Abstract
Many authors showed that aquatic physiotherapy could improve quality of life and reduce postural instability and risk of falling in elderly subjects. The aim of this research was to explore if the thermal aquatic environment is a suitable place for rehabilitative training in person with Parkinson disease (PwP) with results comparable to the standard physiotherapy. A retrospective study was conducted on a database of 14 persons with Parkinson who were admitted to a thermal aquatic rehabilitation to undergo treatments made to improve gait and balance impairments. The rehabilitation training consisted of 45-min sessions conducted twice a week, on non-consecutive days, over 4 weeks of functional re-education and kinesitherapy in the thermal pool. Educational and prevention instructions were also given to the patients during each session. Additionally, nutrition (diet), health education, and cognitive behavioral advice were given to our patients by therapists. The clinical characteristics of the sample were age 66 ± 9, disease duration 7 ± 5, and Hoehn and Yahr 1.5 ± 0.5. The statistical analysis showed a statistically significant improvement for the UPDRS p = 0.0005, for The Berg Balance Scale p = 0.0078, for the PDQ8 p = 0.0039, Tinetti p = 0.0068, and for Mini BESTest p = 0.0002. Our data suggest that this intervention could become a useful strategy in the rehabilitation program of PwP. The simplicity of treatment and the lack of side effects endorse the use of thermal aquatic environment for the gait and balance recovery in PwP.
Similar content being viewed by others
References
Abbruzzese G, Marchese R, Avanzino L, Pelosin E (2016) Rehabilitation for Parkinson’s disease: current outlook and future challenges. Parkinsonism Relat Disord 22:S60–S64. https://doi.org/10.1016/j.parkreldis.2015.09.005
Arnold CM, Busch AJ, Schachter CL, Harrison EL, Olszynski WP (2008) A randomized clinical trial of aquatic versus land exercise to improve balance, function, and quality of life in older women with osteoporosis. Physiother Can 60:296–306. https://doi.org/10.3138/physio.60.4.296
Ayán C, Cancela J (2012) Feasibility of 2 different water-based exercise training programs in patients with Parkinson’s disease: a pilot study. Arch Phys Med Rehabil 93:1709–1714. https://doi.org/10.1016/j.apmr.2012.03.029
Bovolenta F, Sale P, Dall’Armi V et al (2011) Robot-aided therapy for upper limbs in patients with stroke-related lesions. Brief report of a clinical experience. J Neuroeng Rehabil 8:18. https://doi.org/10.1186/1743-0003-8-18
Carroll LM, Volpe D, Morris ME, Saunders J, Clifford AM (2017) Aquatic exercise therapy for people with Parkinson disease: a randomized controlled trial. Arch Phys Med Rehabil 98:631–638. https://doi.org/10.1016/j.apmr.2016.12.006
Devereux K, Robertson D, Briffa NK (2005) Effects of a water-based program on women 65 years and over: a randomised controlled trial. Aust J Physiother 51:102–108
Dewan N, MacDermid JC (2014) Fall efficacy scale - international (FES-I). J Physiother 60:60. https://doi.org/10.1016/j.jphys.2013.12.014
Dong Koog Noh DK, Lim J-Y, Shin H-I, Paik N-J (2008) The effect of aquatic therapy on postural balance and muscle strength in stroke survivors — a randomized controlled pilot trial. Clin Rehabil 22:966–976. https://doi.org/10.1177/0269215508091434
Ferrazzoli D, Ortelli P, Maestri R, Bera R, Giladi N, Ghilardi MF, Pezzoli G, Frazzitta G (2016) Does cognitive impairment affect rehabilitation outcome in Parkinson’s disease? Front Aging Neurosci 8:192. https://doi.org/10.3389/fnagi.2016.00192
Fioravanti A, Cantarini L, Guidelli GM, Galeazzi M (2011) Mechanisms of action of spa therapies in rheumatic diseases: what scientific evidence is there? Rheumatol Int 31:1–8. https://doi.org/10.1007/s00296-010-1628-6
Franceschini M, Colombo R, Posteraro F, Sale P (2015) A proposal for an Italian minimum data set assessment protocol for robot-assisted rehabilitation: a Delphi study. Eur J Phys Rehabil Med 51:745–753
Furnari A, Calabrò RS, Gervasi G, la Fauci-Belponer F, Marzo A, Berbiglia F, Paladina G, de Cola MC, Bramanti P (2014) Is hydrokinesitherapy effective on gait and balance in patients with stroke? A clinical and baropodometric investigation. Brain Inj 28:1109–1114. https://doi.org/10.3109/02699052.2014.910700
Geroin C, Mazzoleni S, Smania N, Gandolfi M, Bonaiuti D, Gasperini G, Sale P, Munari D, Waldner A, Spidalieri R, Bovolenta F, Picelli A, Posteraro F, Molteni F, Franceschini M, Italian Robotic Neurorehabilitation Research Group (2013) Systematic review of outcome measures of walking training using electromechanical and robotic devices in patients with stroke. J Rehabil Med 45:987–996. https://doi.org/10.2340/16501977-1234
Huang T-T, Hsu H-Y, Wang B-H, Chen K-H (2011) Quality of life in Parkinson’s disease patients: validation of the short-form eight-item Parkinson’s disease questionnaire (PDQ-8) in Taiwan. Qual Life Res 20:499–505. https://doi.org/10.1007/s11136-010-9777-3
Kauffman BE, Kauffman BW (2014) Aquatic therapy. In: A Comprehensive Guide to Geriatric Rehabilitation. Elsevier, pp 517–519
Kauffman TL, Scott RW, Barr JO, Moran ML (2014) A comprehensive guide to geriatric rehabilitation, 3rd edn. Churchill Livingstone (Elsevier), London, p 624
Li C, Khoo S, Adnan A (2017) Effects of aquatic exercise on physical function and fitness among people with spinal cord injury: a systematic review. Medicine (Baltimore) 96:e6328. https://doi.org/10.1097/MD.0000000000006328
Magrinelli F, Picelli A, Tocco P, Federico A, Roncari L, Smania N, Zanette G, Tamburin S (2016) Pathophysiology of motor dysfunction in Parkinson’s disease as the rationale for drug treatment and rehabilitation. Parkinsons Dis 2016:1–18. https://doi.org/10.1155/2016/9832839
Mak MK, Wong-Yu IS, Shen X, Chung CL (2017) Long-term effects of exercise and physical therapy in people with Parkinson disease. Nat Rev Neurol 13:689–703. https://doi.org/10.1038/nrneurol.2017.128
Masiero S (2008) Thermal rehabilitation and osteoarticular diseases of the elderly. Aging Clin Exp Res 20:189–194. https://doi.org/10.1007/BF03324772
Masiero S, Vittadini F, Ferroni C, Bosco A, Serra R, Frigo AC, Frizziero A (2018) The role of thermal balneotherapy in the treatment of obese patient with knee osteoarthritis. Int J Biometeorol 62:243–252. https://doi.org/10.1007/s00484-017-1445-7
Mazzoli D, Giannotti E, Longhi M, Prati P, Masiero S, Merlo A (2017) Age explains limited hip extension recovery at one year from total hip arthroplasty. Clin Biomech 48:35–41. https://doi.org/10.1016/j.clinbiomech.2017.07.003
Montagna JC, Santos BC, Battistuzzo CR, Loureiro APC (2014) Effects of aquatic physiotherapy on the improvement of balance and corporal symmetry in stroke survivors. Int J Clin Exp Med 7:1182–1187
Morer C, Boestad C, Zuluaga P, Alvarez-Badillo A, Maraver F (2017) Effects of an intensive thalassotherapy and aquatic therapy program in stroke patients. A pilot study. Rev Neurol 65:249–256
Musumeci A, Pranovi G, Masiero S (2018) Patient education and rehabilitation after hip arthroplasty in an Italian spa center: a pilot study on its feasibility. Int J Biometeorol 62:1489–1496. https://doi.org/10.1007/s00484-018-1548-9
Paoloni M, Bernetti A, Brignoli O et al (2017) Appropriateness and efficacy of Spa therapy for musculoskeletal disorders. A Delphi method consensus initiative among experts in Italy. Ann Ist Super Sanita 53:70–76 http://old.iss.it/binary/publ/cont/ANN_17_01_13.pdf
Park B-S, Noh J-W, Kim M-Y, Lee LK, Yang SM, Lee WD, Shin YS, Kim JH, Lee JU, Kwak TY, Lee TH, Kim JY, Park J, Kim J (2015) The effects of aquatic trunk exercise on gait and muscle activity in stroke patients: a randomized controlled pilot study. J Phys Ther Sci 27:3549–3553. https://doi.org/10.1589/jpts.27.3549
Park B-S, Noh J-W, Kim M-Y, Lee LK, Yang SM, Lee WD, Shin YS, Kim JH, Lee JU, Kwak TY, Lee TH, Park J, Kim J (2016) A comparative study of the effects of trunk exercise program in aquatic and land-based therapy on gait in hemiplegic stroke patients. J Phys Ther Sci 28:1904–1908. https://doi.org/10.1589/jpts.28.1904
Pellecchia MT, Grasso A, Biancardi LG, Squillante M, Bonavita V, Barone P (2004) Physical therapy in Parkinson’s disease: an open long-term rehabilitation trial. J Neurol 251:595–598. https://doi.org/10.1007/s00415-004-0379-2
Sale P, De Pandis MF, Domenica LP et al (2013) Robot-assisted walking training for individuals with Parkinson’s disease: a pilot randomized controlled trial. BMC Neurol 13. https://doi.org/10.1186/1471-2377-13-50
Stewart Williams J, Kowal P, Hestekin H et al (2015) Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-income countries: results from the WHO study on global AGEing and adult health (SAGE). BMC Med 13:147. https://doi.org/10.1186/s12916-015-0390-8
Stocchi F, Sale P, Kleiner AFR, Casali M, Cimolin V, de Pandis F, Albertini G, Galli M (2015) Long-term effects of automated mechanical peripheral stimulation on gait patterns of patients with Parkinson’s disease. Int J Rehabil Res 38:238–245. https://doi.org/10.1097/MRR.0000000000000120
Suomi R, Koceja DM (2000) Postural sway characteristics in women with lower extremity arthritis before and after an aquatic exercise intervention. Arch Phys Med Rehabil 81:780–785
Tan DM, McGinley JL, Danoudis ME et al (2011) Freezing of gait and activity limitations in people with Parkinson’s disease. Arch Phys Med Rehabil 92:1159–1165. https://doi.org/10.1016/j.apmr.2011.02.003
Tripp F, Krakow K (2014) Effects of an aquatic therapy approach (Halliwick-therapy) on functional mobility in subacute stroke patients: a randomized controlled trial. Clin Rehabil 28:432–439. https://doi.org/10.1177/0269215513504942
Vivas J, Arias P, Cudeiro J (2011) Aquatic therapy versus conventional land-based therapy for Parkinson’s disease: an open-label pilot study. Arch Phys Med Rehabil 92:1202–1210. https://doi.org/10.1016/j.apmr.2011.03.017
Volpe D, Giantin MG, Maestri R, Frazzitta G (2014) Comparing the effects of hydrotherapy and land-based therapy on balance in patients with Parkinson’s disease: a randomized controlled pilot study. Clin Rehabil 28:1210–1217. https://doi.org/10.1177/0269215514536060
Volpe D, Giantin MG, Manuela P, Filippetto C, Pelosin E, Abbruzzese G, Antonini A (2017) Water-based vs. non-water-based physiotherapy for rehabilitation of postural deformities in Parkinson’s disease: a randomized controlled pilot study. Clin Rehabil 31:1107–1115. https://doi.org/10.1177/0269215516664122
Zhang Y, Wang Y-Z, Huang L-P, Bai B, Zhou S, Yin MM, Zhao H, Zhou XN, Wang HT (2016) Aquatic therapy improves outcomes for subacute stroke patients by enhancing muscular strength of paretic lower limbs without increasing spasticity. Am J Phys Med Rehabil 95:840–849. https://doi.org/10.1097/PHM.0000000000000512
Zhu Z, Cui L, Yin M, Yu Y, Zhou X, Wang H, Yan H (2016) Hydrotherapy vs. conventional land-based exercise for improving walking and balance after stroke: a randomized controlled trial. Clin Rehabil 30:587–593. https://doi.org/10.1177/0269215515593392
Zhu Z, Yin M, Cui L, Zhang Y, Hou W, Li Y, Zhao H (2018) Aquatic obstacle training improves freezing of gait in Parkinson’s disease patients: a randomized controlled trial. Clin Rehabil 32:29–36. https://doi.org/10.1177/0269215517715763
Zotz TGG, Souza EA, Israel VL, Loureiro APC (2013) Aquatic physical therapy for Parkinson’s disease. Adv Park Dis 02:102–107. https://doi.org/10.4236/apd.2013.24019
Acknowledgements
We thank the Medical Hotel Hermitage Bel Air for making the thermal setting available to our patients.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare that they have no conflict of interest. All authors attest and affirm that the material within has not been and will not be submitted for publication elsewhere.
Rights and permissions
About this article
Cite this article
Masiero, S., Maghini, I., Mantovani, M.E. et al. Is the aquatic thermal environment a suitable place for providing rehabilitative treatment for person with Parkinson’s disease? A retrospective study. Int J Biometeorol 63, 13–18 (2019). https://doi.org/10.1007/s00484-018-1632-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00484-018-1632-1