Brognara Lorenzo, Navarro-Flores Emmanuel, Iachemet Lorenzo, Serra-Catalá Nuria, Cauli Omar
Department of Biomedical and Neuromotor Science, University of Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy.
Frailty and cognitive impairment organized group (FROG), University of Valencia, Valencia 46010, Spain.
Brain Sci. 2020 Jan 27;10(2):69. doi: 10.3390/brainsci10020069.
New treatments based on peripheral stimulation of the sensory-motor system have shown to be promising in rehabilitation strategies for patients with neurological disorders, including Parkinson's disease (PD), especially in regards to reducing gait impairment, and hence, the incidence of falls. The aim of this study was to evaluate the change in several gait parameters measured by sensor inertial measurement in PD patients after acute plantar stimulation, under the distal phalanx of the big toe, and underneath the head of the first metatarsal joint of both feet, using a 3D printing insole. In order to assess whether the effects are selective for PD patients, we compared the effect of the treatment in a control group (age-matched) consisting of patients with other neurological disorders which also displayed gait and balance impairment, and a similar cognitive function, depressive symptoms, body mass index, and comorbidity burden observed in the PD group. Plantar foot stimulation in PD patients eliminated the significant ( < 0.05) alterations existing in stride asymmetry and in stride variability. When comparing the effects of post-plantar stimulation with the respective basal level, considered as 100% in both groups, we observed a significant ( = 0.019, Mann-Whitney test) increase in stride length compared to basal in the PD group and control group. No significant effects of foot plantar stimulation were observed in any of the gait parameters in the control group. Plantar foot stimulation has a positive effect on the step and stride length, and has a positive effect on walking stability, measured by the increase in stride length. No significant effect was observed on bradykinesia because it did not improve walking velocity. These findings indicate that foot plantar stimulation using a 3D printing insole seems to generate a more stable walking pattern in PD patients, with an interesting applicability, and a low-cost, for reducing gait impairment in PD patients.
基于感觉运动系统外周刺激的新疗法在神经系统疾病患者的康复策略中显示出前景，包括帕金森病（PD），特别是在减少步态障碍以及跌倒发生率方面。本研究的目的是评估在PD患者中，使用3D打印鞋垫在双侧大脚趾远节趾骨下方和第一跖骨关节头下方进行急性足底刺激后，通过传感器惯性测量所测得的多个步态参数的变化。为了评估这些效果是否对PD患者具有选择性，我们将该治疗方法在一个对照组（年龄匹配）中的效果进行了比较，该对照组由患有其他神经系统疾病的患者组成，这些患者也表现出步态和平衡障碍，且在认知功能、抑郁症状、体重指数和合并症负担方面与PD组相似。PD患者的足底刺激消除了步幅不对称和步幅变异性中存在的显著（<0.05）改变。在将足底刺激后的效果与各自的基础水平进行比较时，两组均将基础水平视为100%，我们观察到与基础水平相比，PD组和对照组的步幅长度均有显著（=0.019，曼-惠特尼检验）增加。在对照组的任何步态参数中均未观察到足底刺激的显著效果。足底刺激对步幅和步长有积极影响，并且通过步幅长度的增加来衡量，对行走稳定性也有积极影响。未观察到对运动迟缓有显著影响，因为它没有提高行走速度。这些发现表明，使用3D打印鞋垫进行足底刺激似乎能在PD患者中产生更稳定的行走模式，具有有趣的适用性且成本低廉，可用于减少PD患者的步态障碍。
