Emerging Paradigms in Exercise-Based Neuro-Physiotherapy for Holistic Motor and Cognitive Rehabilitation in Parkinson’s Disease
Neuro-Physiotherapy in Parkinson’s Disease
DOI:
https://doi.org/10.54393/tt.v5i04.241Keywords:
Parkinson’s Disease, Neurodegenerative Disorder, Neuro-Physiotherapy, Multimodal Exercise Programs, Technology-Driven InterventionsAbstract
Parkinson’s Disease (PD) is a progressive neurodegenerative disorder that affects motor and non-motor functions, including cognitive, emotional and autonomic systems, severely impacting quality of life. The motor symptoms of PD are successfully treated by traditional physiotherapy, but such treatments often fail to address the complexity and variety of PD. Advancements in exercise-based neuro-physiotherapy are reviewed, with a focus on innovative and multimodal approaches combining motor and cognitive rehabilitation. Technology driven interventions like virtual reality, robotics and AI add real time feedback and personalized care to therapy, while cognitive strategies like dual task training and mindfulness practice address cognitive impairments. Comprehensive benefits of multimodal exercise programs that include aerobic, strength and flexibility exercises are targeted to achieve both physical and mental health. Comparative analysis of traditional, emerging and multimodal approaches shows their strengths and weaknesses, and highlights the need for tailored interventions. Future directions are directed at longitudinal research, combination of pharmacological and surgical treatments, and the use of biomarkers and AI to design a personalized therapy to enhance outcomes and quality of life of PD patients
References
Kumaresan M, Khan S. Spectrum of non-motor symptoms in Parkinson's disease. Cureus. 2021 Feb, 13(2).
Radad K, Moldzio R, Krewenka C, Kranner B, Rausch WD. Pathophysiology of non-motor signs in Parkinsons disease: some recent updating with brief presentation. Exploration of Neuroprotective Therapy. 2023 Feb, 3(1): 24-46.
Brunelli F, Torosantucci L, Gelmetti V, Franzone D, Grünewald A, Krüger R, Arena G, Valente EM. PINK1 protects against staurosporine-induced apoptosis by interacting with Beclin1 and impairing its pro-apoptotic cleavage. Cells. 2022 Feb, 11(4): 678.
Zheng Y, Meng Z, Zhi X, Liang Z. Dual-task training to improve cognitive impairment and walking function in Parkinson's disease patients: A brief review. Sports Medicine and Health Science. 2021 Dec, 3(4): 202-6.
Mylius V, Maes L, Negele K, Schmid C, Sylvester R, Brook CS, Brugger F, Perez-Lloret S, Bansi J, Aminian K, Paraschiv-Ionescu A. Dual-task treadmill training for the prevention of falls in Parkinson's disease: rationale and study design. Frontiers in rehabilitation sciences. 2022 Mar, 2: 774658.
Dong-Chen X, Yong C, Yang X, Chen-Yu S, Li-Hua P. Signaling pathways in Parkinson’s disease: molecular mechanisms and therapeutic interventions. Signal transduction and targeted therapy. 2023 Feb, 8(1): 73.
Dauer W, Przedborski S. Parkinson's disease: mechanisms and models. Neuron. 2003 Sep, 39(6): 889-909.
Song J, Kim J. Degeneration of dopaminergic neurons due to metabolic alterations and Parkinson’s disease. Frontiers in aging neuroscience. 2016 Mar, 8: 65.
Calabresi P, Mechelli A, Natale G, Volpicelli-Daley L, Di Lazzaro G, Ghiglieri V. Alpha-synuclein in Parkinson’s disease and other synucleinopathies: from overt neurodegeneration back to early synaptic dysfunction. Cell death & disease. 2023 Mar, 14(3): 176.
Rosen BI. Alpha-Synuclein Multimerization Is Dependent on Structural Characteristics of Repeated Ktkegv Regions. St. John's University (New York), 2021.
Zhou C, Wang L, Cheng W, Lv J, Guan X, Guo T et al. Two distinct trajectories of clinical and neurodegeneration events in Parkinson’s disease. NPJ Parkinson's Disease. 2023 Jul, 9(1): 111.
Çınar E, Tel BC, Şahin G. Neuroinflammation in parkinson’s disease and its treatment opportunities. Balkan medical journal. 2022 Sep, 39(5): 318.
Jurcau A, Andronie-Cioara FL, Nistor-Cseppento DC, Pascalau N, Rus M, Vasca E et al. The involvement of neuroinflammation in the onset and progression of Parkinson’s disease. International Journal of Molecular Sciences. 2023 Sep, 24(19): 14582.
Salles P, Tirapegui JM, Chaná-Cuevas P. Genetics of Parkinson's disease: Dominant forms and GBA. Neurology Perspectives. 2024 Jul, 4(3): 100153.
Passaretti M, Cilia R, Rinaldo S, Rossi Sebastiano D, Orunesu E, Devigili G et al. Neurophysiological markers of motor compensatory mechanisms in early Parkinson’s Disease. Brain. 2024 Nov, 147(11): 3714-26.
Mak MK, Wong-Yu IS. Exercise for Parkinson's disease. International review of neurobiology. 2019 Jan, 147:1-44.
Kallás MS, Nóbrega KH, dos Santos Figueiredo I, Padilha GB, de Rezende Pinto L. Oral dentures and quality of life related to Parkinson disease: An integrative review. Research, Society and Development. 2024 Jun, 13(6): e13713644657-.
Andersson S, Josefsson M, Stiernman LJ, Rieckmann A. Cognitive decline in Parkinson’s disease: a subgroup of extreme decliners revealed by a data-driven analysis of longitudinal progression. Frontiers in Psychology. 2021 Sep, 12: 729755.
Takeuchi N, Izumi SI. Rehabilitation with poststroke motor recovery: a review with a focus on neural plasticity. Stroke research and treatment. 2013, 2013(1): 128641.
Savoie FA, Benoit S, Riesco E, Tanguay A. Long-term impact of a community-based adapted boxing program on physical functioning and quality of life of individuals with Parkinson’s disease. NeuroRehabilitation. 2024 Jan: 1-2.
Burtscher J, Moraud EM, Malatesta D, Millet GP, Bally JF, Patoz A. Exercise and gait/movement analyses in treatment and diagnosis of Parkinson’s Disease. Ageing Research Reviews. 2024 Jan, 93: 102147.
Taniguchi S, D’cruz N, Nakagoshi M, Osaki T, Nieuwboer A. Determinants of impaired bed mobility in Parkinson’s disease: Impact of hip muscle strength and motor symptoms. NeuroRehabilitation. 2022 Jan, 50(4): 445-52.
Khobkhun F, Hollands M, Tretriluxana J, Srivanitchapoom P, Richards J, Ajjimaporn A. Benefits of task‐specific movement program on en bloc turning in Parkinson's disease: A randomized controlled trial. Physiotherapy Research International. 2022 Oct, 27(4): e1963.
Strand KL, Cherup NP, Totillo MC, Castillo DC, Gabor NJ, Signorile JF. Periodized resistance training with and without functional training improves functional capacity, balance, and strength in Parkinson's disease. The Journal of Strength & Conditioning Research. 2021 Jun, 35(6): 1611-9.
Claus I, Muhle P, Czechowski J, Ahring S, Labeit B, Suntrup‐Krueger S. Expiratory muscle strength training for therapy of pharyngeal dysphagia in Parkinson's disease. Movement Disorders. 2021 Aug, 36(8): 1815-24.
Karpodini CC, Dinas PC, Angelopoulou E, Wyon MA, Haas AN, Bougiesi M et al. Rhythmic cueing, dance, resistance training, and Parkinson's disease: A systematic review and meta-analysis. Frontiers in neurology. 2022 Aug, 13: 875178.
Moratelli JA, Alexandre KH, Boing L, Swarowsky A, Corrêa CL, de Guimarães AC. Dance rhythms improve motor symptoms in individuals with Parkinson's disease: a randomized clinical trial. Journal of Dance Medicine & Science. 2022 Mar, 26(1): 1-6.
Eldemir S, Eldemir K, Saygili F, Ozkul C, Yilmaz R, Akbostancı MC et al. The effects of standard and modified LSVT BIG therapy protocols on balance and gait in Parkinson's disease: A randomized controlled trial. Brain and Behavior. 2024 Mar, 14(3): e3458.
Magdi A, Sayed Ahmed AM, Elsayed E, Ahmad R, Ramakrishnan S, Gabor MG. Effects of cueing techniques on gait, gait-related mobility, and functional activities in patients with parkinson’s disease: a systematic review and meta-analysis. Physical Therapy Reviews. 2021 Mar, 26(3): 188-201.
Carroll LM, Morris ME, O'Connor WT, Clifford AM. Community aquatic therapy for Parkinson’s disease: an international qualitative study. Disability and Rehabilitation. 2022 Jul, 44(16): 4379-88.
Nedergård H, Arumugam A, Sandlund M, Bråndal A, Häger CK. Effect of robotic-assisted gait training on objective biomechanical measures of gait in persons post-stroke: a systematic review and meta-analysis. Journal of Neuroengineering And Rehabilitation. 2021 Dec, 18: 1-22.
Tsai SY, Tai CH, Lee YY. Exploring Potential Predictors of Treadmill Training Effects in People With Parkinson Disease. Archives of Physical Medicine and Rehabilitation. 2024 Mar, 105(3): 525-30.
Anil K, Hall SD, Demain S, Freeman JA, Ganis G, Marsden J. A systematic review of neurofeedback for the management of motor symptoms in Parkinson’s disease. Brain sciences. 2021 Sep, 11(10): 1292.
Rodríguez-Hernández M, Polonio-López B, Corregidor-Sánchez AI, Martín-Conty JL, Mohedano-Moriano A, Criado-Álvarez JJ. Can specific virtual reality combined with conventional rehabilitation improve poststroke hand motor function? A randomized clinical trial. Journal of NeuroEngineering and Rehabilitation. 2023 Apr, 20(1): 38.
Gilat M, Ginis P, Zoetewei D, De Vleeschhauwer J, Hulzinga F, D’Cruz N et al. A systematic review on exercise and training-based interventions for freezing of gait in Parkinson’s disease. npj Parkinson's Disease. 2021 Sep, 7(1): 81.
Lee EY. Memory Deficits in Parkinson’s Disease Are Associated with Impaired Attentional Filtering and Memory Consolidation Processes. Journal of Clinical Medicine. 2023 Jul, 12(14): 4594.
Oliveira de Carvalho A, Murillo-Rodriguez E, Rocha NB, Carta MG, Machado S. Physical exercise for Parkinson’s disease: Clinical and experimental evidence. Clinical Practice and Epidemiology in Mental Health. 2018 Mar, 14(1).
Fang C, Lv L, Mao S, Dong H, Liu B. Cognition deficits in Parkinson’s disease: mechanisms and treatment. Parkinson’s disease. 2020: 2020(1); 2076942.
Hofheinz M, Mibs M, Elsner B. Dual task training for improving balance and gait in people with stroke. The Cochrane Database of Systematic Reviews. 2016: 2016(10).
Bender AD, Filmer HL, Naughtin CK, Dux PE. Dynamic, continuous multitasking training leads to task-specific improvements but does not transfer across action selection tasks. NPJ Science of Learning. 2017 Dec, 2(1): 14.
Bogosian A, Hurt CS, Vasconcelos e Sa D, Hindle JV, McCracken L, Cubi-Molla P. Distant delivery of a mindfulness-based intervention for people with Parkinson’s disease: the study protocol of a randomised pilot trial. Pilot and Feasibility Studies. 2017 Dec, 3: 1-3.
van der Heide A, Meinders MJ, Speckens AE, Peerbolte TF, Bloem BR, Helmich RC. Stress and mindfulness in Parkinson's disease: clinical effects and potential underlying mechanisms. Movement Disorders. 2021 Jan, 36(1): 64-70.
Kwok JY, Choi EP, Wong JY, Lok KY, Ho MH, Fong DY et al. A randomized clinical trial of mindfulness meditation versus exercise in Parkinson’s disease during social unrest. NPJ Parkinson's disease. 2023 Jan, 9(1): 7.
He S, Fang W, Wu J, Lv H, Zhang J, Wang T et al. Whether mindfulness-guided therapy can be a new direction for the rehabilitation of patients with Parkinson’s disease: a network meta-analysis of non-pharmacological alternative motor-/sensory-based interventions. Frontiers in psychology. 2023 Sep, 14: 1162574.
Krylova M, Skouras S, Razi A, Nicholson AA, Karner A, Steyrl D et al. Progressive modulation of resting-state brain activity during neurofeedback of positive-social emotion regulation networks. Scientific reports. 2021 Dec, 11(1): 23363.
Yu L, Long Q, Tang Y, Yin S, Chen Z, Zhu C, et al. Improving emotion regulation through real-time neurofeedback training on the right dorsolateral prefrontal cortex: evidence from behavioral and brain network analyses. Frontiers in Human Neuroscience. 2021 Mar, 15: 620342.
Ventegodt S, Gringols M, Merrick J. Clinical holistic medicine: holistic rehabilitation. The Scientific World Journal. 2005, 5(1): 280-7.
Luo, H., Galvão, D.A., Newton, R.U., Tang, C.I., Spry, N. and Taaffe, D.R. Multimodal Exercise in Older Patients with Advanced Pancreatic Cancer Undergoing First‐Line Chemotherapy: A Case Series Examining Feasibility and Preliminary Efficacy. European Journal of Cancer Care. 2023: 2023(1), 1179848.
Fernandez-Rodriguez EJ, Sanchez-Gomez C, Mendez-Sanchez R, Recio-Rodriguez JI, Puente-Gonzalez AS, Gonzalez-Sanchez J et al. Multimodal physical exercise and functional rehabilitation program in oncological patients with cancer-related fatigue A randomized clinical trial. International Journal of Environmental Research and Public Health. 2023 Mar, 20(6): 4938.
Huang Z, Meng L, Bi X, Xie Z, Liang W, Huang J. Efficacy and safety of robot-assisted deep brain stimulation for Parkinson’s disease: a meta-analysis. Frontiers in Aging Neuroscience. 2024 May, 16: 1419152.
Parekh AD, Shaikh OA, Manan S, Al Hasibuzzaman M. Artificial intelligence (AI) in personalized medicine: AI-generated personalized therapy regimens based on genetic and medical history. Annals of Medicine and Surgery. 2023 Nov, 85(11): 5831-3.
Olawade DB, Wada OZ, Odetayo A, David-Olawade AC, Asaolu F, Eberhardt J. Enhancing mental health with Artificial Intelligence: Current trends and future prospects. Journal of medicine, surgery, and public health. 2024 Apr: 100099.
Sierra M SD, Garcia A DE, Otálora S, Arias-Castro MC, Gómez-Rodas A, Munera M, Cifuentes CA. Assessment of a robotic walker in older adults with Parkinson's disease in daily living activities. Frontiers in Neurorobotics. 2021 Dec, 15: 742281.
Kehnemouyi YM, Coleman TP, Tass PA. Emerging wearable technologies for multisystem monitoring and treatment of Parkinson’s disease: a narrative review. Frontiers in Network Physiology. 2024 Feb, 4: 1354211.
Das J, Barry G, Walker R, Vitorio R, Morris R, Stuart S. The integration of technology into a home-based visuo-cognitive training intervention for people with Parkinson’s: Is the future digital?. Plos one. 2023 Jun, 18(6): e0285100.
Masinde R, Barasa D, Mandillah L. Effectiveness of using multimodal approaches in teaching and learning listening and speaking skills. 2023.
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