Virtual rehabilitation among dopa-resistant signs in patients with Parkinson's Disease and its correlation to striatal dopamine transporter density and cerebral glucose metabolism

• Grant number: 15/07088-6
• Support Opportunities: Regular Research Grants
• Start date: April 01, 2016
• End date: September 30, 2018
• Field of knowledge: Health Sciences - Medicine - Medical Radiology
• Principal Investigator: André Carvalho Felício
• Grantee: André Carvalho Felício
• Host Institution: Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE). Sociedade Beneficente Israelita Brasileira Albert Einstein (SBIBAE). São Paulo , SP, Brazil
• Associated researchers: Edson Amaro Junior ; Rodrigo Affonseca Bressan ; Shirley Silva Lacerda ; Solange Amorim Nogueira

Abstract

Parkinson's disease is the second most common neurodegenerative disorder, and in countries such as Brazil its prevalence (currently 1 to 3% of the population) tend to increase because of ongoing changes in Brazil's age pyramid. Levodopa and dopamine agonists can effectively treat PD motor signs. However, with disease progression dopa-resistant motor signs may occur such as gait difficulties (freezing) and balance issues (postural instability) that can either impact quality of live or increase direct and indirect costs associated with PD. Conventional physiotherapy can provide considerable benefit in order to treat dopa-resistant motor signs. On the other side, virtual rehabilitation not only provides a more dynamic and interactive environment, but also the advantage of motor learning (feedback) and sensorial cueing, therefore, providing a better platform to treat dopa-resistant signs in PD. However, there are no studies yet uncovering the mechanism by which virtual rehabilitation may work in dopa-resistant PD signs (freezingor postural instability). IN this study, we aim to develop a virtual rehabilitation protocol using Xbox 360 S® and itssensor Kinect® in 2 groups of PD patients (with and without dopa-resistant motor signs). All subjects will be submitted to an 8-week trial and motor outcomes will be evaluated using 2 different in vivo functional imaging techniques: SPECT with TRODAT-1, toquantify striatal dopamine transporter density, and MRI-PET with Fluorodeoxyglucose, to evaluate striatal and non-striatal metabolism. Additionally, three-dimensional gait evaluation will be performed before and after intervention (Gait Lab) and clinical data will be recorded throughout protocol. Hence, with the aforementioned protocol we aim to test whether virtual rehabilitation is efficient to treat dopa-resistant signs in PD and to verify the in vivo underlying mechanisms associated with this improvement. (AU)