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A randomized controlled trial of movement strategies compared with exercise for people with Parkinson's disease ME Morris, R Iansek, B Kirkwood Movement Disorders 2008; published online 21 October 2008 Cognitively-based motor training strategies are superior to exercise therapy for short-term improvement in disability, according to this study, although the effect on quality of life is less certain. Twenty-eight PD patients were randomized to receive either movement strategy therapy or exercise therapy for 2 weeks during an in-hospital stay. Patients received approximately a dozen 45-minute sessions with trained therapists. Movement strategy training focused on cognitive strategies such as focusing attention on movement and responding to external cues, aiming to "teach people how to use attention and to use the frontal cortical regions to compensate for movement disorders." Conventional musculoskeletal exercises focused on improving strength, range of movement, posture, fitness, and function. Patients were tested by a blinded physiotherapist at baseline, at the end of treatment, and 3 months after discharge. Motor strategies training led to statistically significant improvements in UPDRS (motor and ADLs), 10-minute walk time, 2-minute walk distance, Timed Get Up and Go time, balance pull test performance, and PDQ39 score. In contrast, exercise improved only PDQ39 score. At 3 months, patients in the movement strategies group retained their improvements in all areas except the 2-minute walk time and PDQ39. Patients in the exercise group retained their improvement in the PDQ39. =============== Nordic walking improves mobility in Parkinson's disease FJM van Eijkeren, RSJ Reijmers, MJ Kleinveld, A Minten, JP ter Bruggen, BR Bloem Movement Disorders, 2008;23:2239-2243 Nineteen PD patients underwent a 6-week, twice-weekly training program in Nordic walking. Nordic walking, also called pole walking, is an aerobic activity in which the upper body is exercised during walking with the use of modified ski poles. Nordic walking significantly increases total energy expenditure compared to walking alone. Compared to baseline, patients performed better at the end of training on three timed walking tests: a 10-meter walk, the Timed Get Up and Go Test, and a 6-minute walk test. In 9 patients retested 5 months after training, performance remained significantly better than baseline. "We suspect that particularly PD patients benefit from Nordic walking because this is a much more ''conscious'' way of walking (deliberately using the arms to handle the poles, consciously increasing step length and paying specific attention to walking), thereby permitting patients to bypass their defective basal ganglia circuitries," the authors state. "Nordic walking could also facilitate walking by providing rhythmic external cues." ============= Identifying fallers with Parkinson's disease using home-based tests: Who is at risk? I Lim, E van Wegen, D Jones, L Rochester, A Nieuwboer, AM Willems, K Baker, V Hetherington, G Kwakkel Movement Disorders 2008; published online 21 October Four factors predict the risk for falling in PD in 74% of cases, according to this study. In-home assessment was conducted of 153 PD patients, average age 67, disease duration of 8 years, with mild-to-moderate gait disturbance. Of 51 selected variables, 13 were significantly related to falls at p<0.05. Of those, multivariate analysis revealed that those most predictive of falling were presence of freezing (Freezing of Gait Questionnaire, sum of items 3-6), longer disease duration, walking difficulty (UPDRS item 15), and worse performance on the Timed Get Up and Go Test. FOGQ alone predicted 65% of fallers, which rose to 71% with the TGUGT, and to 74% with the remaining two items. "This accuracy is in line with the existing literature and we are of the opinion that the model could be used as an indication for identifying patients who are at risk of falling using home-based tests," the authors state. ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn