PhD defence - Martin Høyer Rose

Tegnet af Julie Rose MalskærMartin Høyer Rose is defending his PhD thesis

Rehabilitation in Parkinson's Disease

Time

27 August 2013 at 13:00

Venue

Auditorium 2, August Krogh building, Universitetsparken 13, Copenhagen

Opponents

Professor Bente Kiens (Chair), Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark

Professor Pascal Madeleine, Department of Health Science and Technology, Aalborg University, Denmark

Dr. Poul H. Mogensen, Neuropsychiatric Unit, Aarhus University Hospital Risskov, Denmark

Supervisors

Associate Professor Bente Rona Jensen, Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark

Head Gait Laboratory Stig Sonne-Holm, Orthopedic Surgeon, Department of Orthopedic Surgery, Hvidovre University Hospital.

About the thesis

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by progressive motor and non-motor deficits. Dopaminergic therapy provides effective symptomatic treatment; however, after years of treatment, motor complications with a fluctuating response to medication may occur, resulting in a need for additional motor rehabilitation. Physical training comprises an important adjunct to medical treatment and the understanding of the physiological responses related to different rehabilitation modalities is essential in the process of optimizing PD rehabilitation.

This thesis investigated the effect of 8 weeks of body-weight (BW)-supported progressive high-intensity locomotor training on specific aspects of motor performance, neuromuscular mechanisms and motor control of movement in patients with PD. Cross-sectional investigations showed PD patients had reduced dynamical balance, sit-to-stand performance and walking capacity when compared to healthy subjects. Investigation of the underlying mechanisms suggested that these deficits to some degree were related to impaired muscle activation. Patients had a decreased rate of force development during knee extensions (both isometric and dynamical), which was associated with decreased agonist muscle activation, and patients were found to walk with excessive muscle activation of the thigh muscles. Further, investigations of steady isometric muscle contractions (torque steadiness) suggested decreased motor control of the knee joint and analysis of isometric tremor indicated that dominating pathological central nervous system (CNS) oscillators related to PD influenced tremor irregularity. Eight-week high-intensity locomotor training improved clinical status, quality of life, gait capacity, step length and sit-to-stand performance significantly. Further, abnormal flexor peak muscle activation during BW-supported walking was improved. The training had no measurable effect on muscle activation characteristics during walking without BW support or on dynamical balance, rate of force development, torque steadiness or isometric tremor irregularity. The investigated training was feasible and well tolerated by patients with PD.

The overall results suggest that physical training should be fundamental in the treatment of patients with PD. Training intensity and motor difficulty should be considered important parameters when specialized PD rehabilitation is designed. In this study motor performance improved readily in PD patients, although performance seemed limited by decreased motor control of movement. Both direct and indirect evidence suggested that improvements in motor control are possible in PD.

2013, 120 pages, ISBN 978 87 7611 613 2