Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover
Introduction: The progressive modular rebalancing (PMR) system is a comprehensive rehabilitation approach derived from proprioceptive neuromuscular facilitation principles. PMR training encourages focus on trunk and proximal muscle function through direct perception, strength, and stretching exercis...
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Frontiers Media S.A.
2019-08-01
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Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2019.00902/full |
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doaj-5abf06698351473eb2f7cad7c1d2a85b |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mariano Serrao Mariano Serrao Francesco Pierelli Francesco Pierelli Elisabetta Sinibaldi Giorgia Chini Stefano Filippo Castiglia Marina Priori Marina Priori Dario Gimma Giovanni Sellitto Alberto Ranavolo Carmela Conte Michelangelo Bartolo Giuseppe Monari |
spellingShingle |
Mariano Serrao Mariano Serrao Francesco Pierelli Francesco Pierelli Elisabetta Sinibaldi Giorgia Chini Stefano Filippo Castiglia Marina Priori Marina Priori Dario Gimma Giovanni Sellitto Alberto Ranavolo Carmela Conte Michelangelo Bartolo Giuseppe Monari Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover Frontiers in Neurology neurorehabilitation Parkinson's disease gait analysis progressive modular rebalancing system sensory cues |
author_facet |
Mariano Serrao Mariano Serrao Francesco Pierelli Francesco Pierelli Elisabetta Sinibaldi Giorgia Chini Stefano Filippo Castiglia Marina Priori Marina Priori Dario Gimma Giovanni Sellitto Alberto Ranavolo Carmela Conte Michelangelo Bartolo Giuseppe Monari |
author_sort |
Mariano Serrao |
title |
Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover |
title_short |
Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover |
title_full |
Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover |
title_fullStr |
Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover |
title_full_unstemmed |
Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover |
title_sort |
progressive modular rebalancing system and visual cueing for gait rehabilitation in parkinson's disease: a pilot, randomized, controlled trial with crossover |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2019-08-01 |
description |
Introduction: The progressive modular rebalancing (PMR) system is a comprehensive rehabilitation approach derived from proprioceptive neuromuscular facilitation principles. PMR training encourages focus on trunk and proximal muscle function through direct perception, strength, and stretching exercises and emphasizes bi-articular muscle function in the improvement of gait performance. Sensory cueing, such as visual cues (VC), is one of the more established techniques for gait rehabilitation in PD. In this study, we propose PMR combined with VC for improving gait performance, balance, and trunk control during gait in patients with PD. Our assumption herein was that the effect of VC may add to improved motor performance induced by the PMR treatment. The primary aim of this study was to evaluate whether the PMR system plus VC was a more effective treatment option than standard physiotherapy in improving gait function in patients with PD. The secondary aim of the study was to evaluate the effect of this treatment on motor function severity.Design: Two-center, randomized, controlled, observer-blind, crossover study with a 4-month washout period.Participants: Forty individuals with idiopathic PD in Hoehn and Yahr stages 1–4.Intervention: Eight-week rehabilitation programs consisting of PMR plus VC (treatment A) and conventional physiotherapy (treatment B).Primary outcome measures: Spatiotemporal gait parameters, joint kinematics, and trunk kinematics.Secondary outcome measures: UPDRS-III scale scores.Results: The rehabilitation program was well-tolerated by individuals with PD and most participants showed improvements in gait variables and UPDRS-III scores with both treatments. However, patients who received PMR with VC showed better results in gait function with regard to gait performance (increased step length, gait speed, and joint kinematics), gait balance (increased step width and double support duration), and trunk control (increased trunk motion) than those receiving conventional physiotherapy. While crossover results revealed some differences in primary outcomes, only 37.5% of patients crossed over between the groups. As a result, our findings should be interpreted cautiously.Conclusions: The PMR plus VC program could be used to improve gait function and severity motor of motor deficit in individuals with PD.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03346265. |
topic |
neurorehabilitation Parkinson's disease gait analysis progressive modular rebalancing system sensory cues |
url |
https://www.frontiersin.org/article/10.3389/fneur.2019.00902/full |
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doaj-5abf06698351473eb2f7cad7c1d2a85b2020-11-24T21:40:26ZengFrontiers Media S.A.Frontiers in Neurology1664-22952019-08-011010.3389/fneur.2019.00902463574Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With CrossoverMariano Serrao0Mariano Serrao1Francesco Pierelli2Francesco Pierelli3Elisabetta Sinibaldi4Giorgia Chini5Stefano Filippo Castiglia6Marina Priori7Marina Priori8Dario Gimma9Giovanni Sellitto10Alberto Ranavolo11Carmela Conte12Michelangelo Bartolo13Giuseppe Monari14Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, ItalyMovement Analysis Laboratory, Policlinico Italia, Rome, ItalyDepartment of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, ItalyIRCCS Neuromed, Pozzilli, ItalyDepartment of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, ItalyMovement Analysis Laboratory, Policlinico Italia, Rome, ItalyDepartment of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, ItalyDepartment of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, ItalyMovement Analysis Laboratory, Policlinico Italia, Rome, ItalyDepartment of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, ItalyDepartment of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, ItalyDepartment of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, ItalyIRCCS Don Carlo Gnocchi Foundation, Milan, ItalyNeurorehabilitation Unit, Department of Rehabilitation, HABILITA Zingonia, Bergamo, ItalyDepartment of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, ItalyIntroduction: The progressive modular rebalancing (PMR) system is a comprehensive rehabilitation approach derived from proprioceptive neuromuscular facilitation principles. PMR training encourages focus on trunk and proximal muscle function through direct perception, strength, and stretching exercises and emphasizes bi-articular muscle function in the improvement of gait performance. Sensory cueing, such as visual cues (VC), is one of the more established techniques for gait rehabilitation in PD. In this study, we propose PMR combined with VC for improving gait performance, balance, and trunk control during gait in patients with PD. Our assumption herein was that the effect of VC may add to improved motor performance induced by the PMR treatment. The primary aim of this study was to evaluate whether the PMR system plus VC was a more effective treatment option than standard physiotherapy in improving gait function in patients with PD. The secondary aim of the study was to evaluate the effect of this treatment on motor function severity.Design: Two-center, randomized, controlled, observer-blind, crossover study with a 4-month washout period.Participants: Forty individuals with idiopathic PD in Hoehn and Yahr stages 1–4.Intervention: Eight-week rehabilitation programs consisting of PMR plus VC (treatment A) and conventional physiotherapy (treatment B).Primary outcome measures: Spatiotemporal gait parameters, joint kinematics, and trunk kinematics.Secondary outcome measures: UPDRS-III scale scores.Results: The rehabilitation program was well-tolerated by individuals with PD and most participants showed improvements in gait variables and UPDRS-III scores with both treatments. However, patients who received PMR with VC showed better results in gait function with regard to gait performance (increased step length, gait speed, and joint kinematics), gait balance (increased step width and double support duration), and trunk control (increased trunk motion) than those receiving conventional physiotherapy. While crossover results revealed some differences in primary outcomes, only 37.5% of patients crossed over between the groups. As a result, our findings should be interpreted cautiously.Conclusions: The PMR plus VC program could be used to improve gait function and severity motor of motor deficit in individuals with PD.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03346265.https://www.frontiersin.org/article/10.3389/fneur.2019.00902/fullneurorehabilitationParkinson's diseasegait analysisprogressive modular rebalancing systemsensory cues |