Parkinson Hastalığında Motor İmgeleme ve Eylem Gözleminin Yürüme, Denge ve Donma Fenomeni Üzerine Etkisi- Literatür Derlemesi

Abstract

Amaç: Parkinson Hastalığı (PH) sonucu ortaya çıkan yürüme ve denge bozuklukları, motor donma atakları düşme riskini arttırarak fonksiyonel bağımsızlığın ve yaşam kalitesinin azalmasına neden olmaktadır. Motor imgeleme (Mİ) ve eylem gözlemi (EG) stratejileri son yıllarda PH’de fizyoterapi ve rehabilitasyon girişimleri içinde sıklıkla kullanılan yöntemlerdir. Bu derlemenin amacı; PH rehabilitasyonunda donma fenomeni, yürüme ve denge bozukluklarının azaltılması amacıyla kullanılan Mİ ve EG stratejilerinin etkinliğini araştıran klinik araştırmaların sonuçlarını incelemekti. Yöntem: Bu amaçla 2000-2021 yılları arasında PH rehabilitasyonunda Mİ ve EG stratejilerine yer veren randomize kontrollü çalışmalar ele alındı. Literatür taraması Medline (PubMed), Physiotherapy Evidence Database (PEDro), Web of Science ve Cochrane veri tabanlarında gerçekleştirildi. Bulgular: Literatür taraması sonucu 9 çalışmanın (n=267) dahil edilme kriterlerini sağladığı tespit edildi. Bu çalışmaların 4 tanesinde Mİ stratejisi, 4 tanesinde EG stratejisi tek başına kullanılırken; 1 tanesinde ise her iki stratejinin beraber uygulandığı görüldü. Çalışmaların 2 tanesinde ev-temelli tedavi programları uygulanmıştı. Uygulanan tedavi süreleri 5-45 dk/ seans, 1-3 seans/hafta ve 8 gün-12 hafta arasında idi. Parkinson hastalarında EG ve Mİ stratejilerinin egzersiz uygulamalarına ek olarak kullanıldığında yürüyüş ve mobilite üzerinde olumlu etkisi olduğu gözlemlendi. Donma fenomeni ve denge performansını iyileştirmeyi amaçlayan çalışmaların sonuçları ise çelişkiliydi. Sonuç: EG ve Mİ stratejilerinin Parkinson hastalarında yürüyüş ve mobilite üzerine olumlu etkileri olduğu görülürken; denge ve donma fenomeni üzerindeki etkilerine dair kesin bir yargıya varmak için çalışmaların sayısı yetersizdir. Bu stratejilerin kliniklerde kullanımının yanı sıra ev-temelli olarak da uygulanabildiği görüldü. Gelecek çalışmalarda Mİ ve EG stratejilerinin özellikle donma fenomeni ve denge performansı üzerine etkileri araştırılmalıdır.

Keywords

• Görüntü
• Gözden Geçirme
• Gözlem
• Nörolojik Rehabilitasyon
• Parkinson Hastalığı

The Effect Of Action Observation And Motor Imagery On Gait, Balance And Motor Freezing In Parkinson’s Disease - Literature Review

Abstract

Aim: Gait and balance disorders and motor freezing attacks resulting from Parkinson's Disease (PD) increase the risk of falling, resulting in a decrease in functional independence and quality of life. Motor Imagery (MI) and Action Observation (AO) strategies have been frequently used in physiotherapy and rehabilitation interventions for PD patients in recent years. Methods: The purpose of this review was to examine the results of clinical trials investigating the effectiveness of MI and AO strategies used to reduce motor freezing attacks, gait, and balance disorders in PD rehabilitation. Randomized controlled studies that were published between 2000-2021 and included MI and EG strategies for PD rehabilitation were discussed in this review, The literature search was performed in Medline (PubMed), Physiotherapy Evidence Database (PEDro), Web of Science, and Cochrane databases. Results: As a result, it was determined that 9 studies (n=267) met the inclusion criteria. While the MI strategy was used in 4 of these studies and the AO strategy was used in 4 of them; it was observed that both strategies were applied in 1 of them. Home-based therapy programs were applied in 2 of the studies. The treatment durations were 5-45 minutes/session, 1-3 sessions/week, and 8 days-12 weeks. It has been observed that EG and MI strategies have a positive effect on gait and mobility when used in addition to exercise practices in Parkinson's patients. The results of studies aiming to improve the freezing phenomenon and balance performance were inconsistent. Conclusion: EG and MI strategies have positive effects on gait and mobility in Parkinson's patients, whereas the number of studies is insufficient to make a definite judgment about the effects on balance and freezing phenomenon. It has been observed that these strategies can be applied at home-based as well as in clinics. Further research is needed to investigate the effects of MI and EG strategies on freezing phenomenon and balance performance.

Keywords

• Imagery
• Review
• Observation
• Neurological Rehabilitation
• Parkinson's Disease

References

1. DeMaagd G, Philip A. Parkinson's Disease and Its Management: Part 1: Disease Entity, Risk Factors, Pathophysiology, Clinical Presentation, and Diagnosis. P T. 2015;40(8):504-32.
2. National Collaborating Centre for Chronic Conditions (UK). Parkinson's Disease: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care. London: Royal College of Physicians (UK); 2006. 59–100. PMID: 21089238.
3. Elbaz A, Tranchant C. Epidemiologic studies of environmental exposures in Parkinson's disease. J Neurol Sci. 2007;262(1-2): 37-44.
4. Jankovic J. Parkinson's disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry. 2008;79(4):368-76.
5. Gao C, Liu J, Tan Y, Chen S. Freezing of gait in Parkinson's disease: pathophysiology, risk factors and treatments. Transl Neurodegener. 2020; 9:12.
6. Van der Kolk NM, King LA. Effects of exercise on mobility in people with Parkinson's disease. Mov Disord. 2013;28(11):1587-96.
7. De Vries S, Mulder T. Motor imagery and stroke rehabilitation: a critical discussion. J Rehabil Med. 2007;39(1):5-13.
8. Malouin F, Richards CL. Mental practice for relearning locomotor skills. Phys Ther. 2010;90(2):240-51.

9. Buccino G. Action observation treatment: a novel tool in neurorehabilitation. Philos Trans R Soc Lond B Biol Sci. 2014;369(1644):20130185.
10. Lotze M, Cohen LG. Volition and imagery in neurorehabilitation. Cogn Behav Neurol. 2006;19(3):135-40.
11. Braun S, Kleynen M, van Heel T, Kruithof N, Wade D, Beurskens A. The effects of mental practice in neurological rehabilitation; a systematic review and meta-analysis. Front Hum Neurosci. 2013;7: 390.
12. Braun S, Beurskens A, Kleynen M, Schols J, Wade D. Rehabilitation with mental practice has similar effects on mobility as rehabilitation with relaxation in people with Parkinson's disease: a multicentre randomised trial. J Physiother. 2011;57(1):27-34.
13. Maher CG, Moseley AM, Sherrington C, Elkins MR, Herbert RD. A description of the trials, reviews, and practice guidelines indexed in the PEDro database. Phys Ther. 2008;88(9):1068-77.
14. Tamir R, Dickstein R, Huberman M. Integration of motor imagery and physical practice in group treatment applied to subjects with Parkinson's disease. Neurorehabil Neural Repair. 2007;21(1):68-75.
15. El-Wishy AA, Fayez ES. Effect of locomotor imagery training added to physical therapy program on gait performance in Parkinson patients: a randomized controlled study. Egypt J Neurol Psychiat Neurosurg. 2013;50(1):31-7.
16. Monteiro D, Silva LPd, Sá POd, Oliveira ALRd, Coriolano MdGWdS, Lins OG. Prática mental após fisioterapia mantém mobilidade funcional de pessoas com doença de Parkinson. Fisioterapia e Pesquisa. 2018;25: 65-73.
17. Pelosin E, Barella R, Bet C, Magioncalda E, Putzolu M, Di Biasio F, et al. Effect of group-based rehabilitation combining action observation with physiotherapy on freezing of gait in Parkinson’s disease. Neural Plast. 2018;2018.
18. Jaywant A, Ellis TD, Roy S, Lin C-C, Neargarder S, Cronin-Golomb A. Randomized controlled trial of a home-based action observation intervention to improve walking in Parkinson disease. Arch Phys Med Rehabil. 2016;97(5):665-73.
19. Agosta F, Gatti R, Sarasso E, Volonté MA, Canu E, Meani A, et al. Brain plasticity in Parkinson’s disease with freezing of gait induced by action observation training. J Neurol. 2017;264(1):88-101.
20. Sarasso E, Agosta F, Piramide N, Gardoni A, Canu E, Leocadi M, et al. Action Observation and Motor Imagery Improve Dual Task in Parkinson's Disease: A Clinical/fMRI Study. Mov Disord. 2021;36(11):2569-82.
21. Pelosin E, Avanzino L, Bove M, Stramesi P, Nieuwboer A, Abbruzzese G. Action observation improves freezing of gait in patients with Parkinson’s disease. Neurorehabil Neural Repair. 2010;24(8):746-52.
22. Ryan D, Fullen B, Rio E, Segurado R, Stokes D, O’Sullivan C. Effect of action observation therapy in the rehabilitation of neurologic and musculoskeletal conditions: A systematic review. Arch Rehabil Res Clin Transl. 2021;3(1):100106.
23. Caligiore D, Mustile M, Spalletta G, Baldassarre G. Action observation and motor imagery for rehabilitation in Parkinson's disease: A systematic review and an integrative hypothesis. Neurosci Biobehav Rev. 2017;72: 210-22.
24. Jacobs JV, Horak F. Abnormal proprioceptive-motor integration contributes to hypometric postural responses of subjects with Parkinson’s disease. Neuroscience. 2006;141(2):999-1009.
25. Abraham A, Hart A, Andrade I, Hackney ME. Dynamic neuro-cognitive imagery improves mental imagery ability, disease severity, and motor and cognitive functions in people with Parkinson’s disease. Neural Plast. 2018;2018:6168507.