A double-blind, randomized, controlled

262
Abstracts / Basal Ganglia 2 (2012) 257–265
Background: In the last decade, the relationship between cognitive
function and gait performances has received increasing attention.
The present study aimed to describe the gait pattern in patients
affected by Parkinson’s disease (PD) with or without mild cognitive
impairment (MCI+, MCI ). We also sought to ﬁnd an association
between gait pattern and speciﬁc cognitive proﬁles.
Methods: Forty-three patients with PD (19 MCI+ and 24 MCI )
and 20 age- and gender-matched healthy subjects (HS) were
enrolled. We compared the gait pattern among MCI+ vs MCI vs
HS in the following conditions: (1) normal gait; (2) motor dual task;
(3) cognitive dual task, by means of a gait analysis system. In PD
patients, gait patterns were evaluated in both off and on state. Memory, executive and visuospatial domains were evaluated with an
extensive neuropsychological battery.
Results: Compared with MCI and HS, MCI+ PD patients displayed
reduced step length and swing time and impairment of measures of
dynamic stability, which were only partially reverted by levodopa.
We also found that dual task conditions affected several walking
parameters in MCI+ PD at off and on state with respect to MCI
and HS . Factor analysis revealed two independent factors, namely
pace and stability. The latter was strongly and directly correlated
with the visuospatial domain.
Conclusions: Dysfunctions on speciﬁc gait parameters, which are
poorly responsive to levodopa and highly sensitive to dual tasks,
are associated with MCI in PD patients. Importantly, visuospatial
impairment is strongly associated with the development of instability and more generally with the progression of PD.
http://dx.doi.org/10.1016/j.baga.2012.04.017
17
Rehabilitation improves dyskinesias in Parkinsonian patients: A
pilot study comparing two different rehabilitative treatments
Giuseppe Frazzitta a, Gabriella Bertotti a, Giulio Riboldazzi c, Elisa
Pelosin d, Micaela Morelli e,f, Pietro Balbi a, Natalia Boveri a, Cristoforo
Comi g, Marinella Turla h, Roberta Rovescala a, Guido Felicetti a,
Roberto Maestri b
a
Department of Neurorehabilitation, Scientiﬁc Institute of Montescano,
S. Maugeri Foundation IRCCS, Montescano, Italy,
b
Department of Biomedical Engineering, Scientiﬁc Institute of
Montescano, S. Maugeri Foundation IRCCS, Montescano, Italy,
c
Center for Parkinson’s Disease, Macchi Foundation, Varese and
Department of Rehabilitation, ‘‘Le Terrazze’’ Hospital, Cunardo, Italy,
d
Department of Neurosciences, University of Genoa, Italy,
e
Department of Toxicology, Centre of Excellence for Neurobiology of
Dependence, University of Cagliari, Cagliari, Italy,
f
CNR Institute for Neuroscience, Section of Cagliari, Italy,
g
Department of Neurology, University of the Eastern Piedmont, Novara,
Italy,
h
Department of Neurology, Valle Camonica Hospital, Esine, Italy
Background: The present study was devised: (a) to test whether an
intensive multidisciplinary rehabilitation treatment (60 h) for Parkinsonian patients is effective in improving dyskinesia and motor
performance compared to a control group undergoing a non-intensive non multidisciplinary rehabilitation treatment (30 h) and (b)
to verify whether rehabilitation may lead to a reduction in levodopa
dosage.
Methods: Forty Parkinsonian patients suffering from dyskinesias
were admitted to study: 20 for an intensive (group-1) and 20 for a
standard treatment (group-2). The rating scales used for the clinical
evaluation were: Uniﬁed Parkinson’s Disease Rating Scales (UPDRS)
II, III, IV, Parkinson’s disease disability scale (PDDS), Abnormal Involuntary Movement Scale (AIMS).
Results: All outcome measurements improved in both groups of
patients, but patients group-1 presented better results: UPDRS II
was reduced by 33% in group-1 and by 22% in group-2, UPDRS III
29% vs. 22%, UPDRS IV 74% vs. 10%, PDDS 18% vs. 12%, and AIMS
71% vs. 8%. A different behaviour was observed for levodopa dosage
at baseline and after treatment: dosage decreased by an average
value of 210 mg (p < 0.0001) in group-1 and was virtually unchanged
(30 mg reduction, p = 0.08) in group-2.
Conclusion: Our ﬁndings suggest that a rehabilitation protocol
should be considered as a valid non-invasive therapeutic support
for patients who show dyskinesias and that there are better results
when the treatment is intensive.
http://dx.doi.org/10.1016/j.baga.2012.04.018
18
Short- and long-term efﬁcacy of intensive rehabilitation treatment on balance and gait in Parkinsonian patients: A pilot study
with a 1-year follow-up
G. Frazzitta a, G. Bertotti a, P. Balbi a, D. Uccellini b, N. Boveri a,
R. Rovescala a, R. Maestri a
a
Department of Neurorehabilitation, Scientiﬁc Institute of Montescano,
S. Maugeri Foundation IRCCS, Montescano, Italy,
b
Department of Neurology, Tradate Hospital, Varese, Italy
Background: Parkinson’s disease (PD) is a neurodegenerative disorder in which gait and balance disturbances are relevant symptoms
that respond poorly to pharmacological treatment. Recent studies
demonstrated that physical exercise improves balance and gait but
the persistence over time of beneﬁcial effects and the optimal content of exercise intervention remain open questions. The aim of this
study was to investigate whether a multidisciplinary intensive rehabilitation treatment (IRT) is effective in improving balance and gait
and whether improvements persist at a 1-year follow-up.
Methods: We studied 20 PD patients (age: 71 ± 7 years) who
underwent an IRT (4 weeks, three daily sessions of one hour each,
5 days a week). Outcome measures were UPDRS items for balance,
falls and walk, Berg Balance Scale, 6-min walking test, Timed Up
and Go Test, and Comfortable-Fast gait speeds. Patients were evaluated at admission, at the end of treatment, and at a 1-year follow-up.
Pharmacological therapy was unchanged during IRT and at followup.
Results: All outcome measures improved signiﬁcantly at the end of
IRT. At follow-up, UPDRS_walk and Comfortable-Fast gait speeds still
maintained better values with respect to admission (p = 0.009,
p = 0.03 and p = 0.02, respectively), while the remaining scales did
not differ signiﬁcantly.
Conclusions: Our results demonstrate that the IRT was effective in
improving balance and gait and that the improvement in gait performances was maintained also after 1 year. These results point out
that Parkinsonian patients, despite the degenerative nature of the
disease, have the potential to improve balance and gait, and maintain the result over time.
http://dx.doi.org/10.1016/j.baga.2012.04.019
19
Working on asymmetry in Parkinson’s disease: A double-blind,
randomized, controlled rehabilitation trial
L. Ricciardi a,b, D. Ricciardi c, F. Lena d, M. Petracca a, S. Barricella d, N.
Modugno d, G. Zuccalà c, A.R. Bentivoglio a, A. Fasano a,e
a
Istituto di Neurologia, Università Cattolica del Sacro Cuore, Roma, Italy,
b
Department of Neuroscience, University of Messina, Italy,
Abstracts / Basal Ganglia 2 (2012) 257–265
c
Department of Gerontology and Geriatrics, Catholic University of
Medicine, Rome, Italy,
d
Neuromed Institute, Pozzilli (IS), Italy,
e
Department of Neuroscience, AFaR-Fatebenefratelli Hospital, Rome,
Italy
Background: Posture, gait and balance problems are very disabling
symptoms in Parkinson’s disease (PD). Gait cycle in PD shows
increased stride-to-stride variability because of the reduction of gait
automaticity and asymmetry of lower limbs function. These feature
predispose to freezing of gait (FOG) and recurrent falls. Aim of the
study was to evaluate how the modulation of asymmetry through
physiotherapy might improve gait and FOG preventing falls.
Methods: Twenty-eight PD patients entered the study and were
evaluated at baseline and after three months of rehabilitative program (performed twice a week) by means of the motor part of the
Uniﬁed Parkinson’s Disease Rating Scale (UPDRS-III), Gait and Falls
Questionnaire (GFQ), Tinetti balance and gait scale, Short Physical
Performance Battery (SPPB), European Quality of Life questionnaire
(EQ-5D). Patients were randomly assigned to (1) physiotherapy for
worst side improvement (WSI), (2) physiotherapy for best side
improvement (BSI), and (3) standard physical therapy (SPT). Patients
were unaware of study’s aim and evaluations were carried out by
blinded physiotherapist and doctor.
Results: After three months, all three groups showed a signiﬁcant
improvement at the Tinetti and SPPB scores. The magnitude of
change (end of treatment compared to baseline) was analyzed
among groups: BSI led to a greater improvement than SPT in terms
of UPDRS-III (p = 0.01), Tinetti total score (p = 0.05) and Tinetti gait
subscore (p = 0.01). No other signiﬁcant differences arose.
Conclusions: Our study conﬁrms the usefulness of physical therapy in the treatment of PD and, more importantly, suggests that
speciﬁc intervention tailored on individual feature (e.g. asymmetry
of motor condition) might be even more effective than standard
rehabilitative programs. The impact of such approach on the beneﬁt duration and rate of falls should be prospectively assessed by
future trials.
http://dx.doi.org/10.1016/j.baga.2012.04.020
263
the alterations of walking and freezing were treated by the visual
and auditory stimuli, including multi-sensorial stimulation also
administered by the Wii balance. The obtained results so far point
to an invalid improving performance assessed in the UPDRS III, the
TUG, the beginning and the end of treatment.
http://dx.doi.org/10.1016/j.baga.2012.04.021
21
Conditional entropy-based evaluation of the postural control
complexity in patients with Parkinson’s disease
F. Anasetti, C.A. Frigo, V. Bari, S. Bersini, A. Porta, D. Servello, M. Porta
Laboratory of Motion Analysis, IRCCS Galeazzi Institute, Milan, Italy
The Parkinson’s disease (PD) patient exhibits postural instability
and difﬁculty in generating corrective action. The aim of this study
was to characterize postural control of PD patients and to describe
the effects of electrical stimulation of sub-cortical areas. The posture
of 12 patients with PD undergoing deep brain stimulation (DBS) was
studied during eyes open (EO) and eyes closed (EC) before surgery,
after electrodes implantation and after device activation. This study
proposes a new method to quantify the postural control based on the
complexity analysis of the signal representing the sway of the center
of pressure (CoP) during a 30 s orthostatic standing in sagittal and in
frontal plane. The signal complexity was quantiﬁed by the conditional entropy: an higher conditional entropy means a lower predictability and a greater complexity of the postural control. A temporal
and spectral analysis of the CoP series were also performed. Statistical analysis showed a signiﬁcant inﬂuence of the direction of sway
and of the visual control on the complexity of postural control and
on both temporal and spectral characteristics of the CoP series. A signiﬁcant inﬂuence of the electrical stimulation on both temporal and
spectral analysis but not on the complexity of postural control was
also found. This ﬁnding could be justiﬁed by a reduction of muscle
stiffness after surgical intervention. The lack of visual control may
simplify postural control connectivity due to an increased required
attention level. A short term sub-cortical stimulation has no effects
on PD postural strategy.
http://dx.doi.org/10.1016/j.baga.2012.04.022
20
Use of visual and auditory cues in the freezing control in Parkinson’s disease
P. Marano, M. Seminara
Department of Rehabilitation Villa dei Gerani Clinic, Catania, Italy
The alteration of the step affects nearly all patients suffering from
Parkinson’s disease and increases during the progression of the disease. The deﬁcit is more important than the change in stride length.
The alteration of the gait alters the proportional relationship
between length and height from the ground up, with a signiﬁcant
increase in these patients the risk of tripping during the swing phase
of walking. It is important to educate patients to walk with the
appropriate steps in length. For these reasons, the use of external
cues and cognitive strategies are the most important options for
the correction of the path. The visual cues tend to normalize the spatial and temporal gait variables. The visual cues tend to normalize
the spatial and temporal gait variables. Given attentional strategies,
such as walking with long strides and swinging arms, are effective in
improving stride length and speed. Turn around along the way is
very problematic for patients with episodes of freezing or motor
instability. Usually when the elderly make a 360° turn along the gait,
are less than 6 steps to complete the round. In contrast, patients with
PD and motor instability are also 20 steps to turn, and each step
becomes smaller and smaller until the full stop. In the present study
22
GPi Deep Brain Stimulation after STN DBS: Cases report
I. Bertaina a, B. Minafra a, D. Servello b, R. Zangaglia a, C. Pacchetti a
a
Parkinson’s Disease and Movement Disorders Unit, Fondazione Istituto
Neurologico Nazionale IRCCS ‘‘C.Mondino’’, Pavia, Italy,
b
Functional Neurosurgical Unit, IRCCS ‘‘Galeazzi’’, Milano, Italy
Deep Brain Stimulation (DBS) is the surgical procedure of choice
in advanced patients with Parkinson’s disease (PD) complicated by
motor ﬂuctuations. The subthalamic nucleus (STN) and the globus
pallidus internal (GPi) are the two most common targets used to
treat PD. Anyway the most source of information about the efﬁcacy
of this procedure came from STN DBS. Only recently the comparison
between GPi and STN DBS in advanced PD had shown in 24 months
follow-up study similar improvement in motor score; GPi DBS also
improved depression while in STN patients it worsened, ﬁnally the
reduction of dopaminergic therapy was higher in STN DBS patients
[1]. Experiences of simultaneous stimulation of both STN and GPi
are inconclusive and limited in literature [2,3]. The long term follow-up at 4, 8 and recently at 9 years after STN DBS shows that while
the improvement of levodopa induced motor complications are
maintained, freezing, postural instability, falling, speech difﬁculties
and cognitive impairment emerge as the major source of disability

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