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 APD  Vol.9 No.1 , February 2020
Aquatic Physiotherapy and Parkinson’s Disease: Effects on Functional Motor Skills
Abstract: Parkinson’s Disease (PD) is a progressive disease with motor impairment, and as such requires a multidisciplinary team that includes physiotherapy. Physiotherapy can stimulate learning ability, motor recovery, neuroplasticity and neuroprotection. The aquatic physiotherapy (AP) for PD enables movements to be progressively and safely executed, reducing the risk of falls. Hence, the objective of this study is to analyze the effects of an AP program on the functional motor skills of people with PD. This is a controlled quasi-experimental clinical trial, with blind assessor. The participants were male and female, diagnosed with PD, Hoehn and Yahr stages 1 to 4 and medical certificate for AP. The exclusion criteria were: not presenting independent walking; sensorial deficit; contraindications for attending a heated pool; alterations in levodopa ingestion. The functional assessments conducted on land were: walking speed test; Five Times Sit to Stand Test; Mini BESTest, Unified Parkinson’s Disease Rating Scale (UPDRS) for activities of daily living (ADL); and motor skill parts, evaluated before, after and 4 months after AP. The aquatic assessment was conducted through the Aquatic Functional Assessment Scale (AFAS). The participants were allocated in two groups: Control Group (CG), which did not take part in the pool activities, and Experimental Group (EG), which was submitted to AP, throughout 32 twice-a-week, 50-minute-long appointments. Functional exercises were proposed to respect the principles of specificity and progression regarding complexity in the aquatic activities through aquatic motor skills learning phases. Groups and times were compared statistically. At the end of the study, the EG was composed of 11 participants and the CG 7. There were no differences between the groups at the beginning of the study. A difference was observed between groups for gait speed in evaluation 2; difference between assessment 1 and 2 for GE in the ADL and motor, as well as between assessment 2 and 3 for GE in the motor assessment. CG presented a decline from assessment 1 and 3. In the aquatic assessment, the EG had a statistical difference after the intervention. It was observed that the AP program can modify the aquatic motor skills and the land motor skills of walking speed, the UPDRS ADL and the UPDRS motor.
Cite this paper: Yamaguchi, B. , de Paula Ferreira, M. and Israel, V. (2020) Aquatic Physiotherapy and Parkinson’s Disease: Effects on Functional Motor Skills. Advances in Parkinson's Disease, 9, 1-12. doi: 10.4236/apd.2020.91001.
References

[1]   Van Der Kolk, N.M. and King, L.A. (2013) Effects of Exercise on Mobility in People with Parkinson’s Disease. Movement Disorders, 28, 1587-1596.
https://doi.org/10.1002/mds.25658

[2]   Dashtipour, K., Johnson, E., Kani, C., Kani, K., Hadi, E., Ghamsary, M., Pezeshkian, S. and Chen, J.J. (2015) Effect of Exercise on Motor and Nonmotor Symptoms of Parkinson’s Disease. Parkinson’s Disease, 2015, Article ID: 586378.
https://doi.org/10.1155/2015/586378

[3]   Silva, P.G.C., Domingues, D.D., Carvalho, L.A., Allodi, S. and Correa, C.L. (2016) Neurotrophic Factors in Parkinson’s Disease Are Regulated by Exercise: Evidence-Based Practice. Journal of the Neurological Sciences, 363, 5-15.
https://doi.org/10.1016/j.jns.2016.02.017

[4]   Vojciechowski, A.S., Zotz, T.G.G., Loureiro, A.P.C. and Israel, V.L. (2016) The International Classification of Functioning, Disability and Health as Applied to Parkinson’s Disease: A Literature Review. Advances in Parkinson’s Disease, 5, 29-40.
https://doi.org/10.4236/apd.2016.52005

[5]   Volpe, D., Giantin, M.G., Maestri, R. and Frazzitta, G. (2014) Comparing the Effects of Hydrotherapy and Land-Based Therapy on Balance in Patients with Parkinson’s Disease: A Randomized Controlled Pilot Study. Clinical Rehabilitation, 28, 1210-1217.
https://doi.org/10.1177/0269215514536060

[6]   Israel, V.L. and Pardo, M.B.L. (2014) Hydrotherapy: Application of an Aquatic Functional Assessment Scale (AFAS) in Aquatic Motor Skills Learning. American International Journal of Contemporary Research, 4, 42-52.
http://ri.ufs.br/jspui/handle/riufs/7382

[7]   Veiga, C.C.B., Israel, V.L. and Manffra, E.F. (2012) Análise cinemática do movimento humano da transicao da posicao vertical para horizontal em ambiente aquático. Brazilian Journal of Biomechanics, 13, 1-14.
http://citrus.uspnet.usp.br/biomecan/ojs/index.php/rbb/article/view/86

[8]   Hoehn, M.M. and Yahr, M.D. (1967) Parkinsonism: Onset, Progression, and Mortality. Neurology, 17, 427-442.
https://doi.org/10.1212/WNL.17.5.427

[9]   Salbach, N.M., Mayo, N.E., Higgins, J., Ahmed, S., Finch, L.E. and Richards, C.L. (2001) Responsiveness and Predictability of Gait Speed and Other Disability Measures in Acute Stroke. Archives of Physical Medicine and Rehabilitation, 82, 1204-1212.
https://doi.org/10.1053/apmr.2001.24907

[10]   Okarino, J.M., Goncalves, G.G.P., Vaz, D.V., Cabral, A.A.V., Porto, J.V. and Silva, M.T. (2009) Correlation between a Functional Performance Questionnaire and Physical Capability Tests among Patients with Low Back Pain. Revista Brasileira de Fisioterapia, 13, 343-349.
https://doi.org/10.1590/S1413-35552009005000046

[11]   Leddy, A.L., Crowner, B.E. and Earhart, G.M. (2011) Utility of the Mini-BESTest, BESTest, and BESTest Sections for Balance Assessments in Individuals with Parkinson Disease. Journal of Neurologic Physical Therapy, 35, 90-97.
https://doi.org/10.1097/NPT.0b013e31821a620c

[12]   Fahn, S., Elton, R.L. and Members of the UPDRS Development Committee (1987) Unified Parkinson’s Disease Rating Scale. Recent Developments in Parkinson’s Disease. Macmillan Healthcare Information, Florham Park, 53-63.

[13]   Melzer, I., Elbar, O., Tsedek, I. and Oddsson, L.I. (2008) A Water-Based Training Program That Include Perturbation Exercises to Improve Stepping Responses in Older Adults: Study Protocol for a Randomized Controlled Cross-Over Trial. BMC Geriatrics, 8, Article No. 19.
https://doi.org/10.1186/1471-2318-8-19

[14]   Israel, V.L. and Pardo, M.B.L. (2000) Hydrotherapy: A Teaching Program to Develop Aquatic Motor Skills of Injured Spinal Cord in Thermal Pool. Revista Fisioterapia em Movimento, 1, 111-127.

[15]   Mehrholz, J., Kugler, J., Storch, A., Pohl, M., Hirsch, K. and Elsner, B. (2015) Treadmill Training for Patients with Parkinson’s Disease—Review. Cochrane Database of Systematic Reviews, No. 9, CD007830.
https://doi.org/10.1002/14651858.CD007830.pub3

[16]   Pérez-de-la-Cruz, S. (2017) Effectiveness of Aquatic Therapy for the Control of Pain and Increased Functionality in People with Parkinson’s Disease: A Randomized Clinical Trial. European Journal of Physical and Rehabilitation Medicine, 53, 825-832.

[17]   Villegas, I.L.P. and Israel, V.L. (2014) Effect of Ai-Chi Method on the Functional Activities, Quality of Life and Posture in Patients with Parkinson’s Disease. Topics in Geriatric Rehabilitation, 30, 282-289.
https://doi.org/10.1097/TGR.0000000000000039

[18]   Saint-Hilaire, M. and Ellis, T. (2013) A Prescription for Physical Therapy and Exercise in Parkinson’s Disease. Advances in Parkinson’s Disease, 2, 118-120.
https://doi.org/10.4236/apd.2013.24023

[19]   Ayán, C. and Cancela, J. (2012) Feasibility of 2 Different Water-Based Exercise Training Programs in Patients with Parkinson’s Disease: A Pilot Study. Archives of Physical Medicine and Rehabilitation, 93, 1709-1714.
https://doi.org/10.1016/j.apmr.2012.03.029

[20]   Iucksch, D.D., Israel, V.L., Ribas, D.I. and Manffra, E.F. (2013) Gait Characteristics of Persons with Incomplete Spinal Cord Injury in Shallow Water. Journal of Rehabilitation Medicine, 45, 860-865.
https://doi.org/10.2340/16501977-1193

[21]   Vivas, J., Arias, P. and Cudeiro, J. (2011) Aquatic Therapy versus Conventional Land-Based Therapy for Parkinson’s Disease: An Open-Label Pilot Study. Archives of Physical Medicine and Rehabilitation, 92, 1202-1210.
https://doi.org/10.1016/j.apmr.2011.03.017

[22]   Torres-Ronda, L. and Alcázar, X.S. (2014) The Properties of Water and Their Applications for Training. Journal of Human Kinetics, 44, 237-248.
https://doi.org/10.2478/hukin-2014-0129

[23]   Petzinger, G.M., Fisher, B.E., Van Leeuwen, J.E., Vukovic, M., Akopian, G., Meshul, C.K., Holschneider, D.P., Nacca, A., Walsh, J.P. and Jakowec, M.W. (2010) Enhancing Neuroplasticity in the Basal Ganglia: The Role of Exercise in Parkinson’s Disease. Movement Disorders, 25, S141-S145.
https://doi.org/10.1002/mds.22782

[24]   Duncan, R.P., Leddy, A.L. and Earhart, G.M. (2011) Five Times Sit-to-Stand Test Performance in Parkinson’s Disease. Archives of Physical Medicine and Rehabilitation, 92, 1431-1436.
https://doi.org/10.1016/j.apmr.2011.04.008

[25]   Godi, M., Franchignoni, F., Caligari, M., Giordano, A., Turcato, A.M. and Nardone, A. (2013) Comparison of Reliability, Validity, and Responsiveness of the Mini BESTest and Berg Balance Scale in Patients with Balance Disorders. Physical Therapy, 93, 158-167.
https://doi.org/10.2522/ptj.20120171

[26]   Pompeu, J.E., Gimenes, R.O., Pereira, R.P., Rocha, S. and Santos, M.A.K. (2013) Effects of Aquatic Physical Therapy on Balance and Gait of Patients with Parkinson’s Disease. Journal of the Health Sciences Institute, 31, 201-204.

[27]   Andrade, C.H.S., Silva, B.F. and Dal Corso, S. (2010) Efeitos da hidroterapia no equilíbrio de indivíduos com doenca de Parkinson. ConScientiae Saúde, 9, 317-323.
https://doi.org/10.5585/conssaude.v9i2.2108

[28]   Tomlinson, C.L., Patel, S., Meek, C., Clarke, C.E., Stowe, R., Shah, L., Sackley, C.M., Deane, K.H., Herd, C.P., Wheatley, K. and Ives, N. (2014) Physiotherapy versus Placebo or No Intervention in Parkinson’s Disease. Cochrane Database of Systematic Reviews, No. 7, CD002817.
https://doi.org/10.1002/14651858.CD002817.pub4

 
 
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