1. Introduction
neurodegeneration, UL tremor, tremor, tremors, neurodegenerative movement disorder, Parkinson’s disease, orthosis, PD, rigidity, dysregulation syndrome, bradykinesia, cerebral palsy, deterioration of manual dexterity, dyskinesias
DISEASES, DISEASE PROGRESSION, NEURODEGENERATION, DISEASE, AIDS, CEREBRAL PALSY
Parkinson’s disease (PD) is a chronic, neurodegenerative movement disorder, whose symptoms have a negative impact on quality of life and functionality. Although its main treatment is pharmacological, non-pharmacological aids such as the dynamic elastomeric fabric orthosis (DEFO) merit an evaluation. Our objective is to assess the DEFO in upper limb (UL) functional mobility and in the quality of life of PD patients. A total of 40 patients with PD participated in a randomized controlled crossover study, and were assigned to a control group (CG) and to an experimental group (EG). Both groups used the DEFO for two months, the experimental group the first two months of the study and the control group the last two. Motor variables were measured in the ON and OFF states at the baseline assessment and at two months. Differences from the baseline assessment were observed in some motor items of the Kinesia assessment, such as rest tremor, amplitude, rhythm or alternating movements in the ON and OFF states with and without orthosis. No differences were found in the unified Parkinson’s disease rating scale (UPDRS) or the PD quality-of-life questionnaire. The DEFO improves some motor aspects of the UL in PD patients but this does not translate to the amelioration of the standard of functional and quality-of-life scales.In the Global Burden of Diseases, Injuries and Risk Factors (GBD) study conducted in 2016, it was estimated that between the years 1990 and 2016 the number of people affected by Parkinson’s disease (PD) doubled worldwide, with an incidence rate of 8 to 18 people per 100,000 per year [The motor and non-motor symptoms of PD have negative repercussions on the quality of life and functionality of people with the disease. The burden of motor symptoms and impairment of some activities of daily living (ADLs), such as eating, hygiene and clothing, related to alterations in functional mobility, has been identified as one of the major predictors of quality of life with this disease [Following the perspective of the International Classification of Functioning and Disability (ICF) of the World Health Organization (WHO), three interconnected levels of human functioning are differentiated: (1) Body functions and structures, physiological and psychological functions, and bodily and anatomical impairments; (2) Limitations in the performance of activities; and (3) Restrictions in participation in daily life [As the disease progresses, the worsening of symptoms, such as tremor, rigidity and bradykinesia, leads to a deterioration of manual dexterity, which translates to a greater difficulty in performing some ADLs. The most commonly reported basic self-care activities affected by PD symptoms are bathing/showering, dressing, and grooming/personal hygiene. Other instrumental activities of daily living that are affected are driving, preparing food, shopping, and writing [The treatment of PD is mainly based on the administration of levodopa, whose efficacy decreases over time and can produce side effects such as motor fluctuations, dyskinesias and dopaminergic dysregulation syndrome. The onset of the disease and the variety of possible symptoms makes it difficult to design a therapeutic regimen for the treatment of the disease. So far, approved therapies have focused on compensatory approaches aimed at treating clinical symptoms. However, the current research is focused on delaying or halting disease progression and not only on temporary symptomatic relief. Currently, all therapies are directed toward ameliorating motor deficits by increasing dopamine, but unfortunately, this loses efficacy over time as dopaminergic neurodegeneration progresses, with symptoms worsening in the long-term. Therefore, new non-pharmacological therapies need to be assessed [There are several non-pharmacological therapies design to reduce functional impairments of this disease and, although evidence of their efficacy is increasing, there is still a limited number of studies on them and on the necessary intervention doses [This type of device has been effective in children with cerebral palsy (CP). In the study conducted by Pavão et al., the use, by children with CP, of a vest made of this material showed better postural stability when performing a manual reaching activity [DEFOs have not yet been investigated in in a wide range of motor variables in PD. In the recent review, conducted by Son Nguyen, studies of different types of portable orthoses for UL tremor suppression were assessed, the majority being active orthoses (45%), followed by semi-active orthoses (35%), and passive orthoses (20%). All orthoses have proven to be effective in suppressing tremors, but several had inconveniencies such as being heavy and bulky, had not been evaluated in laboratory settings or were not yet commercially available [Although current orthoses have proven to be effective in suppressing tremor, their clinical or home use is still limited. This limited their clinical or home use for suppressing tremor. Given these former results and lack of studies in PD, our main objective was to analyze the efficacy of a lighter device for the UL, such as the DEFO, in motor variables, functional mobility and quality of life in PD.