عنوان مقاله [English]
English Extended Abstract
Background and aims: Parkinson's disease (PD) is one of the most common diseases of the nervous system, often develops between the ages of 50 and 60 years due to dysfunction of several interconnected brain circuits. Parkinson's disease gradually destroys substantia nigra cells (Substantial nigra) and eventually reduces the neurotransmitter dopamine, which is considered to be the main cause of this disease. Slowness of movement, tremor, muscle stiffness, instability and imbalance, sleep disorders, autonomic disorders, anxiety and depression are the most important symptoms of this disease. As the disease progresses, walking, changing direction, and maintaining balance are increasingly impaired and affect a person's quality of life. These symptoms increase the risk of falls and related complications, including hospitalization due to musculoskeletal injuries. The Otago exercise includes a set of balance and lower extremity strengthening exercises designed to prevent falls. However, few studies have been conducted on the effect of the Otago exercise on selected gait and posture factors in people with Parkinson's disease. The aim of this study was to evaluate the effect of eight-weeks of Otago exercise on gait length and width as well as changes in the extension of the right knee joint at the end of the gait phase in patients with Parkinson's disease.
Materials and Methods: This research was a quasi-experimental and was performed between experimental and control groups with pre-test and post-test. The statistical population of the present study was all patients with Parkinson's disease with at least three score of Hoehn and Yahr scale, referred to the neurologist with an age range of 55-75 years. Accordingly, with a reliability coefficient of 0.95, test power of 0.70 and effect size of 0.80, 28 subjects were required to participate in each of the research groups of at least 14 subjects, including 16 subjects to participate in each group. The subjects were randomly divided into the Otago exercise group (16 people: 14 men and 2 women) and the control group (16 people: 8 men and 8 women). In this study, disease severity was measured using the Hoehn and Yahr scale, which is a valid indicator of Parkinson's severity. Based on this index, patients are classified into five stages such as: stage one) symptom of disease on one side of the body, stage two) sign of bilateral disease without disturbance in the axial position of the body, stage three) sign of disease on both sides of mild to moderate, postural instability but physically independent, stage four) severe disability, unable to stand and walk without assistance, and stage 5) incapable of standing and walking, need for nursing care, confined to a wheelchair. Inclusion criteria were Parkinson's disease with gait disorders, being in the age range of 55 to 75 years and the normal range of body mass index (18.5 to 24), being in stage 3 of the Hoehn and Yahr scale, no cognitive impairment, no stroke and peripheral neuropathy, and no dependence on assistive devices while walking. Also, cases such as absence from more than three sessions, dissatisfaction with cooperation and cardiovascular disorders during the training period were considered as exclusion criteria. After announcing the consent and determining the sample, the necessary coordination was done with the patients to attend the desired location and the consent and personal information form were provided to them. The experimental group did Otago exercises at home for eight weeks and 3 times a week for 60 minutes. Individuals in the control group also received only medication and adhered to meals and lifestyle modifications, including proper ergonomics in daily activities. In the present study, three variables of knee extension at the end of the swing phase, step length, and step width while gait were evaluated using the motion analysis system. To examine the gait factors, the motion analysis system with 8 cameras (Oqus5 Model, Qualisys co., Sweden) and two force plates (AA9260 and 9285BA models with 30-30 cm and 40-60 cm dimensions, respectively; Kistler co., Switzerland) was used. 24 light reflecting markers were placed on the landmarks of the subjects’ pelvis and lower limbs based on Helen Hayes set. The frequency of the cameras was 250 Hz and the force plates were 1000 Hz. Due to the effect of heat and cold on patients' performance, the ambient temperature was frequently monitored by the air conditioning system.
Results: The results showed that before and after participating in the Otago exercise course, a significant increase was obtained in mean step length of experimental group (p<0.001). Also, the results of paired t-test showed that there was no significant difference between the mean step length in the control group in the pre-test and post-test (p<0.001). Also, the results show that there is a significant difference between the experimental and control groups in the step width variable of people with Parkinson's disease (p< 0.001). It was found that after the Otago exercise in the experimental group, the mean step width was lower in the experimental group than control group. The results showed that there was no significant difference between the mean changes of right knee extension when the right and left heels contact in the control group before and after the test (p <0.001). However, right knee extension was improved after the eight-weeks of Otago exercise in the experimental group.
Conclusion: Proper physical activity and exercise can positively affect the health of the elderly community with Parkinson's disease. Since the elderly are important members of any society, budget-friendly (and even free) and strength training exercises are essential for Parkinson's patients. The Findings showed significant improvement in selected gait factors included step length, step width, and knee extension changes in patients with Parkinson's disease.