Bailey Christopher A, Corona Federica, Murgia Mauro, Pili Roberta, Pau Massimiliano, Côté Julie N
Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada.
Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy.
Front Neurol. 2018 Apr 4;9:211. doi: 10.3389/fneur.2018.00211. eCollection 2018.
In persons with Parkinson's disease (PD), gait dysfunctions are often associated with abnormal neuromuscular function. Physical therapy combined with auditory stimulation has been recently shown to improve motor function and gait kinematic patterns; however, the underlying neuromuscular control patterns leading to this improvement have never been identified.
(1) Assess the relationships between motor dysfunction and lower limb muscle activity during gait in persons with PD; (2) Quantify the effects of physical therapy with rhythmic auditory stimulation (PT-RAS) on lower limb muscle activity during gait in persons with PD.
Participants (15 with PD) completed a 17-week intervention of PT-RAS. Gait was analyzed at baseline, after 5 weeks of supervised treatment (T5), and at a 12-week follow-up (T17). For each session, motor dysfunction was scored using the United Parkinson Disease Rating Scale, and muscle activation amplitude, modulation, variability, and asymmetry were measured for the rectus femoris, tibialis anterior, and gastrocnemius lateralis (GL). Spearman correlation analyses assessed the relationships between dysfunction and muscle activity, and mixed effect models (session × muscle) tested for intervention effects.
PT-RAS was effective in decreasing motor dysfunction by an average of 23 (T5) to 36% (T17). Higher GL activity variability and bilateral asymmetry were correlated to higher dysfunction (ρ = 0.301 -0.610, 's < 0.05) and asymmetry significantly decreased during the intervention ( < 0.05).
Results suggest that gait motor dysfunction in PD may be explained by neuromuscular control impairments of GL that go beyond simple muscle amplitude change. Physical therapy with RAS improves bilateral symmetry, but its effect on muscle variability requires future investigation.
在帕金森病（PD）患者中，步态功能障碍通常与异常的神经肌肉功能相关。最近研究表明，物理治疗结合听觉刺激可改善运动功能和步态运动学模式；然而，导致这种改善的潜在神经肌肉控制模式尚未得到确认。
（1）评估PD患者步态期间运动功能障碍与下肢肌肉活动之间的关系；（2）量化有节奏听觉刺激物理治疗（PT-RAS）对PD患者步态期间下肢肌肉活动的影响。
参与者（15名PD患者）完成了为期17周的PT-RAS干预。在基线、监督治疗5周后（T5）和12周随访时（T17）对步态进行分析。对于每个阶段，使用统一帕金森病评定量表对运动功能障碍进行评分，并测量股直肌、胫骨前肌和外侧腓肠肌（GL）的肌肉激活幅度、调制、变异性和不对称性。Spearman相关性分析评估功能障碍与肌肉活动之间的关系，混合效应模型（阶段×肌肉）测试干预效果。
PT-RAS有效降低运动功能障碍，平均降低23%（T5）至36%（T17）。较高的GL活动变异性和双侧不对称性与较高的功能障碍相关（ρ = 0.301 - 0.610，P < 0.05），且在干预期间不对称性显著降低（P < 0.05）。
结果表明，PD患者的步态运动功能障碍可能由GL的神经肌肉控制受损来解释，这超出了简单的肌肉幅度变化。RAS物理治疗可改善双侧对称性，但其对肌肉变异性的影响需要未来进一步研究。
