FEASIBILITY, SAFETY, AND EFFECTIVENESS OF A GROUP INTERVENTION BASED ON THE EUROPEAN PHYSIOTHERAPY GUIDELINE FOR PARKINSON DISEASE
T. B. Freitas,1 R. A. Nuvolini,2 K. Guedes,2 F. Dona,3 J. E. Pompeu,2 and C. Torriani-Pasin1
1Laboratory of Motor Behavior, School of Physical Education and Sports, University of Sao Paulo, Brazil; 2Department of Physical Therapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of Sao Paulo, Brazil; 3Balance Rehabilitation and Social Inclusion Graduate Program, Anhanguera University of Sao Paulo, Brazil
Background and Purpose: Studies have suggested that exercise may contribute to the improvement in physical function, strength, balance, walk speed, and quality of life in individuals with Parkinson disease (PD). The European Physiotherapy Guideline for Parkinson's Disease was developed in 2014 but its feasibility, safety, and effects have not yet been studied. The purpose of this study was to assess the feasibility, safety, and effectiveness of this guideline.
Methods: Ten individuals with idiopathic PD in stages 1 to 2.5 on the Hoehn & Yahr Scale, of both genders (8 men and 2 women), mean age of 63.80 years (standard deviation [SD] = 10.47), mean score of 19.0 (4.24) for the motor scores (section III of The Unified Parkinson's Disease Rating Scale) and 27.0 (2.0) for the Mini-Mental State Examination, were recruited. The feasibility and safety were assessed from the patient's adherence and adverse events during the intervention. The outcomes of the intervention were registered on the basis of the International Classification of Functioning (ICF) using the Mini Balance Evaluation Systems Test (MiniBESTest), PD Questionnaire (PDQ-39), and the Montreal Cognitive Assessment (MoCA). Evaluations were carried out before, immediately after, and 1 month after the intervention as a follow-up. Descriptive statistical analysis [mean +/- SD and mean difference +/- SD [95% CI]) was used to evaluate the baseline, postintervention scores, and the postintervention follow-up. The sessions lasted 1 hour each, twice a week, for 7 weeks. Intervention was designed according to the stage of the disease, during the "on" period of dopaminergic replacement, including external cues and movement cognitive strategies.
Results: A patient's adherence of 70% was observed; 2 patients dropped out because of transport problems and exacerbation of previous low back pain. There was an improvement in the balance, cognition, and quality of life as measured by the MiniBESTest: before 23.71 (2.92), after 24.57 (4.03), and follow-up 25.85 (4.01); by the MoCA: before 21.28 (4.53), after 23.57 (5.53), and follow-up 23.42 (4.54); by the PDQ-39: before 35.71 (7.94), after 26.64 (9.25), and follow-up 26.64 (13.23). No adverse events were observed.
Discussion and Conclusions: The intervention based on the European Physiotherapy Guideline for Parkinson's Disease appears to be feasible and safe for people with PD. The effects were positive for balance, cognition, and quality of life, but they need to be confirmed using a larger sample of subjects with PD.
INFLUENCE OF POSTURAL CONTROL IN THE STABILITY AND PERFORMANCE OF CHILDREN WITH CEREBRAL PALSY
Aline Rabelo,1 Claudia Alcantara Torre,2 and Cristina dos Santos Cardoso Sa1
1Curso de Fisioterapia-Universidade Federal de Sao Paulo-Campus Baixada Santista, Brazil; 2Centro Terapeutico, Brazil
Background and Purpose: Children with cerebral palsy (CP) have deficits in postural control and prejudiced movement of the upper limbs (ULs), limiting their autonomy in carrying out daily activities. This study compared the postural control, performance in manual skills, and functional reach in CP children with those of normal children and the correlation between postural control, functional reach, and manual skills.
Methods: Fourteen children, aged 8.42 (+/-1.50) years, were divided into an experimental group (7 CP: 3 hemiparetic-GMFCS I and 4 diparetic-GMFCS II) and a control group (7 typical children). Both groups were evaluated using the Segmental Assessment of Trunk Control, the Trunk Control Measurement Scale (TCMS), the Pediatric Reach Test, and the Quality of Upper Extremity Skills Test. The Student t test and the Pearson correlation test were used in the analysis.
Results: Significant differences in trunk control between the 2 groups were only revealed by the TCMS. The following differences were found between the groups: for manual function, only dissociated movements (P = 0.027); in the bilateral anterior functional reach standing test (P = 0.018); in the reach the standing position with ULR (P = 0.002); and in the reach on foot with left UL (P = 0.008). The reach in the sitting position only revealed a difference with right UL (P = 0.023). Moderate correlation was found between trunk control (TCMS) and manual function (disassociated movements and weight support) and functional reach standing and sitting.
Discussion and Conclusions: The trunk control of typical children and CP- GMFCS I and II is similar, but the CPs had lower scores. Trunk control directly influences the decoupled motion of the ULs but no fine movements or protection reactions.
BED MOBILITY IS THE MAIN COMPLAINT OF PARKINSONIANS IN BRAZIL (REPARK-BR STUDY): REPARK-BR STUDY
Lidiane Oliveira Lima,1 Raquel de Carvalho Lana,2 Larissa Karlla Rodrigues Lopes,2 and Fatima Rodrigues-de-Paula2
1Universidade Federal do Ceara, Brazil; 2Universidade Federal de Minas Gerais, Brazil; REDE PARKINSON BRASIL (REPARK-BR)
Background and Purpose: The patient-centered approach is recognized as an important part of health care. This is justified by the discordance often found between the patient's preferences and the conduct of health care professionals in neurodegenerative diseases. Patients with Parkinson disease are willing to assume a more active role in their own care processes. However, physicians are not fully responsive to patient preferences regarding their participation in decision making. The health care team should encourage patients to participate in and share the control of treatment and management decisions. The patient's perception of his or her complaints favors therapeutic alliance and treatment adherence. The aim of this study was to identify the activities most often cited as complaints by the individual with Parkinson disease (PD) and quantify the degree of difficulty in execution.
Methods: Individuals with PD answered the Patient Specific Complaints questionnaire that determines the patient's functional status. It lists the activities, limitations, and participation restrictions often found in daily life and perceived by the patient as being important. The patients selected the 5 most important complaints regarding the physical activities they would like to improve. In addition, for each activity, the patient indicated how troublesome it was to carry out that activity in the foregoing week using a Visual Analogue Scale (0 means no difficulty and 10 impossible to perform). The data were expressed as a percentage of the frequency of complaints and median and interquartile of the degree of difficulty. The study was approved by the institutional ethics committee, and each participant provided a signed informed consent.
Results: Of the 463 questionnaires that were filled in, 36.9% were from women and 63.1% from men, with a mean age of 65.3 +/- 10.8 years (37-88 years). For 51.4%, the Hoehn & Yahr (HY) classification was equal to 1 to 2; for 34.9%, HY = 3; and for 12.7%, HY = 4 to 5. The most frequently cited activities were turning over in bed 38.6%, 6.0 (5.0-8.0); standing up for a long time: 35.7%, 7.0 (5.0-8.0); getting in or out of a car: 32.5%, 6.0 (4.0-8.0); getting out of bed: 30.1%, 5.0 (4.0-7.0); and running: 29.1%, 8.0 (5.0-10.0).
Discussion and Conclusions: The main activities pointed out showed the common deficits in PD at different levels of demand. Mobility in bed requires flexibility and affects daily independence. Standing requires postural control and balance and the ability to get in/out of a car also requires adaptation to transition between postures. Running for exercise or to take a bus requires aerobic capacity. Considering the individuals' complaints can create better opportunities for PD patients to share responsibilities and favor the therapeutic alliance. The present results clarify the patients' needs and treatment options to be used for these individuals.
ANALYSIS OF THE CLINICAL USE OF MENTAL PRACTICE BY PHYSICAL THERAPISTS
Pedro Henrique Cortes de Sousa and Clarissa Cardoso dos Santos-Couto-Paz
Programa de Pos Graduacao em Ciencias e Tecnologias em Saude da Universidade de Brasilia - UnB
Background and Purpose: Mental practice (MP) is motor training based on neurophysiology aspects to improve the performance and rehabilitation of people with neurological impairments. However, there are no studies that analyze the clinical use of this technique by physiotherapists. The aim of this study was to analyze the use of MP by physical therapists in the Federal District (DF) of Brazil, their knowledge of the theoretical aspects related to it, the way of application, and the parameters found in the literature.
Methods: Clinical-qualitative research was used and the analysis of the contents of a structured questionnaire. Seventy-two physical therapists with clinical experience in neurological rehabilitation were recruited as the purposive sample.
Results: Only 32 professionals were included in the study with clinical expertise of 11.28 +/- 7.03 years. Nine professionals (28.12%) said that they knew the technique. These professionals defined the technique completely, two said they had stopped using it, and one made mention of the type of MP. No professional could describe the parameters completely but replied to most of the questions (44.45%) and claimed that the results were observed in the first week. The participants, who claimed not to know the technique, after reading its definition, answered that they had used it in an empirical way in their practice.
Discussion and Conclusions: The replies analyzed showed that the professionals did not know the technical definitions and reduced them to an act of imagining, showing a lack of knowledge of the parameters for the correct execution of the technique and a lack of knowledge regarding its application in neurological patients and other subjects.