药物治疗对伴有和不伴有冻结步态的帕金森病患者转身的影响。
The effects of medication on turning in people with Parkinson disease with and without freezing of gait.
机构信息
Program in Physical Therapy, Washington University in St. Louis, MO, USA.
出版信息
J Parkinsons Dis. 2011;1(3):259-70. doi: 10.3233/JPD-2011-11030.
Turning difficulty is prevalent in Parkinson disease (PD) and may lead to falls or freezing. Medication improves motor symptoms of PD, but its effects on turning in people with PD with (PD+FOG) and without (PD-FOG) freezing of gait are unclear. This study evaluated the effects of medication on turning in PD compared to healthy older adults (controls), and in PD+FOG compared to PD-FOG. We assessed timed-up-and-go (TUG), and in-place turns in 16 controls and 20 people with PD (10 PD+FOG, 10 PD-FOG) OFF and ON medication. PD+FOG performed worse than PD-FOG (p < 0.05) in TUG, turn duration, step count, and had earlier head rotation onset (HTO). These measures improved ON medication in PD+FOG and PD-FOG (p < 0.05). Turn duration and step count improved more with medication in PD+FOG than PD-FOG (p < 0.005). There were subtle differences in gastrocnemius and sternocleidomastoid onsets, with PD OFF or ON activating muscles earlier than controls. Tibialis anterior, gastrocnemius, and sternocleidomastoid initial onset times were similar between PD+FOG and PD-FOG. Though medication improved turning, turn duration and step count impairments still existed in PD ON, compared to controls. Relative to PD-FOG, PD+FOG turned worse, but improved more with medication, potentially because PD+FOG were initially more impaired than PD-FOG or were taking higher medication dosages. Further treatment options may be needed to address ON medication turning deficits.
转弯困难在帕金森病（PD）中很常见，可能导致跌倒或冻结。药物改善 PD 的运动症状，但它对有（PD+FOG）和无（PD-FOG）冻结步态的 PD 患者转弯的影响尚不清楚。本研究评估了药物对 PD 患者与健康老年人（对照组）相比以及 PD+FOG 与 PD-FOG 相比转弯的影响。我们评估了定时起立行走（TUG）和原地转弯，在 16 名对照者和 20 名 PD 患者（10 名 PD+FOG，10 名 PD-FOG）停药和服药期间进行。PD+FOG 在 TUG、转弯持续时间、步数和头部旋转开始时间（HTO）方面的表现均差于 PD-FOG（p<0.05）。这些措施改善了 PD+FOG 和 PD-FOG 服药后的表现（p<0.05）。PD+FOG 的转弯持续时间和步数改善程度高于 PD-FOG（p<0.005）。腓肠肌和胸锁乳突肌的起始时间存在细微差异，PD 停药或服药时比对照组更早激活肌肉。胫骨前肌、腓肠肌和胸锁乳突肌的初始起始时间在 PD+FOG 和 PD-FOG 之间相似。尽管药物改善了转弯，但 PD 服药后仍存在转弯持续时间和步数受损的情况，与对照组相比。与 PD-FOG 相比，PD+FOG 转弯更差，但服药后改善更多，这可能是因为 PD+FOG 最初比 PD-FOG 受损更严重，或者服用的药物剂量更高。可能需要进一步的治疗选择来解决服药后转弯缺陷。
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