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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(11): 1008-1015
DOI: 10.1055/s-0043-1772769
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Clinical assessment of upper limb impairments and functional capacity in Parkinson's disease: a systematic review

Avaliação clínica de comprometimentos de membros superiores e capacidade funcional na doença de Parkinson: uma revisão sistemática
Tamine T. C. Capato 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
2   Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands.
,
Rúbia Rodrigues 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
,
Rubens G. Cury 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
,
Manoel Jacobsen Teixeira 
3   Universidade de São Paulo, Departamento de Neurocirurgia, São Paulo SP, Brazil.
,
Egberto R. Barbosa 
1   Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
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Abstract

Background Parkinson's disease (PD) may progressively reduce the upper limb's functionality. Currently, there is no standardized upper limb functional capacity assessment in PD in the rehabilitation field.

Objective To identify specific outcome measurements to assess upper limbs in PD and access functional capacity.

Methods We systematically reviewed and analyzed the literature in English published from August/2012 to August/2022 according to PRISMA. The following keywords were used in our search: “upper limbs” OR “upper extremity” and “Parkinson's disease.” Two researchers searched independently, including studies accordingly to our inclusion and exclusion criteria. Registered at PROSPERO CRD42021254486.

Results We found 797 studies, and 50 were included in this review (n = 2.239 participants in H&Y stage 1–4). The most common upper limbs outcome measures found in the studies were: (i) UPDRS-III and MDS-UPDRS to assess the severity and progression of PD motor symptoms (tremor, bradykinesia, and rigidity) (ii) Nine Hole Peg Test and Purdue Pegboard Test to assess manual dexterity; (iii) Spiral test and Funnel test to provoke and assess freezing of upper limbs; (iv) Technology assessment such as wearables sensors, apps, and other device were also found.

Conclusion We found evidence to support upper limb impairments assessments in PD. However, there is still a large shortage of specific tests to assess the functional capacity of the upper limbs. The upper limbs' functional capacity is insufficiently investigated during the clinical and rehabilitation examination due to a lack of specific outcome measures to assess functionality.

Resumo

Antecedentes A doença de Parkinson (DP) reduz progressivamente a funcionalidade do membro superior. Não existe uma avaliação padronizada da capacidade funcional do membro superior na DP na área da reabilitação.

Objetivo Identificar medidas de resultados específicos para avaliar membros superiores na DP e avaliar capacidade funcional.

Métodos Revisamos e analisamos sistematicamente a literatura publicada de agosto/2012 a agosto/2022 de acordo com PRISMA. Usamos as seguintes palavras-chave “membros superiores” OU “extremidade superior” e “doença de Parkinson.” Dois pesquisadores fizeram a busca de forma independente, incluindo estudos de acordo com os critérios de inclusão e exclusão. Registro PROSPERO CRD42021254486.

Resultados Encontramos 797 estudos, 50 foram incluídos no estudo(n = 2.239 participantes no estágio 1–4 de H&Y). As medidas de resultados de membros superiores mais comuns encontradas foram: (i) UPDRS-III e MDS-UPDRS, para avaliar a gravidade e a progressão dos sintomas motores da DP (tremor, bradicinesia, e rigidez); (ii) Nine Hole Peg Test e Purdue Pegboard Test para avaliar a destreza manual; (iii) Teste da Espiral e Teste do Funil para provocar e avaliar o congelamento de membros superiores; (iv) Avaliação de tecnologia, como sensores vestíveis, aplicativos e outros dispositivos também foram encontrados.

Conclusão Encontramos evidências para dar suporte para as avaliações de deficiências de membros superiores na DP. No entanto, ainda há grande escassez de testes específicos para avaliar a capacidade funcional dos membros superiores. A capacidade funcional dos membros superior é insuficientemente investigada durante o exame clínico e de reabilitação devido à falta de medidas de resultados específicos para avaliar a funcionalidade.

Keywords

Parkinson Disease - Upper Extremity - Physical Therapy Modalities - Treatment Outcome - Rehabilitation - Freezing

Palavras-chave

Doença de Parkinson - Extremidade Superior - Modalidades de Fisioterapia - Resultado do Tratamento - Reabilitação - Congelamento

Authors' Contributions

TTCC: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, supervision, writing – review & editing; RR: data curation, formal analysis, investigation, methodology, writing – original draft, writing – review & editing; RG, MJT, ERB: writing – review & editing; TTCC, RR: These authors contributed equally. All authors contributed to the article and approved the submitted version.


Supplementary Material



Publication History

Received: 09 May 2023

Accepted: 19 July 2023

Article published online:
29 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Fox SH, Katzenschlager R, Lim SY. et al; Movement Disorder Society Evidence-Based Medicine Committee. International Parkinson and movement disorder society evidence-based medicine review: Update on treatments for the motor symptoms of Parkinson's disease. Mov Disord 2018; 33 (08) 1248-1266
    CrossrefPubMedGoogle Scholar
  • 2 Espay AJ, Aybek S, Carson A. et al. Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders. JAMA Neurol 2018; 75 (09) 1132-1141
    CrossrefPubMedGoogle Scholar
  • 3 Armstrong MJ, Okun MS. Diagnosis and Treatment of Parkinson Disease: A Review. JAMA 2020; 323 (06) 548-560
    CrossrefPubMedGoogle Scholar
  • 4 Postuma RB, Berg D, Stern M. et al. MDS clinical diagnostic criteria for Parkinson's disease. Mov Disord 2015; 30 (12) 1591-1601
    CrossrefPubMedGoogle Scholar
  • 5 Bloem BR, Okun MS, Klein C. Parkinson's disease. Lancet 2021; 397 (10291): 2284-2303
    CrossrefPubMedGoogle Scholar
  • 6 van den Noort JC, Verhagen R, van Dijk KJ. et al. Quantification of Hand Motor Symptoms in Parkinson's Disease: A Proof-of-Principle Study Using Inertial and Force Sensors. Ann Biomed Eng 2017; 45 (10) 2423-2436
    CrossrefPubMedGoogle Scholar
  • 7 Jitkritsadakul O, Thanawattano C, Anan C, Bhidayasiri R. Tremor's glove-an innovative electrical muscle stimulation therapy for intractable tremor in Parkinson's disease: A randomized sham-controlled trial. J Neurol Sci 2017; 381: 331-340
    CrossrefPubMedGoogle Scholar
  • 8 Capato TT. C NJ, Barbosa E.R, Bloem R.B. Internal and external compensation strategies to alleviate upper limb freezing in Parkinson's disease. Parkinsonism Relat Disord 2019
    PubMedGoogle Scholar
  • 9 Capato TTdC. Clinical Assessment and Management of Balance Impairments in Parkinson's disease. Donders Institute. Nijmegen, the Netherlands: Radboud University; 2022: 168
    Google Scholar
  • 10 Bloem BR, Marinus J, Almeida Q. et al; Movement Disorders Society Rating Scales Committee. Measurement instruments to assess posture, gait, and balance in Parkinson's disease: Critique and recommendations. Mov Disord 2016; 31 (09) 1342-1355
    CrossrefPubMedGoogle Scholar
  • 11 Heremans E, Nackaerts E, Vervoort G. et al. Amplitude Manipulation Evokes Upper Limb Freezing during Handwriting in Patients with Parkinson's Disease with Freezing of Gait. PLoS One 2015; 10 (11) e0142874
    CrossrefPubMedGoogle Scholar
  • 12 Keus S, Munneke M, Graziano M. et al. European physiotherapy guideline for Parkinson's disease. 2014
    PubMedGoogle Scholar
  • 13 Osborne JA, Botkin R, Colon-Semenza C. et al. Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association. Phys Ther 2022; 102 (04) pzab302
    CrossrefPubMedGoogle Scholar
  • 14 Goetz CG, Tilley BC, Shaftman SR. et al; Movement Disorder Society UPDRS Revision Task Force. Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 2008; 23 (15) 2129-2170
    CrossrefPubMedGoogle Scholar
  • 15 Proud E, Morris ME, Bilney B. et al. Hand dexterity assessment in Parkinson's disease: construct validity of the 9-Hole peg test for the more affected hand. Disabil Rehabil 2021; 43 (26) 3834-3838
    CrossrefPubMedGoogle Scholar
  • 16 Proud EL, Miller KJ, Bilney B, Balachandran S, McGinley JL, Morris ME. Evaluation of measures of upper limb functioning and disability in people with Parkinson disease: a systematic review. Arch Phys Med Rehabil 2015; 96 (03) 540-551.e1
    CrossrefPubMedGoogle Scholar
  • 17 Capato TTdC. Domingos JMM, de Almeida LRS. Versão em Português da Diretriz Europeia de Fisioterapia para a Doença de Parkinson. Omini Farma. 2015: 1
    Google Scholar
  • 18 Saba RA, Maia DP, Cardoso FEC. et al. Guidelines for Parkinson's disease treatment: consensus from the Movement Disorders Scientific Department of the Brazilian Academy of Neurology - motor symptoms. Arq Neuropsiquiatr 2022; 80 (03) 316-329
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Sturkenboom IH, Graff MJ, Borm GF. et al. Effectiveness of occupational therapy in Parkinson's disease: study protocol for a randomized controlled trial. Trials 2013; 14: 34
    CrossrefPubMedGoogle Scholar
  • 20 Page MJ, Moher D, Bossuyt PM. et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021; 372 (160) n160
    CrossrefPubMedGoogle Scholar
  • 21 Sherrington C, Herbert RD, Maher CG, Moseley AM. PEDro. A database of randomized trials and systematic reviews in physiotherapy. Man Ther 2000; 5 (04) 223-226
    CrossrefPubMedGoogle Scholar
  • 22 Fahn SER. UPDRS Development Committee; Unified Parkinson's Disease Rating Scale. In: Fahn S, Marsden CD, Calne DB, Goldstein M. editors. Recent developments in Parkinson's disease. Florham Park, NJ: Macmillan; 1987: 153-163
    Google Scholar
  • 23 Braun Janzen T, Haase M, Thaut MH. Rhythmic priming across effector systems: A randomized controlled trial with Parkinson's disease patients. Hum Mov Sci 2019; 64: 355-365
    CrossrefPubMedGoogle Scholar
  • 24 Momin S, Mahlknecht P, Georgiev D. et al. Impact of Subthalamic Deep Brain Stimulation Frequency on Upper Limb Motor Function in Parkinson's Disease. J Parkinsons Dis 2018; 8 (02) 267-271
    CrossrefPubMedGoogle Scholar
  • 25 David FJ, Robichaud JA, Vaillancourt DE. et al. Progressive resistance exercise restores some properties of the triphasic EMG pattern and improves bradykinesia: the PRET-PD randomized clinical trial. J Neurophysiol 2016; 116 (05) 2298-2311
    CrossrefPubMedGoogle Scholar
  • 26 Ni M, Mooney K, Signorile JF. Controlled pilot study of the effects of power yoga in Parkinson's disease. Complement Ther Med 2016; 25: 126-131
    CrossrefPubMedGoogle Scholar
  • 27 Ni M, Signorile JF, Mooney K. et al. Comparative Effect of Power Training and High-Speed Yoga on Motor Function in Older Patients With Parkinson Disease. Arch Phys Med Rehabil 2016; 97 (03) 345-354.e15
    CrossrefPubMedGoogle Scholar
  • 28 Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 2016; 354: i4086
    CrossrefPubMedGoogle Scholar
  • 29 Pazzaglia C, Imbimbo I, Tranchita E. et al. Comparison of virtual reality rehabilitation and conventional rehabilitation in Parkinson's disease: a randomised controlled trial. Physiotherapy 2020; 106: 36-42
    CrossrefPubMedGoogle Scholar
  • 30 Cikajlo I, Peterlin Potisk K. Advantages of using 3D virtual reality based training in persons with Parkinson's disease: a parallel study. J Neuroeng Rehabil 2019; 16 (01) 119
    CrossrefPubMedGoogle Scholar
  • 31 Picelli A, Tamburin S, Passuello M, Waldner A, Smania N. Robot-assisted arm training in patients with Parkinson's disease: a pilot study. J Neuroeng Rehabil 2014; 11: 28
    CrossrefPubMedGoogle Scholar
  • 32 Samotus O, Lee J, Jog M. Long-term tremor therapy for Parkinson and essential tremor with sensor-guided botulinum toxin type A injections. PLoS One 2017; 12 (06) e0178670
    CrossrefPubMedGoogle Scholar
  • 33 Eggers C, Günther M, Rothwell J, Timmermann L, Ruge D. Theta burst stimulation over the supplementary motor area in Parkinson's disease. J Neurol 2015; 262 (02) 357-364
    CrossrefPubMedGoogle Scholar
  • 34 Messa LV, Ginanneschi F, Momi D. et al. Functional and Brain Activation Changes Following Specialized Upper-Limb Exercise in Parkinson's Disease. Front Hum Neurosci 2019; 13: 350
    CrossrefPubMedGoogle Scholar
  • 35 Nowinski CJ, Siderowf A, Simuni T, Wortman C, Moy C, Cella D. Neuro-QoL health-related quality of life measurement system: Validation in Parkinson's disease. Mov Disord 2016; 31 (05) 725-733
    CrossrefPubMedGoogle Scholar
  • 36 Memedi M, Khan T, Grenholm P, Nyholm D, Westin J. Automatic and objective assessment of alternating tapping performance in Parkinson's disease. Sensors (Basel) 2013; 13 (12) 16965-16984
    CrossrefPubMedGoogle Scholar
  • 37 Jo HJ, Ambike S, Lewis MM, Huang X, Latash ML. Finger force changes in the absence of visual feedback in patients with Parkinson's disease. Clin Neurophysiol 2016; 127 (01) 684-692
    CrossrefPubMedGoogle Scholar
  • 38 Saunders-Pullman R, Derby C, Stanley K. et al. Validity of spiral analysis in early Parkinson's disease. Mov Disord 2008; 23 (04) 531-537
    CrossrefPubMedGoogle Scholar
  • 39 Zetterberg H, Frykberg GE, Gäverth J, Lindberg PG. Neural and nonneural contributions to wrist rigidity in Parkinson's disease: an explorative study using the NeuroFlexor. BioMed Res Int 2015; 2015: 276182
    CrossrefPubMedGoogle Scholar
  • 40 Sterling NW, Cusumano JP, Shaham N. et al. Dopaminergic modulation of arm swing during gait among Parkinson's disease patients. J Parkinsons Dis 2015; 5 (01) 141-150
    CrossrefPubMedGoogle Scholar
  • 41 Ryan D, Fullen B, Rio E, Segurado R, Stokes D, O'Sullivan C. Effect of Action Observation Therapy in the Rehabilitation of Neurologic and Musculoskeletal Conditions: A Systematic Review. Arch Rehabil Res Clin Transl 2021; 3 (01) 100106
    PubMedGoogle Scholar
  • 42 França C, de Andrade DC, Teixeira MJ. et al. Effects of cerebellar neuromodulation in movement disorders: A systematic review. Brain Stimul 2018; 11 (02) 249-260
    CrossrefPubMedGoogle Scholar
  • 43 GBD 2016 Parkinson's Disease Collaborators. Global, regional, and national burden of Parkinson's disease, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2018; 17 (11) 939-953
    CrossrefPubMedGoogle Scholar
  • 44 Simpson MW, Mak M. The effect of transcranial direct current stimulation on upper limb motor performance in Parkinson's disease: a systematic review. J Neurol 2020; 267 (12) 3479-3488
    CrossrefPubMedGoogle Scholar
  • 45 Lora-Millan JS, Delgado-Oleas G, Benito-León J, Rocon E. A Review on Wearable Technologies for Tremor Suppression. Front Neurol 2021; 12: 700600
    CrossrefPubMedGoogle Scholar
  • 46 Mittal SO, Jog M, Lee J, Jabbari B. Novel Botulinum Toxin Injection Protocols for Parkinson Tremor and Essential Tremor - the Yale Technique and Sensor-Based Kinematics Procedure for Safe and Effective Treatment. Tremor Other Hyperkinet Mov (N Y) 2020; 10: 61
    CrossrefPubMedGoogle Scholar
  • 47 Moumdjian L, Sarkamo T, Leone C, Leman M, Feys P. Effectiveness of music-based interventions on motricity or cognitive functioning in neurological populations: a systematic review. Eur J Phys Rehabil Med 2017; 53 (03) 466-482
    CrossrefPubMedGoogle Scholar
  • 48 Vanbellingen T, Nyffeler T, Nigg J. et al. Home based training for dexterity in Parkinson's disease: A randomized controlled trial. Parkinsonism Relat Disord 2017; 41: 92-98
    CrossrefPubMedGoogle Scholar
  • 49 Allen NE, Song J, Paul SS. et al. An interactive videogame for arm and hand exercise in people with Parkinson's disease: A randomized controlled trial. Parkinsonism Relat Disord 2017; 41: 66-72
    CrossrefPubMedGoogle Scholar
  • 50 Mateos-Toset S, Cabrera-Martos I, Torres-Sánchez I, Ortiz-Rubio A, González-Jiménez E, Valenza MC. Effects of a Single Hand-Exercise Session on Manual Dexterity and Strength in Persons with Parkinson Disease: A Randomized Controlled Trial. PM R 2016; 8 (02) 115-122
    CrossrefPubMedGoogle Scholar
  • 51 Paul SS, Dibble LE, Olivier GN, Walter C, Duff K, Schaefer SY. Dopamine replacement improves motor learning of an upper extremity task in people with Parkinson disease. Behav Brain Res 2020; 377: 112213
    CrossrefPubMedGoogle Scholar
  • 52 Jansen AE, Koop MM, Rosenfeldt AB, Alberts JL. Aerobic exercise does improve bimanual coordination in Parkinson's disease: Response to Samuel and colleagues. Parkinsonism Relat Disord 2021; 93: 103-104
    CrossrefPubMedGoogle Scholar
  • 53 Broeder S, Heremans E, Pinto Pereira M. et al. Does transcranial direct current stimulation during writing alleviate upper limb freezing in people with Parkinson's disease? A pilot study. Hum Mov Sci 2019; 65: 65
    CrossrefPubMedGoogle Scholar
  • 54 Nieuwboer A, Vercruysse S, Feys P, Levin O, Spildooren J, Swinnen S. Upper limb movement interruptions are correlated to freezing of gait in Parkinson's disease. Eur J Neurosci 2009; 29 (07) 1422-1430
    CrossrefPubMedGoogle Scholar
  • 55 Delval A, Defebvre L, Tard C. Freezing during tapping tasks in patients with advanced Parkinson's disease and freezing of gait. PLoS One 2017; 12 (09) e0181973
    CrossrefPubMedGoogle Scholar
  • 56 Pradhan S, Scherer R, Matsuoka Y, Kelly VE. Grip force modulation characteristics as a marker for clinical disease progression in individuals with Parkinson disease: case-control study. Phys Ther 2015; 95 (03) 369-379
    CrossrefPubMedGoogle Scholar
  • 57 Williams AJ, Peterson DS, Ionno M, Pickett KA, Earhart GM. Upper extremity freezing and dyscoordination in Parkinson's disease: effects of amplitude and cadence manipulations. Parkinsons Dis 2013; 2013: 595378
    PubMedGoogle Scholar
  • 58 Ospina BM, Chaparro JAV, Paredes JDA, Pino YJC, Navarro A, Orozco JL. Objective Arm Swing Analysis in Early-Stage Parkinson's Disease Using an RGB-D Camera (Kinect®). J Parkinsons Dis 2018; 8 (04) 563-570
    CrossrefPubMedGoogle Scholar
  • 59 Cavallo F, Moschetti A, Esposito D, Maremmani C, Rovini E. Upper limb motor pre-clinical assessment in Parkinson's disease using machine learning. Parkinsonism Relat Disord 2019; 63: 111-116
    CrossrefPubMedGoogle Scholar
  • 60 Chan PY, Ripin ZM, Halim SA. et al. An In-Laboratory Validity and Reliability Tested System for Quantifying Hand-Arm Tremor in Motions. IEEE transactions on neural systems and rehabilitation engineering: a publication of the IEEE Engineering in Medicine and Biology Society. 2018; 26 (02) 460-467
    PubMedGoogle Scholar
  • 61 Proud EL, Miller KJ, Martin CL, Morris ME. Upper-limb assessment in people with Parkinson disease: is it a priority for therapists, and which assessment tools are used?. Physiother Can 2013; 65 (04) 309-316
    CrossrefPubMedGoogle Scholar
  • 62 Fahn S, Tolosa E, Marín C. Clinical rating scale for tremor. Parkinson's disease and movement disorders. 1993; 2: 271-280
    PubMedGoogle Scholar
  • 63 Kueper JK, Speechley M, Lingum NR, Montero-Odasso M. Motor function and incident dementia: a systematic review and meta-analysis. Age Ageing 2017; 46 (05) 729-738
    CrossrefPubMedGoogle Scholar
  • 64 Cabrera-Martos I, Ortiz-Rubio A, Torres-Sánchez I, Rodríguez-Torres J, López-López L, Valenza MC. A randomized controlled study of whether setting specific goals improves the effectiveness of therapy in people with Parkinson's disease. Clin Rehabil 2019; 33 (03) 465-472
    CrossrefPubMedGoogle Scholar
  • 65 Park JK, Kim SJ. Dual-Task-Based Drum Playing with Rhythmic Cueing on Motor and Attention Control in Patients with Parkinson's Disease: A Preliminary Randomized Study. Int J Environ Res Public Health 2021; 18 (19) 10095
    CrossrefPubMedGoogle Scholar
  • 66 Vingerhoets FJ, Schulzer M, Calne DB, Snow BJ. Which clinical sign of Parkinson's disease best reflects the nigrostriatal lesion?. Ann Neurol 1997; 41 (01) 58-64
    CrossrefPubMedGoogle Scholar
  • 67 Knippenberg E, Verbrugghe J, Lamers I, Palmaers S, Timmermans A, Spooren A. Markerless motion capture systems as training device in neurological rehabilitation: a systematic review of their use, application, target population and efficacy. J Neuroeng Rehabil 2017; 14 (01) 61
    CrossrefPubMedGoogle Scholar
  • 68 Samotus O, Mahdi Y, Jog M. Real-World Longitudinal Experience of Botulinum Toxin Therapy for Parkinson and Essential Tremor. Toxins (Basel) 2022; 14 (08) 557
    CrossrefPubMedGoogle Scholar
  • 69 Abbruzzese G, Trompetto C, Mori L, Pelosin E. Proprioceptive rehabilitation of upper limb dysfunction in movement disorders: a clinical perspective. Front Hum Neurosci 2014; 8: 961
    CrossrefPubMedGoogle Scholar
  • 70 Samotus O, Lee J, Jog M. Transitioning from Unilateral to Bilateral Upper Limb Tremor Therapy for Parkinson's Disease and Essential Tremor Using Botulinum Toxin: Case Series. Toxins (Basel) 2018; 10 (10) 394
    CrossrefPubMedGoogle Scholar
  • 71 de Freitas PR, Lemos AE, Santos MP, Michaelsen SM, Corrêa CL, Swarowsky A. “Test D'évaluation Des Membres Supérieurs Des Personnes Âgées” (TEMPA) to assess upper limb activity in Parkinson's disease. J Hand Ther 2017; 30 (03) 320-327
    CrossrefPubMedGoogle Scholar
  • 72 Vercruysse S, Spildooren J, Heremans E. et al. Freezing in Parkinson's disease: a spatiotemporal motor disorder beyond gait. Mov Disord 2012; 27 (02) 254-263
    CrossrefPubMedGoogle Scholar
  • 73 Heideman SG, te Woerd ES, Praamstra P. Rhythmic entrainment of slow brain activity preceding leg movements. Clin Neurophysiol 2015; 126 (02) 348-355
    CrossrefPubMedGoogle Scholar
  • 74 Snijders AH, Haaxma CA, Hagen YJ, Munneke M, Bloem BR. Freezer or non-freezer: clinical assessment of freezing of gait. Parkinsonism Relat Disord 2012; 18 (02) 149-154
    CrossrefPubMedGoogle Scholar