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Chen T, Fan Y, Zhuang X, Feng D, Chen Y, Chan P, Du Y. Postural sway in patients with early Parkinson's disease performing cognitive tasks while standing. Neurol Res 2018; 40:491-498. [PMID: 29869975 DOI: 10.1080/01616412.2018.1451017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES We investigated postural sway in patients with early Parkinson's disease (PD) to test the hypothesis that the postural control system was affected already at an early stage of PD. Moreover, we identified cases of dysfunction of stereopsis in PD patients. METHODS We examined 23 patients with early PD and 23 healthy, sex- and age-matched control subjects. Postural sway was measured with an accelerometer at the center of mass at the lower spine. Subjects were asked to stand quietly for 30 s under two usual conditions (eyes open and eyes closed) and two dual tasks conditions (eyes open with dual task, eyes closed with dual task). Stereopsis was assessed using the Titmus fly test. RESULTS In the usual conditions, no differences were found between the control group and PD group. With increasing task difficulty, PD patients showed an increase of RMS values of sway acceleration, compared to control subjects. These differences reached significance during cognitive task performance. PD patients showed larger JERK values with increasing difficulty of the sway task which also reached significance during cognitive task performance. Relative to controls, PD patients showed decreased stereopsis function. But, there were no statistically significant correlations between log seconds of arc of the Titmus test and JERK, even during cognitive task performance. CONCLUSION Our results indicate that patients with early PD have subtle signs of postural instability when their attention is diverted or reduced. In addition, deficits of stereopsis may be common in early PD patients. St Abbreviations: ACC: Accelerometers; ANOVA: Analysis of variance; AP: Antero-posterior; COP: Center of pressure; EC: Eyes closed; ECDT: eyes closed with dual task; EO: Eyes open; EODT: Eyes open with dual task; GDS: Geriatric depression scale; JERK: Jerkiness of sway; ML: Medio-lateral; MMSE: Mini mental state examination; MoCA: Montreal cognitive assessment; PD: Parkinson's disease; PDAbS: PD Patients with abnormal stereopsis; PDNrS: PD Patients with normal stereopsis; PIGD: Postural instability and gait disorder; RMS: Root mean square; UPDRS: Unified Parkinson's disease rating scale.
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Affiliation(s)
- Tuanzhi Chen
- a Department of Neurology , Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University , Liaocheng , China
| | - Yan Fan
- a Department of Neurology , Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University , Liaocheng , China
| | - Xianbo Zhuang
- a Department of Neurology , Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University , Liaocheng , China
| | - Depeng Feng
- a Department of Neurology , Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University , Liaocheng , China
| | - Yanxiu Chen
- a Department of Neurology , Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University , Liaocheng , China
| | - Piu Chan
- b Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Department of Neurobiology, Beijing Institute of Geriatrics , Xuanwu Hospital, Capital Medical University , Beijing , China
| | - Yifeng Du
- c Department of Neurology , Provincial Hospital Affiliated to Shandong University , Jinan , China
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Takeuchi N, Mori T, Suzukamo Y, Izumi SI. Modulation of Excitability in the Temporoparietal Junction Relieves Virtual Reality Sickness. Cyberpsychol Behav Soc Netw 2018; 21:381-387. [PMID: 29792509 DOI: 10.1089/cyber.2017.0499] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Virtual reality (VR) immersion often provokes subjective discomfort and postural instability, so called VR sickness. The neural mechanism of VR sickness is speculated to be related to visual-vestibular information mismatch and/or postural instability. However, the approaches proposed to relieve VR sickness through modulation of brain activity are poorly understood. Using transcranial direct current stimulation (tDCS), we aimed to investigate whether VR sickness could be relieved by the modulation of cortical excitability in the temporoparietal junction (TPJ), which is known to be involved in processing of both vestibular and visual information. Twenty healthy subjects received tDCS over right TPJ before VR immersion. The order of the three types of tDCS (anodal, cathodal, and sham) was counterbalanced across subjects. We evaluated the subjective symptoms, heart rate, and center of pressure at baseline, after tDCS, and after VR immersion. VR immersion using head-mounted displays provoked subjective discomfort and postural instability. However, anodal tDCS over right TPJ ameliorated subjective disorientation symptoms and postural instability induced by VR immersion compared with sham condition. The amelioration of VR sickness by anodal tDCS over the right TPJ might result from relief of the sensory conflict and/or facilitation of vestibular function. Our result not only has potential clinical implications for the neuromodulation approach of VR sickness but also implies a causal role of the TPJ in VR sickness.
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Affiliation(s)
- Naoyuki Takeuchi
- 1 Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine , Sendai, Japan
| | - Takayuki Mori
- 1 Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine , Sendai, Japan
| | - Yoshimi Suzukamo
- 1 Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine , Sendai, Japan
| | - Shin-Ichi Izumi
- 1 Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine , Sendai, Japan
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Leland A, Tavakol K, Scholten J, Bakhshi S, Kelarestaghi K. Comparative Study of Two Systems for the Assessment of Static Balance in Veterans with Mild Traumatic Brain Injury. ACTA ACUST UNITED AC 2018; 72:120-124. [PMID: 29736101 PMCID: PMC5911174 DOI: 10.5455/medarh.2018.72.120-124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Traditionally, the diagnosis of postural instability relies on the clinical examination of static balance. In recent years, computerized technologies have provided a new approach for the accurate detection of positional changes during functional balance. Aim The aim of this study was to investigate the similarities and differences between two electronic systems, NeuroCom and BioSensics, and their application in the clinical assessment of impaired balance in American veterans. Materials and Methods We examined the sway around the center of mass during static balance conditions in 25 veterans with mild traumatic brain injury, using the two electronic systems. These patients met the inclusion criteria and were assessed for their impaired balance at the District of Columbia Veterans Affair Medical Center, Washington, DC, USA. Results There were six static balance tests conducted on either NeuroCom or BioSensics system in triplicate. Of the data for 36 sets of statistical data analyses, there were significant correlations among those for eight data sets (22.2%) between the two systems. The strongest positive correlation between the data from the two systems was found during the baseline test, when inputs from visual, vestibular and sensorymotor sources were uninterrupted. The data from the remaining experimental conditions did not correlate significantly with one another. Conclusions Both NeuroCom and BioSensics provided comparable data in eight out of 36 experimental conditions in the assessment of static balance in patients with mild traumatic brain injury. The findings clarified the ambiguities in the application of NeuroCom versus BioSensics, provided new knowledge for the field of physical medicine and rehabilitation, and improved the clinical assessment of static balance in patients with mTBI.
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Affiliation(s)
- Azadeh Leland
- Rehabilitation Medicine Service, VA Medical Center, Washington, DC, USA
| | - Kamran Tavakol
- School of Medicine, University of Maryland Baltimore. Baltimore, MD, USA
| | - Joel Scholten
- Rehabilitation Medicine Service, VA Medical Center, Washington, DC, USA
| | - Simin Bakhshi
- Department of Anesthesiology, School of Medicine, Iran University. Tehran, Iran
| | - Kaveh Kelarestaghi
- Department of Civil Engineering, School of Engineering, Virginia Tech University, Falls Church, VA, USA
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Simuni T, Siderowf A, Lasch S, Coffey CS, Caspell-Garcia C, Jennings D, Tanner CM, Trojanowski JQ, Shaw LM, Seibyl J, Schuff N, Singleton A, Kieburtz K, Toga AW, Mollenhauer B, Galasko D, Chahine LM, Weintraub D, Foroud T, Tosun D, Poston K, Arnedo V, Frasier M, Sherer T, Chowdhury S, Marek K. Longitudinal Change of Clinical and Biological Measures in Early Parkinson's Disease: Parkinson's Progression Markers Initiative Cohort. Mov Disord 2018; 33:771-782. [PMID: 29572948 PMCID: PMC6001458 DOI: 10.1002/mds.27361] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/01/2018] [Accepted: 02/05/2018] [Indexed: 11/09/2022] Open
Abstract
Objective: The objective of this study was to assess longitudinal change in clinical and dopamine transporter imaging outcomes in early, untreated PD. Methods: We describe 5‐year longitudinal change of the MDS‐UPDRS and other clinical measures using results from the Parkinson's Progression Markers Initiative, a longitudinal cohort study of early Parkinson's disease (PD) participants untreated at baseline. We also provide data on the longitudinal change in dopamine transporter 123‐I Ioflupane striatal binding and correlation between the 2 measures. Results: A total of 423 PD participants were recruited, and 358 remain in the study at year 5. Baseline MDS‐UPDRS total score was 32.4 (standard deviation 13.1), and the average annual change (assessed medications OFF for the treated participants) was 7.45 (11.6), 3.11 (11.7), 4(11.9), 4.7 (11.1), and 1.74(11.9) for years 1, 2, 3, 4, and 5, respectively (P < .0001 for the change over time), with a steeper change in year 1. Dopaminergic therapy had a significant effect on the change of MDS‐UPDRS. There was a significant longitudinal change in dopamine transporter binding in all striatal regions (P < .001). There was a significant but weak correlation between MDS‐UPDRS and dopamine transporter binding at baseline and years 1, 2, and 4, but no correlation between the rate of change of the 2 variables. Conclusions: We present 5‐year longitudinal data on the change of the MDS‐UPDRS and other clinical and dopamine transporter imaging outcome measures in early PD. These data can be used for sample size estimates for interventional studies in the de novo PD population. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | | | - Shirley Lasch
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | | | | | | | | | | | - Leslie M Shaw
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
| | - Norbert Schuff
- University of California, San Francisco, California, USA
| | - Andrew Singleton
- National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Karl Kieburtz
- Clinical Trials Coordination Center, University of Rochester, Rochester, New York, USA
| | - Arthur W Toga
- University of Southern California, Los Angeles, California, USA
| | | | - Doug Galasko
- University of California, San Diego, California, USA
| | - Lana M Chahine
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Duygu Tosun
- University of California, San Francisco, California, USA
| | - Kathleen Poston
- Stanford University Medical Center, Stanford, California, USA
| | | | | | | | | | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA
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Bohnen NI, Haugen J, Ridder A, Kotagal V, Albin RL, Frey KA, Müller MLTM. Color discrimination errors associate with axial motor impairments in Parkinson's disease. Mov Disord Clin Pract 2017; 4:864-869. [PMID: 29226177 DOI: 10.1002/mdc3.12527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background Visual function deficits are more common in imbalance-predominant compared to tremor-predominant PD suggesting a pathophysiological role of impaired visual functions in axial motor impairments. Objective To investigate the relationship between changes in color discrimination and motor impairments in PD while accounting for cognitive or other confounder factors. Methods PD subjects (n=49, age 66.7±8.3 years; Hoehn & Yahr stage 2.6±0.6) completed color discrimination assessment using the Farnsworth-Munsell 100 Hue Color Vision Test, neuropsychological, motor assessments and [11C]dihydrotetrabenazine vesicular monoamine transporter type 2 PET imaging. MDS-UPDRS sub-scores for cardinal motor features were computed. Timed up and go mobility and walking tests were assessed in 48 subjects. Results Bivariate correlation coefficients between color discrimination and motor variables were significant only for the Timed up and go (RS=0.44, P=0.0018) and the MDS-UPDRS axial motor scores (RS=0.38, P=0.0068). Multiple regression confounder analysis using the Timed up and go as outcome parameter showed a significant total model (F(5,43)= 7.3, P<0.0001) with significant regressor effects for color discrimination (standardized β=0.32, t=2.6, P=0.012), global cognitive Z-score (β=-0.33, t=-2.5, P=0.018), duration of disease (β=0.26, t=1.8, P=0.038), but not for age or striatal dopaminergic binding. The color discrimination test was also a significant independent regressor in the MDS-UPDRS axial motor model (standardized β=0.29, t=2.4, P=0.022; total model t(5,43)= 6.4, P=0.0002). Conclusions Color discrimination errors associate with axial motor features in PD independent of cognitive deficits, nigrostriatal dopaminergic denervation, and other confounder variables. These findings may reflect shared pathophysiology between color discrimination visual impairments and axial motor burden in PD.
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Affiliation(s)
- Nicolaas I Bohnen
- Radiology, University of Michigan, Ann Arbor, MI, United States, 48104.,Neurology, University of Michigan, Ann Arbor, MI, United States, 48104.,Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, United States, 48104.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, United States
| | - Jacob Haugen
- Radiology, University of Michigan, Ann Arbor, MI, United States, 48104
| | - Andrew Ridder
- Neurology, University of Michigan, Ann Arbor, MI, United States, 48104.,Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, United States, 48104
| | - Vikas Kotagal
- Neurology, University of Michigan, Ann Arbor, MI, United States, 48104.,Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, United States, 48104
| | - Roger L Albin
- Neurology, University of Michigan, Ann Arbor, MI, United States, 48104.,Neurology Service and GRECC, VAAAHS, Ann Arbor, MI, United States, 48104.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, United States
| | - Kirk A Frey
- Radiology, University of Michigan, Ann Arbor, MI, United States, 48104.,Neurology, University of Michigan, Ann Arbor, MI, United States, 48104
| | - Martijn L T M Müller
- Radiology, University of Michigan, Ann Arbor, MI, United States, 48104.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, United States
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Abstract
The relationship between postural instability and subcortical structure in AD has received less attention. The aims of this study were to assess whether there are differences in the ability to control balance between Alzheimer's disease (AD) and controls, and to investigate the association between subcortical gray matter volumes and postural instability in AD.We enrolled 107 consecutive AD patients and 37 controls. All participants underwent detailed neuropsychological evaluations, T1-weighted MRI at 3 T, and posture assessment using computerized dynamic posturography. We segmented the volumes of 6 subcortical structures of the amygdala, thalamus, caudate nucleus, putamen, globus pallidus and nucleus accumbens, and of hippocampus, using the FMRIBs integrated registration and segmentation tool.All subcortical structures, except for the globus pallidus, were smaller in AD compared with controls on adjusting for age and gender. Falling frequencies in unilateral stance test (UST) and composite scores in sensory organization test (SOT) were worse in AD than in controls. The motor control test did not reveal any differences between groups. On subgroup analyses in AD, the groups with poor performance in UST or SOT exhibited significantly reduced nucleus accumbens and putamen volumes, and nucleus accumbens volume, respectively. The smaller volume of the nucleus accumbens was associated with postural instability in AD (OR [95% CI] 17.847 [2.59-122.80] for UST, 42.827[6.06-302.47] for SOT, all P < .05).AD patients exhibited reduced ability to control balance compared with controls, and this postural instability was associated with nucleus accumbens volume loss. Furthermore, cognitive dysfunction was more prominent in the group with severe postural instability.
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Affiliation(s)
| | - Hyung Lee
- Department of Neurology
- Brain Research Institute
| | - In-Sung Chung
- Department of Occupational and Environmental Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Hyon-Ah Yi
- Department of Neurology
- Brain Research Institute
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Brandmeir NJ, Brandmeir CL, Kuzma K, McInerney J. Response to Comment on: A Prospective Evaluation of an Outpatient Assessment of Postural Instability to Predict Risk of Falls in Patients with Parkinson's Disease Presenting for Deep Brain Stimulation. Mov Disord Clin Pract 2017; 4:283-284. [PMID: 30838272 PMCID: PMC6353399 DOI: 10.1002/mdc3.12413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/14/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Nicholas J. Brandmeir
- Department of NeurosurgeryPenn State Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Cheryl L. Brandmeir
- Department of Therapy ServicesPenn State Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Kristine Kuzma
- Department of NeurosurgeryPenn State Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
| | - James McInerney
- Department of NeurosurgeryPenn State Milton S. Hershey Medical CenterHersheyPennsylvaniaUSA
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Buated W, Lolekha P, Hidaka S, Fujinami T. Impact of Cognitive Loading on Postural Control in Parkinson's Disease With Freezing of Gait. Gerontol Geriatr Med 2016; 2:2333721416673751. [PMID: 28680941 PMCID: PMC5486484 DOI: 10.1177/2333721416673751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/08/2016] [Indexed: 11/21/2022] Open
Abstract
Objective:To assess standing balance in Parkinson’s disease (PD) patients with and without freezing of gait (FOG) during cognitive loading. Method:A balance assessment with cognitive loading, reading (RE) and counting backward (CB), was performed by the Nintendo Wii Fit in 60 PD patients (Hoehn and Yahr stages 1-3) at Thammasat University Hospital, Thailand. The participants were grouped into FOG and non-FOG according to the Freezing of Gait–Questionnaire (FOG-Q) scores. The center of pressure (CoP) in terms of path length (PL), sway area (SA), root mean square (RMS), medio-lateral (ML), and antero-posterior (AP) were analyzed. Results:Significant increases of PL were observed in both groups of PD patients during cognitive loading (p < .001). Meanwhile, the increased differences of PL during cognitive loading in PD-FOG were larger than in PD-non-FOG. The ML displacement during counting backward was significantly increased in PD-FOG (p = .012). Conclusion:Cognitive loading influenced standing balance and postural sway of PD patients. The effects were more prominent in PD-FOG. These findings represent the interactions between cognitive function, postural control, and FOG in PD.
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Affiliation(s)
- Wannipat Buated
- School of Knowledge Science, Japan Advanced Institute of Science and Technology, Ishikawa, Japan
| | - Praween Lolekha
- Neurology Division, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Shohei Hidaka
- School of Knowledge Science, Japan Advanced Institute of Science and Technology, Ishikawa, Japan
| | - Tsutomu Fujinami
- School of Knowledge Science, Japan Advanced Institute of Science and Technology, Ishikawa, Japan
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Abstract
When standing on a reduced support surface, people increase their reliance on visual information to control posture. This assertion was tested in the current study. The effects of imposed motion and support surface on postural control during visual search were investigated. Twelve participants (aged 21 ± 1.8 years; six men and six women) stood on a reduced support surface (45% base of support). In a room that moved back and forth along the anteroposterior axis, participants performed visual search for a given letter in an article. Postural sway variability and head-room coupling were measured. The results of head-room coupling, but not postural sway, supported the assertion that people increase reliance on visual information when standing on a reduced support surface. Whether standing on a whole or reduced surface, people stabilized their posture to perform the visual search tasks. Compared to a fixed target, searching on a hand-held target showed greater head-room coupling when standing on a reduced surface.
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Affiliation(s)
- Chia-Chun Huang
- Department of Physical Education, National Taiwan Normal University, Taiwan
| | - Chih-Mei Yang
- Department of Physical Education, National Taiwan Normal University, Taiwan
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Di Giulio I, St George RJ, Kalliolia E, Peters AL, Limousin P, Day BL. Maintaining balance against force perturbations: impaired mechanisms unresponsive to levodopa in Parkinson's disease. J Neurophysiol 2016; 116:493-502. [PMID: 27098030 PMCID: PMC4978787 DOI: 10.1152/jn.00996.2015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 04/20/2016] [Indexed: 11/22/2022] Open
Abstract
We introduce a new method to investigate postural instability in Parkinson's disease (PD) using computer-controlled motors to deliver precise pulls to the shoulders of subjects while standing. It mimics the clinical pull test but uses forces with unpredictable timing, direction, and magnitude. It revealed a number of balance control deficits in PD. Notably, the identified deficits were not significantly altered by levodopa medication, suggesting that disruption to nondopaminergic systems contributes to postural instability in PD. There is evidence that postural instability associated with Parkinson's disease (PD) is not adequately improved by levodopa, implying involvement of nondopaminergic pathways. However, the mechanisms contributing to postural instability have yet to be fully identified and tested for their levodopa responsiveness. In this report we investigate balance processes that resist external forces to the body when standing. These include in-place responses and the transition to protective stepping. Forward and backward shoulder pulls were delivered using two force-feedback-controlled motors and were randomized for direction, magnitude, and onset. Sixteen patients with PD were tested OFF and ON levodopa, and 16 healthy controls were tested twice. Response behavior was quantified from 3-dimensional ground reaction forces and kinematic measurements of body segments and total body center-of-mass (CoM) motion. In-place responses resisting the pull were significantly smaller in PD as reflected in reduced horizontal anteroposterior ground reaction force and increased CoM displacement. Ankle, knee, and hip moments contributing to this resistance were smaller in PD, with the knee extensor moment to backward pulls being the most affected. The threshold force needed to evoke a step was also smaller for PD in the forward direction. Protective steps evoked by suprathreshold pulls showed deficits in PD in the backward direction, with steps being shorter and more steps being required to arrest the body. Levodopa administration had no significant effect on either in-place or protective stepping deficits. We conclude that processes employed to maintain balance in the face of external forces show impairment in PD consistent with disruption to nondopaminergic systems.
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Affiliation(s)
- Irene Di Giulio
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Rebecca J St George
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom; School of Medicine, University of Tasmania, Hobart, Australia; and
| | - Eirini Kalliolia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom; St. Luke's Hospital, Thessaloniki, Greece
| | - Amy L Peters
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom
| | - Brian L Day
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom;
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Abstract
Psychogenic parkinsonism (PP), although often quite disabling, is one of the least commonly reported subtypes of psychogenic movement disorders. There are certain features that help distinguish PP from idiopathic Parkinson's disease, such as abrupt onset, early disability, bilateral shaking and slowness, nondecremental slowness when performing repetitive movements, voluntary resistance against passive movement without cogwheel rigidity, distractibility, "give-way" weakness, stuttering speech, bizarre gait, and a variety of behavioral symptoms. While the diagnosis of PP is clinical, functional imaging evaluating the integrity of nigrostriatal pathways can help distinguish PP from other types of parkinsonism. PP can coexist in patients with organic parkinsonism, adding to the challenge of making a diagnosis of PP. Being cognizant of the clinical signs of psychogenic movement disorders, including PP, will lead to earlier diagnosis and hopefully improved outcomes.
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Affiliation(s)
- M A Thenganatt
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - J Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
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Brandmeir NJ, Brandmeir CL, Kuzma K, McInerney J. A Prospective Evaluation of an Outpatient Assessment of Postural Instability to Predict Risk of Falls in Patients with Parkinson's Disease Presenting for Deep Brain Stimulation. Mov Disord Clin Pract 2015; 3:151-155. [PMID: 30713907 DOI: 10.1002/mdc3.12257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 08/04/2015] [Accepted: 08/08/2015] [Indexed: 11/11/2022] Open
Abstract
Background Postural instability (PI) and falls, major causes of morbidity in patients with PD, are often overlooked. DBS is a mainstay therapy for Parkinson's disease (PD) and has been purported to both worsen and improve PI. An effective PI evaluation that can predict fall risk in patients with PD presenting for DBS is needed. Methods Forty-nine consecutive patients with PD were enrolled. Self-reported falls were the gold standard. Tests evaluated were the Berg Balance Scale (BBS), Timed-Up-and-Go (TUG), Pull Test, and Biodex Balance System Sway Index on firm (SI-FIRM) and soft (SI-SOFT) surfaces. Results The best single tests for fall risk were the BBS and SI-FIRM, each with sensitivities of 79% and specificities of 60% and 65%, respectively. When the evaluation was combined into a composite measure requiring four positive tests out of five, the sensitivity was 72% and specificity was 80%. Conclusions A simple, efficient outpatient physical therapy assessment is effective in diagnosing fall risk in patients with PD.
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Affiliation(s)
- Nicholas J Brandmeir
- Department of Neurosurgery Penn State Milton S. Hershey Medical Center Hershey Pennsylvania USA
| | - Cheryl L Brandmeir
- Department of Therapy Services Penn State Milton S. Hershey Medical Center Hershey Pennsylvania USA
| | - Kristine Kuzma
- Department of Neurosurgery Penn State Milton S. Hershey Medical Center Hershey Pennsylvania USA
| | - James McInerney
- Department of Neurosurgery Penn State Milton S. Hershey Medical Center Hershey Pennsylvania USA
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Nonnekes J, Goselink R, Weerdesteyn V, Bloem BR. The retropulsion test: a good evaluation of postural instability in Parkinson's disease? J Parkinsons Dis 2015; 5:43-7. [PMID: 25613349 DOI: 10.3233/jpd-140514] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postural instability is a disabling feature of Parkinson's disease (PD), contributing to recurrent falls and fall-related injuries. The retropulsion test is widely regarded as the gold standard to evaluate postural instability, and is therefore a key component of the neurological examination in PD. Many variants exist, which confuses both clinical practice and research. Here, we evaluate the merits of this test by discussing three common variants: (1) the pull test as described in the MDS-UPDRS scale; (2) using an unexpected shoulder pull, without prior warning; and (3) the push-and-release test. All variants are a quick method to index the degree of postural instability, but the outcome can vary considerably due to variability in test execution and -interpretation. This partially explains why the retropulsion test fails to predict future falls in PD. Another explanation is that falling results from the complex interplay between gait, balance, cognitive decline and environmental factors, and the retropulsion test captures only part of that. We conclude with several recommendations for current clinical practice.
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Affiliation(s)
- Jorik Nonnekes
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Rianne Goselink
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - Vivian Weerdesteyn
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands Sint Maartenskliniek Research, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
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Ozinga SJ, Machado AG, Miller Koop M, Rosenfeldt AB, Alberts JL. Objective assessment of postural stability in Parkinson's disease using mobile technology. Mov Disord 2015; 30:1214-21. [PMID: 25809137 DOI: 10.1002/mds.26214] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/09/2015] [Accepted: 02/26/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A significant gap remains in the ability to effectively characterize postural instability in individuals with Parkinson's disease. Clinical evaluation of postural declines is largely subjective, whereas objective biomechanical approaches are expensive and time consuming, thus limiting clinical adoption. Recent advances in mobile devices present an opportunity to address the gap in the quantification of postural stability. The aim of this project was to determine whether kinematic data measured by hardware within a tablet device, a 3rd generation iPad, was of sufficient quantity and quality to characterize postural stability. METHODS Seventeen patients and 17 age-matched controls completed six balance conditions under altered surface, stance, and vision. Simultaneous kinematic measurements were gathered from a three-dimensional motion capture system and tablet. RESULTS The motion capture system and tablet provided similar measures of stability across groups. In particular, within the patient population, correlation between the two systems for peak-to-peak, normalized path length, root mean square, 95% volume, and total power values ranged from 0.66 to 1.00. Kinematic data from five balance conditions--double-leg stance with eyes open on a foam surface, double-leg stance with eyes closed on firm and foam surfaces, and tandem stance on firm and foam surfaces--were capable of discriminating patients from controls. CONCLUSIONS The hardware within the tablet provides data of sufficient accuracy for the quantification of postural stability in patients with Parkinson's disease. The objectivity, portability, and ease of use of this device make it ideal for use in clinical environments lacking sophisticated biomechanical systems.
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Affiliation(s)
- Sarah J Ozinga
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, Ohio, USA
| | - Andre G Machado
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mandy Miller Koop
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anson B Rosenfeldt
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
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Deputat IS, Gribanov AV, Nekhoroshkova AN, Moroz TP. [The DC-potential of the brain in older women with postural instability]. Adv Gerontol 2015; 28:749-754. [PMID: 28509466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The article presents the results of studies of the DC-potential of the brain level distribution in elderly women with postural instability. Analysis of the DC-potential of the brain level distribution was held by mapping obtained by measuring the monopolar values of the DC-potential of the brain and calculating deviations in each of the leads from the average records which were registered in all areas of the head. It is established that elderly women with postural instability DC-potential of the brain level distribution are characterized by increasing in background values and rigid structure of the interaction between brain regions. The disturbance of the principle of the dome-shaped DC-potential of the brain level distribution due to the alignment of values for brain regions was revealed. Factor model with postural instability reflects the control strengthening over the potential falls from the frontal areas of the brain.
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Affiliation(s)
- I S Deputat
- M. V. Lomonosov Institute of Medical and Biological Research, Arkhangelsk, 163045, Russian Federation;
| | - A V Gribanov
- M. V. Lomonosov Institute of Medical and Biological Research, Arkhangelsk, 163045, Russian Federation;
| | - A N Nekhoroshkova
- M. V. Lomonosov Institute of Medical and Biological Research, Arkhangelsk, 163045, Russian Federation;
| | - T P Moroz
- M. V. Lomonosov Institute of Medical and Biological Research, Arkhangelsk, 163045, Russian Federation;
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66
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Morita H, Hass CJ, Moro E, Sudhyadhom A, Kumar R, Okun MS. Pedunculopontine Nucleus Stimulation: Where are We Now and What Needs to be Done to Move the Field Forward? Front Neurol 2014; 5:243. [PMID: 25538673 PMCID: PMC4255598 DOI: 10.3389/fneur.2014.00243] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 11/10/2014] [Indexed: 11/13/2022] Open
Abstract
Falls and gait impairment in Parkinson's Disease (PD) is a leading cause of morbidity and mortality, significantly impacting quality of life and contributing heavily to disability. Thus far axial symptoms, such as postural instability and gait freezing, have been refractory to current treatment approaches and remain a critical unmet need. There has been increased excitement surrounding the surgical targeting of the pedunculopontine nucleus (PPN) for addressing axial symptoms in PD. The PPN and cuneate nucleus comprise the mesencephalic locomotor region, and electrophysiologic studies in animal models and human imaging studies have revealed a key role for the PPN in gait and postural control, underscoring a potential role for DBS surgery. Previous limited studies of PPN deep brain stimulation (DBS) in treating gait symptoms have had mixed clinical outcomes, likely reflect targeting variability and the inherent challenges of targeting a small brainstem structure that is both anatomically and neurochemically heterogeneous. Diffusion tractography shows promise for more accurate targeting and standardization of results. Due to the limited experience with PPN DBS, several unresolved questions remain about targeting and programing. At present, it is unclear if there is incremental benefit with bilateral versus unilateral targeting of PPN or whether PPN targeting should be performed as an adjunct to one of the more traditional targets. The PPN also modulates non-motor functions including REM sleep, cognition, mood, attention, arousal, and these observations will require long-term monitoring to fully characterize potential side effects and benefits. Surgical targeting of the PPN is feasible and shows promise for addressing axial symptoms in PD but may require further refinements in targeting, improved imaging, and better lead design to fully realize benefits. This review summarizes the current knowledge of PPN as a DBS target and areas that need to be addressed to advance the field.
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Affiliation(s)
- Hokuto Morita
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration , Gainesville, FL , USA
| | - Chris J Hass
- Department of Applied Physiology and Kinesiology, University of Florida , Gainesville, FL , USA
| | - Elena Moro
- Department of Psychiatry and Neurology, CHU de Grenoble , Grenoble , France
| | - Atchar Sudhyadhom
- Department of Radiation Oncology, University of California at San Francisco , San Francisco, CA , USA
| | - Rajeev Kumar
- Rocky Mountain Movement Disorder Center , Denver, CO , USA
| | - Michael S Okun
- Department of Neurology, University of Florida Center for Movement Disorders and Neurorestoration , Gainesville, FL , USA
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Ustinova KI, Chernikova LA, Dull A, Perkins J. Physical therapy for correcting postural and coordination deficits in patients with mild-to-moderate traumatic brain injury. Physiother Theory Pract 2014; 31:1-7. [PMID: 25083579 DOI: 10.3109/09593985.2014.945674] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to test the effects of a conventional exercise program designed for correcting postural and coordination abnormalities in patients with mild-to-moderate traumatic brain injury (TBI). Using principles of motor learning applied to functional exercise training, exercises were performed while lying, sitting, standing and walking, with the goal of improving intra- and inter-limb coordination in the upper and lower extremities, postural stability and gait pattern. Twenty-two participants with TBI-related deficits received therapy in a supervised outpatient clinic. Therapy included 20 sessions, each approximately 55 to 60 min in duration, scheduled four to five times a week over four consecutive weeks. Each participant was evaluated with a battery of clinical tests at baseline and immediately after therapy. Upon completion of the therapy, participants improved static and dynamic postural stability and gait, evaluated with the Berg Balance Scale (from 45.2 ± 5.9 to 49.2 ± 4.2 points) and the Functional Gait Assessment (from 22.8 ± 4.1 to 26.9 ± 3.4 points). They also reduced truncal, upper and lower extremity ataxia, evaluated with the Ataxia Scale (from 7.3 ± 4.5 to 5.9 ± 4.2 points). Results will be used to refine the current version of the exercise therapy, which focused on whole body coordination and balance, and to design a large-scale clinical trial establishing effectiveness of this intervention and for comparison with other forms of therapy.
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Affiliation(s)
- Ksenia I Ustinova
- Doctoral Program in Physical Therapy, Central Michigan University , Mount Pleasant, MI , USA
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68
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Abstract
One of the core elements of Parkinson's disease is postural reflex compromise. To test postural stability, the International Parkinson and Movement Disorder Society revision of the UPDRS (MDS-UPDRS) provides very specific instructions for uniform and safe testing. Item 3.12 (postural stability) is assessed after properly positioning the subject and explaining the testing procedure. After, the rater pulls briskly on the shoulders so that the subject must step backward and attempt to stabilize without falling. Based on the stability response, the rater enters the appropriate integer (0, 1, 2, 3, or 4) using the descriptive anchors for this item from the overall scale. With following proper safety measures and guidelines, all raters can perform this testing maneuver.
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Furnari A, Calabrò RS, Imbesi D, La Fauci Belponer F, Militi D, Gervasi G, Pastura C, Bramanti P. Can Baropodometric Analysis be a Useful Tool in the Early Diagnosis of Atypical Parkinsonism? Preliminary Findings. Innov Clin Neurosci 2014; 11:23-25. [PMID: 24653938 PMCID: PMC3960783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The differential diagnosis between atypical parkinsonism and Parkinson's disease is difficult, especially in the early stage. Severe postural instability, falls, and complex gait impairments are usually confined to the later stage of Parkinson's disease, while atypical parkinsonism patients may present a severe postural instability with consequent falls in the earlier stages. METHODS We retrospectively studied 20 subjects with parkinsonism using clinical and baropodometric tools to give quantitative and objective data on the postural, balance, and gait disturbances. RESULTS The statistical analysis between atypical parkinsonism and Parkinson's disease patients showed a significant difference in the frequency of long lead time parameter, foot area, foot load and speed, and, in particular, atypical parkinsonism patients presented a prevalent long lead time impairment (8/8 patients) when compared with Parkinson's disease patients. DISCUSSION Beside significant differences in the clinical features between the Parkinson's disease and atypical parkinsonism, our study showed that baropodometric investigation may a valuable tool for the definition of postural and motor extrapyramidal abnormalities, permitting an earlier differentiation between atypical parkinsonism and Parkinson's disease.
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Affiliation(s)
- Anna Furnari
- All from IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | | | | | | | - David Militi
- All from IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
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Basso Moro S, Bisconti S, Muthalib M, Spezialetti M, Cutini S, Ferrari M, Placidi G, Quaresima V. A semi-immersive virtual reality incremental swing balance task activates prefrontal cortex: a functional near-infrared spectroscopy study. Neuroimage 2014; 85 Pt 1:451-60. [PMID: 23684867 DOI: 10.1016/j.neuroimage.2013.05.031] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/17/2013] [Accepted: 05/03/2013] [Indexed: 12/14/2022] Open
Abstract
Previous functional near-infrared spectroscopy (fNIRS) studies indicated that the prefrontal cortex (PFC) is involved in the maintenance of the postural balance after external perturbations. So far, no studies have been conducted to investigate the PFC hemodynamic response to virtual reality (VR) tasks that could be adopted in the field of functional neurorehabilitation. The aim of this fNIRS study was to assess PFC oxygenation response during an incremental and a control swing balance task (ISBT and CSBT, respectively) in a semi-immersive VR environment driven by a depth-sensing camera. It was hypothesized that: i) the PFC would be bilaterally activated in response to the increase of the ISBT difficulty, as this cortical region is involved in the allocation of attentional resources to maintain postural control; and ii) the PFC activation would be greater in the right than in the left hemisphere considering its dominance for visual control of body balance. To verify these hypotheses, 16 healthy male subjects were requested to stand barefoot while watching a 3 dimensional virtual representation of themselves projected onto a screen. They were asked to maintain their equilibrium on a virtual blue swing board susceptible to external destabilizing perturbations (i.e., randomizing the forward-backward direction of the impressed pulse force) during a 3-min ISBT (performed at four levels of difficulty) or during a 3-min CSBT (performed constantly at the lowest level of difficulty of the ISBT). The center of mass (COM), at each frame, was calculated and projected on the floor. When the subjects were unable to maintain the COM over the board, this became red (error). After each error, the time required to bring back the COM on the board was calculated (returning time). An eight-channel continuous wave fNIRS system was employed for measuring oxygenation changes (oxygenated-hemoglobin, O2Hb; deoxygenated-hemoglobin, HHb) related to the PFC activation (Brodmann Areas 10, 11 and 46). The results have indicated that the errors increased between the first and the second level of difficulty of the ISBT, then decreased and remained constant; the returning time progressively increased during the first three levels of difficulty and then remained constant. During the CSBT, the errors and the returning time did not change. In the ISBT, the increase of the first three levels of difficulty was accompanied by a progressive increase in PFC O2Hb and a less consistent decrease in HHb. A tendency to plateau was observable for PFC O2Hb and HHb changes in the fourth level of difficulty of the ISBT, which could be partly explained by a learning effect. A right hemispheric lateralization was not found. A lower amplitude of increase in O2Hb and decrease in HHb was found in the PFC in response to the CSBT with respect to the ISBT. This study has demonstrated that the oxygenation increased over the PFC while performing an ISBT in a semi-immersive VR environment. These data reinforce the involvement of the PFC in attention-demanding balance tasks. Considering the adaptability of this virtual balance task to specific neurological disorders, the absence of motion sensing devices, and the motivating/safe semi-immersive VR environment, the ISBT adopted in this study could be considered valuable for diagnostic testing and for assessing the effectiveness of functional neurorehabilitation.
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Johnson L, James I, Rodrigues J, Stell R, Thickbroom G, Mastaglia F. Clinical and posturographic correlates of falling in Parkinson's disease. Mov Disord 2013; 28:1250-6. [PMID: 23609352 DOI: 10.1002/mds.25449] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 11/13/2012] [Accepted: 11/26/2012] [Indexed: 11/09/2022] Open
Abstract
Various clinical tests and balance scales have been used to assess postural stability and the risk of falling in patients with idiopathic Parkinson's disease (IPD). Quantitative posturography allows a more objective assessment but the findings in previous studies have been inconsistent and few studies have investigated which posturographic measures correlate best with a history of falling. The purpose of this study was to determine the efficacy of clinical tests, balance scales, and stable-platform posturography in detecting postural instability and discriminating between fallers and non-fallers in a home-dwelling PD cohort. Forty-eight PD subjects (Hoehn & Yahr stage 1-3) and 17 age-matched controls had the following assessments: Activities-specific Balance Confidence scale, Berg Balance Scale, Unified Parkinson's Disease Rating Scale (UPDRS) (motor), pull-test, timed up-and-go, static posturography, and dynamic posturography to assess multidirectional leaning balance. Of the clinical assessments, all but the pull-test were closely correlated with a history of falling. Static posturography discriminated between PD fallers and controls but not between PD fallers and non-fallers, whereas dynamic posturography (reaction time, velocity, and target hit-time) also discriminated between fallers and non-fallers. Our findings suggest that this combination of clinical and posturographic measures would be useful in the prospective assessment of falls risk in PD patients. A further prospective study is now required to assess their predictive value. © 2013 Movement Disorder Society.
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Affiliation(s)
- Liam Johnson
- University of Western Australia, Nedlands, Western Australia, Australia
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Duque G, Boersma D, Loza-Diaz G, Hassan S, Suarez H, Geisinger D, Suriyaarachchi P, Sharma A, Demontiero O. Effects of balance training using a virtual-reality system in older fallers. Clin Interv Aging 2013; 8:257-63. [PMID: 23467506 PMCID: PMC3588606 DOI: 10.2147/cia.s41453] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Poor balance is considered a challenging risk factor for falls in older adults. Therefore, innovative interventions for balance improvement in this population are greatly needed. The aim of this study was to evaluate the effect of a new virtual-reality system (the Balance Rehabilitation Unit [BRU]) on balance, falls, and fear of falling in a population of community-dwelling older subjects with a known history of falls. In this study, 60 community-dwelling older subjects were recruited after being diagnosed with poor balance at the Falls and Fractures Clinic, Nepean Hospital (Penrith, NSW, Australia). Subjects were randomly assigned to either the BRU-training or control groups. Both groups received the usual falls prevention care. The BRU-training group attended balance training (two sessions/week for 6 weeks) using an established protocol. Change in balance parameters was assessed in the BRU-training group at the end of their 6-week training program. Both groups were assessed 9 months after their initial assessment (month 0). Adherence to the BRU-training program was 97%. Balance parameters were significantly improved in the BRU-training group (P < 0.01). This effect was also associated with a significant reduction in falls and lower levels of fear of falling (P < 0.01). Some components of balance that were improved by BRU training showed a decline after 9 months post-training. In conclusion, BRU training is an effective and well-accepted intervention to improve balance, increase confidence, and prevent falls in the elderly.
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Affiliation(s)
- Gustavo Duque
- Falls and Fractures Clinic, Department of Geriatric Medicine, Nepean Hospital, Penrith, NSW, Australia.
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Abstract
Piercings (body art, i.e., with jewelry) are more and more widespread. They can induce various complications such as infections, allergies, headaches, and various skin, cartilage, or dental problems, and represent a public health problem. We draw attention to possible side effects resulting from face piercing complications observed on four young adults such as eye misalignment, decreased postural control efficiency, and non-specific chronic back pain with associated comorbidity. We found that the origin was pierced jewelry on the face. Removing the jewelry restored eye alignment, improved postural control, and alleviated back pain in a lasting way. We suggest that pierced facial jewelry can disturb somaesthetic signals driven by the trigeminal nerve, and thus interfere with central integration processes, notably in the cerebellum and the vestibular nucleus involved in postural control and eye alignment. Facial piercings could induce sensory–motor conflict, exacerbate, or precipitate a pre-existing undetermined conflict, which leads pain and complaints. These findings are significant for health; further investigations would be of interest.
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Affiliation(s)
- Eric Matheron
- IRIS Group, UMR 8194, CNRS, Service d'Ophtalmologie-ORL-Stomatologie, Hôpital Européen Georges Pompidou Paris, France
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Factor SA, Steenland NK, Higgins DS, Molho ES, Kay DM, Montimurro J, Rosen AR, Zabetian CP, Payami H. Postural instability/gait disturbance in Parkinson's disease has distinct subtypes: an exploratory analysis. J Neurol Neurosurg Psychiatry 2011; 82:564-8. [PMID: 20884673 PMCID: PMC4646086 DOI: 10.1136/jnnp.2010.222042] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To test the hypothesis that postural instability with falling (PIF) and freezing of gait (FOG) are distinct subtypes of the postural instability/gait disturbance (PIGD) form of Parkinson's disease (PD). METHODS 499 PD subjects from the NeuroGenetics Research Consortium were studied using logistic regression to examine, in a cross sectional analysis, predictors of FOG and PIF. Potential predictors were from four spheres; demographic, clinical motor, clinical non-motor and genetic. RESULTS FOG and PIF were both associated with greater gait subscores and lower tremor subscores on the Unified Parkinson's Disease Rating Scale (p ≤ 0.02). However, they differed with regard to demographic, non-motor and genetic predictors. FOG was associated with greater duration of disease, with ORs of 3.01 (95% CI 1.35 to 6.72) and 4.91 (95% CI 2.29 to 10.54) for third and fourth quartiles of duration, respectively, versus the lowest half of duration. The risk of having psychotic symptoms was also significantly increased (OR 3.02, 95% CI 1.41 to 6.49; p=0.004). FOG was inversely associated with the presence of the CYP2D6*4 allele (OR 0.41, 95% CI 0.21 to 0.80; p=0.009) suggesting a protective effect. PIF was associated with depression (OR 1.08, 95% CI 1.01 to 1.15; p<0.02) and was inversely associated with APOE ε4 (OR 0.21, 95% CI 0.05 to 0.87; p=0.03), again suggesting a protective effect. CONCLUSION FOG and PIF have different demographic, non-motor and genetic predictors suggesting that they may be pathophysiologically distinct subtypes of PIGD. These findings have implications in the discovery of therapeutic targets for these disabling features as well as for predicting outcomes of PD.
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Affiliation(s)
- Stewart A Factor
- Emory University School of Medicine, Department of Neurology, 1841 Clifton Road NE, Atlanta, GA 30329, USA.
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Abstract
Methods of varying complexity have been devised to measure movements involved in the control of posture (sway). Dose-related effects of centrally acting drugs on postural sway have been demonstrated.
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