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Postural instability is common in neurological diseases. Although transcranial direct current stimulation (tDCS) seems to be a promising complementary therapy, emerging evidence indicates mixed results and protocols' characteristics. We conducted a systematic review and meta-analysis on PubMed, EMBASE, Scopus, and Web of Science to synthesize key findings of the effectiveness of single and multiple sessions of tDCS alone and combined with other interventions on balance in adults with neurological disorders. Thirty-seven studies were included in the systematic review and 33 in the meta-analysis. The reviewed studies did not personalize the stimulation protocol to individual needs/characteristics. A random-effects meta-analysis indicated that tDCS alone (SMD = -0.44; 95%CI = -0.69/-0.19; p 0.001) and combined with another intervention (SMD = -0.31; 95%CI = -0.51/-0.11; p = 0.002) improved balance in adults with neurological disorders (small to moderate effect sizes). Balance improvements were evidenced regardless of the number of sessions and targeted area. In summary, tDCS is a promising therapy for balance rehabilitation in adults with neurological disorders. However, further clinical trials should identify factors that influence responsiveness to tDCS for a more tailored approach, which may optimize the clinical use of tDCS.

Background: There is a lack of recommendations for selecting the most appropriate gait measures of Parkinson’s disease (PD)-specific dual-task costs to use in clinical practice and research. Objective: We aimed to identify measures of dual-task costs of gait and turning that best discriminate performance in people with PD from healthy individuals. We also investigated the relationship between the most discriminative measures of dual-task costs of gait and turning with disease severity and disease duration. Methods: People with mild-to-moderate PD (n = 144) and age-matched healthy individuals (n = 79) wore 8 inertial sensors while walking under single and dual-task (reciting every other letter of the alphabet) conditions. Outcome measures included 26 objective measures within four gait domains (upper/lower body, turning and variability). The area under the curve (AUC) from the receiver-operator characteristic plot was calculated to compare discriminative ability of dual-task costs on gait across outcome measures. Results: PD-specific, dual-task interference was identified for arm range of motion, foot strike angle, turn velocity and turn duration. Arm range of motion (AUC = 0.73) and foot strike angle (AUC = 0.68) had the largest AUCs across dual-task costs measures and they were associated with disease severity and/or disease duration. In contrast, the most commonly used dual-task gait measure, gait speed, showed an AUC of only 0.54. Conclusion: Findings suggest that people with PD rely more than healthy individuals on executive-attentional resources to control arm swing, foot strike, and turning, but not gait speed. The dual-task costs of arm range of motion best discriminated people with PD from healthy individuals.

Submitted by Lilian Teresa Gobbi (lilian.gobbi@unesp.br) on 2021-05-20T23:07:36Z No. of bitstreams: 1 Manuscript_accepted.pdf: 2005538 bytes, checksum: a08c00a8a6e0666817369b6853a61115 (MD5) Rejected by Marcia Correa Bueno Degasperi null (mcbueno@rc.unesp.br), reason: Prezado Gabriel, O documento enviado para a coleção Campus Unesp Rio Claro foi recusado pelo(s) seguinte(s) motivo(s): - É necessário o autor indicar o prazo de embargo para o artigo conforme normas da revista. Em consulta ao Sherpa Romeo, verificamos que o embargo para versão postprint é de 12 meses: https://v2.sherpa.ac.uk/id/publication/6992?template=romeo Tutorial para autoarquivamento de artigos preprint, postprint e publicados: https://www2.unesp.br/Home/cgb/tutorial-autoarquivamento-artigos-e-capitulos-de-livro-versao-1.0.pdf Em caso de dúvidas entre em contato pelos e-mails: stati.rc@unesp.br marcia.bueno@unesp.br WhatsApp (19) 3526-9666 Solicitamos que realize uma nova submissão seguindo as orientações destacadas. Agradecemos a compreensão. Atenciosamente, Márcia Correa Bueno Degasperi Biblioteca Campus Rio Claro Repositório Institucional UNESP https://repositorio.unesp.br on 2021-08-23T19:00:22Z (GMT) Submitted by Lilian Teresa Gobbi (lilian.gobbi@unesp.br) on 2021-08-23T20:10:19Z No. of bitstreams: 1 Manuscript_accepted.pdf: 2005538 bytes, checksum: a08c00a8a6e0666817369b6853a61115 (MD5) Approved for entry into archive by Marcia Correa Bueno Degasperi null (mcbueno@rc.unesp.br) on 2021-08-24T13:44:55Z (GMT) No. of bitstreams: 1 moraca_gag_postprint_rcla_center.pdf: 2005538 bytes, checksum: a08c00a8a6e0666817369b6853a61115 (MD5) Made available in DSpace on 2021-08-24T13:44:55Z (GMT). No. of bitstreams: 1 moraca_gag_postprint_rcla_center.pdf: 2005538 bytes, checksum: a08c00a8a6e0666817369b6853a61115 (MD5) Previous issue date: 2022-04-27 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Falls are associated with impairment in postural control in people with Parkinson's disease (PwPD). We aimed to predict the fall risk through models combining postural responses with clinical and cognitive measures. Also, we compared the center of pressure (CoP) between PwPD fallers and non-fallers after unpredictable external perturbations. We expected that CoP parameters combined with clinical and cognitive measures would predict fall risk. Seventy-five individuals participated in the study. CoP parameters were measured during postural responses through five trials with unpredictable translations of the support-surface in posterior direction. Range and peak of CoP were analyzed in two periods: early and late responses. Time to peak (negative peak) and recovery time were analyzed regardless of the periods. Models included the CoP parameters in early (model 1), late responses (model 2), and temporal parameters (model 3). Clinical and cognitive measures were entered into all models. Twenty-nine participants fell at least once, and 46 PwPD did not fall during 12 months following the postural assessment. Range of CoP in late responses was associated with fall risk (p = .046). However, although statistically non-significant, this parameter indicated low accuracy in predicting fall risk (area under the curve = 0.58). Fallers presented a higher range of CoP in early responses than non-fallers (p = .033). In conclusion, although an association was observed between fall risk and range of CoP in late responses, this parameter indicated low accuracy in predicting fall risk in PwPD. Also, fallers demonstrate worse postural control during early responses after external perturbations than non-fallers, measured by CoP parameters. Postprint Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Department of Neurology, Oregon Health & Science University, Portland, OR, USA FAPESP: 16/00503-0. FAPESP: 19/01203-9. CNPq: 429549/2018-0. CNPq: 309045/2017-7. CAPES: 001

Submitted by Lilian Teresa Gobbi (lilian.gobbi@unesp.br) on 2021-01-21T17:11:25Z No. of bitstreams: 1 beretta_vs_postprint_rcla_effect.pdf: 7014041 bytes, checksum: 8735a4ef9586943afabc9ccc76cd5ccb (MD5) Approved for entry into archive by Ana Paula Santulo Custódio de Medeiros null (asantulo@rc.unesp.br) on 2021-04-08T20:36:14Z (GMT) No. of bitstreams: 1 beretta_vs_postprint_rcla_effect.pdf: 7189173 bytes, checksum: 78e2dc7fbcf9b63779e41b77973a09c8 (MD5) Made available in DSpace on 2021-04-08T20:36:14Z (GMT). No. of bitstreams: 1 beretta_vs_postprint_rcla_effect.pdf: 7189173 bytes, checksum: 78e2dc7fbcf9b63779e41b77973a09c8 (MD5) Previous issue date: 2020-11 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background. Habituation of postural response to perturbations is impaired in people with Parkinson’s disease (PD) due to deficits in cortico-basal pathways. Although transcranial direct current stimulation (tDCS) modulate cortico-basal networks, it remains unclear if it can benefit postural control in PD. Objective. To analyze the effect of different intensities of anodal tDCS on postural responses and prefrontal cortex (PFC) activity during the habituation to the external perturbation in patients with PD (n = 24). Methods. Anodal tDCS was applied over the primary motor cortex (M1) with 1 mA, 2 mA, and sham stimulation in 3 different sessions (~2 weeks apart) during 20 minutes immediately before the postural assessment. External perturbation (7 trials) was applied by a support base posterior translation (20 cm/s and 5 cm). Primary outcome measures included lower limb electromyography and center of pressure parameters. Measures of PFC activity are reported as exploratory outcomes. Analyses of variance (Stimulation Condition × Trial) were performed. Results. Habituation of perturbation was evidenced independent of the stimulation conditions. Both active stimulation intensities had shorter recovery time and a trend for lower cortical activity in the stimulated hemisphere when compared to sham condition. Shorter onset latency of the medial gastrocnemius as well as lower cortical activity in the nonstimulated hemisphere were only observed after 2 mA concerning the sham condition. Conclusions. tDCS over M1 improved the postural response to external perturbation in PD, with better response observed for 2 mA compared with 1 mA. However, tDCS seems to be inefficient in modifying the habituation of perturbation. Postprint São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil Oregon Health & Science University, Portland, OR, USA FAPESP: 2018/07385-9 FAPESP: 2016/21499-1 FAPESP: 2014/22308-0 CNPq: 142057/2017-7 CNPq: 309045/2017-7 CAPES: 001

Made available in DSpace on 2020-12-10T20:01:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-07-01 Royal Academy of Engineering (RAoE) Currently, there are major EU-based projects to better utilise wearables as useful diagnostic aids/tools in clinical settings as well for deployment in the home to capture ageing processes. To date, there has been little investigation of the translation of those tools beyond the geographical regions in which they were developed and implemented. Our objective was to examine pragmatic issues and challenges in the use of wearables in a diverse, low-resource, middle-income country like Brazil. We found barriers to their understanding and adoption converge on three themes: (i) regional inequalities; (ii) knowledge and resources; and (iii) trust. Current large-scale projects should consider the scalability and implementation of their methods, given those themes, facilitating a stratified and global approach to healthy ageing. Northumbria Univ, Dept Comp & Informat Sci, Newcastle Upon Tyne NE1 8ST, Tyne & Wear, England UCL, Med Phys & Biomed Engn Dept, London, England Univ Birmingham, Inst Translat Med ITM, Birmingham, W Midlands, England Univ Fed Bahia, Dept Comp Sci, AtyImoLab, Salvador, BA, Brazil Univ Fed Minas Gerais, Fac Econ, Dept Business Adm, Belo Horizonte, MG, Brazil Sao Paulo State Univ, Dept Phys Educ, Rio Claro, Brazil Oregon Hlth & Sci Univ, Dept Neurol, Portland, OR 97201 USA Sao Paulo State Univ, Dept Phys Educ, Rio Claro, Brazil Royal Academy of Engineering (RAoE): FoESF1819T621

Introduction Transcranial direct current stimulation (tDCS) improves postural response to perturbation in patients with Parkinson's disease (PwPD). However, the influence of baseline characteristics such as clinical/cognitive and postural performance on the response to tDCS remains unclear. Objective To investigate whether baseline level of postural control (performance during sham condition) and clinical/cognitive characteristics are associated with tDCS-related changes in postural responses to external perturbations in PwPD. Methods Twenty-four PwPD participated in this study. Clinical assessment included disease severity, disease duration, levodopa equivalent dose and global cognition. Anodal tDCS protocols targeting the primary motor cortex were applied in two separate sessions (at least 2 weeks apart): active (2 mA for 20 min) and sham stimulation. Seven trials with the backward translation of the support base (20 cm/s and 5 cm) were performed after tDCS. Postural outcomes included the recovery time to stable position and onset latency of the medial gastrocnemius (MG). Pearson and Spearman correlation tests were performed. Results No significant correlations were observed between clinical/cognitive characteristics and tDCS-related changes in postural responses. Negative associations were observed between the baseline level of postural control and tDCS-related changes in postural responses for the recovery time (r = −0.657; p < 0.001) and the MG onset latency (rs = −0.539; p = 0.007). PwPD with worse baseline postural control demonstrated greater improvement after active stimulation. Conclusions Findings suggest that tDCS-related effects on postural response to perturbation are related to the baseline level of postural control, but not to clinical characteristics in PwPD. Those with worse baseline postural control responded better to tDCS.

Various cueing strategies (internal and external) have been used to alleviate gait deficits in Parkinson’s disease (PD). However, it remains unclear which type of cueing strategy is most effective at different disease stages or with more severe walking impairment, such as freezing of gait (FOG). The underlying neural mechanisms of response to cueing are also unknown. This trial aims to: (i) determine brain activity response to cue stimulus (internal, visual, auditory or tactile) when walking in PD and; (ii) examine changes in brain activity to cues at different stages of PD. This ongoing single-site study uses an exploratory observational design, with laboratory application of cues for gait deficit. A total of 80 people with PD who meet the inclusion criteria will be enrolled. Participants are split into groups dependent on their disease stage (classified with the Hoehn and Yahr (H&Y) scale); n = 20 H&YI; n = 30 H&YII; n = 30 H&YIII. Within the H&Y stage II and III groups, we will also ensure recruitment of a sub-group of 15 individuals with FOG within each group. Participants perform walking tasks under several conditions: baseline walking without cues; randomized cued walking conditions [internal and external (visual, auditory and tactile) cues]. A combined functional near-infrared spectroscopy and electroencephalography system quantifies cortical brain activity while walking. Inertial sensors are used to assess gait. Primary outcome measures are cue-related changes in cortical brain activity while walking, including the relative change in cortical HbO2 and the power spectral densities at alpha (8-13Hz), beta (13-30Hz), delta (0.5-4Hz), theta (4-8Hz) and gamma (30-40Hz) frequency bandwidths. Secondary outcome measures are cue-related changes in spatiotemporal gait characteristics. Findings will enhance our understanding about the cortical responses to different cueing strategies and how they are influenced by PD progression and FOG status. This trial is registered at clinicaltrials.gov (NCT04863560; April 28, 2021, https://clinicaltrials.gov/ct2/show/NCT04863560).

Made available in DSpace on 2019-10-06T17:05:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-08-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Introduction: Postural instability during walking and tripping over obstacles are the main causes of falls in people with Parkinson's disease (PD). Preliminary limited evidence suggests that the length of the prospective follow-up period affects falls prediction in PD, with shorter periods leading to more accurate prediction. Thus, the primary aim of the present study was to test the performance of center of pressure (CoP) variables during obstacle crossing to predict fall risk in people with PD during subsequent periods of four, six, and 12 months. We also compared CoP variables during obstacle crossing between fallers and non-fallers. Methods: Forty-two individuals with PD, in mild to moderate stages, completed the baseline obstacle crossing assessment and reported falls for 12 months. Participants walked at their self-selected pace and were instructed to cross an obstacle (half knee height) positioned in the middle of an 8-m long pathway. A force platform was used to analyze CoP parameters of the stance phase of the trailing limb (most affected limb). The ability of each outcome measure to predict fall risk at four, six, and 12 months was assessed using receiver operating characteristic curve analyses. Results: Ten individuals (23.8%) were considered fallers at four months, twelve individuals (28.5%) at six months, and twenty-one individuals (50%) at 12 months. CoP amplitude and CoP velocity in the mediolateral direction significantly predicted fall risk at four, six, and 12 months. As judged by the area under the curve, mediolateral CoP velocity showed the best performance at four months, while mediolateral CoP amplitude showed the best performance at six months. Fallers presented greater values of mediolateral CoP velocity and amplitude than non-fallers. Conclusion: These findings suggest that mediolateral CoP velocity and amplitude during obstacle crossing might be useful to predict fall risk in people with PD. Therefore, larger studies are encouraged. São Paulo State University (Unesp) Institute of Biosciences São Paulo State University (Unesp) Institute of Biosciences FAPESP: 2010/07040-0 FAPESP: 2014/22308-0

Made available in DSpace on 2019-10-06T16:08:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-02-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação para o Desenvolvimento da UNESP (FUNDUNESP) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Postural control asymmetry is an important aspect of Parkinson's disease (PD) that may be associated with falls. The aim of this study was to compare the postural control asymmetry during postural tasks between fallers and non-fallers in people with PD and neurological healthy age-matched controls (CG). Individuals with idiopathic PD (n = 24) and CG (n = 24) were sub-divided into groups of fallers and non-fallers based on their fall history over the past year. Participants performed blocks of three 30-s trials of quiet standing with feet in a side-by-side and semi-tandem stance position. The center of pressure parameters for each limb were measured and used to calculate the symmetry index. Fallers compared to non-fallers had decreased asymmetry of vertical force in the side-by-side condition. During the tandem-front leg condition, PD non-fallers increased asymmetry of the medial-lateral velocity of sway compared to CG non-fallers. In addition, for the tandem–back leg condition, PD non-fallers increased asymmetry of total displacement and medial-lateral root mean square and mean velocity of sway compared to PD fallers. The results of the study did not support the hypothesis that PD fallers are more asymmetric than PD non-fallers. On the contrary, our results indicated that PD non-fallers had higher postural control asymmetry, especially during the more challenging (semi-tandem standing) postural task. São Paulo State University (UNESP) – Campus Bauru Graduate Program in Movement Science Human Movement Research Laboratory (MOVI-LAB) Department of Physical Education University of British Columbia School of Kinesiology São Paulo State University (UNESP) – Campus Rio Claro Graduate Program in Movement Science Posture and Gait Studies Laboratory (LEPLO) Department of Physical Education São Paulo State University (UNESP) – Campus Bauru Graduate Program in Movement Science Human Movement Research Laboratory (MOVI-LAB) Department of Physical Education São Paulo State University (UNESP) – Campus Rio Claro Graduate Program in Movement Science Posture and Gait Studies Laboratory (LEPLO) Department of Physical Education FUNDUNESP: 0716/011 FAPESP: 2012/24040-9 FAPESP: 2013/00925-4

Made available in DSpace on 2021-06-25T11:17:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Background: Since people with Parkinson disease (PD) rely on limited prefrontal executive resources for the control of gait, interventions targeting the prefrontal cortex (PFC) may help in managing PD-related gait impairments. Transcranial direct current stimulation (tDCS) can be used to modulate PFC excitability and improve prefrontal cognitive functions and gait. Objective: We investigated the effects of adding anodal tDCS applied over the PFC to a session of aerobic exercise on gait, cognition, and PFC activity while walking in people with PD. Methods: A total of 20 people with PD participated in this randomized, double-blinded, sham-controlled crossover study. Participants attended two 30-minute sessions of aerobic exercise (cycling at moderate intensity) combined with different tDCS conditions (active- or sham-tDCS), 1 week apart. The order of sessions was counterbalanced across the sample. Anodal tDCS (2 mA for 20 minutes [active-tDCS] or 10 s [sham-tDCS]) targeted the PFC in the most affected hemisphere. Spatiotemporal gait parameters, cognitive functions, and PFC activity while walking were assessed before and immediately after each session. Results: Compared with the pre-assessment, participants decreased step time variability (effect size: −0.4), shortened simple and choice reaction times (effect sizes: −0.73 and −0.57, respectively), and increased PFC activity in the stimulated hemisphere while walking (effect size: 0.54) only after aerobic exercise + active-tDCS. Conclusion: The addition of anodal tDCS over the PFC to a session of aerobic exercise led to immediate positive effects on gait variability, processing speed, and executive control of walking in people with PD. São Paulo State University (UNESP) Institute of Biosciences Graduate Program in Movement Sciences Oregon Health and Science University Department of Neurology Federal University of ABC (UFABC) Center for Mathematics Computation and Cognition São Paulo State University (UNESP) Institute of Biosciences Graduate Program in Movement Sciences

Background Dopaminergic medication improves gait in people with Parkinson disease (PD). However, it remains unclear if dopaminergic medication modulates cortical activity while walking. Objective We investigated the effects of dopaminergic medication on cortical activity during unobstructed walking and obstacle avoidance in people with PD. Methods A total of 23 individuals with PD, in both off (PDOFF) and on (PDON) medication states, and 30 healthy older adults (control group [CG]) performed unobstructed walking and obstacle avoidance conditions. Cortical activity was acquired through a combined functional near-infrared spectroscopy electroencephalography (EEG) system, along with gait parameters, through an electronic carpet. Prefrontal cortex (PFC) oxygenated hemoglobin (HbO2) and EEG absolute power from FCz, Cz, and CPz channels were calculated. Results HbO2 concentration reduced for people with PDOFF during obstacle avoidance compared with unobstructed walking. In contrast, both people with PDON and the CG had increased HbO2 concentration when avoiding obstacles compared with unobstructed walking. Dopaminergic medication increased step length, step velocity, and β and γ power in the CPz channel, regardless of walking condition. Moreover, dopaminergic-related changes (ie, on-off) in FCz/CPz γ power were associated with dopaminergic-related changes in step length for both walking conditions. Conclusions PD compromises the activation of the PFC during obstacle avoidance, and dopaminergic medication facilitates its recruitment. In addition, PD medication increases sensorimotor integration during walking by increasing posterior parietal cortex (CPz) activity. Increased γ power in the CPz and FCz channels is correlated with step length improvements achieved with dopaminergic medication during unobstructed walking and obstacle avoidance in PD.

Made available in DSpace on 2021-06-25T11:14:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-04-01 Parkinson's disease (PD) is often classified into tremor dominant (TD) and postural instability gait disorder (PIGD) subtypes. Degeneration of subcortical/cortical pathways is different betweenPD subtypes, which leads to differences in motor behavior. However, the influence of PD subtype on cortical activity during walking remains poorly understood. Therefore, we aimed to investigate the influence of PD motor subtypes on cortical activity during unobstructed walking and obstacle avoidance. Seventeen PIGD and 19 TD patients performed unobstructed walking and obstacle avoidance conditions. Brain activity was measured using a mobile functional near-infrared spectroscopy-electroencephalography (EEG) systems, and gait parameters were analyzed using an electronic carpet. Concentrations of oxygenated hemoglobin (HbO2) of the prefrontal cortex (PFC) and EEG absolute power from alpha, beta, and gamma bands in FCz, Cz, CPz, and Oz channels were calculated. These EEG channels correspond to supplementary motor area, primary motor cortex, posterior parietal cortex, and visual cortex, respectively. Postural instability gait disorder patients presented higher PFC activity than TD patients, regardless of the walking condition. Tremor dominant patients presented reduced beta power in the Cz channel during obstacle avoidance compared to unobstructed walking. Both TDand PIGD patients decreased alpha and beta power in the FCz and CPz channels. In conclusion, PIGD patients need to recruit additional cognitive resources from the PFC for walking. Both TD and PIGD patients presented changes in the activation of brain areas related to motor/sensorimotor areas in order to maintain balance control during obstacle avoidance, being that TD patients presented further changes in the motor area (Cz channel) to avoid obstacles. São Paulo State University (UNESP) Institute of Biosciences Posture and Gait Studies Laboratory (LEPLO), Avenida 24-A, 1515 Department of Neurology Oregon Health and Science University Department of Materials and Production Aalborg University São Paulo State University (UNESP) Institute of Biosciences Posture and Gait Studies Laboratory (LEPLO), Avenida 24-A, 1515

Introduction Cholinergic dysfunction contributes to mobility deficits in Parkinson's disease (PD). People with PD rely on limited prefrontal executive-attentional resources for the control of locomotion, including turning. Cortical and behavioral responses to cholinergic augmentation during turning remains unclear. We examined prefrontal cortex (PFC) activity while turning-in-place and spatiotemporal measures of turns in response to usual dopaminergic medication and adjunct cholinergic augmentation. Methods This study consisted of a single-site, randomized, double-blind crossover trial. Twenty PD participants were assessed in the levodopa-off state and then randomized to either levodopa + donepezil (5 mg) or levodopa + placebo treatments for two weeks followed by a 2-week washout before crossover. The primary outcome was change from off state in PFC activity while turning-in-place (assessed with functional near-infrared spectroscopy). Secondary outcomes were changes in spatiotemporal turning measures (assessed with body-worn inertial measurement units) and accuracy in the secondary task. Results Nineteen participants completed the trial. While levodopa + placebo had no effect on PFC activity when turning-in-place with a dual-task, levodopa + donepezil led to a large reduction in PFC activity (effect size, −0.82). Spatiotemporal measures of turning improved with both treatments, with slightly greater effect sizes observed for levodopa + donepezil. Additionally, the accuracy in the concurrent cognitive task improved only with levodopa + donepezil (effect size, 0.63). Conclusion The addition of cholinergic therapy with donepezil (5 mg/day for 2 weeks) to standard dopaminergic therapy reduced the burden on prefrontal executive-attentional resources while turning with a dual-task and improved secondary task accuracy and turning.

BACKGROUND: Functional near-infrared spectroscopy (fNIRS) is increasingly used in the field of posture and gait to investigate patterns of cortical brain activation while people move freely. fNIRS methods, analysis and reporting of data vary greatly across studies which in turn can limit the replication of research, interpretation of findings and comparison across works.\ud \ud RESEARCH QUESTION AND METHODS: Considering these issues, we propose a set of practical recommendations for the conduct and reporting of fNIRS studies in posture and gait, acknowledging specific challenges related to clinical groups with posture and gait disorders.\ud \ud RESULTS: Our paper is organized around three main sections: 1) hardware set up and study protocols, 2) artefact removal and data processing and, 3) outcome measures, validity and reliability; it is supplemented with a detailed checklist.\ud \ud SIGNIFICANCE: This paper was written by a core group of members of the International Society for Posture and Gait Research and posture and gait researchers, all experienced in fNIRS research, with the intent of assisting the research community to lead innovative and impactful fNIRS studies in the field of posture and gait, whilst ensuring standardization of research.

Background Declines in gait parameters are common with aging and more pronounced in tasks with increased executive demand. However, the neural correlates of age-related gait impairments are not fully understood yet. Objectives To investigate ( a) the effects of aging on prefrontal cortex (PFC) activity and gait parameters during usual walking, obstacle crossing and dual-task walking and ( b) the association between PFC activity and measures of gait and executive function. Methods Eighty-eight healthy individuals were distributed into 6 age-groups: 20-25 (G20), 30-35 (G30), 40-45 (G40), 50-55 (G50), 60-65 (G60), and 70-75 years (G70). Participants walked overground under 3 conditions: usual walking, obstacle crossing, and dual-task walking. Changes in oxygenated and deoxygenated hemoglobin in the PFC were recorded using functional near-infrared spectroscopy. Gait spatiotemporal parameters were assessed using an electronic walkway. Executive function was assessed through validated tests. Results Between-group differences on PFC activity were observed for all conditions. Multiple groups (ie, G30, G50, G60, and G70) showed increased PFC activity in at least one of the walking conditions. Young adults (G20 and G30) had the lowest levels of PFC activity while G60 had the highest levels. Only G70 showed reduced executive function and gait impairments (which were more pronounced during obstacle crossing and dual-task walking). PFC activity was related to gait and executive function. Conclusions Aging causes a gradual increase in PFC activity during walking. This compensatory mechanism may reach the resource ceiling in the 70s, when reduced executive function limits its efficiency and gait impairments are observed.

Made available in DSpace on 2020-12-12T02:42:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-07-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Background. Although dopaminergic medication improves dual task walking in people with Parkinson disease (PD), the underlying neural mechanisms are not yet fully understood. As prefrontal cognitive resources are involved in dual task walking, evaluation of the prefrontal cortex (PFC) is required. Objective. To investigate the effect of dopaminergic medication on PFC activity and gait parameters during dual task walking in people with PD. Methods. A total of 20 individuals with PD (69.8 ± 5.9 years) and 30 healthy older people (68.0 ± 5.6 years) performed 2 walking conditions: single and dual task (walking while performing a digit vigilance task). A mobile functional near infrared spectroscopy system and an electronic sensor carpet were used to analyze PFC activation and gait parameters, respectively. Relative concentrations of oxygenated hemoglobin (HbO2) from the left and right PFC were measured. Results. People with PD in the off state did not present changes in HbO2 level in the left PFC across walking conditions. In contrast, in the on state, they presented increased HbO2 levels during dual task compared with single task. Regardless of medication state, people with PD presented increased HbO2 levels in the right PFC during dual task walking compared with single task. The control group demonstrated increased PFC activity in both hemispheres during dual task compared with single task. People with PD showed increases in both step length and velocity in the on state compared with the off state. Conclusions. PD limits the activation of the left PFC during dual task walking, and dopaminergic medication facilitates its recruitment. Institute of Biosciences Posture and Gait Studies Laboratory (LEPLO) São Paulo State University (UNESP) Graduate Program in Movement Sciences São Paulo State University (UNESP) Institute of Biosciences Posture and Gait Studies Laboratory (LEPLO) São Paulo State University (UNESP) Graduate Program in Movement Sciences São Paulo State University (UNESP) FAPESP: 2014/22308-0 FAPESP: 2016/21499-1 CNPq: 429549/2018-0 CAPES: Finance Code 001

Technology is advancing at an extraordinary rate. Continuous flows of novel data are being generated with the potential to revolutionize how we better identify, treat, manage, and prevent disease across therapeutic areas. However, lack of security of confidence in digital health technologies is hampering adoption, particularly for biometric monitoring technologies (BioMeTs) where frontline healthcare professionals are struggling to determine which BioMeTs are fit-for-purpose and in which context. Here, we discuss the challenges to adoption and offer pragmatic guidance regarding BioMeTs, cumulating in a proposed framework to advance their development and deployment in healthcare, health research, and health promotion. Furthermore, the framework proposes a process to establish an audit trail of BioMeTs (hardware and algorithms), to instill trust amongst multidisciplinary users., Proposal of a digital standardized BioMeT and algorithm evaluation framework (based on a software reference architecture approach) to overcome challenges in the field.

Made available in DSpace on 2020-12-12T02:35:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-12-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Gait asymmetry during unobstructed walking in people with Parkinson’s disease (PD) has been well documented. However, under complex situations, such as environments with double obstacles, gait asymmetry remains poorly understood in PD. Therefore, the aim of this study was to analyze inter-limb asymmetry while crossing a single obstacle and double obstacles (with different distances between them) in people with PD and healthy older adults. Nineteen people with PD and 19 healthy older people performed three conditions: (i) walking with one obstacle (Single); (ii) walking with two obstacles with a 50 cm distance between them (Double-50); (iii) walking with two obstacles with a 108 cm distance between them (Double-108). The participants performed the obstacle crossing with both lower limbs. Asymmetry Index was calculated. We found that people with PD presented higher leading and trailing toe clearance asymmetry than healthy older people. In addition, participants increased asymmetry in the Double-50 compared to Single condition. It can be concluded that people with PD show higher asymmetry during obstacle crossing compared to healthy older people, independently of the number of obstacles. In addition, a challenging environment induces asymmetry during obstacle crossing in both people with PD and healthy older people. São Paulo State University (UNESP) Institute of Biosciences Posture and Gait Studies Laboratory (LEPLO) Graduate Program in Movement Sciences São Paulo State University (UNESP) São Paulo State University (UNESP) Faculty of Science Human Movement Research Laboratory (MOVI-LAB) University of Groningen University Medical Center Groningen Center for Human Movement Sciences São Paulo State University (UNESP) Institute of Biosciences Posture and Gait Studies Laboratory (LEPLO) Graduate Program in Movement Sciences São Paulo State University (UNESP) São Paulo State University (UNESP) Faculty of Science Human Movement Research Laboratory (MOVI-LAB) FAPESP: 2013/27032-0 CNPq: 309045/2017-7

Made available in DSpace on 2019-10-06T15:19:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-11-20 People with Parkinson's disease (PD) have decreased arm swing movements during walking, which can be related to PD motor signs and symptoms. In this context, the aim of this study was to determine the effects of an increased arm swing frequency or amplitude on the gait parameters in people with PD and healthy older adults. Seventeen individuals with PD and 19 older people were invited to walk on a 10 m pathway under three experimental conditions: (i) usual walking (no arm swing instructions); (ii) an increased arm swing amplitude; and (iii) an increased arm swing frequency. Both groups had an increased stride speed, vertical center of mass and arm swing accelerations and decreased double support time under the increased arm swing amplitude and frequency conditions. People with PD were able to modulate the gait parameters according to the experimental conditions, but at a smaller magnitude than the older individuals. These results indicate that bradykinesia and hypometria of gait can be positively overcome by increasing the amplitude and frequency of arm swing. Arm movements should be included in gait rehabilitation protocols for PD. São Paulo State University (UNESP) Institute of Biosciences Posture and Gait Studies Laboratory (LEPLO) University of Groningen University Medical Center Groningen Center for Human Movement Sciences São Paulo State University (UNESP) Institute of Biosciences Posture and Gait Studies Laboratory (LEPLO)

This study aimed to determine the relationship between postural asymmetry and falls in Parkinson's disease (PD). In total, 28 patients with PD were included. Postural control was analyzed in bipedal, tandem, and unipedal standing. Center of pressure (CoP) parameters were calculated for both limbs, and asymmetry was assessed using the asymmetry index. Logistic regression was used to predict/classify fallers through postural asymmetry. The Spearman correlation was performed to relate asymmetry and falls number. Poisson regression models were created to predict the number of falls in each condition. The results demonstrated that asymmetry can classify 75% of fallers and nonfallers. Asymmetry in anteroposterior-mean velocity of CoP in unipedal standing was related to the number of falls. Poisson regression showed that anteroposterior-mean velocity of CoP predicts falls in PD, indicating that increased asymmetry results in a greater number of falls. Anteroposterior-mean velocity of CoP seems to be a sensitive parameter to detect falls in PD, mainly during a postural challenging task.

UNSTRUCTURED Technology is advancing at extraordinary rates with novel data being generated which could potentially revolutionary different therapeutic areas of medicine. However, adoption is medicine is hampered by a lack of trust, particularly for biometric monitoring technologies (BioMeTs) where a key question facing frontline healthcare professionals is are BioMeTs fit for purpose? Here, we discuss pragmatic barriers and guidance regarding BioMeTs, cumulating in a proposed guidance framework to better inform their development and deployment in digital medicine. Furthermore, the framework proposes a process to establish an audit trail of BioMeTs (hardware and algorithms), to instil trust amongst multidisciplinary users.

An emerging body of literature has examined cortical activity during walking and balance tasks in older adults and in people with Parkinson’s disease, specifically using functional near infrared spectroscopy (fNIRS) or electroencephalography (EEG). This review provides an overview of this developing area, and examines the disease-specific mechanisms underlying walking or balance deficits. Medline, PubMed, PsychInfo and Scopus databases were searched. Articles that described cortical activity during walking and balance tasks in older adults and in those with PD were screened by the reviewers. Thirty-seven full-text articles were included for review, following an initial yield of 566 studies. This review summarizes study findings, where increased cortical activity appears to be required for older adults and further for participants with PD to perform walking and balance tasks, but specific activation patterns vary with the demands of the particular task. Studies attributed cortical activation to compensatory mechanisms for underlying age- or PD-related deficits in automatic movement control. However, a lack of standardization within the reviewed studies was evident from the wide range of study protocols, instruments, regions of interest, outcomes and interpretation of outcomes that were reported. Unstandardized data collection, processing and reporting limited the clinical relevance and interpretation of study findings. Future work to standardize approaches to the measurement of cortical activity during walking and balance tasks in older adults and people with PD with fNIRS and EEG systems is needed, which will allow direct comparison of results and ensure robust data collection/reporting. Based on the reviewed articles we provide clinical and future research recommendations.

Background Pharmacologic therapy is the primary treatment used to manage Parkinson’s disease (PD) symptoms. However, it becomes less effective with time and some symptoms do not respond to medication. Complementary interventions are therefore required for PD. Recent studies have implemented transcranial direct current stimulation (tDCS) in combination with other modalities of interventions, such as physical and cognitive training. Although the combination of tDCS with physical and cognitive training seems promising, the existing studies present mixed results. Therefore, a systematic review of the literature is necessary. Aims This systematic review aims to (i) assess the clinical effects of tDCS when applied in combination with physical or cognitive therapies in people with PD and; (ii) analyze how specific details of the intervention protocols may relate to findings. Methods The search strategy detailed the technique of stimulation, population and combined interventions (i.e. cognitive and/or physical training). Only controlled studies were included. Results Seventeen of an initial yield of 408 studies satisfied the criteria. Studies involved small sample sizes. tDCS protocols and characteristics of combined interventions varied. The reviewed studies suggest that synergistic effects may be obtained for cognition, upper limb function, gait/mobility and posture when tDCS is combined with cognitive and/or motor interventions in PD. Conclusion The reported results encourage further research to better understand the therapeutic utility of tDCS and to inform optimal clinical use in PD. Future studies in this field should focus on determining optimal stimulation parameters and intervention characteristics for maximal benefits in people with PD.

Made available in DSpace on 2019-10-06T16:59:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-04-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Different clinical subtypes of Parkinson's disease (PD) have long been recognized. Recent studies have focused on two PD subtypes: Postural Instability and Gait Difficulty (PIGD) and Tremor Dominant (TD). PIGD patients have greater difficulties in postural control in relation to TD. However, knowledge about the differences in reactive adjustment mechanisms following a perturbation in TD and PIGD is limited. This study aimed to compare reactive postural adjustments under unexpected external perturbation in TD, PIGD, and control group (CG) subjects. Forty-five individuals (15 TD, 15 PIGD, and 15 CG) participated in this study. Postural perturbation was applied by the posterior displacement of the support surface in an unexpected condition. The velocity (15 cm/s) and displacement (5 cm/s) of perturbation were the same for all participants. Center of pressure (CoP) and center of mass (CoM) were analyzed for two reactive windows after the perturbation (0–200 ms and 200–700 ms). The Bonferroni post hoc test indicated a higher range of CoP in the PIGD when compared to the CG (p = 0.021). The PIGD demonstrated greater time to recover the stable posture compared to the TD (p = 0.017) and CG (p = 0.003). Furthermore, the TD showed higher AP-acceleration peak of CoM when compared to the PIGD (p = 0.048) and CG (p = 0.013), and greater AP-acceleration range of CoM in relation to the CG (p = 0.022). These findings suggest that PD patients present worse reactive postural control after perturbation compared to healthy older individuals. CoP and CoM parameters are sensitive to understand and detect the differences in reactive postural mechanisms in PD subtypes. São Paulo State University (Unesp) Institute of Biosciences Posture and Gait Studies Laboratory (LEPLO) Post-Graduation Program in Movement Sciences São Paulo State University - UNESP São Paulo State University (Unesp) Institute of Biosciences Posture and Gait Studies Laboratory (LEPLO) Post-Graduation Program in Movement Sciences São Paulo State University - UNESP FAPESP: 2016/00503-0

Aim The aim of the present study was to analyze the association of depressive and anxiety symptoms with usual walking and obstacle avoidance in patients with Parkinson's disease. Methods Patients were divided into three groups: without depressive and anxiety symptoms (n = 28); depressive symptoms only (n = 15); and depressive and anxiety symptoms (n = 19). Symptoms of depression and anxiety were evaluated by the Hospital Anxiety and Depression scale. Participants walked across a pathway in two experimental conditions: usual walking and obstacle avoidance. Kinematic data were recorded using an optoelectronic three-dimensional system. Results During usual walking, the depressive and anxiety symptoms group presented shorter stride length and longer double support phase compared with the without depressive and anxiety symptoms group, and lower velocity than the without depressive and anxiety symptoms and depressive symptoms groups. During the approach phase of obstacle avoidance, the depressive and anxiety symptoms group decreased the stride length and velocity, whereas the without depressive and anxiety symptoms and depressive symptoms groups did not modulate these parameters. The depressive and anxiety symptoms group also showed shorter step length and velocity, longer step duration, and wider step width during obstacle crossing. Additionally, the depressive and anxiety symptoms group presented shorter foot-to-obstacle horizontal distances, and lower horizontal mean velocities during obstacle crossing. Partial correlation analyses showed that both depressive and anxiety symptoms were associated with spatiotemporal gait parameters. Conclusion Combined symptoms of depression and anxiety are associated with walking impairments in patients with Parkinson's disease in both usual walking and obstacle avoidance. Geriatr Gerontol Int 2019; 19: 868-873.

Made available in DSpace on 2019-10-06T15:30:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-02-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) This study investigated the effects of Parkinson’s Disease (PD) on the perceptive judgment of stair step height using both exteroceptive visual and exproprioceptive judgments. We invited 14 individuals with PD and 14 neurologically healthy older adults (OA) to perform perceptual judgment tasks for first step stairway heights of 11 and 20 cm. Initially, participants performed first the exteroceptive visual judgment and then the exproprioceptive judgment in five randomized trials for each stair height. An analysis of variance for the exteroceptive visual judgment revealed no main effects or interaction between PD versus OA groups and height. However, the analysis of variance for exproprioceptive judgment revealed a significant interaction between group and height (F 1,26 = 9.519; p =.005; Pη 2 =.268) such that both groups made more errors in exproprioceptive judgment at a height of 11 cm. The OA group made more errors in exproprioceptive judgment for the 20-cm step when compared with the PD group (p =.016) but the PD group underestimated the step height. We conclude that PD influences exproprioceptive perception of step height and that steps with smaller (vs. larger) heights induce greater exproprioceptive error. Posture and Gait Studies Laboratory Institute of Biosciences São Paulo State University (UNESP) Postgraduate Program in Movement Sciences Sao Paulo State University – UNESP UNIFAFIBE–Centro Universitário Posture and Gait Studies Laboratory Institute of Biosciences São Paulo State University (UNESP) Postgraduate Program in Movement Sciences Sao Paulo State University – UNESP FAPESP: 2015/00612-1

Made available in DSpace on 2019-10-06T15:25:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-01-01 Biotechnology Research Center, Tabriz University of Medical Sciences Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) National Institute on Disability and Rehabilitation Research Performance of several tasks simultaneously (dual-tasks) is common in everyday walking. Studies indicate that dual-task walking performance declines with age together with cognitive function, but neural mechanisms underpinning deficits remain unclear. Recent developments in mobile imaging techniques, such as functional near infrared spectroscopy (fNIRS), allow real-time monitoring of cortical activity during walking. This study aimed to: 1) examine activity in motor and cognitive cortical regions when walking with a dual-task in young and older adults; and 2) determine the effect of cognition on dual-task cortical activity changes. Seventeen young (20.3 ± 1.2 years) and eighteen older adults (72.6 ± 8.0 years) performed dual-task conditions, lasting 5 min, with alternating 30-second experimental blocks. The primary outcome was cortical activity, assessed by measuring changes in oxygenated haemoglobin (HbO2) concentrations. Cortical regions of interest (ROI) included motor regions (premotor cortex (PMC), supplementary motor area (SMA), primary motor cortex (M1)), and cognitive regions (prefrontal cortex (PFC)). Cognitive domains were assessed using standard tests and accelerometers were used to extract gait features. Cortical activity increased with a dual-task in PMC, SMA and M1 but not in PFC regions across groups, with response most evident with initial task exposure. Older adults did not increase SMA activity with a dual-task to the same level as young adults. Dual-task cortical response was consistently associated with greater executive function across groups. In conclusion, both young and older adults responded in a similar manner to dual-task conditions. Dual-task walking activated multiple motor regions in both groups, but no significant change occurred for cognitive region activation. Cortical activation with a dual-task related to executive function. Department of Neurology Oregon Health and Science University Institute of Neuroscience Newcastle University Newcastle upon Tyne Hospitals NHS Foundation Trust Instituto de Biociências Universidade Estadual Paulista (UNESP), Campus Rio Claro Institute of Ageing Clinical Ageing Research Unit Campus for Ageing and Vitality Newcastle University Instituto de Biociências Universidade Estadual Paulista (UNESP), Campus Rio Claro

Made available in DSpace on 2019-10-06T15:24:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-11-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) National Institute for Health Research Background. Aging is associated with declining mobility, which negatively affects quality of life and incurs substantial economic costs. Techniques to maintain safe mobility in older adults are therefore essential. Rhythmic auditory cueing (RAC) can improve walking patterns in older adults. However, the neural correlates associated with RAC, how they are influenced by repeated exposure and their relationships with gait response, cognitive function, and depressive symptoms are unclear. Objectives. This study aimed to investigate the effects of RAC during walking on cortical activation and the relationship between RAC-related cortical changes and cognitive function, depressive symptoms, and gait response. Methods. Seventeen young adults and eighteen older adults walked on a motorized treadmill for 5 minutes (5 trials with alternating 30-second blocks of usual walking and RAC walking). Changes in oxygenated hemoglobin (HbO 2 ) in the frontal cortex were recorded using functional near-infrared spectroscopy. Cognitive domains were assessed through validated tests. A triaxial accelerometer measured gait parameters. Results. Gait variability decreased and prefrontal HbO 2 levels increased during cued walking relative to usual walking. Older adults showed greater HbO 2 levels in multiple motor regions during cued walking although the response reduced with repeated exposure. In older adults, lower depression scores, higher cognitive functioning, and reduced gait variability were linked with increased HbO 2 levels during RAC walking. Conclusion. These findings suggest that walking improves with RAC in older adults and is achieved through increased activity in multiple cortical areas. The cortical response decline with repeated exposure indicates older adults’ ability to adapt to a new task. Institute of Neuroscience Newcastle University Institute of Ageing Sao Paulo State University (UNESP) Institute of Biosciences, Campus Rio Claro The Newcastle upon Tyne NHS Foundation Trust Sao Paulo State University (UNESP) Institute of Biosciences, Campus Rio Claro FAPESP: 2016/22750-0

Made available in DSpace on 2018-11-29T15:54:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-05-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background: Objective measures of gait in Parkinson's disease (PD) patients according to motor subtypes are not yet fully understood. Although recent advances have been made for unobstructed walking, further work is required on locomotor tasks challenging postural stability, such as obstacle avoidance. Research question: This study aimed to investigate the influence of PD motor subtypes on objective measures of locomotion during unobstructed walking and obstacle avoidance. Methods: Thirty-five PD patients classified as postural instability and gait disorder (PIGD) and 30 as tremor dominant (TD), as well as 45 healthy controls (CG) walked along an 8-m pathway under two conditions: (a) unobstructed walking and (b) obstacle avoidance. Outcome measures included spatiotemporal parameters recorded by an optoelectronic tridimensional system. Results: During unobstructed walking, the PIGD group exhibited shorter stride length, slower velocity, and longer double support phase compared to the TD and CG groups. The TD group also presented slower stride velocity compared to the CG. The PIGD and TD groups presented shorter stride duration than the CG. Regarding obstacle avoidance, the PIGD group exhibited shorter distances for leading foot placement before obstacle, trailing foot placement after obstacle and trailing crossing step length compared to the TD and CG groups. The PIGD group exhibited wider leading crossing step width, lower trailing toe clearance, and slower leading and trailing velocity during obstacle avoidance compared to the CG. Significance: PIGD subtype patients showed worse modifications in objective measures of unobstructed walking and obstacle avoidance. The observed modifications may contribute to increased fall occurrence in PIGD patients. Sao Paulo State Univ, UNESP, Inst Biosci, Posture & Gait Studies Lab LEPLO, Campus Rio Claro,Ave 24-A,1515 Bela Vista, BR-13506900 Rio Claro, SP, Brazil Univ Groningen, Univ Med Ctr Groningen, Ctr Human Movement Sci, Groningen, Netherlands Sao Paulo State Univ, UNESP, Inst Biosci, Posture & Gait Studies Lab LEPLO, Campus Rio Claro,Ave 24-A,1515 Bela Vista, BR-13506900 Rio Claro, SP, Brazil FAPESP: 2010/07040-0 FAPESP: 2013/27032-0 FAPESP: 2014/22308-0

Apesar da literatura apresentar os benefícios de programas de atividade física para a pessoa com deficiência intelectual (DI), aspectos como os relacionados à prescrição de exercício físico, benefícios de cada tipo de programa de exercício físico, exercícios mais recomendados, controle de carga, limitações das intervenções para adultos com DI são assuntos em espera de investigação científica. O objetivo deste estudo foi verificar, por meio de uma revisão sistemática, quais os efeitos de programas de atividade física para adultos com DI. O procedimento incluiu uma busca eletrônica da literatura publicada de janeiro de 1960 até agosto de 2014, considerando termos relacionados à atividade física, DI e programa de atividade física. Oito manuscritos preencheram os critérios da elegibilidade e foram incluídos no estudo. Com base na revisão sistemática, foi encontrado um limitado número de estudos que investigou, de forma estruturada, o efeito de programas de atividade física para adultos com DI. De forma geral, os programas sistematizados de exercício físico promoveram benefícios consistentes e significantes para adultos com DI. Entretanto, parece não haver um consenso do tipo de intervenção a ser utilizada para promover a prática de atividade física de adultos com DI. Além disso, a qualidade metodológica dos estudos parece ser limitada. Concluímos que estudos de intervenção com atividade física em adultos com DI que envolvem exercícios aeróbios, especialização esportiva e combinação de exercício de força muscular e aeróbio realizadas duas ou três vezes por semana por mais de 40 minutos parecem ser os mais recomendados para adultos com DI.