Rodrigues A1, Pikel M1, d'Alencar M1, Pimentel Piemonte ME1
1University of Sao Paulo, Physical Therapy, Sao Paulo, Brazil
Background: The increased cognitive supervision is considered a compensatory mechanism to minimize the disruption in gait automaticity associated to dopamine depletion in Parkinson's disease. Then, cognitive strategies (CS) have been recommended for people with Parkinson's disease (PwPD) for improving of the gait performance. Although mental practice (MP) also involves an increased cognitive control on motor performance, it has been little recommended for PwPD due to lack of evidences about its positive results. MP is defined as the repeated use of kinesthetic imagery (internal rehearsal of movements from a first-person perspective without any overt physical movement) to improve motor performance. The internal representation developed by MP is likely based on motor and sensory estimation of planned movement consequences by a top-down process, resulting in an internal forward model. The association between CS and MP could be useful to increase the compensate mechanism's efficency associated to increased cortical control in PD.
Purpose: To compare the effects of two distinct approaches to improve the gait performance in PwPD:
(1) Gait training using CS associate to gait´s MP and
(2) gait training using CS only.
Methods: A blinded, randomized, controlled, longitudinal clinical trial was conducted with 30 idiopathic PwPD diagnosed according Bank of London criteria, mean age of 66.63 years (S.D. = 8.22), mean years of schooling of 10.4 (S.D. =4.7), 16 men, at stages 1-3 of disease evolution according to the Hoehn and Yahr Classification, asymptomatic for depression and dementia. The PwPD were randomly divided into two groups: MP group (MPG) that performed physical gait training guided by CS intercalated with gait MP and Control Group (CG) that performed physical gait training guided by CS only. In order to guarantee a similar volume and condition of training, the CG performed a relaxing MP (not gait´s MP) intercalated with physical gait training. Both groups performed eight session of training. The CS consist of six key movements involved in the gait movement sequence. The primary outcomes were Dynamic gait index (DGI) to evaluate the gait performance under complex condition and Montreal Cognitive assessment (MoCA) to evaluate the cognition. All outcomes were applied at baseline (BT)and 1-week after the training (AT).
Results: Two 2X2 ANOVA using as factor Group (MPG and CG) and Evaluations (BTXAT), being the last one repeated measures, were performed for each outcome score. The results showed a significant interaction between the factors for DGI (F(1, 20)=12.811, p=.001, ES=.99) and MoCA F(1, 20)=6,6844, p=.01, ES=.92). Tukey pos-hoc test (TT) for these measures showed a significant increase in the score for DGI (p=.0001) and MoCA (p=.009) after training only for participants in MPG.
Conclusion(s): The gait´s MP was able to increase the effectiveness of gait training based on CS to improve the gait performance under complex condition and cognitive capacity in PwPD.
Implications: Mental practice may be a powerful approach to increase the efficiency of cortical mechanisms used in PD to compensate automaticity disruption and should be included among the physiotherapeutic options to improve gait performance in PwPD.
Keywords: Automaticity, compensatory strategies, attention
Funding acknowledgements: Fundação Faculdade de Medicina
Brazil Parkinson´s association
Purpose: To compare the effects of two distinct approaches to improve the gait performance in PwPD:
(1) Gait training using CS associate to gait´s MP and
(2) gait training using CS only.
Methods: A blinded, randomized, controlled, longitudinal clinical trial was conducted with 30 idiopathic PwPD diagnosed according Bank of London criteria, mean age of 66.63 years (S.D. = 8.22), mean years of schooling of 10.4 (S.D. =4.7), 16 men, at stages 1-3 of disease evolution according to the Hoehn and Yahr Classification, asymptomatic for depression and dementia. The PwPD were randomly divided into two groups: MP group (MPG) that performed physical gait training guided by CS intercalated with gait MP and Control Group (CG) that performed physical gait training guided by CS only. In order to guarantee a similar volume and condition of training, the CG performed a relaxing MP (not gait´s MP) intercalated with physical gait training. Both groups performed eight session of training. The CS consist of six key movements involved in the gait movement sequence. The primary outcomes were Dynamic gait index (DGI) to evaluate the gait performance under complex condition and Montreal Cognitive assessment (MoCA) to evaluate the cognition. All outcomes were applied at baseline (BT)and 1-week after the training (AT).
Results: Two 2X2 ANOVA using as factor Group (MPG and CG) and Evaluations (BTXAT), being the last one repeated measures, were performed for each outcome score. The results showed a significant interaction between the factors for DGI (F(1, 20)=12.811, p=.001, ES=.99) and MoCA F(1, 20)=6,6844, p=.01, ES=.92). Tukey pos-hoc test (TT) for these measures showed a significant increase in the score for DGI (p=.0001) and MoCA (p=.009) after training only for participants in MPG.
Conclusion(s): The gait´s MP was able to increase the effectiveness of gait training based on CS to improve the gait performance under complex condition and cognitive capacity in PwPD.
Implications: Mental practice may be a powerful approach to increase the efficiency of cortical mechanisms used in PD to compensate automaticity disruption and should be included among the physiotherapeutic options to improve gait performance in PwPD.
Keywords: Automaticity, compensatory strategies, attention
Funding acknowledgements: Fundação Faculdade de Medicina
Brazil Parkinson´s association
Topic: Neurology: Parkinson's disease; Disability & rehabilitation; Older people
Ethics approval required: Yes
Institution: Faculty of Medicine of University of São Paulo
Ethics committee: Ethical commitee of FMUSP
Ethics number: 7896
All authors, affiliations and abstracts have been published as submitted.
