Objective: This systematic review aims to assess the efficacy of automated mechanical peripheral stimulation (AMPS) as a therapy for Parkinson’s disease (PD).

Background: One of the major unmet needs in PD is mobility and walking disorders (freezing of gait, festination gait, reduced speed, shorter steps, increased double support). However, the current treatment options have a limited effect on walking impairments. A new therapy such as AMPS could be a promising solution for walking rehabilitation in PD. AMPS therapy consists of the mechanical stimulation of four specific points, the head of the hallux and the first metatarsal joint for each foot.

Method: The literature search of articles published in English was performed in 2 electronic databases (PubMed and CENTRAL Cochrane library). The keywords used were “automated mechanical peripheral stimulation.” Then, articles reporting outcome measures in PD patients after AMPS therapy were selected following the PRISMA methodology.

Results: The search yielded 38 potentially relevant articles, leading to 13 selected articles (including eight randomized controlled trials). AMPS was administered via insoles while standing in one study (2); AMPS was delivered automatically using the Gondola Medical Device in the remaining 12 articles (1; 3-13). The results indicated that AMPS had a significant effect on the following walking features: increased speed, increased step/stride length, decreased variability, decreased asymmetry, decreased double support, and improved Timed Up and Go test. These positive effects have also been reported with PD patients suffering from freezing of gait. No significant effect was demonstrated on statistic balance. Moreover, two fMRI studies have identified that AMPS increased resting-state connectivity within motor networks, and one study highlighted an increase in Brain-Derived Neurotrophic Factor immediately after AMPS. These results suggest that AMPS could induce brain plasticity leading to improvement in walking abilities in PD. Other studies highlighted that AMPS significantly reduce resting blood pressure and improved the cardiovascular autonomic control. None of the studies reported negative effects or adverse events.

Conclusion: This systematic review highlighted AMPS therapy has been reported as an effective and safe therapy. Therefore, AMPS is a promising option for the management of PD symptoms.

References: 1. Barbic F, Galli M, Dalla Vecchia L, et al. Effects of mechanical stimulation of the feet on gait and cardiovascular autonomic control in Parkinson’s disease. Journal of Applied Physiology. 2014;116(5):495-503. doi:10.1152/japplphysiol.01160.2013 2. Brognara L, Navarro-Flores E, Iachemet L, Serra-Catalá N, Cauli O. Beneficial Effect of Foot Plantar Stimulation in Gait Parameters in Individuals with Parkinson’s Disease. Brain Sci. 2020;10(2). doi:10.3390/brainsci10020069 3. Galli M, Kleiner A, Gaglione M, et al. Timed Up and Go test and wearable inertial sensor: a new combining tool to assess change in subject with Parkinson’s disease after automated mechanical peripheral stimulation treatment. International Journal of Engineering and Innovative Technology. 2015;4(11):9. 4. Galli M, Vicidomini C, Rozin Kleiner AF, et al. Peripheral neurostimulation breaks the shuffling steps patterns in Parkinsonian gait: a double blind randomized longitudinal study with automated mechanical peripheral stimulation. European Journal of Physical and Rehabilitation Medicine. 2018;54(6):860-865. doi:10.23736/S1973-9087.18.05037-2 5. Kleiner A, Galli M, Gaglione M, et al. The Parkinsonian Gait Spatiotemporal Parameters Quantified by a Single Inertial Sensor before and after Automated Mechanical Peripheral Stimulation Treatment. Parkinson’s Disease. 2015;2015:1-6. doi:10.1155/2015/390512 6. Kleiner AFR, Souza Pagnussat A, Pinto C, Redivo Marchese R, Salazar AP, Galli M. Automated Mechanical Peripheral Stimulation Effects on Gait Variability in Individuals With Parkinson Disease and Freezing of Gait: A Double-Blind, Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation. 2018;99(12):2420-2429. doi:10.1016/j.apmr.2018.05.009 7. Pagnussat AS, Kleiner AFR, Rieder CRM, et al. Plantar stimulation in parkinsonians: From biomarkers to mobility – randomized-controlled trial. RNN. 2018;36(2):195-205. doi:10.3233/RNN-170744 8. Pagnussat AS, Salazar AP, Pinto C, et al. Plantar stimulation alters brain connectivity in idiopathic Parkinson’s disease. Acta Neurol Scand. 2020;142(3):229-238. doi:10.1111/ane.13253 9. Pinto C, Pagnussat AS, Rozin Kleiner AF, et al. Automated Mechanical Peripheral Stimulation Improves Gait Parameters in Subjects With Parkinson Disease and Freezing of Gait: A Randomized Clinical Trial. American Journal of Physical Medicine & Rehabilitation. 2018;97(6):383-389. doi:10.1097/PHM.0000000000000890 10. Prusch JS, Kleiner AFR, Salazar AP, et al. Automated mechanical peripheral stimulation and postural control in subjects with Parkinson’s disease and freezing of gait: a randomized controlled trial. Functional Neurology. 2018;33(4):206-212. 11. Quattrocchi CC, de Pandis MF, Piervincenzi C, et al. Acute Modulation of Brain Connectivity in Parkinson Disease after Automatic Mechanical Peripheral Stimulation: A Pilot Study. Hu D, ed. PLoS ONE. 2015;10(10):e0137977. doi:10.1371/journal.pone.0137977 12. Stocchi F, Sale P, Kleiner AFR, et al. Long-term effects of automated mechanical peripheral stimulation on gait patterns of patients with Parkinson’s disease: International Journal of Rehabilitation Research. 2015;38(3):238-245. doi:10.1097/MRR.0000000000000120 13. Zamunér AR, Shiffer D, Barbic F, et al. Mechanical somatosensory stimulation decreases blood pressure in patients with Parkinsonʼs disease: Journal of Hypertension. 2019;37(8):1714-1721. doi:10.1097/HJH.0000000000002084

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MDS Abstracts - https://www.mdsabstracts.org/abstract/automated-mechanical-peripheral-stimulation-for-walking-rehabilitation-in-parkinsons-disease-a-systematic-review/