Physical Therapy and Deep Brain Stimulation in Parkinson Disease (PTDBS)
While deep brain stimulation of the subthalamic nucleus (STN-DBS) is commonly used to reduce tremor, muscle stiffness, and bradykinesia in people with Parkinson disease (PD), preliminary studies suggest balance may worsen and falls may increase after STN-DBS. Walking speed, known to be reduced in PD, typically improves after surgery; however, other important gait qualities may not improve. Given the potential for worsening balance and gait and increasing falls after surgery, it is imperative that researchers explore interventions that complement the positive effects of STN-DBS and delay worsening of balance and gait.
Physical therapy (PT) is reported to be effective in improving balance and walking in people with PD. However, there have been no studies to investigate how individuals with STN-DBS respond to PT. As such, it is unclear if exercise in the post-DBS population is safe, feasible, and effective. The purpose of this study is to examine the safety, feasibility, and efficacy of PT in people with PD with STN-DBS.
The investigators hypothesize that PT will be safe and feasible for people with PD with STN-DBS. Further, the investigators hypothesize that those assigned to PT group will demonstrate improvements in balance and gait while those assigned to the control group will demonstrate no change or a decline in balance and gait.
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Outcomes Assessor
Outcomes assessor will be blinded to group assignment.Primary Purpose: Treatment
|Official Title:||Physical Therapy and Deep Brain Stimulation in Parkinson Disease|
- Incidence of Treatment-Emergent Adverse Events [Safety & Tolerability] [ Time Frame: 8 weeks ]Number of falls, orthopedic injuries, or other adverse events that are related to treatment.
- Treatment-Related Adherence [Feasibility] [ Time Frame: 8 weeks ]Feasibility of the treatment as measured by the percentage of PT sessions attended
- Balance [ Time Frame: 8 weeks ]Change in Balance Evaluation Systems Test score
- Gait [ Time Frame: 8 weeks ]Change in gait velocity (cm/sec)
|Anticipated Study Start Date:||June 22, 2017|
|Estimated Study Completion Date:||January 31, 2019|
|Estimated Primary Completion Date:||January 31, 2019 (Final data collection date for primary outcome measure)|
Experimental: Physical Therapy
Participants assigned to Physical Therapy (PT) will attend a 1-hour visit with a physical therapist twice weekly for 8 weeks. The PT intervention, which will mirror traditional PT for those with PD, will include exercises designed to improve balance and gait.
Behavioral: Physical Therapy
Postural stability exercises will follow a framework targeting quiet stance, anticipatory and reactive postural adjustments, and dynamic postural control. Gait exercises will include treadmill walking and practice with dual-task gait. A home exercise program (HEP), to be completed twice weekly, will be provided on each participant's initial visit with the physical therapist following STN-DBS surgery. The HEP will include the following exercises: trunk rotation, standing hip flexion, standing hip abduction, standing plantarflexion, and standing squat.
Other Name: Physical Rehabilitation
No Intervention: Control
Participants in the control group will receive the current standard of care following STN-DBS. As such, STN-DBS settings and anti-PD medications will be optimized according to the determination of their neurologist in the same fashion as they will be in the experimental group. Those in the control group will not receive prescribed exercise from a physical therapist.
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Please refer to this study by its ClinicalTrials.gov identifier: NCT03181282
|Contact: Ryan P Duncan, DPTfirstname.lastname@example.org|
|United States, Missouri|
|Washington University in St. Louis School of Medicine - Program in Physical Therapy||Recruiting|
|Saint Louis, Missouri, United States, 63108|
|Contact: Ryan p Duncan, DPT 314-273-1052 email@example.com|
|Principal Investigator: Ryan P Duncan, DPT|
|Principal Investigator:||Ryan P Duncan, DPT||Washington University in St. Louis School of Medicine - Program in Physical Therapy|