This review suggests that progressive resistance exercise can be effective and worthwhile in people with mild to moderate Parkinson's disease, but carryover of benefit does not occur for all measures of physical performance. The current evidence suggests that progressive resistance training should be implemented in Parkinson's disease rehabilitation, particularly when the aim is to improve walking capacity.
| Background: Older adults and individuals with neurological problems such as Parkinson's disease (PD) exhibit balance deficits that might impair their mobility and independence. The assessment of balance must be useful in identifying the presence of instability and orient interventions. Objective: To translate and perform a cross-cultural adaptation of the Balance Evaluation Systems Test (BESTest) and MiniBESTest to Brazilian Portuguese and analyze its psychometric properties. Method: The tests were translated and adapted to Portuguese according to a standard method and then subjected to a test-retest reliability assessment (10 older adults; 10 individuals with PD). The psychometric properties were assessed by the Rasch model (35 older adults; 35 individuals with PD). Results: The reliability coefficient of the tests relative to the items and subjects varied from 0.91 and 0.98, which is indicative of the stability and reproducibility of the measures. In the BESTest, the person (4.19) and item (5.36) separation index established six balance ability levels and seven levels of difficulty, respectively. In the MiniBESTest, the person (3.16) and item (6.41) separation index established four balance ability levels and nine levels of difficulty, respectively. Two items in the BESTest did not fit with the model expectations, but the construct validity was not compromised. No item in the MiniBESTest was erratic. Conclusions: The results corroborate the diagnostic and screening functions of the BESTest and MiniBESTest, respectively, and indicate that the Brazilian versions exhibit adequate reliability, construct validity, response stability, and capacity to distinguish among various balance ability levels in older adults and individuals with PD.
Background and Purpose
It is well known that people with Parkinson’s disease (PD) have significant difficulty turning, and that such difficulty is related to freezing episodes and falls. However, it is unclear how clinicians should evaluate turning. The purpose of this exploratory study was to determine whether the common clinical assessment instruments reflect turning deficits in persons with PD compared with an instrumented measure.
Methods
Forty healthy controls, 23 participants with mild PD, and 23 participants with severe PD were assessed using the Berg Balance Scale (Berg), Tinetti Mobility Test (Tinetti), Activities-Specific Balance Confidence Scale (ABC), and the new instrumented Timed Up and Go (iTUG) using wearable inertial sensors.
Results
Turns during iTUG showed significant differences among groups (χ2=43.6, p<0.0001). Specifically, controls and mild PD (p< 0.001) and controls and severe PD (p<1·10-7). The number of steps (χ2 =32.1; p<0.0001) and peak speed (χ2 =31.9; p<0.0001) during turning were significantly different among all groups. Clinical scales were less likely to detect these differences. Of the clinical scales, the Berg was best able to detect differences between control and mild PD groups. Correlations between clinical measures of balance and instrumented turning were moderate but significant.
Conclusions
We show evidence that turning is impaired, even in mildly-impaired participants with PD and that this deficit is not obviously reflected in common clinical scales of balance such as the Berg or Tinetti. It may be more useful for a clinician to examine particular items within the Berg or the turning component of the TUG if turning difficulty is suspected.
Neuromuscular coordination abnormalities were observed in both lower limbs. The paretic limb was unable to recruit the muscles at the proper time and to achieve the amplitude for executing the sit-to-stand task, whereas significant compensations occurred on the nonparetic side.
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