphasis was placed on the ability to cope with everyday activities. [Results] A significant difference in scores for the given scales between before and after research the intervention period was observed in the intervention group. [Conclusion] The obtained results revealed positive that the influence of applied rehabilitation program had a positive influence on the degree of intensity of movement symptoms in people with Parkinson’s disease.Key words: Parkinson’s disease, Functional movement rehabilitation, Quality of life     

Effect of the Intrinsic Foot Muscle Exercise Combined with Interphalangeal Flexion Exercise on Metatarsalgia with Morton’s Toe

[Purpose] This study examined the effects of the intrinsic foot muscle exercise combined with interphalangeal flexion exercise on metatarsalgia with Morton’s toe. [Subject] A 38-year-old male with Morton’s toe, who complained of pain in his left metatarsophalangeal joints was the subject. [Methods] The pressure pain threshold, peak contact pressure of the metatarsophalangeal region during gait, and the navicular drop were measured before and after the intrinsic foot muscles exercises combined with interphalangeal flexion exercise. [Results] After exercising for 2 weeks, the pressure pain threshold increased from 1 to 1.5 kg, while the peak contact pressure decreased from 0.63 to 0.50 kg/cm², and the navicular drop improved from 5 to 8 mm. [Conclusion] The results show that the combined exercises alleviated the pain while walking by reducing the excessive pressure on the metatarsophalangeal region, and the improvement of gait with Morton’s toe.Key words: Contact pressure, Interphalangeal flexion, Metatarsalgia     

Can Walking Ability Enhance the Effectiveness of Breathing Exercise in Children with Spastic Cerebral Palsy?

[Purpose] The purpose of this study was to compare differences in respiratory pressure and pulmonary function and the effectiveness of respiratory feedback training according to walking ability in children with cerebral palsy (CP). [Subjects and Methods] Twenty-three children with spastic CP were enrolled in the final analysis and were divided into an independent walking group (n=12) and non-independent walking group. All children received respiratory feedback training for four weeks. Before and after the training, respiratory muscle strength was measured and a pulmonary function test was performed. [Results] Comparison of respiratory pressure and pulmonary function test results between the two revealed that the independent walking group had significantly higher respiratory function than the other group in all variables except peak expiratory flow. In comparison of changes in respiratory function between the two groups, the independent walking group showed significantly higher improvement of respiratory function in terms of maximal inspiratory pressure, maximal expiratory pressure, and forced vital capacity. [Conclusion] These findings showed that children with independent walking ability had better respiratory muscle strength and pulmonary function compared with children without independent walking ability. Understanding respiratory function and the effectiveness of respiratory training according to walking ability will be valuable clinical information for respiratory assessment and therapy in children with CP.Key words: Cerebral palsy, Respiratory function, Walking ability     

The Safety of Fecal Microbiota Transplantation for Crohn’s Disease: Findings from A Long-Term Study

Introduction

Fecal microbiota transplantation (FMT) has been used as a potential treatment option for Crohn’s disease (CD). However, there is still lack of safety and efficacy evidence based on large samples of CD undergoing FMT. This study aimed to evaluate the risk factors of adverse event (AE) in the long term and the efficacy of FMT in the short term for patients with CD.

Methods

FMT via mid-gut for mild to severe CD in a single center trial (NCT01793831) was performed from October 2012 to December 2016. The possible factors with AE and efficacy after FMT were prospectively recorded.

Results

A total of 184 frequencies of FMT were performed for 139 patients who received FMT. During 1 month after FMT, 13.6% of mild AEs occurred, including increased frequency of defecation, fever, abdominal pain, flatulence, hematochezia, vomiturition, bloating and herpes zoster. No AE beyond 1 month was observed. Therefore, a 1 month cut-off could be suggested to define short-term and long-term AEs of FMT. Among the possible risk factors, only fecal microbiota purification methods were closely associated with the occurrence of AEs. The rate of AEs in patients undergoing manual methods for the preparation of fecal microbiota was 21.7%, which was significantly higher than the 8.7% in those experiencing an automatic method. The manual or automatic purification of fecal microbiota had no correlation with the efficacy of FMT.

Conclusion

This cohort study based on the largest size of cases demonstrated that improved fecal microbiota preparation reduced the rates of AEs, but did not affect the clinical efficacy in patients with CD.

     

Clash of the microbes: let’s bring back the good guys

A 38-year-old man with a history of HIV infection virologically suppressed on antiretroviral therapy presents to his gastroenterologist for evaluation of iron deficiency anemia and weight loss. A diagnostic colonoscopy demonstrates a two-centimeter ulcerated mass in the cecum. Biopsies of the lesion return moderately differentiated adenocarcinoma that is wild type for the KRAS mutation by real-time PCR.It is truly fascinating that we are only 10% human, sorely outnumbered by the intestinal bacteria we harbor within (1). Our incredibly complex microbiome is functionally an organ unto itself, weighing up to 1 kg and serving as a “virtual bioreactor” that facilitates digestion, nutrient absorption, and the trajectory of our immune system (1). Intuitively, alterations in the composition of our intestinal symbionts may have as much impact on our health as other major medical interventions. There has been an explosion of interest in probiotics over the last decade. On the shelves of supermarkets and pharmacies nationwide, this markedly heterogeneous class of medications promises improved colonic health, digestive regularity, and overall well-being. Mechanistically, probiotics are believed to modulate intestinal immune function by increasing secretory IgA, reducing proinflammatory cytokine production, enhancing mucosal barrier function, and reducing bacterial attachment (1). There is mounting evidence to support the use of various probiotics for infectious and Clostridium difficile–associated diarrhea, irritable bowel syndrome, inflammatory bowel disease and post-surgical complications thereof (i.e. pouchitis), and hepatic encephalopathy (1). Emerging studies lend credence to the concept that modulation of intestinal flora can provide benefit in HIV infection. Within days following infection, there is a rapid and sustained depletion of gut mucosal CD4⁺ T cells in HIV-positive individuals (ref. 2 and Figure ​Figure1).1). In particular, there is a massacre of gastrointestinal-associated (GI-associated) CD4⁺ Th17 cells, which differentiate in response to normal bacterial microflora (3). This depletion, combined with local immune activation, is thought to directly contribute to defective mucosal barrier function, increased intestinal permeability, augmented translocation of intestinal microbial products, and to the vulnerability of opportunistic infection (4). Importantly, antiretroviral therapy (ART) does not readily reverse these deficits in the GI mucosa, which can persist despite reconstitution of the peripheral CD4⁺ repertoire (5). It has been hypothesized that systemic immune activation may be reduced by enhancing the mucosal barrier, decreasing the degree of translocated microbial products, or both. The latter is being addressed in a clinical investigation of rifaximin in HIV-infected subjects ({"type":"clinical-trial","attrs":{"text":"NCT01466595","term_id":"NCT01466595"}}NCT01466595). Probiotics may have an important adjunctive role in addressing the former ({"type":"clinical-trial","attrs":{"text":"NCT01439841","term_id":"NCT01439841"}}NCT01439841). Open in a separate windowFigure 1Endoscopic and histological analysis of the terminal ileum in an HIV-uninfected (A) and HIV-infected patient (B). Immunohistological staining for CD4 was performed by sectioning biopsies from ileal lymphoid tissue followed by H&E staining and immunostaining for CD4 (C and D). Reproduced with permission from The Journal of Experimental Medicine (2). Probiotics have been safely administered to subjects with HIV, have alleviated GI symptoms associated with viral replication, have proven active against bacterial vaginosis in HIV-infected women, and have enhanced growth in infants with congenitally acquired infection (6). However, the effects of probiotics on the mucosal immune environment in HIV-infected patients are currently unknown. In this issue of the JCI, Klatt et al. demonstrate that the addition of a prebiotic/probiotic mixture to ART enhances mucosal immunity in SIV-infected pigtail macaques by reconstituting GI CD4⁺ T cells and decreasing inflammation-associated fibrosis in the gut-associated lymphoid tissue (GALT) (7). The results are intriguing and expand our perspective on the potential impact of probiotics in HIV infection. But is this reconstitution clinically important? As the case illustrates, many patients infected with HIV are not considered to be at average risk for colorectal cancer. HIV-infected patients have been shown to have a higher prevalence of colon cancer, to develop adenocarcinomas at a younger age, and to develop more aggressive lesions compared with HIV-uninfected controls (8). They also have a predilection toward developing right-sided adenomas that may escape colonoscopic detection and result in delays in diagnosis and care. The increased prevalence of GI cancer in HIV is not limited to the colon; recent data suggest that patients with AIDS are at increased risk for esophageal and gastric carcinoma as well (9). These features may be due to a lack of appropriate host immune surveillance in the gut, increased intestinal inflammation and reactive oxygen species associated with the immunopathogenic effect of HIV, and/or the presence of certain opportunistic enteropathogens. Despite these findings, national and societal guidelines do not currently recommend earlier or more frequent screening colonoscopies in HIV-infected patients (10). One could imagine a scenario whereby reconstitution of the GI CD4⁺ compartment with probiotics could enhance immune surveillance, promote cancer cell apoptosis, and in some capacity, restore the colonic mucosa to its native pre-HIV state. The authors imply that one of the mechanisms behind GI immune reconstitution with probiotic administration is a reduction in inflammation-associated fibrosis within the lymphoid follicles of the GI tract. Perhaps probiotics also reduce the amount of oxidative stress on the colon in the same manner, a feature of colitis-associated carcinogenesis that may partially explain the increased prevalence of colon cancer in HIV patients. The use of probiotics may be an inexpensive, noninvasive, and generally well-tolerated adjunctive treatment for HIV, should further research support this indication.     

Experiential Learning: Transforming Theory into Practice through the Parkinson’s Disease Buddy Program

Abstract

Problem: Persons over age 65 constitute a large proportion of patients presenting for healthcare services; therefore, physicians must be prepared to provide care to patients that face degenerative neurological diseases. Medical students can have difficulty identifying and caring for older patients with neurological difficulties, and often perceive neurology to be a challenging specialty. Medical education service-learning programming that engages community members and medical students, while fostering specialized neurology training, may help improve care for this patient population. Intervention: We developed the Parkinson’s Disease Buddy Program for first year medical students (M1s), which involved pairing students with patients with Parkinson’s disease (PD) to engage in a social relationship. Students attended monthly seminars covering a range of topics specific to PD patient care and met with their PD buddies throughout the year. A mixed-methods approach was used to evaluate the program and involved pre/post assessments, as well as focus groups with both students and patients. Context: The University of Louisville’s School of Medicine and College of Education implemented this volunteer service-learning program for students by partnering with a locally based nonprofit, dedicated to serving PD patients. A total of 70 (35 M1s and 35 PD patients) participated. Outcome: Students’ total correct PD knowledge scores significantly increased after participation with a large effect size (pre-test mean?=?14.77, [SD?=?2.57]; post-test mean?=?19.69 [SD?=?2.06], Cohen’s d?=?1.64) and a paired t-test indicated a significant change in students’ Parkinson’s Attitude Scale scores (t (34) = 2.22, p < .05). Ninety-one percent of students (31) indicated they would recommend the program and 82% (29) indicated they would participate again. During focus groups, students reflected on the relationships they formed with their buddies, indicating the program provided a support system while helping them learn about PD. Patients indicated the program expanded their social circle and meetings with M1s were beneficial. Lessons Learned: An experiential learning opportunity can help medical students become better acquainted with patients living with a neurological disease. We identified an impact on PD patients’ self-efficacy and social behavior that was not originally expected. We learned the importance of incorporating active learning modalities such as PD buddy panels and peer-to peer group discussions. The resources required to implement programs like ours can be lightened by engaging with local community partners and collaborating within and outside departments.     

Oral rehabilitation of a Parkinson’s patient: A case report

Parkinson’s disease is an idiopathic disorder of the central nervous system, characterized by resting tremors, muscular rigidity, slow and decreased movements. Oral rehabilitation of these patients requires special care, especially in those cases where the patient’s socioeconomic status is not good and patient cannot come several times for fabrication of a complete denture. This clinical report presents a case of a Parkinson’s patient who was completely rehabilitated in 3 appointments using special techniques. Border molding, final impression and jaw relation procedures were done in one appointment by using a custom tray with detachable handles and occlusal rims.     

Exenatide and the treatment of patients with Parkinson’s disease

Background. There is increasing interest in methods to more rapidly and cost-efficiently investigate drugs that are approved for clinical use in the treatment of another condition. Exenatide is a type 2 diabetes treatment that has been shown to have neuroprotective/neurorestorative properties in preclinical models of neurodegeneration. Methods. As a proof of concept, using a single-blind trial design, we evaluated the progress of 45 patients with moderate Parkinson’s disease (PD), randomly assigned to receive subcutaneous exenatide injection for 12 months or to act as controls. Their PD was compared after overnight withdrawal of conventional PD medication using blinded video assessment of the Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), together with several nonmotor tests, at baseline, 6 months, and 12 months and after a further 2-month washout period (14 months). Results. Exenatide was well tolerated, although weight loss was common and l-dopa dose failures occurred in a single patient. Single-blinded rating of the exenatide group suggested clinically relevant improvements in PD across motor and cognitive measures compared with the control group. Exenatide-treated patients had a mean improvement at 12 months on the MDS-UPDRS of 2.7 points, compared with mean decline of 2.2 points in control patients (P = 0.037). Conclusion. These results demonstrate a potential cost-efficient approach through which preliminary clinical data of possible biological effects are obtainable, prior to undertaking the major investment required for double-blind trials of a potential disease-modifying drug in PD. Trial registration. Clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01174810","term_id":"NCT01174810"}}NCT01174810. Funding. Cure Parkinson’s Trust.     

Assessing postural balance in early Parkinson’s Disease—validity of the BDL balance scale

Background: There is a need for a valid assessment test of balance in early Parkinson’s disease (PD). Objective: To validate the Bäckstrand Dahlberg Liljenäs Balance Scale (BDL), a test of balance performance constructed to assess mild to moderate balance disability due to neurological disease, for use in persons with early PD. Methods: Cross-sectional psychometric evaluation study from a convenience sample community-dwelling persons with PD (n = 28). Main measures: The BDL was validated using the Berg Balance Scale (BBS), the motor part of the Unified Parkinson’s Disease Rating Scale (mUPDRS), the Timed Up and Go (TUG) and Timed Up and Go-cognition (CTUG). Correlations were calculated by Spearman’s rank correlation coefficient (rho). Rasch analyses were used to test the internal construct of the BDL. The result from the BDL was compared to a healthy reference group. Results: The correlation between the BDL and the BBS (rho = 0.703) was high positive, while for mUPDRS (rho = ?0.280), TUG (rho = ?0.321) and CTUG (rho = ?0.361) the correlations with the BDL were negligible to low negative. The Rasch analyses for the BDL showed a good distribution of the task difficulties with neither ceiling nor floor effect among individual measures. There was a significant difference (p = 0.03) in performance of the BDL between the PD group and the healthy reference group. Conclusions: The BDL Balance Scale can be considered a valid clinical assessment test when evaluating balance training interventions in persons with early PD. It can be recommended as an outcome measure in clinical practice and in clinical research within this population.