AUTHOR=Putortì Alessia , Corrado Michele , Avenali Micol , Martinelli Daniele , Allena Marta , Cristina Silvano , Grillo Valentina , Martinis Luca , Tamburin Stefano , Serrao Mariano , Pisani Antonio , Tassorelli Cristina , De Icco Roberto 

TITLE=The Effects of Intensive Neurorehabilitation on Sequence Effect in Parkinson's Disease Patients With and Without Freezing of Gait

JOURNAL=Frontiers in Neurology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.723468

DOI=10.3389/fneur.2021.723468

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> The sequence effect (SE), defined as a reduction in amplitude of repetitive movements, is a common clinical feature of Parkinson's disease (PD) and is supposed to be a major contributor to freezing of gait (FOG). During walking, SE manifests as a step-by-step reduction in step length when approaching a turning point or gait destination, resulting in the so-called destination sequence effect (dSE). Previous studies explored the therapeutic effects of several strategies on SE, but none of them evaluated the role of an intensive rehabilitative program.</p><p><bold>Objectives:</bold> Here we aim to study the effects of a 4-week rehabilitative program on dSE in patients with PD with and without FOG.</p><p><bold>Methods:</bold> Forty-three patients (30 males, 70.6 ± 7.5 years old) with idiopathic PD were enrolled. The subjects were divided into two groups: patients with (PD + FOG, <italic>n</italic> = 23) and without FOG (PD – FOG, <italic>n</italic> = 20). All patients underwent a standardized 4-week intensive rehabilitation in-hospital program. At hospital admission (T0) and discharge (T1), all subjects were evaluated with an inertial gait analysis for dSE recording.</p><p><bold>Results:</bold> At T0, the dSE was more negative in the PD + FOG group (−0.80 ± 0.6) when compared to the PD – FOG group (−0.39 ± 0.3) (<italic>p</italic> = 0.007), even when controlling for several clinical and demographic features. At T1, the dSE was reduced in the overall study population (<italic>p</italic> = 0.001), with a more pronounced improvement in the PD + FOG group (T0: −0.80 ± 0.6; T1: −0.23 ± 0.4) when compared to the PD – FOG group (T0: −0.39 ± 0.3; T1: −0.22 ± 0.5) (<italic>p</italic> = 0.012). At T1, we described in the overall study population an improvement in speed, cadence, stride duration, and stride length (<italic>p</italic> = 0.001 for all variables).</p><p><bold>Conclusions:</bold> dSE is a core feature of PD gait dysfunction, specifically in patients with FOG. A 4-week intensive rehabilitative program improved dSE in PD patients, exerting a more notable beneficial effect in the PD + FOG group.</p>