Effect of Resistance Exercise on Tremor and Hand Dexterity of Parkinson's Disease

抗阻运动对帕金森病震颤和手灵活性的影响

• 批准号: 9114896
• 负责人: Monthaporn S Bryant
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-10-01 至 2017-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9114896
• 关键词: Activities of Daily Living; Bradykinesia; Caring; Clinical; Data; Dependency; Diagnosis; Digit structure; Disabled Persons; Eating; Elderly; Electromyography; Essential Tremor; Exercise; Fingers; Hand; Hand Strength; Hand functions; Handwriting; Healthcare Systems; Home environment; Hour; Impairment; Individual; Intervention; Manuals; Measures; Medical; Methodology; Methods; Mission; Motor; Motor Activity; Movement; Muscle; Muscle Weakness; Neurologic; Parkinson Disease; Patient Care; Patients; Performance; Performance at work; Persons; Pharmaceutical Preparations; Population; Posture; Purdue pegboard test; Quality of life; Randomized; Reaction Time; Recruitment Activity; Rehabilitation therapy; Reporting; Research; Research Personnel; Self-Administered; Social isolation; Surface; Testing; Time; Toothbrushing; Travel; Tremor; Upper Extremity; Veterans; Waiting Lists; advanced disease; arm; base; biceps brachii muscle; clinical care; design; dexterity; disability; exercise program; experience; functional restoration; grasp; hand dysfunction; hand therapy; improved; improved functioning; innovation; motor impairment; pill; programs; public health relevance; resistance exercise; strength training; time use

 DESCRIPTION (provided by applicant): Background/rationale: Tremor is the second most common complaint in patients with Parkinson's disease (PD) after slowness, as it is bothersome to patients and interferes with many hand functions (e.g. eating, buttoning, zipping, shaving, typing, handling pills, tying shoelace, and brushing teeth). Muscle weakness is also a consequence of slowness and contributes to impaired fine movements and manual dexterity. Patients with pronounced tremor are disabled by the tremor itself and may suffer from social isolation that further decreases quality of life. Postural tremor can limit activities of daily living (ADL). Pronounced tremor can impair fine motor dexterity as well as job performance. In such cases, the tremor results in handicap and disability. Previous evidence demonstrated that resistance training significantly reduced motor unit firing rate variability, reduced upper limb coactivation, improved digit force steadiness, and improved intra- and intermuscular coordination, factors which could improve tremor and movement control in persons with neurological conditions. There has been no study on a rehabilitation intervention for impaired hand dexterity and tremor in PD. Project objectives: In this project, the investigators (Dr. Bryant and her research team) will study the effect of progressive resistance exercise of hand and arm (HREX) on hand dexterity and tremor in patients with PD. The specific purposes of this proposal are to: 1) Estimate the efficacy of HREX to improve hand dexterity, and strength; 2) Estimate the efficacy of HREX in reducing tremor and bradykinesia; and 3) Estimate the efficacy of HREX to reduce motor impairments from PD and ADL. Project methods: This study is a randomized wait-list controlled design using 6 weeks of HREX, as a home-based program. 62 Veterans with a diagnosis of PD will be recruited and randomized into wait-list control (WAIT) and exercise (HREX) groups. Subjects will use a dumbbell, a hand grip, and hand therapy putty to exercise at home. Volume of exercise (sets and repetitions) will be increased to gradually progress the exercises during the 6 weeks. The subjects will be asked to do the exercise 3 times a week on 3 different days, with at least 24- hour intervals between sessions. The WAIT group will start their exercise at the end of a 6- week waiting period. Measures to evaluate the efficacy are tremor amplitude, finger tapping test, Purdue pegboard test, electromyography (EMG), tremor clinical rating score, grip strength, motor and activity of daily living (ADL) scores. Long-term objectives: If efficacy of the resistanc exercise is demonstrated, the team will develop a larger multi-center proposal to implement this intervention in clinical care to benefit Veterans suffering from PD. The home-based, strengthening exercise program can be used as an adjunct to medical treatment in Veterans with PD.

 描述（由申请人提供）： 背景/依据：震颤是帕金森病（PD）患者中仅次于缓慢的第二大常见主诉，因为它对患者来说是麻烦的，并且干扰许多手部功能（例如进食、扣扣子、拉拉链、剃须、打字、处理药丸、系鞋带和刷牙）。肌肉无力也是缓慢的结果，并导致精细运动和手动灵活性受损。患有明显震颤的患者因震颤本身而残疾，并可能遭受社会孤立，进一步降低生活质量。姿势性震颤可限制日常生活活动（ADL）。明显的震颤会损害精细运动的灵活性以及工作表现。在这种情况下，震颤导致残疾和残疾。以前的证据表明，阻力训练显着降低运动单位放电率的变异性，减少上肢共激活，改善手指力量的稳定性，并改善肌内和肌间的协调，这些因素可以改善震颤和运动控制的人与神经系统疾病。目前还没有关于PD患者手部灵活性受损和震颤的康复干预研究。项目目标：在本项目中，研究者（Bryant博士和她的研究小组）将研究手和手臂的渐进阻力运动（HREX）对PD患者手部灵活性和震颤的影响。本提案的具体目的是：1）评估HREX改善手部灵活性和力量的功效; 2）评估HREX减少震颤和运动迟缓的功效; 3）评估HREX减少PD和ADL运动障碍的功效。项目方法：本研究是一个随机的等待名单对照设计，使用6周的HREX，作为一个家庭为基础的程序。将招募62名诊断为PD的退伍军人，并随机分为等待列表对照组（WAIT）和运动组（HREX）。受试者将使用哑铃、握把和手部治疗油灰在家锻炼。在6周内，将增加运动量（成套和重复），以逐步推进运动。受试者将被要求每周在3个不同的日子进行3次运动，两次运动之间至少间隔24小时。等待组将在6周等待期结束时开始锻炼。评价疗效的指标为震颤幅度、手指敲击试验、Purdue钉板试验、肌电图（EMG）、震颤临床评分、握力、运动和日常生活活动（ADL）评分。长期目标：如果抗阻运动的有效性得到证明，该团队将制定一个更大的多中心提案，在临床护理中实施这种干预措施，以使患有PD的退伍军人受益。以家庭为基础的强化锻炼计划可以作为PD退伍军人医疗的辅助手段。