J. Janssens, PT, MSc, Neurorehabilitation Center Klinik Bethesda Tschugg, Tschugg, Switzerland.
K. Malfroid, PT, MSc, Physiotherapie Robellaz, Köniz, Switzerland.
Phys Ther. 2014 Jul;94(7):1014-23. doi: 10.2522/ptj.20130232. Epub 2014 Feb 20.
BACKGROUND AND PURPOSE: Lee Silverman Voice Treatment Big (LSVT BIG) is characterized by intensive exercising of high-amplitude movements to overcome bradykinesia and hypokinesia in patients with Parkinson disease (PD). The aim of the present case series was to explore possible beneficial effects of LSVT BIG training on gait, balance, bed mobility, and dexterity. CASE DESCRIPTION: Three patients with mild to moderate PD (all male; aged 52, 54, and 70 years; Hoehn & Yahr stages I-III) completed a 4-week LSVT BIG training program (16 individual 1-hour sessions) and an intensive home training program in accordance with the LSVT BIG protocol. Two certified LSVT BIG physical therapists delivered the LSVT BIG training sessions. OUTCOMES: The outcome measures for gait and balance included the Functional Gait Assessment (FGA), Functional Reach Test (FRT), Timed "Up & Go" Test (TUG), Freezing of Gait Questionnaire (FOGQ), and motor score on part III of the Unified Parkinson's Disease Rating Scale (UPDRS III). Bed mobility was addressed using the Lindop Parkinson's Disease Mobility Assessment (LPA). The Nine-Hole Peg Test (9HPT) was used to measure dexterity. The 3 patients performed better on balance and gait assessments, as indicated by increased scores on the FRT and FGA (all 3 patients) and decreased scores on the TUG, FOGQ, and UPDRS III, of which scores of the FRT and UPDRS III achieved the minimal detectable change. Furthermore, the patients were quicker in tasks related to bed mobility (LPA). The patients' dexterity skills did not improve for their dominant (right) hand (9HPT). DISCUSSION: This case series suggests that the LSVT BIG may be beneficial for gait, balance, and bed mobility. Future work is needed to ascertain the effectiveness by means of randomized controlled trials.
背景与目的:Lee Silverman 嗓音治疗法强化版(LSVT BIG)的特点是通过高强度运动来锻炼,以克服帕金森病(PD)患者的运动迟缓与运动减少。本病例系列研究旨在探索 LSVT BIG 训练对步态、平衡、床旁移动和灵巧性可能产生的有益影响。
病例描述:3 名男性 PD 患者(年龄分别为 52、54 和 70 岁;Hoehn & Yahr 分期 I-III 期)完成了 4 周的 LSVT BIG 训练计划(16 次 1 小时的个体训练),并按照 LSVT BIG 方案进行了强化家庭训练。2 名经过认证的 LSVT BIG 物理治疗师提供了 LSVT BIG 训练课程。
结果:步态和平衡的评估结果包括功能性步态评估(FGA)、功能性伸手测试(FRT)、计时“站起-行走”测试(TUG)、冻结步态问卷(FOGQ)以及帕金森病统一评定量表第三部分(UPDRS III)的运动评分。床旁移动能力通过林多帕金森病移动评估(LPA)进行评估。九孔插栓测试(9HPT)用于测量灵巧性。3 名患者在平衡和步态评估方面表现更好,FRT 和 FGA 评分增加(3 名患者均如此),TUG、FOGQ 和 UPDRS III 评分降低,其中 FRT 和 UPDRS III 评分达到最小可检测变化。此外,患者在与床旁移动相关的任务中表现更快(LPA)。患者的惯用手(右手)的灵巧性技能没有提高(9HPT)。
讨论:本病例系列研究表明,LSVT BIG 可能对步态、平衡和床旁移动有益。未来需要通过随机对照试验来确定其有效性。
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