Ganesan Mohan, Sathyaprabha Talakad N, Gupta Anupam, Pal Pramod Kumar
Department of Neurophysiology, National Institute of Mental Health & Neurosciences, Bangalore, India; currently at Department of Physical Therapy, University of Illinois, Chicago, IL(∗).
Department of Neurophysiology, National Institute of Mental Health & Neurosciences, Bangalore, India(†).
PM R. 2014 Jan;6(1):22-33. doi: 10.1016/j.pmrj.2013.08.604. Epub 2013 Sep 8.
To investigate the role of conventional gait training and partial weight-supported treadmill gait training (PWSTT) in improving the balance of patients with Parkinson disease (PD).
Prospective randomized controlled design.
National-level university tertiary hospital for mental health and neurosciences.
Sixty patients with PD fulfilling the United Kingdom Brain Bank PD diagnostic criteria were recruited from the neurology outpatient department and movement disorder clinic.
The patients were randomly assigned into 3 equal groups: (1) a control group that only received a stable dosage of dopaminomimetic drugs; (2) a conventional gait training (CGT) group that received a stable dosage of dopaminomimetic drugs and conventional gait training; and (3) a PWSTT group that received a stable dosage of dopaminomimetic drugs and PWSTT with unloading of 20% of body weight. The sessions for the CGT and PWSTT groups were provided for 30 minutes per day, 4 days per week, for 4 weeks (16 sessions).
The Unified Parkinson Disease Rating Scale (UPDRS) motor score, dynamic posturography, Berg Balance Scale, and Tinetti performance-oriented mobility assessment (POMA) were used as main outcome measures.
A significant interaction effect was observed in the UPDRS motor score, mediolateral index, Berg Balance Scale, limits of stability (LOS) total score, POMA gait score, and balance score. Post-hoc analysis showed that in comparison with the control group, the PWSTT group had a significantly better UPDRS motor score, balance indices, LOS in 8 directions, POMA gait, and balance score. The CGT group had a significantly better POMA gait score compared with control subjects. Compared with the CGT group, the PWSTT group had a significantly better UPDRS motor score, mediolateral index, POMA gait score, and LOS total score.
PWSTT may be a better interventional choice than CGT for gait and balance rehabilitation in patients with PD.
探讨传统步态训练和部分体重支持跑步机步态训练（PWSTT）对改善帕金森病（PD）患者平衡能力的作用。
前瞻性随机对照设计。
国家级大学三级精神卫生与神经科学医院。
从神经内科门诊和运动障碍诊所招募了60例符合英国脑库PD诊断标准的PD患者。
将患者随机分为3组，每组人数相等：（1）对照组，仅接受稳定剂量的拟多巴胺药物；（2）传统步态训练（CGT）组，接受稳定剂量的拟多巴胺药物和传统步态训练；（3）PWSTT组，接受稳定剂量的拟多巴胺药物和体重卸载20%的PWSTT。CGT组和PWSTT组的训练每天进行30分钟，每周4天，共4周（16节）。
主要观察指标包括统一帕金森病评定量表（UPDRS）运动评分、动态姿势描记法、伯格平衡量表和Tinetti以性能为导向的移动性评估（POMA）。
在UPDRS运动评分、内外侧指数、伯格平衡量表、稳定性极限（LOS）总分、POMA步态评分和平衡评分方面观察到显著的交互作用。事后分析表明，与对照组相比，PWSTT组的UPDRS运动评分、平衡指数、8个方向的LOS、POMA步态和平衡评分明显更好。CGT组的POMA步态评分明显优于对照组。与CGT组相比，PWSTT组的UPDRS运动评分、内外侧指数、POMA步态评分和LOS总分明显更好。
对于PD患者的步态和平衡康复，PWSTT可能是比CGT更好的干预选择。
