Reabilitação Robótica da Marcha na Doença de Parkinson

CPT sessions will involve a warm-up using a cycle ergometer or treadmill walking, stretching, progressive strength training exercises, and balance training. Gait training will be provided using traditional over-ground walking. Additional strategies for home exercises, fall prevention, and appropriate assistive devices (i.e., orthotics) will be provided. Training will be administered 2 times per week for 40-60 minutes for six weeks.

Therapists will use traditional methods of neurological rehabilitation for improved gait and balance. These approaches will include stretching, strengthening, therapeutic exercises, balance training, and over-ground walking

CPT-GEO sessions will involve a warm-up using a cycle ergometer or treadmill walking, stretching, progressive strength training exercises, and balance training. Gait training will be administered using end-effector gait training protocols (G-EO trainer). Training will be administered 2 times per week for 40-60 minutes for six weeks.

Therapists will use traditional methods of neurological rehabilitation for improved gait and balance. These approaches will include stretching, strengthening, therapeutic exercises, balance training, and over-ground walking

The G-EO Gait Trainer uses distal fixation to promote a gait recovery by facilitating a controlled walking environment that includes an over-ground pattern and stair climbing. In addition, the device provides body position control to enable the patient to concentrate on the cyclical motion of walking without the fear of falling. Physical therapists can control different parameters of the gait cycle through computerized adjustments and the training setting can be manipulated to engage patients in active participation.

Participants will be asked to walk over a 14-foot pressure mat that will capture their comfortable walking speed. Patients will be instructed to walk at their normal comfortable speed. Walking will begin 5 feet prior to the mat so that each individual walks across the mat at a consistent speed. Participants will pass over the mat 2 times and an average speed will be calculated. It will take 5 minutes to complete this test and will be performed first.

Participants will be asked to walk over a 14-foot pressure mat that will capture their fast walking speed. Patients will be instructed to walk at their fastest speed while maintaining safe, accurate gait. Walking will begin 5 feet prior to the mat so that each individual walks across the mat at a consistent speed. Participants will pass over the mat 2 times and an average speed will be calculated. It will take 5 minutes to complete this test and will be performed second.

Participants will be asked to walk for 6 minutes along a 30m track that is a flat surface and obstacle free. Subjects may stop and rest as often as needed. Researchers will record the distance traveled during the six minute time period.

Average walking speed during the 6-Minute Walk Test was measured in meters per second (m/s). Change from baseline was calculated at post-intervention and one-month follow-up. Positive change scores indicate increased average walking speed and improved performance. This is not a scale score.

The test will quantify functional lower extremity strength. It provides insight into the coordination of functional strength for the accomplishment of transitioning from one posture to another. The participant is asked to safely rise from sitting in a chair to standing and then sit back down five times in a row without using their hands. This test will take about 5 minutes to administer.

The Activities-specific Balance Confidence (ABC) Scale assesses self-reported confidence in maintaining balance while performing activities of daily living. The scale contains 16 items, with each item rated from 0 (no confidence) to 100 (complete confidence). The total ABC score is calculated as the average of the 16 item scores and ranges from 0 to 100. Higher scores indicate greater balance confidence and a better outcome; lower scores indicate less balance confidence and a worse outcome.

The Mini-Balance Evaluation Systems Test (MiniBESTest) is a performance-based measure of dynamic balance. The Anticipatory subscale assesses anticipatory postural adjustments during functional movement. Item scores are summed to produce a subscale score ranging from 0 to 6 points. Higher scores indicate better balance performance and lower scores indicate greater balance impairment.

The Mini-Balance Evaluation Systems Test (MiniBESTest) is a performance-based measure of dynamic balance. The Reactive Postural Control subscale assesses the ability to recover balance following an external perturbation; examining the effectiveness of compensatory stepping response. Item scores are summed to produce a subscale score ranging from 0 to 6 points. Higher scores indicate better balance performance and lower scores indicate greater balance impairment.

The Mini-Balance Evaluation Systems Test (MiniBESTest) evaluates an individual's ability to maintain postural stability when sensory information is altered or conflicting. It assesses how effectively a person uses visual, vestibular, and somatosensory inputs to maintain balance under increasingly challenging conditions. Item scores are summed to produce a subscale score ranging from 0 to 6 points. Higher scores indicate better balance performance and lower scores indicate greater balance impairment.

The Mini-Balance Evaluation Systems Test (MiniBESTest) is a performance-based measure of dynamic balance. It evaluates an individual's ability to maintain balance while walking under increasingly complex and functionally relevant conditions. It assesses the capacity to adapt gait when confronted with environmental demands, dual-tasking, changes in speed, head movements, obstacle negotiation, and turning. Item scores are summed to produce a subscale score ranging from 0 to 10 points. Higher scores indicate better balance performance and lower scores indicate greater balance impairment.

The Parkinson's Disease Questionnaire-39 (PDQ-39) is a 39-item, disease-specific questionnaire assessing health-related quality of life in individuals with Parkinson's disease. It includes eight domains: Mobility, Activities of Daily Living, Emotional Well-being, Stigma, Social Support, Cognitions, Communication, and Bodily Discomfort. Each item is scored from 0 to 4, with higher scores indicating greater difficulty. Individual domain scores are calculated by summing item responses, dividing by the maximum possible domain score, and multiplying by 100. Each domain ranges from 0 to 100. The PDQ-39 Summary Index is calculated as the unweighted mean of the eight domain scores and ranges from 0 to 100. Lower scores indicate better health-related quality of life, while higher scores indicate worse health-related quality of life.