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BACKGROUND

IMPROVEMENT OF GAIT, FUNCTIONAL AND COGNITIVE PERFORMANCE IN PATIENTS WITH PARKINSON’S DISEASE AFTER GAIT TRAINING ASSOCIATED WITH EXECUTIVE FUNCTION TASKS. BACKGROUND. BACKGROUND. PURPOSE.

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BACKGROUND

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  1. IMPROVEMENT OF GAIT, FUNCTIONAL AND COGNITIVE PERFORMANCE IN PATIENTS WITH PARKINSON’S DISEASE AFTER GAIT TRAINING ASSOCIATED WITH EXECUTIVE FUNCTION TASKS

  2. BACKGROUND

  3. BACKGROUND

  4. PURPOSE • The aim of this study was to compare the effectiveness of gait training associated with executive function tasks versus gait training alone, to improve gait, functional performance and cognitive functions in PD patients.

  5. METHODS • DESING • A double-blinded, randomized, controlled, longitudinal clinical trial • PARTICIPANTS • 20 patients with idiopathic PD, mean age of 68.5 years (S.D = 5.24), 12 men and 8 women, at stages 1 and 2 of the disease according to the Hoehn and Yahr Classification, and who were asymptomatic for depression and dementia, took part in the study. All participants signed the HCFMUSP informed consent term.

  6. OUTCOME MEASURES • PRIMARY • GAIT SPEED • SINGLE TASK • DUAL TASK • GAIT + MOTOR TASK • GAIT + COGNITIVE TASK • SECUNDARY • DYNAMIC GAIT INDEX • MONTREAL COGNITIVE ASSESSMENT (MoCa) • UNIFED PARKINSONS DISEASE RATING SCALE (UPDRS)

  7. INTERVENTION • Both types of training session were preceded by 30 minutes of general mobility exercises. • In the EFGT, gait was trained in association with six different tasks simulating daily living situation of the patients and requiring divided attention, memory, particularly working memory, perceptual judgment, decision-making, response inhibition, response monitoring, among others.

  8. INTERVENTION • In the GT, gait was trained in the same trajectory and for the same period but with no associated tasks. • Patients from both groups were instructed to walk while taking long steps as quickly as possible.

  9. DATA ANALYSIS • The following measures were compared: (1) Unified Parkinson Disease Rating Scale (UPDRS), for assessing functionality; (2) Montreal Cognitive Assessment (MOCA), for assessing cognitive functions; (3) gait performance on a single task; (4) gait performance on a dual-task; and (5) functional gait performance before training (BT), 7 (AT), 30 (RET 1) days after end of training, using repeated measures ANOVA.

  10. RESULTS • The results revealed significant interaction between training type (EFGT and GT) and scores (BT; AT; RET1; RET2) on UPDRS and MOCA assessments (ANOVA, p< 0.001) as well as dual-task and functional gait performance (ANOVA, p< 0.0001), confirmed by Tukey’s post-hoc test which showed that EFGT led to superior improvement and retention compared to GT. • Regarding single-task gait, only a significant assessment effect was observed, confirmed by Tukey’s post-hoc test, which showed that both groups improved gait performance on this task.

  11. CONCLUSION • EFGT was found to be superior to GT for improving motor and cognitive performance in PD patients.

  12. IMPLICATIONS • The findings of this study demonstrate the importance of motor training associated with cognitive functions to attenuate the functional impairments in PD patients, showing that despite automatic motor control dysfunctions and cognitive deficiencies, performance of this patient group on multiple tasks can be improved.

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