Stability Parameters From The Test With Eyes Closed
The comparison of the test results with eyes closed in the experimental group showed significant changes in five parameters. In the second trial the total sway path calculated in both planes , the sway path in milimeters calculated in sagittal plane , the mean velocity of the center of pressure in both planes , the mean velocity of the center of pressure in the sagittal plane and the amount of sway in sagittal plane were significantly reduced . The comparison of the results of the same parameters for the control group showed no significant difference, while statistically significant differences were observed in the sway path in frontal plane and the mean velocity of the center pressure in frontal plane .
FIGURE 4. Comparison of SPAP-EC in the experimental and control group . Comparison of MVAP-EC in the experimental and control group . Comparison of LWAP-EC in the experimental and control group .
Music Therapies For Parkinsons Disease
Music therapy, which utilizes rhythm, movement, voice and creativity to try to improve Parkinsons disease symptoms, are very popular for people with PD. Music-based therapies may work in a variety of ways to improve Parkinsons related challenges. The types of therapies that utilize the qualities of music are numerous and varied and it is hard to capture the full breadth of what is available.
A few types of music therapy:
All of these activities may have additional benefits including:
- Providing avenues for socialization Working with others to perform a dance or a song offers the opportunity for socialization and collaboration.
- Enhancing mood and/or cognitive function Some studies support the ability of music-based therapies to improve mood and cognition.
Analysis Of Spatial Gait Parameters
The second measure of spatial gait parameters was significantly higher than the first one for the step length, velocity and the stride length. Analysis of the results for the same parameters in the control group also demonstrated significant differences, but the significance level was lower than in the experimental group. Step width did not differ significantly in any of the examined groups .
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Neurologic Music Therapy Procedure
The therapeutic program for the experimental group included 4 weeks of individual 45-min sessions of NMT four times a week. At the time of the sessions the subjects were in an on phase . Participation in the sessions did not require any previous knowledge or musical skills. Each of the therapy sessions took place according to the same scheme. It comprised practicing activities of daily living, balance, pre-gait and gait training by using sensorimotor NMT techniques: TIMP, PSE, and RAS. For planning the therapy sessions the TDM was employed. Percussion instruments , a metronome and recorded rhythmic music were the basis for each session. Different sizes, shapes and sounds of the instruments provided numerous possibilities for motor activity stimulation.
Comparison Of Changes In Spatial Parameters Between The Groups
A significance level lower than 0.001 indicated a statistically significant difference in the elongation of both step and stride length in the experimental group in comparison to the control group. An increase of velocity in the experimental group was also higher than in the control group. Furthermore, a significant difference in the increase of step width observed in the control group was higher than for the experimentals .
TABLE 5.Spatial parameters groups comparison .
FIGURE 2. Elongation of step length. Increasing of velocity. Elongation of stride length. Increasing of step width.
Figures 1 and 2 graphically depict significant differences in the changes of gait parameters between the groups, demonstrating the efficacy of the applied therapy. The second gait measure in the experimental group was significantly different for the majority of parameters in comparison to the first one. There were also statistically significant differences in the comparison of both groups. These outcomes indicate the effectiveness of the research protocol employed to improve the temporal and spatial parameters of gait in PD.
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Getting Creative And The Road To A Standardized Therapy
Another component of the neurologic music therapy sessions whether or not they use externally driven movements, is a period of time where patients can improvise at the piano.
We dont really know why or how, but theres a big emotional contentment component that comes with producing music. It seems to increase quality of life for some people, she says. A lot of people feel very uncomfortable improvising at the beginning, but by the end, theyre very much liking it.
Buard and her team plan to collect data throughout the study, measuring finger dexterity through a grooved pegboard test that requires a series of 25 pegs to be rotated into certain positions to be placed correctly. They will measure quality of life and anxiety and depression levels as well.
The mechanistic data collected may inform future research leading to treatment and rehabilitative interventions for patients with Parkinsons and other basal ganglia disorders, and possibly other neurologic diseases, Buard says it may also further knowledge of the neural processes utilized by music.
For patients with Parkinsons, she hopes the study eventually leads to a standardized musical intervention to help improve fine motor skills.
Comparison Of Changes In Temporal Parameters Between The Groups
In the experimental group the shortening of the parameters such as stance phase, double support time, and stride time was more considerable than in the control group. Moreover, for the subjects from the experimental group the extension of the swing phase and increasing of cadence was significantly higher than for the controls .
TABLE 4.Temporal parameters groups comparison .
FIGURE 1. Shortening of stance phase. Extension of swing phase. Shortening of double support. Shortening of stride time. Increasing of cadence.
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Papers Of Particular Interest Published Recently Have Been Highlighted As: Of Importance Of Major Importance
Cheever T, Taylor A, Finkelstein R, et al. NIH/Kennedy center workshop on music and the brain: finding harmony. Neuron. 2018 97:12148 This is a white paper broadly outlining the knowledge gaps in the mechanisms of musics effect on the body and the effects of music-based interventions in improving health findings from the workshop summarized in this paper informed a subsequent request for grant applications related to Music in Health .
Jones CR, Jahanshahi M. Motor and perceptual timing in Parkinsons disease. Adv Exp Med Biol. 2014 829:26590.
Ashoori A, Eagleman DM, Jankovic J. Effects of auditory rhythm and music on gait disturbances in Parkinsons disease. Front Neurol. 2015 6:234.
Alves-Pinto A, Turova V, Blumenstein T, Thienel A, Wohlschlager A, Lampe R. fMRI assessment of neuroplasticity in youths with neurodevelopmental-associated motor disorders after piano training. Eur J Paediatr Neurol. 2015 19:1528.
Batson G, Soriano C, Laurienti P, Burdette J, Migliarese S, Hristov N. Effects of group-delivered improvisational dance on balance in adults with middle stage Parkinsons disease: a two-phase pilot with fMRI case study. J Park Dis. 2013 3:192.
Ma LY, Chen XD, He Y, Ma HZ, Feng T. Disrupted brain network hubs in subtype-specific Parkinsons disease. Eur Neurol. 2017 78:2009.
Analysis Of Temporal Gait Parameters
The second measure of the temporal gait parameters was significantly higher than the first for the duration of swing phase and cadence. The second measure of duration of stance phase, the double support time and the stride time was significantly lower than the first. The comparison of the results of temporal gait parameters in the control group did not reveal any statistically significant differences between the trial I and II .
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Into The Groove: Can Rhythm Influence Parkinson’s Disease
Review of rhythmic auditory stimulation on pathological conditions as Parkinson’s disease.
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Rhythmic auditory training improves gait velocity, cadence and stride length in parkinsonian patients.
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Gait, temporal stability, step length and gait cadence may be impaired by not properly adapted auditory stimulus.
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Future therapies should focus on patient-based stimuli, attending to the individual’s clinical features.
Clinical Trials For Complementary Therapies In Pd
Just like they do for medications, clinical trials are also done for complementary therapies. Trials that test complementary therapies in PD can be conducted in a variety of ways, some more rigorous than others. Typically, patients are assessed for different outcome measures depending on the treatment. For example, a study of massage investigated the change in pain level as an outcome measure, whereas studies of acupuncture looked at changes in sleep and depression as outcome measures. The different types of treatments have not been compared to each other, so there is little way of knowing if one edges out the others in terms of effectiveness on any given measure.
In general, however, these modalities are low-risk and typically demonstrate improvement in either a motor or a non-motor symptom. Additional research with larger and more rigorous trials is needed, but it is exciting to realize that there are many possible therapeutic avenues to explore. It is also important to note that complementary therapies are typically not covered by insurance, so they may be out of financial reach for many people with PD. Increased research demonstrating the efficacy of these modalities is the first step in convincing insurance providers that these services are worth covering.
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Mental Status And Social Networks
As previously mentioned, depression and pain are significant clinical problems that are comorbid with PD. Marital status, as well as other social networks, interferes with these conditions. The patientspouse relationship, which indicates physical and emotional support, may have a mitigating effect on patient outcomes of depression prevalence and pain interference. Single PD patients seem to have greater pain interference scores than cohabiting PD patients.
Music Therapy Interventions In Parkinsons Disease: The State
Keywords:
Parkinsons disease is a neurological disorder involving the progressive degeneration of the dopaminergic system, which gives rise to movement-related dysfunctions as well as other symptoms, mainly of cognitive and psychological nature. In the latter case, mood disorders prevails frequently causing anxiety and depression in all phases of the disease, sometimes even before the motor symptoms occur.
Aarsland and colleagues report that 35% of the patients affected by PD present depression, whereas Richard states that anxiety is to be found in 40% of the cases.
The literature shows that playing and listening to music may modulate emotions, behaviors, movements, communication, and cognitive factors, modifying the activity of the brain areas involved in the perception and regulation of these aspects .
Music can produce substantial effects on movement-related symptoms as well as psychological ones in PD treatment. Concerning the first aspect, rhythm has a crucial role in rehabilitation, enhancing connections between the motor and auditory systems .
Literature showed how a rhythmic auditory cues-based training can produce a compensation of the cerebello-thalamo-cortical network leading to beneficial effects, for example, improving not only speed and step length but also perceptual and motor timing abilities .
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Feel The Rhythm: Music Therapy And Parkinsons Disease
Every year, the top Parkinsons experts from around the world who treat people with Parkinsons at a Parkinsons Foundation-designated Center of Excellence convene to discuss the latest Parkinsons research and treatments. This article summarizes the 2018 Center Leadership Conference presentation on music therapy led by Concetta M. Tomaino, DA, LCAT, MT-BC, Executive Director and Co-Founder of the Institute for Music and Neurologic Function in New York City. Read the articles covering some of the other topics discussed: intimacy issues, art therapy, new therapies in trial and oral health.
Music therapists are professionals who are academically trained and board certified to improve the everyday lives of their patients. More specifically, when people with Parkinsons disease work with a music therapist they see improvements in movement symptoms, speech, cognitive issues and mental health. Through dance programs, choirs and drumming programs, music therapy helps people with PD maintain function, express creativity and experience a better quality of life.
Music therapy can help someone with PD with:
Music therapy uses rhythm, melody and preferred movement to address issues that commonly affect people with PD, such as bradykinesia .
For more information about music therapy or where to find a music therapist near you, contact the Parkinsons Foundation toll-free Helpline at 1-800-4PD-INFO or .
Stability Parameters From The Test With Eyes Opened
Out of 17 measured parameters in the test with eyes open, only two changed significantly in the experimental group. The change concerned the center of pressure mean frequency measured in Hz and the amount of sway in sagittal plane by center of pressure . There was no significant difference demonstrated in the comparison of the results of the same parameters in the control group. In the control group only one of the parameters changed significantly . It was the mean velocity of the center of pressure in frontal plane on the level of significance p = 0.049.
FIGURE 3. Comparison of MF-EO in the experimental and control group . Comparison of LWAP-EO in the experimental and control group .
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Examples Of Pain Scales In Pd
Pain-O-Meter
This is a self-administered pain assessment tool developed for the purpose of improving pain assessment and management in acute and chronic pain patients, not exclusively for PD pain. It is a hard, white, plastic tool. Two methods for assessing pain are located on the Pain-O-Meter . The first is a 10-cm VAS with a moveable marker that patients use to rate their pain. The second is a list of 15 sensory and eleven affective WDSs. Each WDS is assigned an intensity value that can be as low as 1 or as high as 5 .
| Durationa of disease, 5 years/> 5 years | Pain before/after PD diagnosis | Durationb of pain/day, 10 h/> 10 h | VAS,c5 cm/> 5 cm | Pain expressions by participants |
|---|
Notes: POM results for PD and chronic pain patients. Data from Skogar et al.
P
Abbreviations: PD, Parkinsons disease h, hours VAS, visual analog scale RLS, restless legs syndrome POM, Pain-O-Meter.
Kings PD Pain Scale
Physiological Pathways Of Pain Relief
In the early 1960s, theories initially developed by Melzack and Wall were introduced. They proposed three features of afferent input that were signed for pain: the ongoing activity that precedes the stimulus, the stimulus-evolved activity, and the relative balance of activity in large versus small fibers. The concept of the gate control theory was introduced. Pain messages encounter nerve gates in the spinal cord that open or close depending upon a number of factors . When the gates are open, pain messages pass more easily and pain can be intense. When the gates are closed, pain messages are prevented from reaching the brain and may not even be experienced. Although the details of this process remain poorly understood, it can help to explain why various treatments are effective.
The existence of low-threshold mechanoreceptive C-tactile afferents was initially described by Vallbo et al. These afferents comprise a second anatomically and functionally distinct system that signals touch in human beings. The activation of these fibers is more closely related to limbic functions rather than cognitive and motor functions. Although rapid, accurate, and informative A touch acutely reflects the external world through cutaneous events in an exteroceptive manner, CT activation shares more characteristics with interceptive modalities. This slow, affective nature is likely to be involved in the maintenance of physical well-being.
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Incidence And Prevalence Of Pd General Pain And Pd
Estimates of PD prevalence and incidence have provided conflicting estimates. In Europe, the annual incidence estimates range from 5/100,000 to 346/100,000. Approximately 60,000 Americans are diagnosed with PD each year. The challenges involved with differential diagnoses and other forms of Parkinsonism, as well as the long time course from initial PD-like symptoms to a correct diagnosis, are likely responsible for the discrepancy in numbers.
The reported prevalence of pain in PD and PD-related pain also varies between studies. In 2008, Negre-Pages et al estimated the prevalence of chronic pain in PD to be > 60%. PD pain is often reported as heterogeneous in its clinical presentation, with a disabling effect on quality of life assessments. In 1998, the Swedish Parkinson Association reported on a survey of nonmotor symptoms comprising almost 1,000 PD respondents, revealing that pain was more common in females than males . However, general pain is also common in the population, with 18%19% in a general adult population according to the prevalence data.,
In early-stage PD, pain is rated as one of the most troublesome NMS, and it seems to affect the side of the body that was initially worst impacted by motor symptoms of the disease .
Examples Of Pain Scales
Visual analog scale
A visual analog scale measures a continuum of a chosen present characteristic. For example, the experienced pain that a patient feels extends over a continuum from no pain to an extreme intensity of pain. This range of perceived pain appears continuous for the patient. Pain does not appear as an ordinary scale with jumps between the values, such as discrete, moderate, or severe. Word descriptors are only used in both ends of the line, which is usually 100 mm in length. This valuation is very subjective and best used within an individual and not between groups of individuals at the same time point. Most experts argue that a VAS at best can produce data of ordinal type. This is important to consider in the statistical analysis of VAS data. Rank ordering of scores rather than the exact values might be the best way to handle patient registrations on the 100 mm line.
Brief Pain Inventory
The Brief Pain Inventory was initially created for the purpose of measuring pain in cancer patients. It measures pain relief, pain quality, and patient perception of the cause of pain in terms of pain intensity and pain interference .
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