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European Journal of Physical and Rehabilitation Medicine 2021 May 05

DOI: 10.23736/S1973-9087.21.06621-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Is fatigue a muscular phenomenon in Parkinson’s disease? Implications for rehabilitation

Cira FUNDARÓ 1 , Marco GAZZONI 2, Gian Domenico PINNA 3, Carlo DALLOCCHIO 4, Alberto RAINOLDI 5, Roberto CASALE 6

1 Neurophysiopathology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCSS, Pavia, Italy; 2 LISiN, Laboratory of Engineering of Neuromuscular System, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy; 3 Department of Biomedical Engineering of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCSS,, Pavia, Italy; 4 Neurology Unit, Department of Medical Area, ASST Pavia, Voghera, Pavia, Italy; 5 Department of Medical Sciences, NeuroMuscularFunction Research Group, School of Exercise & Sport Sciences, University of Turin, Turin, Italy; 6 OPUSMedica PC&R,Persons, Care & Research, Piacenza, Italy


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BACKGROUND: Fatigue in Parkinson’s Disease (PD) compromises patients’ physical activity and poses questions on how to plan correct rehabilitation training. In addition, the relationship between subjective perceived fatigue and fatigue in motor performance is not yet entirely understood. As a consequence, a conclusive interpretation of muscular mechanisms of fatigue in PD has not yet been achieved. Among the various instrumental evaluations for fatigue, multichannel surface electromyography (sEMG) is a recognized tool that permits the study of myoelectric manifestations of fatigue.
AIM: To assess if muscles in PD show a different myoelectric fatigue pattern compared to the muscles of healthy age-matched subjects.
DESIGN: Observational controlled study.
POPULATION: Idiopathic Parkinson’s Disease, Hohen &Yahr II and III stage, Parkinsonian Fatigue Scale average score ≥ 2.95, no therapy modification in the 4 weeks preceding the study; exclusion criteria: Mini Mental State Examination ≤ 24, upper limb disease/symptoms that might interfere with sEMG analysis, presence of other fatiguerelated conditions. Twenty patients were selected according to these criteria. Twenty untrained healthy subjects were matched.
METHODS: All subjects underwent a muscle fatigue protocol and a sEMG analysis of the right biceps brachii muscle during electrically stimulated and voluntary contractions in order to obtain a myoelectric fatigue muscular pattern. The myoelectric pattern is characterized by the modifications of the following sEMG variables: reduction of mean frequency and muscle fibre conduction velocity, increase of average rectified value.
RESULTS: No statistical differences where observed between groups for sEMG variables and muscular electric behaviour in all contraction conditions (all p> .05).
CONCLUSIONS: Our results show that parkinsonian muscles does not differ from the muscles of healthy age-matched subjects in developing peripheral myoelectric fatigue. Nevertheless, the role of fatigue perception at rest and particularly during physical activity must be clearly understood in order to further target the rehabilitative approach for fatigued parkinsonian patients and to reduce hypomobility.
CLINICAL REHABILITATION IMPACT: In rehabilitative terms, these findings allow us to highlight the possibility of performing sustained training with isometric contractions in PD subjects; therefore, fatigue “per se” does not constitute a barrier for the execution of muscular exercises, likewise intensive.


KEY WORDS: Parkinson’s disease; Fatigue; Parkinson Fatigue Scale; Multichannel surface electromyography; Rehabilitation

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