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Do Patients With Parkinson's Disease With Freezing of Gait Respond Differently Than Those Without to Treadmill Training Augmented by Virtual Reality?
Neurorehabil Neural Repair. 2020 05; 34(5):440-449.NN

Abstract

Background.

People with Parkinson's disease and freezing of gait (FOG+) have more falls, postural instability and cognitive impairment compared with FOG-.

Objective.

To conduct a secondary analysis of the V-TIME study, a randomized, controlled investigation showing a greater reduction of falls after virtual reality treadmill training (TT + VR) compared with usual treadmill walking (TT) in a mixed population of fallers. We addressed whether these treadmill interventions led to similar gains in FOG+ as in FOG-. Methods. A total of 77 FOG+ and 44 FOG- were assigned randomly to TT + VR or TT. Participants were assessed pre- and posttraining and at 6 months' follow-up. Main outcome was postural stability assessed by the Mini Balance Evaluation System Test (Mini-BEST) test. Falls were documented using diaries. Other outcomes included the New Freezing of Gait Questionnaire (NFOG-Q) and the Trail Making Test (TMT-B).

Results.

Mini-BEST scores and the TMT-B improved in both groups after training (P = .001), irrespective of study arm and FOG subgroup. However, gains were not retained at 6 months. Both FOG+ and FOG- had a greater reduction of falls after TT + VR compared with TT (P = .008). NFOG-Q scores did not change after both training modes in the FOG+ group.

Conclusions.

Treadmill walking (with or without VR) improved postural instability in both FOG+ and FOG-, while controlling for disease severity differences. As found previously, TT + VR reduced falls more than TT alone, even among those with FOG. Interestingly, FOG itself was not helped by training, suggesting that although postural instability, falls and FOG are related, they may be controlled by different mechanisms.

Authors+Show Affiliations

KU Leuven, Leuven, Belgium.Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.Newcastle University, Newcastle upon Tyne, UK.Newcastle University, Newcastle upon Tyne, UK.Radboud University Medical Center, Nijmegen, The Netherlands.Radboud University Medical Center, Nijmegen, The Netherlands.University of Genoa, Genoa, Italy. IRCCS Ospedale Policlinico San Martino, Genoa, Italy.University of Genoa, Genoa, Italy. IRCCS Ospedale Policlinico San Martino, Genoa, Italy.University of Sassari, Sassari, Italy. Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy.University of Sassari, Sassari, Italy. Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy.Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Rush University Medical Center, Chicago, IL, USA.KU Leuven, Leuven, Belgium.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32202203

Citation

Bekkers, Esther M J., et al. "Do Patients With Parkinson's Disease With Freezing of Gait Respond Differently Than Those Without to Treadmill Training Augmented By Virtual Reality?" Neurorehabilitation and Neural Repair, vol. 34, no. 5, 2020, pp. 440-449.
Bekkers EMJ, Mirelman A, Alcock L, et al. Do Patients With Parkinson's Disease With Freezing of Gait Respond Differently Than Those Without to Treadmill Training Augmented by Virtual Reality? Neurorehabil Neural Repair. 2020;34(5):440-449.
Bekkers, E. M. J., Mirelman, A., Alcock, L., Rochester, L., Nieuwhof, F., Bloem, B. R., Pelosin, E., Avanzino, L., Cereatti, A., Della Croce, U., Hausdorff, J. M., & Nieuwboer, A. (2020). Do Patients With Parkinson's Disease With Freezing of Gait Respond Differently Than Those Without to Treadmill Training Augmented by Virtual Reality? Neurorehabilitation and Neural Repair, 34(5), 440-449. https://doi.org/10.1177/1545968320912756
Bekkers EMJ, et al. Do Patients With Parkinson's Disease With Freezing of Gait Respond Differently Than Those Without to Treadmill Training Augmented By Virtual Reality. Neurorehabil Neural Repair. 2020;34(5):440-449. PubMed PMID: 32202203.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Do Patients With Parkinson's Disease With Freezing of Gait Respond Differently Than Those Without to Treadmill Training Augmented by Virtual Reality? AU - Bekkers,Esther M J, AU - Mirelman,Anat, AU - Alcock,Lisa, AU - Rochester,Lynn, AU - Nieuwhof,Freek, AU - Bloem,Bastiaan R, AU - Pelosin,Elisa, AU - Avanzino,Laura, AU - Cereatti,Andrea, AU - Della Croce,Ugo, AU - Hausdorff,Jeffrey M, AU - Nieuwboer,Alice, Y1 - 2020/03/23/ PY - 2020/3/24/pubmed PY - 2021/4/20/medline PY - 2020/3/24/entrez KW - Parkinson’s disease KW - falls KW - freezing of gait KW - postural control KW - rehabilitation KW - virtual reality SP - 440 EP - 449 JF - Neurorehabilitation and neural repair JO - Neurorehabil Neural Repair VL - 34 IS - 5 N2 - Background. People with Parkinson's disease and freezing of gait (FOG+) have more falls, postural instability and cognitive impairment compared with FOG-. Objective. To conduct a secondary analysis of the V-TIME study, a randomized, controlled investigation showing a greater reduction of falls after virtual reality treadmill training (TT + VR) compared with usual treadmill walking (TT) in a mixed population of fallers. We addressed whether these treadmill interventions led to similar gains in FOG+ as in FOG-. Methods. A total of 77 FOG+ and 44 FOG- were assigned randomly to TT + VR or TT. Participants were assessed pre- and posttraining and at 6 months' follow-up. Main outcome was postural stability assessed by the Mini Balance Evaluation System Test (Mini-BEST) test. Falls were documented using diaries. Other outcomes included the New Freezing of Gait Questionnaire (NFOG-Q) and the Trail Making Test (TMT-B). Results. Mini-BEST scores and the TMT-B improved in both groups after training (P = .001), irrespective of study arm and FOG subgroup. However, gains were not retained at 6 months. Both FOG+ and FOG- had a greater reduction of falls after TT + VR compared with TT (P = .008). NFOG-Q scores did not change after both training modes in the FOG+ group. Conclusions. Treadmill walking (with or without VR) improved postural instability in both FOG+ and FOG-, while controlling for disease severity differences. As found previously, TT + VR reduced falls more than TT alone, even among those with FOG. Interestingly, FOG itself was not helped by training, suggesting that although postural instability, falls and FOG are related, they may be controlled by different mechanisms. SN - 1552-6844 UR - https://www.unboundmedicine.com/medline/citation/32202203/Do_Patients_With_Parkinson's_Disease_With_Freezing_of_Gait_Respond_Differently_Than_Those_Without_to_Treadmill_Training_Augmented_by_Virtual_Reality L2 - https://journals.sagepub.com/doi/10.1177/1545968320912756?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -