Analysis of functional profile and mobility in Parkinson’s disease: a cross sectional study
Wildja de Lima Gomes; Larissa Melo de Souza Miranda; Neildja Maria da Silva; Gisele Kariny Souza Davi; Robison Carlos Silva Costa; Isabelly Cristina Regalado; Roberta de Oliveira Cacho; Enio Walker Azevedo Cacho; Núbia Maria Freire Vieira Lima
Abstract
Background: Idiopathic Parkinson’s disease (PD) is a progressive neurodegenerative disease that has a prevalence of 18–328 per 100,000 in habitants in developing countries, with an estimated 3.3% of the Brazilian elderly population affected by PD throughout life. The classic symptoms include a resting tremor, muscular rigidity, bradykinesia and postural instability, which are all motor symptoms. The mobility of the subjects is compromised early, thus impairing their balance and limiting their ability to perform simple tasks. The restricted movement prevents dissociation between the head and trunk during walking, and freezing occurs as advanced disease reduces the progression of movements during walking. Objective: To analyze mobility and functionality profiles in subjects with Parkinson’s disease and compare them with healthy subjects. Method: A sample was consisted of 10 subjects with PD and 10 healthy elderly subjects. Assessment tools were used to quantify the severity of PD the scale Hoehn and Yah (HY), for mobility were used the Dynamic Parkinson’s Gait Scale (DYPAGS) and Modified Parkinson Activity Scale (PAS modified), for functionality were used the Unified Parkinson’s Disease Rating Scale (UPDRS) and dual task (DT) performance. Results: The subjects with PD showed worse performance in mobility and DT as determined by the modified PAS (p=0.0001) and DYPAGS (p=0.0001). Correlations were found between the UPDRS, the Gait Freezing Questionnaire (FOG), the PAS modified score, left-hand grip strength and the HY values (p<0.05). There were no differences in prehensile muscle strength between PD and healthy subjects. Conclusions: Subjects with PD showed decreased mobility and functionality for activities related to ADLs, gait and DT compared to healthy elderly subjects. Disease severity, muscle strength and freezing were correlated with the mobility and DT performance in subjects with PD.
Keywords
References
1. Carr J, Shepherd R. Neurological Rehabilitation. Oxford: ButterworthHeinemann; 1999.
2. Dorsey ER, Constantinescu R, Thompson JP, Biglan KM, Holloway RG, Kieburtz K, et al. Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology. 2007;68:384–386.
3. Barbosa MT, Caramelli P, Maia DP, Cunningham MC, Guerra HL, LimaCosta MF, et al. Parkinsonism and Parkinson’s disease in the elderly: a community-based survey in Brazil (the Bambui study). Mov Disord. 2006;21:800-808.
4. Jo H.J, Park J, Lewis MM, Huang X, Latash ML. Prehension synergies and hand function in early-stage Parkinson’s disease. Experimental Brain Research. 2014;233(2):425–440.
5. Chong RKY, Horak FB, Woollacott, M. Parkinson’s disease impairs the ability to change set quickly. J. Neurol. Sci. 2000;(175):57-70.
6. Nutt JG, BR Giladi, N Hallett, M Horak, FB Nieuwboer. Freezing of gait: moving forward on a mysterious clinical phenomenon. Lancet Neurol. 2011;10:734–744.
7. Huang X, Mahoney JM, Lewis MM, Guangwei Du, Piazza SJ, Cusumano JP, et al. Both coordination and symmetry of arm swing are reduced in Parkinson’s disease. Gait & posture. 2012;35(3):373-377.
8. Munhoz RP, Moro A, Silveira-Moriyama L, Teive HA. Non-motor signs in Parkinson’s disease: a review. Arq Neuropsiquiatr. 2015;73(5):454-462.
9. Aarsland D, Bronnick K, Ehrt U, De Deyn PP, Tekin S, Emre M, et al. Neuropsychiatric symptoms in patients with Parkinson’s disease and dementia: frequency, profile and associated caregiver stress. J Neurol Neurosurg Psychiatry. 2007;78:36–42.
10. Borek LL, Amick MM, Friedman JH. Non-Motor Aspects of Parkinson’s Disease. CNS Spectr. 2006;11(7):541-54.
11. Proud EL, Morris ME. Skilled hand dexterity in Parkinson´s Disease: effects of adding a concurrent task. Arch Phys Med Rehabil. 2010;91:794-799.
12. Brauer SG, Woollacott M, Lamont R, Clewett S, O’Sullivan J, Silburn P. Single and dual task gait training in people with Parkinson’s disease: a protocol for a randomised controlled trial. BMC Neurol. 2011;11:1–6.
13. Stegemöller EL, Buckley TA, Pitsikoulis C, Barthelemy E, Roemmich R, Hass CJ. . Postural Instability and Gait Impairment During Obstacle. Crossing in Pakinson’s Disease. Arch Phys Med Rehabil. 2012;93(4):703-9.
14. Bertolucci PHF, Brucki SMD, Campacci S, Juliano Y. O Mini-Exame do Estado Mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.
15. Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research.1975;12(3):189-198.
16. Hoehn MM, Yahr MD. Parkinsonism: onset, progression, and mortality. Neurology. 1998;50(2):318.
17. Fahn S, Elton RL, Members of the UPDRS Development. Committee. Unified Parkinson’s disease rating scale. In: Fahn S, Marsden CD, Calne DB, Goldstein M editors. Recent developments in Parkinson’s disease. Florham Park, NJ: Macmillan Healthcare Information, 1987:153–64.
18. Crémers J, Phan Ba R, Delvaux V, Garraux G. Construction and validation of the Dynamic Parkinson Gait Scale (DYPAGS). Parkinsonism & related disorders. 2012;18(6):759-764.
19. Franco CRC, Leão P, Townsend R, Rieder CRM. Confiabilidade e validade de uma escala para medição de mobilidade do tronco na doença de Parkinson: Tronco Mobilidade Escala. Arq. Neuro-Psiquiatria. 2011;69.
20. Baggio JA, Curtarelli MB, Rodrigues GR, Tumas V. Validity of the Brazilian version of the freezing of gait questionnaire. Arquivos de neuropsiquiatria. 2012;70(8):599-603.
21. Keus SHJ, Nieuwboer A, Bloem BR, Borm GF, Munneke M. Clinimetric analyses of the modified Parkinson activity scale. Parkinsonism & related disorders. 2009;15(4):263-269.
22. Soares AV, Kerscher C, Uhlig L, Domenech SC, Borges Júnior NG. Dinamometria de preensão manual como parâmetro de avaliação funcional do membro superior de pacientes hemiparéticos por acidente vascular cerebral. Fisioter Pesq. 2011;18(4):359-364.
23. Matinollia M, Korpelainen JT, Korpelainen R, Sotaniemi KA, Matinolli VM, Myllylä VV. Mobility and balance in Parkinson disease: a population-based study. European Journal of Neurology. 2009;16(1):105–111.
24. Munhoz RP, Teive HA. Pull test performance and correlation with falls risk in Parkinson’s disease. Arq Neuropsiquiatr. 2014;72(8):587-591.
25. Duncan RP, Leddy AL, Cavanaugh JT, Dibble LE, Ellis TD, Ford MP, et al. Balance differences in people with Parkinson disease with and without freezing of gait Gait & Posture. 2015;42(3):306–309.
26. Peterson DS, Brett W, Fling BW, Mancini M, Cohen RG, Nutt JG, et al. Dual-task interference and brain structural connectivity in people with Parkinson’s disease who freeze. Journal of Neurology, Neurosurgery & Psychiatry.2014;86:786-792
27. Wild LB, de Lima DB, Balardin JB, Rizzi L, Giacobbo BL, Oliveira HB, et al. Characterization of cognitive and motor performanceduringdual-tasking in healthy older adults and patients with Parkinson’s Disease. Neurol. 2013;260(2):580–589.
28. Teixeira NB, Alouche SR. O desempenho da dupla tarefa na doença de Parkinson. Braz. J. Phys. Ther. 2007;11(2)127-132.
29. Paul SS, Canning CG, Sherrington C, Fung VSC. Reproducibility of measures of leg muscle power, leg muscle strength, postural sway and mobility in people with Parkinson’s disease. Gait & Posture. 2012;36(3):639–642.
30. Frazzitta G, Ferrazzoli D, Maestri R, Rovescala R, Guaglio G, Bera R. Differences in Muscle Strength in Parkinsonian Patients Affected on the Right and Left Side. PloS one. 2015;10(3).