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Pimentel Piemotne M.E.1,2, d'Alencar M.1, Dionisio C.1, Oliveira T.1
1University of Sao Paulo, Physical Therapy, Sao Paulo, Brazil, 2Neuromat Project, Sao Paulo, Brazil
Background: The automaticity has been defined as the ability to control the tasks with minimal attentional supervision on motor components. The lack in automaticity due to dopamine depletion in nigro-striatal circuits is considered a pivotal of several motor alterations of Parkinson's disease. Deficits exhibited by people with PD (PPD) during performance of dual-tasks (DT) have also been associated with lack of automatic control. That is, patients tend to engage attentional control in order to compensate for the impaired automatic control of motor performance. Consequently, the remaining attentional resources are not enough to support performance of the secondary task. Functionality for daily living activities (ADL) dependent on the ability to perform movements under dual-task conditions. This would explain why PD patients exhibit difficulties for ADL, that is, their disturbance would be related to loss in automaticity.
Purpose: To investigate the association between lack in automaticity and independence in daily living activities in PPD.
Methods: Thirty PPD in stage 1 to 3 according to Hoehn and Yahr classification, treated with levodopa, age 60 to 80 years, took part in the study. All PD patients were tested in ON period of dopaminergic reposition medication. The automaticity was evaluated by cost effect that was expressed by time to walk 10 meters in condition without demand for attention division, i.e., single-task condition (ST) as one hundred percent and by calculating the percentage of reduction of the corresponding performance in the DT condition. The independence in ADL was evaluated by Section II of Unified Parkinsons Disease Rating Scale (UPDRS-II). All participants were evaluated by Montreal Cognitive Assessment, to assess cognitive decline; Geriatric Depression Scale, to assess depression; Mini Balance Evaluation Systems Test (MiniBESTest), to assess balance and UPDRS, to assess motor impairment and disability in Parkinsons disease.
Results: All participants showed a significant increase in time to walk 10 meters under DT condition (p .01, ES>,95). The cost effect was correlated with scores in UPDRS II (R=.80, p=.0001), regardless of disease stage, age, depression, cognitive decline, balance impairments and severity of motor symptoms.
Conclusion(s): The lack in automaticity in PD decreases the ability to perform routine tasks that demand attention division between motor components and environment, decreasing the independence in ADL.
Implications: To preserve or recovery the automaticity should be a therapeutic purpose of physiotherapy treatment for PPD in order to improve or preserve the independence in ADL.
Funding acknowledgements: FAPESP Research, Innovation and Dissemination Center for Neuromathematics (grant #2013/ 07699-0 , S.Paulo Research Foundation
Topic: Neurology: Parkinson's disease
Ethics approval: All patients signed a term approved by Faculty of Medicine University of São Paulo
All authors, affiliations and abstracts have been published as submitted.
