Li Kun-Peng, Zhang Zeng-Qiao, Zhou Zong-Lei, Su Jian-Qing, Wu Xian-Hua, Shi Bo-Han, Xu Jian-Guang
School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Front Aging Neurosci. 2022 Oct 19;14:924784. doi: 10.3389/fnagi.2022.924784. eCollection 2022.
Progression of freezing of gait (FOG), a common pathological gait in Parkinson's disease (PD), has been shown to be an important risk factor for falls, loss of independent living ability, and reduced quality of life. However, previous evidence indicated poor efficacy of medicine and surgery in treating FOG in patients with PD. Music-based movement therapy (MMT), which entails listening to music while exercising, has been proposed as a treatment to improve patients' motor function, emotions, and physiological activity. In recent years, MMT has been widely used to treat movement disorders in neurological diseases with promising results. Results from our earlier pilot study revealed that MMT could relieve FOG and improve the quality of life for patients with PD.
To explore the effect of MMT on FOG in patients with PD.
This was a prospective, evaluator-blinded, randomized controlled study. A total of 81 participants were randomly divided into music-based movement therapy group (MMT, = 27), exercise therapy group (ET, = 27), and control group ( = 27). Participants in the MMT group were treated with MMT five times (1 h at a time) every week for 4 weeks. Subjects in the ET group were intervened in the same way as the MMT group, but without music. Routine rehabilitation treatment was performed on participants in all groups. The primary outcome was the change of FOG in patients with PD. Secondary evaluation indicators included FOG-Questionnaire (FOG-Q) and the comprehensive motor function.
After 4 weeks of intervention, the double support time, the cadence, the max flexion of knee in stance, the max hip extension, the flexion moment of knee in stance, the comprehensive motor function (UPDRS Part III gait-related items total score, arising from chair, freezing of gait, postural stability, posture, MDS-UPDRS Part II gait-related items total score, getting out of bed/a car/deep chair, walking and balance, freezing), and the FOG-Q in the MMT group were lower than that in the control group and ET group ( < 0.05). The gait velocity, the max ankle dorsiflexion in stance, ankle range of motion (ROM) during push-off, ankle ROM over gait cycle, the knee ROM over gait cycle, and the max extensor moment in stance (ankle, knee) in the MMT group were higher than that in the control group and ET group ( < 0.05). However, no significant difference was reported between the control group and ET group ( > 0.05). The stride length and hip ROM over gait cycle in the MMT group were higher than that in the control group ( < 0.05), and the max knee extension in stance in the MMT group was lower than that in the control group ( < 0.05). Nevertheless, there was no significant difference between the ET group and MMT group ( > 0.05) or control group ( > 0.05).
MMT improved gait disorders in PD patients with FOG, thereby improving their comprehensive motor function.
冻结步态（FOG）是帕金森病（PD）常见的病理性步态，其进展已被证明是跌倒、失去独立生活能力和生活质量下降的重要危险因素。然而，先前的证据表明药物和手术治疗PD患者FOG的疗效不佳。基于音乐的运动疗法（MMT），即在锻炼时听音乐，已被提议作为改善患者运动功能、情绪和生理活动的一种治疗方法。近年来，MMT已被广泛用于治疗神经疾病中的运动障碍，并取得了有前景的结果。我们早期的初步研究结果显示，MMT可以缓解PD患者的FOG并提高其生活质量。
探讨MMT对PD患者FOG的影响。
这是一项前瞻性、评估者盲法、随机对照研究。共81名参与者被随机分为基于音乐的运动疗法组（MMT组，n = 27）、运动疗法组（ET组，n = 27）和对照组（n = 27）。MMT组参与者每周接受5次MMT治疗（每次1小时），共4周。ET组受试者接受与MMT组相同的干预，但没有音乐。所有组的参与者均进行常规康复治疗。主要结局是PD患者FOG的变化。次要评估指标包括FOG问卷（FOG-Q）和综合运动功能。
干预4周后，MMT组的双支撑时间、步频、站立时膝关节最大屈曲度、最大髋关节伸展度、站立时膝关节屈曲力矩、综合运动功能（统一帕金森病评定量表第三部分步态相关项目总分、从椅子上起身、冻结步态、姿势稳定性、姿势、MDS-UPDRS第二部分步态相关项目总分、从床上/汽车/深椅子上下来、行走和平衡、冻结）以及FOG-Q均低于对照组和ET组（P < 0.05）。MMT组的步态速度、站立时踝关节最大背屈度、蹬离期踝关节活动范围（ROM）、步态周期中踝关节ROM、步态周期中膝关节ROM以及站立时最大伸肌力矩（踝关节、膝关节）均高于对照组和ET组（P < 0.05）。然而，对照组和ET组之间未报告有显著差异（P > 0.05）。MMT组的步长和步态周期中髋关节ROM高于对照组（P < 0.05），MMT组站立时膝关节最大伸展度低于对照组（P < 0.05）。然而，ET组与MMT组之间（P > 0.05）或与对照组之间（P > 0.05）均无显著差异。
MMT改善了PD伴FOG患者的步态障碍，从而改善了他们的综合运动功能。
