Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Doctor of Philosophy Programme in Medicine (Neurology), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Parkinsonism Relat Disord. 2022 Dec;105:43-51. doi: 10.1016/j.parkreldis.2022.10.024. Epub 2022 Oct 28.
Freezing of gait (FOG) is a devastating symptom that develops in patients with advanced Parkinson's disease (PD) and is often unresponsive to pharmacological treatment. Recent research suggests that FOG may result from dysfunctional plantar peripheral sensory systems. The impact of combined plantar pressure and vibratory stimulation over vibratory or pressure alone on FOG remains unexplored.
PD patients with FOG were randomised into four groups and treated with combined vibratory and pressure stimulation, vibratory stimulation alone, pressure stimulation alone, or controls (no stimulation). Vibratory stimulation targeted both Achilles' tendons. Simultaneous bilateral pressure stimulation was applied to the first hallux, first metatarsal bone, and the sole. The primary outcome included normalized percent changes in percent FOG measured both pre- and immediately post-stimulation. Other outcomes including clinical rating scale, response to questionnaires, number and duration of freezing episodes, and spatiotemporal gait parameters at pre- and freezing episodes were also explored.
Sixty PD patients participated in the study. Patients who were treated with combined vibratory and pressure stimulation responded with significant decreases in normalized percent changes of percent FOG (62.75 ± 25.54%, p < 0.001) compared with those treated with vibration alone (11.38 ± 8.29%, p < 0.001), pressure alone (15.15 ± 16.18%, p < 0.001), or controls (8.59 ± 16.85%, p < 0.001).
Our study demonstrated the benefit of combined vibratory and pressure stimulation on FOG suggesting that this strategy might be developed as a novel treatment modality for PD patients with FOG.
冻结步态（FOG）是一种严重的症状，发生在晚期帕金森病（PD）患者中，且通常对药物治疗无反应。最近的研究表明，FOG 可能是由于足底外周感觉系统功能障碍引起的。足底压力和振动刺激的联合作用对 FOG 的影响，与单纯振动或单纯压力刺激相比，尚未得到探索。
将患有 FOG 的 PD 患者随机分为四组，分别接受联合振动和压力刺激、单纯振动刺激、单纯压力刺激或对照组（无刺激）治疗。振动刺激针对跟腱。同时对第一跖骨、第一跖骨骨和足底施加双侧压力刺激。主要结果包括刺激前后正常化的 FOG 百分比变化率。其他结果包括临床评分量表、对问卷的反应、冻结发作的次数和持续时间，以及冻结发作前后的时空步态参数。
60 名 PD 患者参与了研究。与接受单纯振动刺激的患者相比，接受联合振动和压力刺激的患者的 FOG 百分比正常化变化百分比（62.75 ± 25.54%，p < 0.001）有显著降低，而接受单纯压力刺激的患者（15.15 ± 16.18%，p < 0.001）、单纯振动刺激的患者（11.38 ± 8.29%，p < 0.001）或对照组（8.59 ± 16.85%，p < 0.001）的变化百分比则无显著差异。
我们的研究表明，联合振动和压力刺激对 FOG 有疗效，这表明这种策略可能被开发为治疗 FOG 的新型治疗方法。
