10/7-PD Evidence Intervention

Question 1

What did the 2012 Cochrane collaborative review conclude about physiotherapy vs Placebo or No intervention in PD?

Answer 1

Most short-term benefits from PT were small but of a size that patients would consider meaningful.

Question 2

What were some benefits found from: PT, exercise, treadmill, dance and martial arts, in patients with PD?

Answer 2

Gait: Velocity, step length, 2 and 6 minute walk Functional reach Timed Up and Go Berg Balance Scale Clinician-rated UPDRS

Question 3

In Schenkman’s 2012 study “Stay active with PD” what were groups under comparison?

Answer 3

H&Y stages 1-3, patients with parkinson’s, in a Flexibility/Balance/Function (FBF) group, an Aerobic Endurance (AE) group, and a usual care control group.

Question 4

In Schenkman’s 2012 study “Stay active with PD” what were the results for the FBF group?

Answer 4

Significantly better on CS-PFP at 4 months than control group AE group. Not significantly better at 10 months or 16 months. Significantly better on UPDRS ADL at 16 months (secondary). Not significantly better for FR (functional reach?) at any time point.

Question 5

In Schenkman’s 2012 study “Stay active with PD” what were the results for the AE group?

Answer 5

Walking economy improved in the AE group compared with FBF group at 4 months, FBF group at 16 months. Not significantly different at any time point for any other measure.

Question 6

In Schenkman’s 2012 study “Stay active with PD” what was the conclusion?

Answer 6

Greatest short term benefits for: FBF program led to better overall function for household activities at 4 months. Greatest long term benefits AE group led to better economy of gait over 16 months.All participants: Overall – almost no change in UPDRS scores over 16 months, which is terrific.

Question 7

What were the results of Corcos et. al.’s RCT on resistance exercise for developing strength in patients with PD?

Answer 7

Results: Off medication UPDRS Motor Score:Resistance Exercise group improved substantially more on UPDRS Motor than Control at 24 months.

Question 8

What were the results from the 2012 Li et. al. study on Tai Chi vs Resistance vs Stretching?

Answer 8

Balance measures: Tai chi was better than with strengthening or stretching.Gait measures: Tai chi better than stretching.Falls: Tai chi was better than stretching.UPDRS Motor: Tai chi better than stretching.

Question 9

What did the 2012 Li et. al. study on Tai Chi conclude about Tai Chi vs Resistance?

Answer 9

Tai Chi was not superior to strengthening on any outcome except balance (primary measure).

Question 10

What is the bottom line from 3 recent studies on Exercise and patients with PD?

Answer 10

Flexibility/balance/ function: improves overall ability for household activities; may be hard to continue without a trainer. Aerobic conditioning improves walking efficiency; improvements sustained long term. Resistance exercise improves UPDRS Motor; improvements sustained long term.Tai Chi improves balance; also improves walking, UPDRS Motor, reduces falls.

Question 11

What is the bottom line FOR CLINICIANS from 3 recent studies on Exercise and patients with PD?

Answer 11

Different exercise approaches have different benefits. Patient’s greatest problems can help determine the right approach. Short-term benefits are not sufficient. Decide with patient what s/he can do to sustain the benefits. May need a program that addresses a combination of issues (strength, flexibility, aerobic exercise, balance).Consider a directed exercise program followed bygeneral activities (e.g., dance, group high intensityexercise).Need studies!

Question 12

What does the 2011 Ahlskog et.al. study from the Harvard health database conclude about Evidence related to vigorous activity and PD?

Answer 12

Retrospective evidence – suggests midlife, regular exercise reduces risk of subsequent PD. Exercise reduces cognitive impairment in general population: Prospective and retrospective evidence, Studies of older people with / without dementia. Animal models – physical exercise enhances brain plasticity.

Question 13

What is the evidence for exercise being neuro-protective against PD?

Answer 13

Animal studies (rodents, primates) suggest thatexercise might be neuroprotective for PD. Studies are needed in humans but areexpensive

Question 14

What were the results of a study using forced tandem biking (where pts w/ PD pedaled 30% faster than voluntary rate)?

Answer 14

large drop in UPDRS motor score, but this score regressed back to control group after discontinued forced tandem biking.

Question 15

what were the conclusions about imagery and exercise for pts w/ PD?

Answer 15

positive outcomes for pts who used imagery before practice.

Question 16

what were the results of cueing training for pts w/ PD?

Answer 16

people w/ auditory stimulation did the best, people who imagined the beat did 2nd best. No lasting effects after beat taken away. improved freezing by 5.5%, increased step length by 4cm, falls efficacy improved.

Question 17

What is the protocol for using rhythmic auditory stimulation (RAS) in pts with PD?

Answer 17

find pt’s natural cadence. gradually increase (10% increment). Build up to normal cadence of 112 to 116 steps/min. Use metronome or tone embedded in music, or music w/ specific tempo.

Question 18

What are good PT interventions for pts with PD to reduce sequelae?

Answer 18

Spinal flexibility exercises Strength training Endurance training Combination programs

Question 19

A study under review by Stevens-Lapsley and Schenkman found what about strength in pts with PD?

Answer 19

If the UPDRS motor and force scores were under 30, than those pts had no difference in quadriceps force and central activation. for scores greater than 30, there was significant decrease in force and ability to control activation.

Question 20

what did the 2006 study by Dibble et al find in pts with PD who underwent eccentric LE training compared to control?

Answer 20

after 12 weeks the eccentric training group had improved quadriceps muscle volume, improved stair descent, improved 6 min walk.

Question 21

What is Morris et al (ongoing study) finding about strategy training to help reduce falls?

Answer 21

Strategy training alone does not reduce falls, so probably need a multi-factorial approach.

Question 22

What is significant about postural instability in pts with PD and what are the causes?

Answer 22

postural instability is a cardinal sign of PD, and does not necessarily mean pt a higher fall risk. Postural instability is from a loss of postural response mechanisms. ROM loss, altered alignment, dystonic posturing, cognitive/emotional elements contribute to postural instability.

Question 23

Which dance style has been studied in PD, why, and what are the results?

Answer 23

Tango, because it has critical elements related to PD like walking backwards, rhythm, and moving in relation to partner. 28% improvement in UPDRS-III score. Case study also showed improvement in H&Y stage IV 86yo man with rapidly progressing PD.

Question 24

What are exercise guidelines for early stage pts with PD?

Answer 24

Keep active, Emphasize activities that specificallychallenge balance control. Tango Dance. Consider need for flexibility, strength, andeconomy of movement. ‘Training Big’. Sensorimotor agility program early.

Question 25

Intervention Strategies- Middle Stage of PD

Answer 25

Sensorimotor agility program to delay mobilitydisability. Strategies training. Maintain / regain flexibility, aerobic capacity. Training Big’. Combining the approaches.

Question 26

Intervention Strategies- Late Stage of PD

Answer 26

Intervention to improve balance and gaitis appropriate for people in Stage 4. Few studies from which to identify guidelines for intervention.