Work and power reduced in L-dopa naïve patients in the early-stages of Parkinson’s disease

Abstract

Parkinson's disease (PD) is a neuro-degenerative disease in which the progressions of the symptoms are associated with progressive loss of strength and power, which leads to deterioration of physical abilities 1,2 . Studies that employed measures of peak torque have observed muscular deficits in individuals at various stages of PD, mainly in the intermediate and advanced phases 3,4 . Usually, these individuals demonstrated bilateral motor impairments, which are associated with deficits in balance and gait and may contribute to immobility and poorer functional performance 5 .Recently, studies have found that in the early stages, individuals with PD already demonstrate cognitive decline 6 , impaired planning 7 , altered dynamic postural control 8 , and functional losses when compared to those without the disease 9 . In addition to these impairments, it is possible that muscle deficits may also contribute to the functional losses. However, few studies have investigated muscular performance in individuals in the early stages of PD. Bridgewater and Sharpe 10 showed decreases in trunk extensor torque during the early-stages of PD, which could contribute to the flexed posture observed in the advanced stages. Koller and Kase 11 observed decreases in the maximal isotonic knee strength of individuals in the early stages of the disease; however, the hip and ankle muscular groups were not assessed. Furthermore, several studies have AbstrACtStudies which have investigated muscular performance during the initial stages of Parkinson´s disease (PD) without L-dopa treatments were not found. Objective: to assess whether muscular performance, work and power, of the trunk and lower limbs in L-dopa naïve patients in the early stages of PD was lower than those of healthy subjects and to compare muscular performance between the lower limbs. Method: Ten subjects with PD, Hoehn and Yahr (HY) I-II, L-dopa naïve and 10 subjects in the control group were assessed with the isokinetic dynamometer. Results: ANOVAs revealed that work and power measures of the trunk, hip, knee, and ankle muscular groups were lower in PD compared with the control group (p < 0.05). There were no significant differences in muscular performance between the lower limbs. Conclusion:The results suggested the use of specific exercises, as rehabilitation strategies, to improve the ability to produce work and power with this population.Keywords: Parkinson's disease; muscle strength; Muscle strength dynamometer; rehabilitation; physical therapy speciality. resumo Estudos que investigaram o desempenho muscular durante os estágios iniciais da doença de Parkinson (DP), sem tratamento com L-dopa não foram encontrados. Objetivo: Avaliar se o desempenho muscular, por meio de medidas de trabalho e potência, do tronco e dos membros inferiores em pacientes sem o uso de L-dopa nas fases iniciais da DP é menor do que o de indivíduos saudáveis e comparar o desempenho muscular entre os membros inferiores. Método: Dez indivíduos com DP, Hoehn and Yahr (HY) I-II, sem L-dopa e 10 indiv...

People with mild PD have impaired force production in all lower limb muscle groups: A cross‐sectional study

“…It is also clear that people with PD have reduced power (i.e., reduced ability to produce force quickly) in a range of lower limb muscle groups (Allen, Canning, Sherrington, & Fung, 2009; Lima, Cardoso, Teixeira‐Salmela, & Rodrigues‐de‐Paula, 2016). Power is important for performing daily activities (Foldvari et al., 2000); however, in people with PD, bradykinesia (i.e., decreased speed of movement) contributes to reduced power generation (Allen et al., 2009; Lima et al., 2016) and this limits activity (Allen et al., 2009). It is not clear, however, whether the power deficit evident is a result of bradykinesia alone, or whether it is a result of bradykinesia as well as impaired force production (i.e., weakness).…”

“…People with PD have many motor impairments including bradykinesia, balance impairment, tremor and rigidity. It is also clear that people with PD have reduced power (i.e., reduced ability to produce force quickly) in a range of lower limb muscle groups (Allen, Canning, Sherrington, & Fung, 2009; Lima, Cardoso, Teixeira‐Salmela, & Rodrigues‐de‐Paula, 2016). Power is important for performing daily activities (Foldvari et al., 2000); however, in people with PD, bradykinesia (i.e., decreased speed of movement) contributes to reduced power generation (Allen et al., 2009; Lima et al., 2016) and this limits activity (Allen et al., 2009).…”

“…Power is important for performing daily activities (Foldvari et al, 2000); however, in people with PD, bradykinesia (i.e., decreased speed of movement) contributes to reduced power generation (Allen et al, 2009;Lima et al, 2016) and this limits activity (Allen et al, 2009). It is not clear, however, whether the power deficit evident is a result of bradykinesia alone, or whether it is a result of bradykinesia as well as impaired force production (i.e., weakness).…”

“…power (i.e., reduced ability to produce force quickly) in a range of lower limb muscle groups (Allen, Canning, Sherrington, & Fung, 2009;Lima, Cardoso, Teixeira-Salmela, & Rodrigues-de-Paula, 2016).…”

Leg Muscle Strength Correlates with Gait Performance in Advanced Parkinson Disease

“…The present study results showed that, in advanced PD patients, LMS decreased with increasing severity of the disease. Lima et al ( 24 ) showed that the muscle power of the trunk, hip, knee flexors and extensors, and ankle plantar flexors was lower in L-dopa-naïve early-stage PD (H&Y 1 and 2) than in the control group. Nogaki et al ( 25 ) reported that leg muscle weakness was seen more often on the affected side as disease progression in early-stage PD (H&Y 1 and 2) than less affected side.…”