Background Exercises with motor complexity induce neuroplasticity in individuals with Parkinson's disease (PD), but its effects on freezing of gait are unknown. The objective of this study was to verify if adapted resistance training with instability — exercises with motor complexity will be more effective than traditional motor rehabilitation — exercises without motor complexity in improving freezing‐of‐gait severity, outcomes linked to freezing of gait, and brain function. Methods Freezers were randomized either to the adapted resistance training with instability group (n = 17) or to the active control group (traditional motor rehabilitation, n = 15). Both training groups performed exercises 3 times a week for 12 weeks. The primary outcome was the New Freezing of Gait Questionnaire. Secondary outcomes were freezing of gait ratio (turning task), cognitive inhibition (Stroop‐III test), motor signs (Unified Parkinson's Disease Rating Scale part‐III [UPDRS‐III]), quality of life (PD Questionnaire 39), anticipatory postural adjustment (leg‐lifting task) and brain activation during a functional magnetic resonance imaging protocol of simulated anticipatory postural adjustment task. Outcomes were evaluated before and after interventions. Results Only adapted resistance training with instability improved all the outcomes (P < 0.05). Adapted resistance training with instability was more effective than traditional motor rehabilitation (in improving freezing‐of‐gait ratio, motor signs, quality of life, anticipatory postural adjustment amplitude, and brain activation; P < 0.05). Our results are clinically relevant because improvement in the New Freezing of Gait Questionnaire (−4.4 points) and UPDRS‐III (−7.4 points) scores exceeded the minimally detectable change (traditional motor rehabilitation group data) and the moderate clinically important difference suggested for PD, respectively. The changes in mesencephalic locomotor region activation and in anticipatory postural adjustment amplitude explained the changes in New Freezing of Gait Questionnaire scores and in freezing‐of‐gait ratio following adapted resistance training with instability, respectively. Conclusions Adapted resistance training with instability is able to cause significant clinical improvement and brain plasticity in freezers. © 2020 International Parkinson and Movement Disorder Society

Background Previous reviews have generally reported cognitive//behavioral improvements after cognitively oriented treatments (COTs) in persons with MCI. However, comparatively little is known about the neural mechanisms associated with such cognitive improvement. Objective The primary aim of the current review was to examine neurophysiological changes measured by functional magnetic resonance imaging (fMRI) and possible cognitive changes following COTs in those with MCI. Methods. An extensive literature search was conducted up to August 2018. Inclusion criteria were (1) studies that evaluated the effects of the COTs in patients with amnestic single- or multiple-domain MCI using fMRI, (2) the MCI patient sample having met Petersen's or Jack/Bond's criteria, (3) randomized and/or controlled trials, (4) fMRI and cognitive assessments completed pre- and post-intervention, and (5) articles available in English. Results Amongst the 26 articles found, 7 studies were included according to the above inclusion criteria. A total of 3 studies applied rehearsal-based strategies as the primary intervention, all of which used computerized cognitive training. Four studies used fMRI to investigate the neurophysiologic and cognitive changes associated with memory strategy training. The majority of the studies included in this review showed evidence of improved objective cognitive performance associated with COTs, even in tasks similar to everyday life activities. In addition, there were significant changes in brain activation associated with interventions, in both typical and atypical brain areas and networks related to memory. Conclusions Although additional studies are needed given the small sample size, these initial findings suggest that cognitive improvement after COTs is generally associated with both compensatory (i.e., engaging alternative brain regions or networks not “typically” engaged) and restorative (i.e., reengaging the “typical” brain regions or networks) mechanisms.

Background Deficits in the cerebellar locomotor region (CLR) have been associated with loss of gait automaticity in individuals with freezing of gait in Parkinson's disease (freezers); however, exercise interventions that restore gait automaticity in freezers are lacking. We evaluated the effects of the adapted resistance training with instability ([ARTI] complex exercises) compared with traditional motor rehabilitation (without complex exercises) on gait automaticity and attentional set‐shifting. We also verified associations between gait automaticity change and CLR activation change previously published. Methods Freezers were randomized either to the experimental group (ARTI, n = 17) or to the active control group (traditional motor rehabilitation, n = 15). Both training groups performed exercises 3 times a week for 12 weeks. Gait automaticity (dual‐task and dual‐task cost [DTC] on gait speed and stride length), single‐task gait speed and stride length, attentional set‐shifting (time between Trail Making Test parts B and A), and CLR activation during a functional magnetic resonance imaging protocol of simulated step initiation task were evaluated before and after interventions. Results Both training groups improved gait parameters in single task (P < 0.05), but ARTI was more effective than traditional motor rehabilitation in improving DTC on gait speed, DTC on stride length, dual‐task stride length, and CLR activation (P < 0.05). Changes in CLR activation were associated with changes in DTC on stride length (r = 0.68, P = 0.002) following ARTI. Only ARTI improved attentional set‐shifting at posttraining (P < 0.05). Conclusions ARTI restores gait automaticity and improves attentional set‐shifting in freezers attributed to the usage of exercises with high motor complexity. © 2020 International Parkinson and Movement Disorder Society

Highlights High hemodynamic response in the AI and SMA in the FoG when an APA was required. Connectivity between the right and left insulae was correlated with severity of FoG. Both groups showed different brain network organizations between SMA and bilateral AI. SMA was found to be a hub in patients with FoG when an APA was required.

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