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Treadmill Incline Training Improves Walking Speed of Parkinson’s Patients, Study Finds

treadmill incline training

Eight weeks of training on a treadmill with continuously varying surface inclines improved gait disturbances, particularly walking speed, in Parkinson’s disease patients, researchers report.

Their finding were published in the study, “Exploring gait adaptations to perturbed and conventional treadmill training in Parkinson’s disease: Time-course, sustainability, and transfer,” in the journal Human Movement Science.

As the disease progresses, Parkinson’s patients experience an increase in gait difficulties and balance problems, lowering their mobility and quality of life.

In addition, studies have shown that Parkinson’s patients take shorter and slower steps, and have high stride-to-stride variability.

Because some gait disturbances are drug-resistant, nonpharmacological treatment options are needed to improve these patients’ quality of life.

“Improved stride length and stride-to-stride variability have been demonstrated following several weeks of treadmill practice for both, overground and treadmill walking, respectively,” the authors wrote.

Researchers had recently demonstrated that eight weeks of treadmill therapy with additional postural perturbations (i.e., varying surface inclines) improved overground gait speed and dynamic balance control in Parkinson’s patients.

Now the same team at Friedrich-Alexander University Erlangen-Nürnberg has analyzed spatiotemporal gait adaptations to treadmill training — with and without an incline — both on and off the machine.

They used data from a randomized controlled Phase 1 trial (NCT01856244) aimed at investigating the effectiveness of a sensorimotor treadmill intervention to improve walking and balance abilities in people in the early stages of Parkinson’s disease.

Sensorimotor treadmill training was conducted on a special machine that challenged the participants through small oscillations, simulating walking on natural, uneven surfaces. This intervention was compared with conventional treadmill training without surface perturbations.

Thirty-eight Parkinson’s patients were randomly assigned to 40 minutes of treadmill training two times per week for eight weeks. Of these patients, 18 performed treadmill training with continuously varying surface inclines, while the other 20 walked on the treadmill without surface perturbations.

Patients were assessed every week during training protocol (prior to the training sessions), within one week after the intervention, and at a three-month follow-up.

Gait variability significantly decreased in both training groups. Nonetheless, longer stride length and time, stance time, and swing time were significantly improved only in the treadmill incline training group.

For reference, one gait cycle consists of two phases: stance, or the period of time that the foot is on the ground, and swing, meaning the period of time that the foot is off the ground moving forward.

Researchers then investigated the sustainability of gait changes over three months.

At the three-month follow-up, there were significant changes between the groups in stance and swing time, which were due to a much higher variability in the conventional treadmill training group. Statistical comparisons within the groups revealed no significant changes in the treadmill incline training group.

Additional statistical analysis also showed decreased step length asymmetry in the conventional treadmill training group.

The team then assessed the extent of transfer effects to overground gait in both training regimes.

“When considering the entire sample, significant changes in overground gait parameters at [week 8] were observed only for stance- and swing time, with a significantly decreased stance time … and a corresponding increase in swing time,” they wrote. However, these findings were statistically significant only in the treadmill incline training regime.

“[Parkinson’s disease] patients demonstrated marked gait adaptations to the eight-week treadmill intervention, which were partially retained after three months follow-up,” they noted.

Treadmill training with small oscillations seemed to reduce gait disturbances, but the transfer of such changes to overground walking was limited in most evaluated variables.

Further research is still necessary to corroborate these findings.

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Vitamin D May Improve Balance in Younger Parkinson’s Patients, Pilot Study Suggests

Short-term supplementation of vitamin D in high doses may improve balance in people with Parkinson’s disease younger than 66, according to results of a Phase 2 pilot study.
The study, “A randomized, controlled pilot study of the effects of vitamin D supplementation on balance in Parkinson’s disease: Does age matter?” was published in Plos One.
Parkinson’s patients are at a high risk of falling mainly due to problems with balance — one of the primary symptoms of the disease. It is estimated that 70 percent of Parkinson’s patients fall at least once a year.
Falls are associated with substantial injury, disability, hospitalization, and reduced quality of life in Parkinson’s patients and in older people in general. However, no pharmaceutical or surgical intervention is currently known to significantly improve balance.
As a result, there is an unmet need to discover or develop therapeutic approaches to improve balance in Parkinson’s patients.
At the same time, individuals with Parkinson’s, particularly those with advanced disease, have lower levels of vitamin D, which is involved not only in bone health, but also in brain function.
Previous studies have shown that vitamin D supplementation reduces fall rates and improves balance in older people. While it has been suggested that higher doses of vitamin D are more effective than lower ones, more recent evidence suggests that higher doses in older populations may have the opposite effect, being associated with more frequent falls and fractures.
A randomized, double-blinded, placebo-controlled Phase 2 pilot study (NCT01119131) evaluated the safety and effectiveness of high-dose vitamin D supplementation on balance, gait, falls, strength, and cognition in Parkinson’s patients. Disease severity and quality of life were also assessed.
Researchers analyzed the data of 51 patients, at a mean age of 66.57 years, who were randomized to receive either a high dose of vitamin D (27 patients) or a placebo (24 patients), in addition to 1,000 mg of calcium, daily for four months.
Balance function was measured using the Sensory Organization Test (SOT), an objective test to measure impairments in postural stability or balance, which has been found to be the most suitable for assessing balance in relation to vitamin D levels.
Results showed that vitamin D supplementation doubled patients’ vitamin D blood levels after four months of treatment, while patients who received placebo showed no substantial changes in their levels.
Patients receiving the high dose of the supplement showed no significant improvements in balance, compared with those in the placebo group. In addition, no significant changes were found for gait, strength, cognition, disease severity, or quality of life between the two groups of patients.
However, when researchers divided the patients who received vitamin D into two age groups — those 66 or younger, and those 67 and older — the supplement was found to significantly improve the balance of patients in the younger group, compared with the older age group. No significant therapeutic effect of the supplement was found for any of the other measures.
High-dose vitamin D supplementation appeared to be safe, with no serious adverse events reported.
These findings highlight the possibility of an “age-dependent role for vitamin

Source: Parkinson's News Today

Parkinson’s Patients with Tendency to Fall Control Balance Differently than Non-Fallers, Study Suggests

Parkinson's fall risk

Parkinson’s disease patients who have a tendency to fall use different strategies to control their balance than those who do not fall, according to a recent study.

The study, “Fallers with Parkinson’s disease exhibit restrictive trunk control during walking,” was published in Gait and Posture.

Due to Parkinson’s-related motor imbalance, falls are a common consequence of the disease, and the risk of falling increases as patients get older and as the disease progresses.

Parkinson’s patients are twice as likely to fall than older adults living independently, and are also nine times more likely to have recurrent falls.

Observational studies suggest these patients underestimate the amount of work necessary for their muscles to produce a certain movement. They compensate for this lack of motor and perceptual ability by adopting distinct postural strategies to keep their balance during both static and dynamic movements.

Static measures of posture control can distinguish Parkinson’s patients from healthy older adults, but not Parkinson’s fallers from non-fallers.

“A better understanding of the relationship between falls and static and dynamic movements may provide further insight into falls-risk assessment in this clinical population,” the researchers said.

To study this, researchers at the University of Ottawa in Canada conducted a study that recruited 25 Parkinson’s patients and 17 healthy older adults used as controls.

They analyzed postural differences between Parkinson’s fallers and non-fallers, based on the self-reported occurrence of falls in the previous three months, and between healthy controls.

Motor disability was measured using the Unified Parkinson’s Disease Rating Scale III, cognitive impairment by the Montreal Cognitive Assessment, and freezing of gait by the Freezing of Gait questionnaire.

Participants were given static and dynamic motor tasks, consisting of one quiet standing condition and one walking condition (walking 15 meters while looking straight ahead).

Both tasks were presented twice and lasted for 30 seconds. Testing was performed while patients were optimally medicated with dopaminergic therapies.

The standing test was sensitive enough to distinguish between Parkinson’s patients and healthy controls, but not between fallers and non-fallers with Parkinson’s disease. However, static tasks were less sensitive in differentiating between fallers and non-fallers with Parkinson’s disease and healthy older adults than dynamic tasks.

Fallers had difficulty controlling their upper body (torso) when walking, compared with non-fallers and the control group. This was also true for individuals with Parkinson’s disease versus older healthy adults.

Importantly, falling was associated with static and dynamic postural control in Parkinson’s patients, with fallers and non-fallers adopting different postural strategies to regulate balance.

“Overall, this study provides useful information for falls-risk assessments as well as for developing fall prevention program specific to fallers and non-fallers with PD,” the researchers concluded.

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Source: Parkinson's News Today

The ABCs of Parkinson’s Disease: The Letter B

letter B, botox

Sherri Journeying Through

Second in a series. Read part one.

The letter B is for balance and Botox.

Balance

Many people with Parkinson’s experience walking or balance problems, which can occur in differing degrees. Gait problems can range from the disease slowing your speed, to a lessening of your arm swing and steps that tend to mimic shuffling instead of having a regular stride. You may also struggle with difficulty getting started or freezing in place. Experiencing problems with your balance can cause unsteadiness and falls that make everyday tasks challenging and frustrating.

These symptoms can be tough to treat, but there are ways to manage them: medication adjustment, exercise, and physical therapy. A home safety evaluation may also help.

There are exercises to improve balance for people with Parkinson’s disease. Plus, you can learn methods for getting back up after a fall to avoid injury as much as possible.

Botox

And what else is connected to Parkinson’s disease that begins with “B”?

Why, Botox, of course. People have Botox injections for many different reasons, but in Parkinson’s disease, researchers have found it to be a great help for those suffering from dystonia.

Dystonia is the contraction of a muscle or group of muscles. These contractions can often cause painful and abnormal positions of various parts of the body, for example, the curling of a patient’s toes.

Botox is injected into the affected muscles. The contracted muscles are weakened by the use of Botox, causing them to return to a more normal state. Because of its short effectiveness duration, Botox will most likely need to be reinjected every three to four months.

My neurologist talked about the benefits of Botox for relieving the areas where I was suffering from dystonia, mainly in my back and neck. He injected me with Botox, and within two days I could move my neck again and the pain in my back subsided. It made a world of difference.

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

The post The ABCs of Parkinson’s Disease: The Letter B appeared first on Parkinson’s News Today.

Source: Parkinson's News Today

The Ridiculous Complications of Parkinson’s Disease

complications

Sherri Journeying Through

“It’s gonna be 40, 60 degrees today.” That was the weather report given this morning by my 3-year-old grandson. Well, he almost got it right. It was supposed to get up into the 80s.

We went to Boingo’s, the bouncy house playground, to work out some wiggles and then we stopped at the market for a few things. Because Finn knows which market we were at, he also knew that it was the market that sells ice cream cones to grandchildren in need of a treat. So, Grammy took him to the counter and Finn got a single scoop of chocolate chip mint and Grammy got a scoop of mocha almond fudge.

We exited the store with three bags of groceries and two scoops of ice cream in hand. I got Finn all buckled in and handed him his ice cream. As I stood near him, the car door open where he sat eating his ice cream in the back seat, he said to me, “Grammy, come sit by me.”

So I went around to the other side of the car and got in the backseat with him. We sat and chatted about his favorite Transformer of the week, Green Boulder. Finn commented that he felt hot. I pulled on the handle so I could get out and to my surprise, the child locks were engaged and there was no way I was getting out that door.

“Uh oh.”

A little voice: “What, Grammy?”

“Oh, nothing. Grammy’s going to have to climb over the front seat to open the window.”

Do you know how hard to is for someone with Parkinson’s to just climb over the front seat? Especially someone with Parkinson’s who could stand to lose a few pounds? Yeah, well I didn’t. But now I do.

I set my cup of ice cream on the floor and stood up. Well, I didn’t really stand up. It was more of an attempt to stand while remaining hunched over. Then I proceeded to step onto the front seat. Because of the cramped quarters and the stiffness in my legs, I had to lift my left leg up to the passenger’s seat and then bring my right leg up. Not gonna happen.

I have had so much pain and stiffness in that leg lately that as soon as I attempted to put my right leg on the front seat, it cramped up. As fast as I could, I straightened it out and gathered my courage to retrace my steps so I could get out of the car.

The little voice questioned, “What’s wrong Grammy?”

“This isn’t gonna be easy.”

“Grammy. I’m hot.” Again, that sweet little voice.

“Hang on Finn. Hang on.”

So, I closed my eyes, and on the count of three, pulled my right leg to the front seat, ignoring the cramping that was now ravaging my leg. I opened the passenger door and wondered how I was going to get from the front seat to the ground in front of me. Should I somersault from my crouched position? Just gracefully fall? Try and repeat pulling my leg down to the ground and go through the cramping again?

I opted for the latter, as the somersault would not end anywhere near graceful, and the falling option … I’ve done it before, and it didn’t turn out well at all.

I pulled my leg forward and the cramping immediately returned. As fast as I could, I pulled my leg toward the door and stood up, holding the door for support and praying it didn’t swing open and take me with it.

Once I had both feet firmly planted on the ground, I slowly stood and then walked to ease the cramping. I finally walked around and opened the windows, and not wasting any time, changed the child locks to open.

“Grammy, come sit with me,” Finn said again.

Leaving the door wide open, we sat and drank the rest of our ice cream. As a person with PD and its many unwanted complications, I was just grateful I didn’t have to go to the bathroom during that episode. So very grateful.

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

The post The Ridiculous Complications of Parkinson’s Disease appeared first on Parkinson’s News Today.

Source: Parkinson's News Today

Michael J. Fox Foundation Announces New $7M Initiative to Support Parkinson’s Research, Therapy Development

Michael J. Fox Foundation

The Michael J. Fox Foundation (MJFF) announced a new $7 million funding program to support Parkinson’s disease research and accelerate development of new therapeutic targets and biomarkers.

Through the program, researchers can request project funding in four major research areas. The organization is now accepting pre-proposals through May 2018, with funding anticipated by November 2018.

“We are working diligently toward breakthroughs for people with Parkinson’s and are committed to helping make therapy options available to treat the disease,” Todd Sherer, PhD, chief executive officer of MJFF, said in a press release. “The targeted funding programs announced today will fuel cutting-edge research in areas of significant scientific potential, providing multiple shots on goal.”

One of the four research areas will dedicate $2 million to study nonpharmacological interventions for gait and balance disturbances, two of the most troubling and under-addressed aspects of the disease.

Parkinson’s patients suffer from frequent falls, injury, loss of independence, and decreased quality of life due to problems with gait and balance. Current therapies are insufficient to improve challenges in this area.

The program will fund research projects seeking to gain a deeper insight of the brain circuitry and clinical experience of gait and balance problems. It will also fund studies to investigate the therapeutic benefit of assistive devices, novel technologies, or rehabilitative therapy programs. Excluded from this funding are exercise programs or cognitive strategies.

An additional $1.5 million will be geared toward studying the protein alpha-synuclein, the major component of Lewy bodies, protein clumps found in virtually every Parkinson’s patient’s brain and body cells. To test if Lewy bodies may play a causal role in the disease’s onset and progression, the program will fund researchers seeking to deepen understanding of alpha-synuclein and refine therapy development.

The foundation has also allocated $1.5 million to fund projects investigating GBA protein dysfunction and mutations in the GBA gene in Parkinson’s and speed learning toward practical therapies.

GBA mutations are among the most common in Parkinson’s disease, found in 5 to 10 percent of patients. However, alterations of the normal GBA protein have been found in patients who are not carriers of the GBA mutation, making it a particularly promising target in the development of new therapeutic targets.

A fourth area of research will have a dedicated budget of $2 million. The program will fund researchers seeking to develop and test biomarker assays in three relevant areas: protein handing/autophagy, exosomes, and lipidomics.

Objective measures of Parkinson’s risk, onset, and progression are critical to transform patient care and therapy development. Biomarkers are not only useful to enable an early and accurate diagnosis, but they are also particularly important for more efficient, cost-effective clinical trials. To date, no objective biomarker for Parkinson’s has been developed.

The deadline for pre-proposal submissions is 5:00 p.m. EST May 31, 2018.

MJFF will host an informational webinar at 12:00 p.m. EST May 10 to review the aims of the program and to detail funding process and applicant questions.

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Source: Parkinson's News Today

Vitamin B12 Supplements May Help Slow Parkinson’s Progression, Study Finds

Vitamin B12 supplement

Low levels of vitamin B12 in patients in the early stages of Parkinson’s disease are linked to faster motor and cognitive decline, suggesting that vitamin supplements may help slow the progression of these symptoms, a study has found.

The study, “Vitamin B12 and homocysteine levels predict different outcomes in early Parkinson’s disease,” was published in the journal Movement Disorders.

Several previous studies have shown that B12 deficiencies are common in Parkinson’s patients. Deficiency of this vitamin promotes development of neurological and motor symptoms associated with the disease, including depression, paranoia, muscular numbness, and weakness.

While most studies have addressed the association of B12 with more advanced Parkinson’s disease, little is known about its contribution in the early stages of the disease before treatment begins.

University of California San Francisco (UCSF) researchers analyzed B12 levels in 680 patients recently diagnosed with Parkinson’s who had not begun treatment. The participants were followed for two years, during which physical and cognitive evaluations were conducted, in addition to B12 assessments. After initial evaluations, the patients were given the option to take a controlled daily multivitamin supplement.

Patients were divided into three groups according to their B12 levels at the beginning of the study. Approximately 13% of the participants had borderline low levels of B12, and 5% had a B12 deficiency. No association was found between low vitamin levels and early motor or cognitive symptoms of Parkinson’s.

The team did find that over time, symptoms in patients with lower B12 levels developed more rapidly than those with higher levels: Patients with lower B12 levels had a significantly reduced ambulatory capacity than patients with higher levels.

“Our findings demonstrate that low B12 levels are associated with greater walking and balance problems, possibly due to the known effect of B12 deficiency on the central and peripheral nervous systems,” Chadwick Christine, MD, UCSF neurologist and lead author of the study, said in a university press release. “Alternatively, low B12 may have a direct effect on the progression of Parkinson’s disease, or it may be a marker of an unknown associated factor, perhaps correlating with another aspect of the disease or nutritional status.”

Subsequent analysis showed improved B12 levels in about 50% of participants, indicating they had chosen to take the multivitamin supplement. Disease progression in this group of patients was found to be much slower, based on the annualized average increase of disability on the Unified Parkinson’s Disease Rating Scale (UPDRS) score  — a measure of Parkinson’s disability. Patients with improved B12 levels had an increase to only 10.11 on the scale, showing less disability, compared with 14.38 in patients who maintained low B12 levels throughout the study.

The team also evaluated the blood levels of homocysteine, an amino acid that is usually elevated in people with low B12 levels. There was a significant association between high levels of homocysteine — thus lower B12 — and faster cognitive decline.

“Our results suggest that the measurement of B12 levels early in Parkinson’s may be beneficial,” Christine said. “If levels are at the low end of normal, supplementation to get the level into the middle or upper end of the normal range may slow development of symptoms.”

Further studies are warranted to shed light on how vitamin B12 might benefit Parkinson’s patients, and to fully address its therapeutic potential on disease progression.

The study was supported by funding from the Michael J. Fox Foundation, and gifts from the Ko and Tsu family and William and Mary Ann S. Margaretten.

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Source: Parkinson's News Today