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Holden H, Venkatesh S, Budrow C, Nezaria S, Coyle M, Centner A, Lipari N, McManus G, Bishop C. The effects of L-DOPA on gait abnormalities in a unilateral 6-OHDA rat model of Parkinson's disease. Physiol Behav 2024; 281:114563. [PMID: 38723388 DOI: 10.1016/j.physbeh.2024.114563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/27/2024]
Abstract
Parkinson's Disease (PD) is a neurodegenerative movement disorder characterized by dopamine (DA) cell loss in the substantia nigra pars compacta (SNc). As PD progresses, patients display disruptions in gait such as changes in posture, bradykinesia, and shortened stride. DA replacement via L-DOPA alleviates many PD symptoms, though its effects on gait are not well demonstrated. This study aimed to assess the relationship between DA lesion, gait, and deficit-induced reversal with L-DOPA. To do so, Sprague-Dawley rats (N = 25, 14 males, 11 females) received unilateral medial forebrain bundle (MFB) DA lesions with 6-hydroxydopamine (6-OHDA). An automated gait analysis system assessed spatiotemporal gait parameters pre- and post-lesion, and after various doses of L-DOPA (0, 3, or 6 mg/kg; s.c.). The forepaw adjusting steps (FAS) test was implemented to evaluate lesion efficacy while the abnormal involuntary movements (AIMs) scale monitored the emergence of L-DOPA-induced dyskinesia (LID). High performance liquid chromatography (HPLC) assessed changes in brain monoamines on account of lesion and treatment. Results revealed lesion-induced impairments in gait, inclusive of max-contact area and step-sequence alterations that were not reversible with L-DOPA. However, the emergence of AIMs were observed at higher doses. Post-mortem, 6-OHDA lesions induced a loss of striatal DA and norepinephrine (NE), while prefrontal cortex (PFC) displayed noticeable reduction in NE but not DA. Our findings indicate that hemiparkinsonian rats display measurable gait disturbances similar to PD patients that are not rescued by DA replacement. Furthermore, non-DA mechanisms such as attention-related NE in PFC may contribute to altered gait and may constitute a novel target for its treatment.
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Affiliation(s)
- Hannah Holden
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Shruti Venkatesh
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Carla Budrow
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Sareen Nezaria
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Michael Coyle
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Ashley Centner
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Natalie Lipari
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Grace McManus
- Department of Psychology, Binghamton University, Binghamton, NY, USA
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Hong R, Wu Z, Peng K, Zhang J, He Y, Zhang Z, Gao Y, Jin Y, Su X, Zhi H, Guan Q, Pan L, Jin L. Kinect-based objective assessment of the acute levodopa challenge test in parkinsonism: a feasibility study. Neurol Sci 2024; 45:2661-2670. [PMID: 38183553 DOI: 10.1007/s10072-023-07296-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/28/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION The acute levodopa challenge test (ALCT) is an important and valuable examination but there are still some shortcomings with it. We aimed to objectively assess ALCT based on a depth camera and filter out the best indicators. METHODS Fifty-nine individuals with parkinsonism completed ALCT and the improvement rate (IR, which indicates the change in value before and after levodopa administration) of the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III) was calculated. The kinematic features of the patients' movements in both the OFF and ON states were collected with an Azure Kinect depth camera. RESULTS The IR of MDS-UPDRS III was significantly correlated with the IRs of many kinematic features for arising from a chair, pronation-supination movements of the hand, finger tapping, toe tapping, leg agility, and gait (rs = - 0.277 ~ - 0.672, P < 0.05). Moderate to high discriminative values were found in the selected features in identifying a clinically significant response to levodopa with sensitivity, specificity, and area under the curve (AUC) in the range of 50-100%, 47.22%-97.22%, and 0.673-0.915, respectively. The resulting classifier combining kinematic features of toe tapping showed an excellent performance with an AUC of 0.966 (95% CI = 0.922-1.000, P < 0.001). The optimal cut-off value was 21.24% with sensitivity and specificity of 94.44% and 87.18%, respectively. CONCLUSION This study demonstrated the feasibility of measuring the effect of levodopa and objectively assessing ALCT based on kinematic data derived from an Azure Kinect-based system.
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Affiliation(s)
- Ronghua Hong
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons' Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, School of Medicine, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University, Shanghai, China
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China
| | - Zhuang Wu
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons' Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, School of Medicine, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University, Shanghai, China
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China
| | - Kangwen Peng
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China
| | - Jingxing Zhang
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China
| | - Yijing He
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China
| | - Zhuoyu Zhang
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China
| | - Yichen Gao
- IFLYTEK Suzhou Research Institute, Suzhou, China
| | - Yue Jin
- IFLYTEK Suzhou Research Institute, Suzhou, China
| | - Xiaoyun Su
- IFLYTEK Suzhou Research Institute, Suzhou, China
| | - Hongping Zhi
- IFLYTEK Suzhou Research Institute, Suzhou, China
| | - Qiang Guan
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China
| | - Lizhen Pan
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China.
| | - Lingjing Jin
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons' Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, School of Medicine, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University, Shanghai, China.
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, School of Medicine, Neurotoxin Research CenterTongji HospitalTongji University, Shanghai, China.
- Collaborative Innovation Center for Brain Science, Tongji University, Shanghai, China.
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van Midden V, Simončič U, Pirtošek Z, Kojović M. The Effect of taVNS at 25 Hz and 100 Hz on Parkinson's Disease Gait-A Randomized Motion Sensor Study. Mov Disord 2024. [PMID: 38757756 DOI: 10.1002/mds.29826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/27/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Transcutaneous electrostimulation of the auricular branch of the vagal nerve (taVNS) has the propensity to reach diffuse neuromodulatory networks, which are dysfunctional in Parkinson's disease (PD). Previous studies support the use of taVNS as an add-on treatment for gait in PD. OBJECTIVES We assessed the effect of taVNS at 25 Hz (taVNS25), taVNS at 100 Hz (taVNS100), and sham earlobe stimulation (sVNS) on levodopa responsive (arm swing velocity, arm range of motion, stride length, gait speed) and non-responsive gait characteristics (arm range of motion asymmetry, anticipatory postural adjustment [APA] duration, APA first step duration, APA first step range of motion), and turns (first turn duration, double 360° turn duration, steps per turn) in advanced PD. METHODS In our double blind sham controlled within-subject randomized trial, we included 30 PD patients (modified Hoehn and Yahr stage, 2.5-4) to assess the effect of taVNS25, taVNS100, and sVNS on gait characteristics measured with inertial motion sensors during the instrumented stand and walk test and a double 360° turn. Separate generalized mixed models were built for each gait characteristic. RESULTS During taVNS100 compared to sVNS arm swing velocity (P = 0.030) and stride length increased (P = 0.027), and APA duration decreased (P = 0.050). During taVNS25 compared to sVNS stride length (P = 0.024) and gait speed (P = 0.021) increased and double 360° turn duration decreased (P = 0.039). CONCLUSIONS We have found that taVNS has a frequency specific propensity to improve stride length, arm swing velocity, and gait speed and double 360° turn duration in PD patients. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Vesna van Midden
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Urban Simončič
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
- Jozef Stefan Institute, Ljubljana, Slovenia
| | - Zvezdan Pirtošek
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Kojović
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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Zhang X, Jin Y, Wang M, Ji C, Chen Z, Fan W, Rainer TH, Guan Q, Li Q. The impact of anxiety on gait impairments in Parkinson's disease: insights from sensor-based gait analysis. J Neuroeng Rehabil 2024; 21:68. [PMID: 38689288 PMCID: PMC11059709 DOI: 10.1186/s12984-024-01364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Sensor-based gait analysis provides a robust quantitative tool for assessing gait impairments and their associated factors in Parkinson's disease (PD). Anxiety is observed to interfere with gait clinically, but this has been poorly investigated. Our purpose is to utilize gait analysis to uncover the effect of anxiety on gait in patients with PD. METHODS We enrolled 38 and 106 PD patients with and without anxiety, respectively. Gait parameters were quantitively examined and compared between two groups both in single-task (ST) and dual-task (DT) walking tests. Multiple linear regression was applied to evaluate whether anxiety independently contributed to gait impairments. RESULTS During ST, PD patients with anxiety presented significantly shorter stride length, lower gait velocity, longer stride time and stance time, longer stance phase, smaller toe-off (TO) and heel-strike (HS) angles than those without anxiety. While under DT status, the differences were diminished. Multiple linear regression analysis demonstrated that anxiety was an independent factor to a serials of gait parameters, particularly ST-TO (B = -2.599, (-4.82, -0.38)), ST-HS (B = -2.532, (-4.71, -0.35)), ST-TO-CV (B = 4.627, (1.71, 7.64)), ST-HS-CV(B = 4.597, (1.66, 7.53)), ST stance phase (B = 1.4, (0.22, 2.58)), and DT stance phase (B = 1.749, (0.56, 2.94)). CONCLUSION Our study discovered that anxiety has a significant impact on gait impairments in PD patients, especially exacerbating shuffling steps and prolonging stance phase. These findings highlight the importance of addressing anxiety in PD precision therapy to achieve better treatment outcomes.
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Affiliation(s)
- Xiaodan Zhang
- Department of Neurology, Ningbo NO.2 Hospital, Ningbo, Zhejiang Province, China
- Department of Emergency Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Yulan Jin
- Department of Clinical Laboratory, Ningbo NO.2 Hospital, Ningbo, Zhejiang Province, China
| | - Mateng Wang
- Department of General Surgery, Yinzhou NO.2 Hospital, Ningbo, Zhejiang Province, China
| | - Chengcheng Ji
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang Province, China
| | - Zhaoying Chen
- Department of Neurology, Ningbo NO.2 Hospital, Ningbo, Zhejiang Province, China
| | - Weinv Fan
- Department of Neurology, Ningbo NO.2 Hospital, Ningbo, Zhejiang Province, China
| | | | - Qiongfeng Guan
- Department of Neurology, Ningbo NO.2 Hospital, Ningbo, Zhejiang Province, China.
| | - Qianyun Li
- Department of Neurology, Ningbo NO.2 Hospital, Ningbo, Zhejiang Province, China.
- Department of Emergency Medicine, University of Hong Kong, Hong Kong SAR, China.
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Zampogna A, Borzì L, Rinaldi D, Artusi CA, Imbalzano G, Patera M, Lopiano L, Pontieri F, Olmo G, Suppa A. Unveiling the Unpredictable in Parkinson's Disease: Sensor-Based Monitoring of Dyskinesias and Freezing of Gait in Daily Life. Bioengineering (Basel) 2024; 11:440. [PMID: 38790307 PMCID: PMC11117481 DOI: 10.3390/bioengineering11050440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Dyskinesias and freezing of gait are episodic disorders in Parkinson's disease, characterized by a fluctuating and unpredictable nature. This cross-sectional study aims to objectively monitor Parkinsonian patients experiencing dyskinesias and/or freezing of gait during activities of daily living and assess possible changes in spatiotemporal gait parameters. METHODS Seventy-one patients with Parkinson's disease (40 with dyskinesias and 33 with freezing of gait) were continuously monitored at home for a minimum of 5 days using a single wearable sensor. Dedicated machine-learning algorithms were used to categorize patients based on the occurrence of dyskinesias and freezing of gait. Additionally, specific spatiotemporal gait parameters were compared among patients with and without dyskinesias and/or freezing of gait. RESULTS The wearable sensor algorithms accurately classified patients with and without dyskinesias as well as those with and without freezing of gait based on the recorded dyskinesias and freezing of gait episodes. Standard spatiotemporal gait parameters did not differ significantly between patients with and without dyskinesias or freezing of gait. Both the time spent with dyskinesias and the number of freezing of gait episodes positively correlated with the disease severity and medication dosage. CONCLUSIONS A single inertial wearable sensor shows promise in monitoring complex, episodic movement patterns, such as dyskinesias and freezing of gait, during daily activities. This approach may help implement targeted therapeutic and preventive strategies for Parkinson's disease.
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Affiliation(s)
- Alessandro Zampogna
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.Z.); (M.P.)
- IRCCS Neuromed Institute, 86077 Pozzilli, IS, Italy
| | - Luigi Borzì
- Data Analytics and Technologies for Health Lab (ANTHEA), Department of Control and Computer Engineering, Politecnico di Torino, 10129 Turin, Italy; (L.B.); (G.O.)
| | - Domiziana Rinaldi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (D.R.); (F.P.)
| | - Carlo Alberto Artusi
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Torino, Italy; (C.A.A.); (G.I.); (L.L.)
- Neurology 2 Unit, A.O.U, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Torino, Italy; (C.A.A.); (G.I.); (L.L.)
| | - Martina Patera
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.Z.); (M.P.)
| | - Leonardo Lopiano
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Torino, Italy; (C.A.A.); (G.I.); (L.L.)
- Neurology 2 Unit, A.O.U, Città della Salute e della Scienza di Torino, 10126 Torino, Italy
| | - Francesco Pontieri
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy; (D.R.); (F.P.)
| | - Gabriella Olmo
- Data Analytics and Technologies for Health Lab (ANTHEA), Department of Control and Computer Engineering, Politecnico di Torino, 10129 Turin, Italy; (L.B.); (G.O.)
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.Z.); (M.P.)
- IRCCS Neuromed Institute, 86077 Pozzilli, IS, Italy
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Barbosa R, Mendonça M, Bastos P, Pita Lobo P, Valadas A, Correia Guedes L, Ferreira JJ, Rosa MM, Matias R, Coelho M. 3D Kinematics Quantifies Gait Response to Levodopa earlier and to a more Comprehensive Extent than the MDS-Unified Parkinson's Disease Rating Scale in Patients with Motor Complications. Mov Disord Clin Pract 2024. [PMID: 38610081 DOI: 10.1002/mdc3.14016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/20/2024] [Accepted: 02/13/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Quantitative 3D movement analysis using inertial measurement units (IMUs) allows for a more detailed characterization of motor patterns than clinical assessment alone. It is essential to discriminate between gait features that are responsive or unresponsive to current therapies to better understand the underlying pathophysiological basis and identify potential therapeutic strategies. OBJECTIVES This study aims to characterize the responsiveness and temporal evolution of different gait subcomponents in Parkinson's disease (PD) patients in their OFF and various ON states following levodopa administration, utilizing both wearable sensors and the gold-standard MDS-UPDRS motor part III. METHODS Seventeen PD patients were assessed while wearing a full-body set of 15 IMUs in their OFF state and at 20-minute intervals following the administration of a supra-threshold levodopa dose. Gait was reconstructed using a biomechanical model of the human body to quantify how each feature was modulated. Comparisons with non-PD control subjects were conducted in parallel. RESULTS Significant motor changes were observed in both the upper and lower limbs according to the MDS-UPDRS III, 40 minutes after levodopa intake. IMU-assisted 3D kinematics detected significant motor alterations as early as 20 minutes after levodopa administration, particularly in upper limbs metrics. Although all "pace-domain" gait features showed significant improvement in the Best-ON state, most rhythmicity, asymmetry, and variability features did not. CONCLUSION IMUs are capable of detecting motor alterations earlier and in a more comprehensive manner than the MDS-UPDRS III. The upper limbs respond more rapidly to levodopa, possibly reflecting distinct thresholds to levodopa across striatal regions.
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Affiliation(s)
- Raquel Barbosa
- Neurology Deparment, Centre Hospitalier Universitaire Toulouse, Toulouse, France
- Nova Medical School, Faculdade de Ciências Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Marcelo Mendonça
- Nova Medical School, Faculdade de Ciências Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Paulo Bastos
- Neurology Deparment, Centre Hospitalier Universitaire Toulouse, Toulouse, France
- Nova Medical School, Faculdade de Ciências Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Patrícia Pita Lobo
- Department of Neurosciences and Mental Health, Neurology Hospital Santa Maria, CHLUN, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Anabela Valadas
- Department of Neurosciences and Mental Health, Neurology Hospital Santa Maria, CHLUN, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Leonor Correia Guedes
- Department of Neurosciences and Mental Health, Neurology Hospital Santa Maria, CHLUN, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- CNS- Campus Neurológico Senior, Torres Vedras, Portugal
| | - Mário Miguel Rosa
- Department of Neurosciences and Mental Health, Neurology Hospital Santa Maria, CHLUN, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ricardo Matias
- Physics Department & Institute of Biophysics and Biomedical Engineering (IBEB), Faculty of Sciences, University of Lisbon, Lisbon, Portugal
- Kinetikos, Coimbra, Portugal
| | - Miguel Coelho
- Department of Neurosciences and Mental Health, Neurology Hospital Santa Maria, CHLUN, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Baudendistel ST, Franz JR, Schmitt AC, Wade FE, Pappas MC, Au KLK, Hass CJ. Visual feedback improves propulsive force generation during treadmill walking in people with Parkinson disease. J Biomech 2024; 167:112073. [PMID: 38599018 PMCID: PMC11046741 DOI: 10.1016/j.jbiomech.2024.112073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/29/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
Persons with Parkinson's disease experience gait alterations, such as reduced step length. Gait dysfunction is a significant research priority as the current treatments targeting gait impairment are limited. This study aimed to investigate the effects of visual biofeedback on propulsive force during treadmill walking in persons with Parkinson's. Sixteen ambulatory persons with Parkinson's participated in the study. They received real-time biofeedback of anterior ground reaction force during treadmill walking at a constant speed. Peak propulsive force values were measured and normalized to body weight. Spatiotemporal parameters were also assessed, including stride length and double support percent. Persons with Parkinson's significantly increased peak propulsive force during biofeedback compared to baseline (p <.0001, Cohen's dz = 1.69). Variability in peak anterior ground reaction force decreased across repeated trials (p <.0001, dz = 1.51). While spatiotemporal parameters did not show significant changes individually, stride length and double support percent improved marginally during biofeedback trials. Persons with Parkinson's can increase propulsive force with visual biofeedback, suggesting the presence of a propulsive reserve. Though stride length did not significantly change, clinically meaningful improvements were observed. Targeting push-off force through visual biofeedback may offer a potential rehabilitation technique to enhance gait performance in Persons with Parkinson's. Future studies could explore the long-term efficacy of this intervention and investigate additional strategies to improve gait in Parkinson's disease.
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Affiliation(s)
- Sidney T Baudendistel
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA; Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA.
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Abigail C Schmitt
- Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Francesca E Wade
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Marc C Pappas
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA
| | | | - Chris J Hass
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA; Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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8
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Mirando M, Penati R, Godi M, Giardini M, Nardone A. The Effect of Upright Stance and Vision on a Cognitive Task in Elderly Subjects and Patients with Parkinson's Disease. Brain Sci 2024; 14:305. [PMID: 38671957 PMCID: PMC11047827 DOI: 10.3390/brainsci14040305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Standing compared to sitting enhances cognitive performance in healthy subjects. The effect of stance on cognitive performance has been addressed here in patients with Parkinson's disease (PwPD). We hypothesized that a simple cognitive task would be less enhanced in PwPD by standing with respect to sitting, because of a larger cognitive effort for maintenance of standing posture than in healthy subjects. We recruited 40 subjects (20 PwPD and 20 age-matched healthy subjects, HE). Each participant performed an arithmetic task (backward counting aloud by 7) in two postural states, sitting and standing, with eyes open (EO) and with eyes closed (EC). All trials lasted 60 s and were randomized across subjects and conditions. The number of correct subtractions per trial was an index of counting efficiency and the ratio of correct subtractions to total subtractions was an index of accuracy. All conditions collapsed, the efficiency of the cognitive task was significantly lower in PwPD than HE, whilst accuracy was affected to a lower extent. Efficiency significantly improved from sitting to standing in HE under both visual conditions whilst only with EO in PwPD. Accuracy was not affected by posture or vision in either group. We suggest that standing, compared to sitting, increases arousal, thus improving the cognitive performance in HE. Conversely, in PwPD this improvement was present only with vision, possibly due to their greater balance impairment with EC consuming an excess of attentional resources. These findings have implications for balance control and the risk of falling in PwPD in the absence of visual cues.
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Affiliation(s)
- Marta Mirando
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (M.M.); (R.P.)
| | - Rachele Penati
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (M.M.); (R.P.)
| | - Marco Godi
- Physical Medicine and Rehabilitation Unit of Veruno Institute, Istituti Clinici Scientifici Maugeri IRCCS, 28010 Veruno, Italy; (M.G.); (M.G.)
| | - Marica Giardini
- Physical Medicine and Rehabilitation Unit of Veruno Institute, Istituti Clinici Scientifici Maugeri IRCCS, 28010 Veruno, Italy; (M.G.); (M.G.)
| | - Antonio Nardone
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (M.M.); (R.P.)
- Centro Studi Attività Motorie and Neurorehabilitation and Spinal Units of Pavia Institute, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
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Farokhniaee A, Palmisano C, Del Vecchio Del Vecchio J, Pezzoli G, Volkmann J, Isaias IU. Gait-related beta-gamma phase amplitude coupling in the subthalamic nucleus of parkinsonian patients. Sci Rep 2024; 14:6674. [PMID: 38509158 PMCID: PMC10954750 DOI: 10.1038/s41598-024-57252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/15/2024] [Indexed: 03/22/2024] Open
Abstract
Analysis of coupling between the phases and amplitudes of neural oscillations has gained increasing attention as an important mechanism for large-scale brain network dynamics. In Parkinson's disease (PD), preliminary evidence indicates abnormal beta-phase coupling to gamma-amplitude in different brain areas, including the subthalamic nucleus (STN). We analyzed bilateral STN local field potentials (LFPs) in eight subjects with PD chronically implanted with deep brain stimulation electrodes during upright quiet standing and unperturbed walking. Phase-amplitude coupling (PAC) was computed using the Kullback-Liebler method, based on the modulation index. Neurophysiological recordings were correlated with clinical and kinematic measurements and individual molecular brain imaging studies ([123I]FP-CIT and single-photon emission computed tomography). We showed a dopamine-related increase in subthalamic beta-gamma PAC from standing to walking. Patients with poor PAC modulation and low PAC during walking spent significantly more time in the stance and double support phase of the gait cycle. Our results provide new insights into the subthalamic contribution to human gait and suggest cross-frequency coupling as a gateway mechanism to convey patient-specific information of motor control for human locomotion.
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Affiliation(s)
- AmirAli Farokhniaee
- Fondazione Grigioni Per Il Morbo Di Parkinson, Via Gianfranco Zuretti 35, 20125, Milano, Italy.
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy.
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Jasmin Del Vecchio Del Vecchio
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Gianni Pezzoli
- Fondazione Grigioni Per Il Morbo Di Parkinson, Via Gianfranco Zuretti 35, 20125, Milano, Italy
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Ioannis U Isaias
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
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10
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Herbers C, Zhang R, Erdman A, Johnson MD. Distinguishing features of Parkinson's disease fallers based on wireless insole plantar pressure monitoring. NPJ Parkinsons Dis 2024; 10:67. [PMID: 38503777 PMCID: PMC10951221 DOI: 10.1038/s41531-024-00678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
Postural instability is one of the most disabling motor signs of Parkinson's disease (PD) and often underlies an increased likelihood of falling and loss of independence. Current clinical assessments of PD-related postural instability are based on a retropulsion test, which introduces human error and only evaluates reactive balance. There is an unmet need for objective, multi-dimensional assessments of postural instability that directly reflect activities of daily living in which individuals may experience postural instability. In this study, we trained machine-learning models on insole plantar pressure data from 111 participants (44 with PD and 67 controls) as they performed simulated static and active postural tasks of activities that often occur during daily living. Models accurately classified PD from young controls (area under the curve (AUC) 0.99+/- 0.00), PD from age-matched controls (AUC 0.99+/- 0.01), and PD fallers from PD non-fallers (AUC 0.91+/- 0.08). Utilizing features from both static and active postural tasks significantly improved classification performances, and all tasks were useful for separating PD from controls; however, tasks with higher postural threats were preferred for separating PD fallers from PD non-fallers.
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Affiliation(s)
- Cara Herbers
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, 55455, MN, USA
| | - Raymond Zhang
- Department of Biomedical Engineering, University of Minnesota, 312 Church Street SE, Minneapolis, 55455, MN, USA
| | - Arthur Erdman
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, 55455, MN, USA
| | - Matthew D Johnson
- Department of Biomedical Engineering, University of Minnesota, 312 Church Street SE, Minneapolis, 55455, MN, USA.
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11
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Monaghan AS, Hooyman A, Dibble LE, Mehta SH, Peterson DS. Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease. J Neurol Phys Ther 2024:01253086-990000000-00061. [PMID: 38489661 DOI: 10.1097/npt.0000000000000471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND AND PURPOSE Reactive balance training improves reactive postural control in people with Parkinson disease (PwPD). However, the extent to which reactive balance training generalizes to a novel, unpracticed reactive balance task is unknown. This study aimed to determine whether reactive training stepping through support surface translations can be generalized to an unpracticed, instrumented tether-release task. METHODS Twenty-five PwPD (70.52 years ± 7.15; Hoehn and Yahr range 1-3) completed a multiple baseline, open-label, uncontrolled pre-post intervention study. Stepping was trained through a 2-week (6-session) intervention with repeated support surface translations. Performance on an untrained tether-release task (generalization task) was measured at 2 baseline assessments (B1 and B2, 2 weeks apart), immediately after the intervention (P1), and 2 months after training (P2). The tether-release task outcomes were the anterior-posterior margin of stability (MOS), step length, and step latency during backward and forward steps. RESULTS After support surface translation practice, tether-release stepping performance improved in MOS, step length, and step latency for both backward and forward steps compared to baseline (P < 0.05). Improvements in MOS and step length during backward and forward steps in the tether-release task, respectively, were related to stepping changes in the practiced task. However, the improvements in the generalization task were not retained for 2 months. DISCUSSION AND CONCLUSIONS These findings support short-term generalization from trained balance tasks to novel, untrained tasks. These findings contribute to our understanding of the effects and generalization of reactive step training in PwPD. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at http://links.lww.com/JNPT/A465).
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Affiliation(s)
- Andrew S Monaghan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, Georgia (A.S.M.); School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona (A.H.); Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah (L.E.D.); Department of Neurology, Mayo Clinic, Scottsdale, Arizona (S.H.M.); College of Health Solutions, Arizona State University, Tempe, Arizona (D.S.P.); and Phoenix VA Health Care Center, Phoenix, Arizona (D.S.P.)
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12
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Seuthe J, Heinzel A, Hulzinga F, Ginis P, Zeuner KE, Deuschl G, D’Cruz N, Nieuwboer A, Schlenstedt C. Towards a better understanding of anticipatory postural adjustments in people with Parkinson's disease. PLoS One 2024; 19:e0300465. [PMID: 38466709 PMCID: PMC10927092 DOI: 10.1371/journal.pone.0300465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/12/2024] [Indexed: 03/13/2024] Open
Abstract
INTRODUCTION Previous studies have shown that anticipatory postural adjustments (APAs) are altered in people with Parkinson's disease but its meaning for locomotion is less understood. This study aims to investigate the association between APAs and gait initiation, gait and freezing of gait and how a dynamic postural control challenging training may induce changes in these features. METHODS Gait initiation was quantified using wearable sensors and subsequent straight walking was assessed via marker-based motion capture. Additionally, turning and FOG-related outcomes were measured with wearable sensors. Assessments were conducted one week before (Pre), one week after (Post) and 4 weeks after (Follow-up) completion of a training intervention (split-belt treadmill training or regular treadmill training), under single task and dual task (DT) conditions. Statistical analysis included a linear mixed model for training effects and correlation analysis between APAs and the other outcomes for Pre and Post-Pre delta. RESULTS 52 participants with Parkinson's disease (22 freezers) were assessed. We found that APA size in the medio-lateral direction during DT was positively associated with gait speed (p<0.001) and stride length (p<0.001) under DT conditions at Pre. The training effect was largest for first step range of motion and was similar for both training modes. For the associations between changes after the training (pooled sample) medio-lateral APA size showed a significant positive correlation with first step range of motion (p = 0.033) only in the DT condition and for the non-freezers only. CONCLUSIONS The findings of this work revealed new insights into how APAs were not associated with first step characteristics and freezing and only baseline APAs during DT were related with DT gait characteristics. Training-induced changes in the size of APAs were related to training benefits in the first step ROM only in non-freezers. Based on the presented results increasing APA size through interventions might not be the ideal target for overall improvement of locomotion.
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Affiliation(s)
- Jana Seuthe
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anna Heinzel
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Femke Hulzinga
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Pieter Ginis
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Kirsten E. Zeuner
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nicholas D’Cruz
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Christian Schlenstedt
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
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Tsai SY, Tai CH, Lee YY. Exploring Potential Predictors of Treadmill Training Effects in People With Parkinson Disease. Arch Phys Med Rehabil 2024; 105:525-530. [PMID: 37757940 DOI: 10.1016/j.apmr.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/30/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To explore the potential predictors of people with Parkinson disease (PD) who would benefit the most from treadmill training. DESIGN A cohort study. SETTING Medical university rehabilitation settings. PARTICIPANTS Seventy participants diagnosed of idiopathic PD. INTERVENTIONS Twelve sessions of treadmill training. MAIN OUTCOME MEASURES Hierarchical logistic regression models were used to explore significant predictors of the treadmill training effect with respect to 3 health domains: Unified Parkinson's Disease Rating Scales part III (UPDRS III); gait speed; Parkinson's Disease Questionnaire-39 (PDQ-39). A receiver operating characteristic (ROC) curve analysis was conducted to identify proper cut-off points for clinical use. RESULTS Male sex (adjusted odds ratio [OR]: 3.73, P=.036) significantly predicted the improvement of UPDRS III. Individuals with a slower baseline gait speed (cut-off: 0.92 m/s, adjusted OR: 14.06, P<.001) and higher baseline balance confidence measured by the Activity-specific Balance Confidence scale (cut-off: 84.5 points, adjusted OR: 4.66, P=.022) have greater potential to achieve clinically relevant improvements in gait speed. A poorer baseline PDQ-39 score (cut-off: 23.1, adjusted OR: 7.47, P<.001) predicted a greater quality of life improvement after treadmill training. CONCLUSIONS These findings provide a guideline for clinicians to easily identify suitable candidates for treadmill training. Generalization to more advanced patients with PD warrants further investigation.
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Affiliation(s)
- Si-Yu Tsai
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Hwei Tai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
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14
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Wei X, Wang S, Zhang M, Yan Y, Wang Z, Wei W, Tuo H, Wang Z. Gait impairment-related axonal degeneration in Parkinson's disease by neurite orientation dispersion and density imaging. NPJ Parkinsons Dis 2024; 10:45. [PMID: 38413647 PMCID: PMC10899173 DOI: 10.1038/s41531-024-00654-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/06/2024] [Indexed: 02/29/2024] Open
Abstract
Microstructural alterations in the brain networks of Parkinson's disease (PD) patients are correlated with gait impairments. Evaluate microstructural alterations in the white matter (WM) fiber bundle tracts using neurite orientation dispersion and density imaging (NODDI) technique in PD versus healthy controls (HC). In this study, 24 PD patients and 29 HC were recruited. NODDI and high-resolution 3D structural images were acquired for each participant. The NODDI indicators, including the intracellular neurite density index (NDI), orientation dispersion index (ODI), and isotropic volume fraction (ISO), were compared between the two groups. Diffusion-weighted (DW) images were preprocessed using MRtrix 3.0 software and the orientation distribution function to trace the main nerve fiber tracts in PD patients. Quantitative gait and clinical assessment scales were used to compare the medication "ON" and "OFF" states of PD patients. The NDI, ODI, and ISO values of the WM fiber bundles were significantly higher in PD patients compared to HC. Fiber bundles, including the anterior thalamic radiation, corticospinal tract, superior longitudinal fasciculus, forceps major, cingulum, and inferior longitudinal fasciculus, were found to be significantly affected in PD. The NDI changes of PD patients were well correlated with stride lengths in the "ON" state; ODI changes were correlated with the stride time in the "ON" and "OFF" states and ISO changes were correlated with the stride time and cadence in the "ON" state. In conclusion, combination of NODDI technique and gait parameters can help detect gait impairment in PD patients early and accurately.
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Grants
- 82202097 National Natural Science Foundation of China (National Science Foundation of China)
- 82071257 National Natural Science Foundation of China (National Science Foundation of China)
- Beijing Scholars Program is the highest-level talent development program approved by the Beijing Municipal People’s Government. It aims to cultivate a group of scientists, engineers, and renowned experts who are at the forefront of global science and technology, possess innovative capabilities, and have international advanced levels. The program provides intellectual support for the construction of a globally influential science and technology innovation center.
- Beijing Hospitals Authority’ Youth Programme is one of the three major talent development programs, namely "Qingmiao, Dengfeng, Shiming," launched by the Beijing Hospital Management Center in 2015. This program aims to support and cultivate young talents and provide a development platform for the growth of young talents in municipal hospitals through various training initiatives. Training Fund for Open Projects at Clinical Institutes and Departments of Capital Medical University is a research support fund program for young doctors opened by Capital Medical University, targeting different specialties, colleges, and departments.
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Affiliation(s)
- Xuan Wei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shiya Wang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mingkai Zhang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ying Yan
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei Wei
- Division of Science and Technology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Houzhen Tuo
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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15
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Silva-Batista C, Lira J, Coelho DB, de Lima-Pardini AC, Nucci MP, Mattos ECT, Magalhaes FH, Barbosa ER, Teixeira LA, Amaro Junior E, Ugrinowitsch C, Horak FB. Mesencephalic Locomotor Region and Presynaptic Inhibition during Anticipatory Postural Adjustments in People with Parkinson's Disease. Brain Sci 2024; 14:178. [PMID: 38391752 PMCID: PMC10887111 DOI: 10.3390/brainsci14020178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
Individuals with Parkinson's disease (PD) and freezing of gait (FOG) have a loss of presynaptic inhibition (PSI) during anticipatory postural adjustments (APAs) for step initiation. The mesencephalic locomotor region (MLR) has connections to the reticulospinal tract that mediates inhibitory interneurons responsible for modulating PSI and APAs. Here, we hypothesized that MLR activity during step initiation would explain the loss of PSI during APAs for step initiation in FOG (freezers). Freezers (n = 34) were assessed in the ON-medication state. We assessed the beta of blood oxygenation level-dependent signal change of areas known to initiate and pace gait (e.g., MLR) during a functional magnetic resonance imaging protocol of an APA task. In addition, we assessed the PSI of the soleus muscle during APA for step initiation, and clinical (e.g., disease duration) and behavioral (e.g., FOG severity and APA amplitude for step initiation) variables. A linear multiple regression model showed that MLR activity (R2 = 0.32, p = 0.0006) and APA amplitude (R2 = 0.13, p = 0.0097) explained together 45% of the loss of PSI during step initiation in freezers. Decreased MLR activity during a simulated APA task is related to a higher loss of PSI during APA for step initiation. Deficits in central and spinal inhibitions during APA may be related to FOG pathophysiology.
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Affiliation(s)
- Carla Silva-Batista
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo 05508-070, Brazil
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
| | - Jumes Lira
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo 05508-070, Brazil
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo 03828-000, Brazil
- School of Physical Education and Sport, University of São Paulo, São Paulo 05508-030, Brazil
| | - Daniel Boari Coelho
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo 09210-170, Brazil
| | | | | | | | | | - Egberto Reis Barbosa
- Movement Disorders Clinic, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05508-070, Brazil
| | - Luis Augusto Teixeira
- School of Physical Education and Sport, University of São Paulo, São Paulo 05508-030, Brazil
| | - Edson Amaro Junior
- Department of Radiology, University of São Paulo, São Paulo 05508-090, Brazil
| | - Carlos Ugrinowitsch
- School of Physical Education and Sport, University of São Paulo, São Paulo 05508-030, Brazil
| | - Fay B Horak
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
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16
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Afshari M, Hernandez AV, Joyce JM, Hauptschein AW, Trenkle KL, Stebbins GT, Goetz CG. A Novel Home-Based Telerehabilitation Program Targeting Fall Prevention in Parkinson Disease: A Preliminary Trial. Neurol Clin Pract 2024; 14:e200246. [PMID: 38213401 PMCID: PMC10781563 DOI: 10.1212/cpj.0000000000200246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024]
Abstract
Background and Objectives Falls in a person with Parkinson disease (PwP) are frequent, consequential, and only partially prevented by current therapeutic options. Notably, most falls in PwPs occur in the home or its immediate surroundings; however, our current strategies for fall prevention are clinic-centered. The primary objective of this nonrandomized pilot trial was to investigate the feasibility and preliminary efficacy of the novel implementation of home-based PD telerehabilitation (tele-physical/occupational therapy) focusing on fall risk reduction and home-safety modification. Methods Persons with mild-to-moderate PD who were identified as being at risk of falls by their movement disorders neurologist were recruited from a tertiary movement disorders clinic. After an initial in-person evaluation by the study physical and occupational therapists, 15 patients with PD (Hoehn and Yahr Stage 2 (n = 8) and Stage 3 (n = 7)) participated in 4 biweekly PT/OT televisits with care partner supervision over the course of 10 weeks. The Goal Attainment Scale (GAS) was implemented to assess progress toward individualized PT/OT goals established at baseline. Outcomes were assessed at the end of the intervention at 10 weeks and at a six-month follow-up. Results Participants completed all 120 protocol-defined televisits without dropouts and adverse events. At 10 weeks, mean composite PT and OT-GAS scores showed significant improvement from baseline (PT: p < 0.001, OT: p < 0.008), which continued at 6 months (PT: p < 0.0005, OT: p < 0.0005). Home-modification recommendations made through novel virtual home-safety tours were cumulatively met by participants at 87% at 10 weeks and 91% at 6 months. Discussion Home-based telerehabilitation is a promising new strategy toward fall prevention in PD. The GAS has the potential to serve as an effective and patient-driven primary outcome variable for rehabilitation interventions for heterogeneous PwPs to assess progress toward personalized goals. Trial Registration Information ClinicalTrial.gov identifier: NCT04600011.
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Affiliation(s)
- Mitra Afshari
- Department of Neurological Sciences (MA, AVH, JMJ, GTS, CGG); Department of Physical Therapy (AWH), College of Health Sciences; and Department of Occupational Therapy (KLT), College of Health Sciences, Rush University Medical Center, Chicago, IL
| | - Andrea V Hernandez
- Department of Neurological Sciences (MA, AVH, JMJ, GTS, CGG); Department of Physical Therapy (AWH), College of Health Sciences; and Department of Occupational Therapy (KLT), College of Health Sciences, Rush University Medical Center, Chicago, IL
| | - Jessica M Joyce
- Department of Neurological Sciences (MA, AVH, JMJ, GTS, CGG); Department of Physical Therapy (AWH), College of Health Sciences; and Department of Occupational Therapy (KLT), College of Health Sciences, Rush University Medical Center, Chicago, IL
| | - Alison W Hauptschein
- Department of Neurological Sciences (MA, AVH, JMJ, GTS, CGG); Department of Physical Therapy (AWH), College of Health Sciences; and Department of Occupational Therapy (KLT), College of Health Sciences, Rush University Medical Center, Chicago, IL
| | - Kristie L Trenkle
- Department of Neurological Sciences (MA, AVH, JMJ, GTS, CGG); Department of Physical Therapy (AWH), College of Health Sciences; and Department of Occupational Therapy (KLT), College of Health Sciences, Rush University Medical Center, Chicago, IL
| | - Glenn T Stebbins
- Department of Neurological Sciences (MA, AVH, JMJ, GTS, CGG); Department of Physical Therapy (AWH), College of Health Sciences; and Department of Occupational Therapy (KLT), College of Health Sciences, Rush University Medical Center, Chicago, IL
| | - Christopher G Goetz
- Department of Neurological Sciences (MA, AVH, JMJ, GTS, CGG); Department of Physical Therapy (AWH), College of Health Sciences; and Department of Occupational Therapy (KLT), College of Health Sciences, Rush University Medical Center, Chicago, IL
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17
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Peng K, Xie L, Hong R, Wu Z, Gu H, He Y, Xing Z, Guan Q, Pan L, Jin L, Li L. Early-onset and late-onset Parkinson's disease exhibit a different profile of gait and posture features based on the Kinect. Neurol Sci 2024; 45:139-147. [PMID: 37555875 DOI: 10.1007/s10072-023-07009-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Gait and posture abnormalities are the common disabling motor symptoms in Parkinson's disease (PD). This study aims to investigate the differential characteristics of gait and posture in early-onset PD (EOPD) and late-onset PD (LOPD) using the Kinect depth camera. METHODS Eighty-eight participants, including two subgroups of 22 PD patients and two subgroups of 22 healthy controls (HC) matched for age, sex, and height, were enrolled. Gait and posture features were quantitatively assessed using a Kinect-based system. A two-way analysis of variance was used to compare the difference between different subgroups. RESULTS EOPD had a significantly higher Gait score than LOPD (p = 0.031). Specifically, decreased swing phase (p = 0.034) was observed in the EOPD group. Although the Posture score was similar between the two groups, LOPD was characterized by an increased forward flexion angle of the trunk at the thorax (p = 0.042) and a decreased forward flexion angle of the head relative to the trunk (p = 0.009). Additionally, age-independent features were observed in both PD subgroups, and post hoc tests revealed that EOPD generally performed worse gait features. In comparison, LOPD was characterized by worse performance in posture features. CONCLUSIONS EOPD and LOPD exhibit different profiles of gait and posture features. The phenotype-specific characteristics likely reflect the distinct neurodegenerative processes between them.
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Affiliation(s)
- Kangwen Peng
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ludi Xie
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ronghua Hong
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons' Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Zhuang Wu
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hongkai Gu
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yijing He
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ziwen Xing
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qiang Guan
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lizhen Pan
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lingjing Jin
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons' Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China.
- Collaborative Innovation Center for Brain Science (Sponsored By Shanghai Blue Cross Brain Hospital Co., Ltd. and Shanghai Tongji University Education Development Foundation), Tongji University, Shanghai, China.
| | - Lixi Li
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Neurological Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
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Burtscher J, Moraud EM, Malatesta D, Millet GP, Bally JF, Patoz A. Exercise and gait/movement analyses in treatment and diagnosis of Parkinson's Disease. Ageing Res Rev 2024; 93:102147. [PMID: 38036102 DOI: 10.1016/j.arr.2023.102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
Cardinal motor symptoms in Parkinson's disease (PD) include bradykinesia, rest tremor and/or rigidity. This symptomatology can additionally encompass abnormal gait, balance and postural patterns at advanced stages of the disease. Besides pharmacological and surgical therapies, physical exercise represents an important strategy for the management of these advanced impairments. Traditionally, diagnosis and classification of such abnormalities have relied on partially subjective evaluations performed by neurologists during short and temporally scattered hospital appointments. Emerging sports medical methods, including wearable sensor-based movement assessment and computational-statistical analysis, are paving the way for more objective and systematic diagnoses in everyday life conditions. These approaches hold promise to facilitate customizing clinical trials to specific PD groups, as well as personalizing neuromodulation therapies and exercise prescriptions for each individual, remotely and regularly, according to disease progression or specific motor symptoms. We aim to summarize exercise benefits for PD with a specific emphasis on gait and balance deficits, and to provide an overview of recent advances in movement analysis approaches, notably from the sports science community, with value for diagnosis and prognosis. Although such techniques are becoming increasingly available, their standardization and optimization for clinical purposes is critically missing, especially in their translation to complex neurodegenerative disorders such as PD. We highlight the importance of integrating state-of-the-art gait and movement analysis approaches, in combination with other motor, electrophysiological or neural biomarkers, to improve the understanding of the diversity of PD phenotypes, their response to therapies and the dynamics of their disease progression.
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Affiliation(s)
- Johannes Burtscher
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.
| | - Eduardo Martin Moraud
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland; Defitech Centre for Interventional Neurotherapies (NeuroRestore), UNIL-CHUV and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Davide Malatesta
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Julien F Bally
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Aurélien Patoz
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland; Research and Development Department, Volodalen Swiss Sport Lab, Aigle, Switzerland
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19
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Monaghan AS, Hooyman A, Dibble LE, Mehta SH, Peterson DS. Stability Changes in Fall-Prone Individuals With Parkinson Disease Following Reactive Step Training. J Neurol Phys Ther 2024; 48:46-53. [PMID: 37259190 DOI: 10.1097/npt.0000000000000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND PURPOSE Poor reactive steps may lead to falls in people with Parkinson disease (PwPD). However, whether reactive steps can be improved in PwPD at risk for falls or whether step training reduces falls remains unclear. This study aimed to determine whether 2 weeks of reactive step training result in (1) immediate and retained improvements in stepping and (2) fewer prospective falls in PwPD at fall risk. METHODS Twenty-five PwPD (70.52 years ± 7.15; Hoehn & Yahr range 1-3) at risk for falls completed a multiple baseline, open-label, uncontrolled pre-/postintervention study. Stepping performance was assessed at 2 baseline assessments (B1 and B2) followed by a 2-week, 6-session training protocol. Stepping was assessed immediately (P1) and 2 months after training (P2). Primary outcomes were anterior-posterior margin of stability (MOS), step length, and step latency during backward stepping. Fall frequency was measured for 2 months before and after training. RESULTS MOS during backward steps was significantly larger (better) after training ( P < 0.001, d = 0.83), and improvements were retained for 2 months ( P = 0.04, d = 0.66). Step length was not statistically significant different after training ( P = 0.13, d = 0.46) or at follow-up ( P = 0.08, d = 0.62), although effect sizes were medium and large, respectively. Step latency improved after initial exposure ( P = 0.01, d = 0.60) but not following training ( P = 0.43, d = 0.35). Twelve participants experienced fewer falls after training than before (10 = no change, 5 = increase; P = 0.12). Greater improvements in MOS were related to fewer falls ( P = 0.04). DISCUSSION AND CONCLUSIONS Two weeks of reactive step training resulted in immediate and retained improvements in some reactive stepping outcomes in PwPD at risk for falls and may reduce fall risk. Reactive step training may be a viable approach to reduce falls in PwPD.
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Affiliation(s)
- Andrew S Monaghan
- College of Health Solutions, Arizona State University, Phoenix (A.S.M., D.S.P.); School of Biological and Health Systems Engineering, Arizona State University, Tempe (A.H.); Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City (L.E.D.); Mayo Clinic, Scottsdale, Arizona (S.H.M.); and Phoenix VA Health Care Center, Phoenix, Arizona (D.S.P.)
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20
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Zhang H, Cao X, Wang L, Tong Q, Sun H, Gan C, Shan A, Yuan Y, Zhang K. Transcutaneous auricular vagus nerve stimulation improves gait and cortical activity in Parkinson's disease: A pilot randomized study. CNS Neurosci Ther 2023; 29:3889-3900. [PMID: 37311693 PMCID: PMC10651956 DOI: 10.1111/cns.14309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/17/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVE In this randomized, double-blind, sham-controlled trial, we explored the effect of 20 Hz transcutaneous auricular vagus nerve stimulation (taVNS) on gait impairments in Parkinson's disease (PD) patients and investigated the underlying neural mechanism. METHODS In total, 22 PD patients and 14 healthy controls were enrolled. PD patients were randomized (1:1) to receive active or sham taVNS (same position as active taVNS group but without releasing current) twice a day for 1 week. Meanwhile, all subjects were measured activation in the bilateral frontal and sensorimotor cortex during usual walking by functional near-infrared spectroscopy. RESULTS PD patients showed instable gait with insufficient range of motion during usual walking. Active taVNS improved gait characteristics including step length, stride velocity, stride length, and step length variability compared with sham taVNS after completion of the 7-day therapy. No difference was found in the Unified Parkinson's Disease Rating Scale III, Timed Up and Go, Tinetti Balance, and Gait scores. Moreover, PD patients had higher relative change of oxyhemoglobin in the left dorsolateral prefrontal cortex, pre-motor area, supplementary motor area, primary motor cortex, and primary somatosensory cortex than HCs group during usual walking. Hemodynamic responses in the left primary somatosensory cortex were significantly decreased after taVNS therapy. CONCLUSION taVNS can relieve gait impairments and remodel sensorimotor integration in PD patients.
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Affiliation(s)
- Heng Zhang
- Department of NeurologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Xing‐yue Cao
- Department of NeurologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Li‐na Wang
- Department of NeurologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Qing Tong
- Department of NeurologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Hui‐min Sun
- Department of NeurologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Cai‐ting Gan
- Department of NeurologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Ai‐di Shan
- Department of NeurologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Yong‐sheng Yuan
- Department of NeurologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Ke‐zhong Zhang
- Department of NeurologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
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21
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Hu ZD, Zhu SG, Huang JF, Chen JY, Huang SS, Liu RP, Chen ZL, Ma LL, Zhang X, Wang JY. Carpets with visual cues can improve gait in Parkinson's disease patients: may be independent of executive function. Eur J Med Res 2023; 28:530. [PMID: 37974270 PMCID: PMC10652558 DOI: 10.1186/s40001-023-01472-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Gait impairment is common in Parkinson's disease (PD) patients, which greatly reduces their quality of life. Executive dysfunction is associated with gait impairment. Compensatory strategies, including visual cues, have been shown to be effective in improving PD gait. In this study, we aimed to understand whether carpets with visual cues could improve PD gait, and how the improvement varies across patients with different executive function state. METHODS We designed carpets with chessboard and stripe cues. A total of 65 Chinese PD patients were recruited. Movement Disorder Society Unified Parkinson's Disease Rating Scale, L-dopa equivalent daily dosage, Hoehn & Yahr stage, Frontal Assessment Battery, Mini Mental State Examination Scale, Hamilton Anxiety Scale, and Hamilton Depression Scale were evaluated. Gait parameters including stride length, gait speed and fall risk were recorded by a wearable electronic device. RESULTS The stride length and gait speed were significantly improved and the fall risk was significantly mitigated when PD patients walked on carpets with chessboard and stripe patterns. Further analysis showed the amelioration of gait parameters was independent of executive dysfunction. CONCLUSIONS Our study demonstrates that carpets with visual cues can improve the gait of PD patients even in those with mild executive dysfunction.
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Affiliation(s)
- Ze-Di Hu
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shi-Guo Zhu
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jie-Fan Huang
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jin-Yu Chen
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shi-Shi Huang
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rong-Pei Liu
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhu-Ling Chen
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lu-Lu Ma
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiong Zhang
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Jian-Yong Wang
- Department of Neurology, Institute of Geriatric Neurology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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22
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Moreau C, Rouaud T, Grabli D, Benatru I, Remy P, Marques AR, Drapier S, Mariani LL, Roze E, Devos D, Dupont G, Bereau M, Fabbri M. Overview on wearable sensors for the management of Parkinson's disease. NPJ Parkinsons Dis 2023; 9:153. [PMID: 37919332 PMCID: PMC10622581 DOI: 10.1038/s41531-023-00585-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
Parkinson's disease (PD) is affecting about 1.2 million patients in Europe with a prevalence that is expected to have an exponential increment, in the next decades. This epidemiological evolution will be challenged by the low number of neurologists able to deliver expert care for PD. As PD is better recognized, there is an increasing demand from patients for rigorous control of their symptoms and for therapeutic education. In addition, the highly variable nature of symtoms between patients and the fluctuations within the same patient requires innovative tools to help doctors and patients monitor the disease in their usual living environment and adapt treatment in a more relevant way. Nowadays, there are various body-worn sensors (BWS) proposed to monitor parkinsonian clinical features, such as motor fluctuations, dyskinesia, tremor, bradykinesia, freezing of gait (FoG) or gait disturbances. BWS have been used as add-on tool for patients' management or research purpose. Here, we propose a practical anthology, summarizing the characteristics of the most used BWS for PD patients in Europe, focusing on their role as tools to improve treatment management. Consideration regarding the use of technology to monitor non-motor features is also included. BWS obviously offer new opportunities for improving management strategy in PD but their precise scope of use in daily routine care should be clarified.
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Affiliation(s)
- Caroline Moreau
- Department of Neurology, Parkinson's disease expert Center, Lille University, INSERM UMRS_1172, University Hospital Center, Lille, France
- The French Ns-Park Network, Paris, France
| | - Tiphaine Rouaud
- The French Ns-Park Network, Paris, France
- CHU Nantes, Centre Expert Parkinson, Department of Neurology, Nantes, F-44093, France
| | - David Grabli
- The French Ns-Park Network, Paris, France
- Assistance Publique Hôpitaux de Paris, Department of Neurology, CIC Neurosciences, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Sorbonne University, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Isabelle Benatru
- The French Ns-Park Network, Paris, France
- Department of Neurology, University Hospital of Poitiers, Poitiers, France
- INSERM, CHU de Poitiers, University of Poitiers, Centre d'Investigation Clinique CIC1402, Poitiers, France
| | - Philippe Remy
- The French Ns-Park Network, Paris, France
- Centre Expert Parkinson, NS-Park/FCRIN Network, CHU Henri Mondor, AP-HP, Equipe NPI, IMRB, INSERM et Faculté de Santé UPE-C, Créteil, FranceService de neurologie, hôpital Henri-Mondor, AP-HP, Créteil, France
| | - Ana-Raquel Marques
- The French Ns-Park Network, Paris, France
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurology department, Clermont-Ferrand, France
| | - Sophie Drapier
- The French Ns-Park Network, Paris, France
- Pontchaillou University Hospital, Department of Neurology, CIC INSERM 1414, Rennes, France
| | - Louise-Laure Mariani
- The French Ns-Park Network, Paris, France
- Assistance Publique Hôpitaux de Paris, Department of Neurology, CIC Neurosciences, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Sorbonne University, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Emmanuel Roze
- The French Ns-Park Network, Paris, France
- Assistance Publique Hôpitaux de Paris, Department of Neurology, CIC Neurosciences, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Sorbonne University, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - David Devos
- The French Ns-Park Network, Paris, France
- Parkinson's Disease Centre of Excellence, Department of Medical Pharmacology, Univ. Lille, INSERM; CHU Lille, U1172 - Degenerative & Vascular Cognitive Disorders, LICEND, NS-Park Network, F-59000, Lille, France
| | - Gwendoline Dupont
- The French Ns-Park Network, Paris, France
- Centre hospitalier universitaire François Mitterrand, Département de Neurologie, Université de Bourgogne, Dijon, France
| | - Matthieu Bereau
- The French Ns-Park Network, Paris, France
- Service de neurologie, université de Franche-Comté, CHRU de Besançon, 25030, Besançon, France
| | - Margherita Fabbri
- The French Ns-Park Network, Paris, France.
- Department of Neurosciences, Clinical Investigation Center CIC 1436, Parkinson Toulouse Expert Centre, NS-Park/FCRIN Network and NeuroToul COEN Center, Toulouse University Hospital, INSERM, University of Toulouse 3, Toulouse, France.
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23
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Espinoza-Araneda J, Caparrós-Manosalva C, Caballero PM, da Cunha MJ, Marchese RR, Pagnussat AS. Arm swing asymmetry in people with Parkinson's disease and its relationship with gait: A systematic review and meta-analysis. Braz J Phys Ther 2023; 27:100559. [PMID: 37980716 PMCID: PMC10695845 DOI: 10.1016/j.bjpt.2023.100559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Individuals with Parkinson's disease present arm swing alterations that can adversely affect their locomotion. OBJECTIVE To identify differences in arm swing asymmetry (ASA) between individuals with Parkinson's disease (PD) and healthy individuals and to investigate the relationship between ASA, temporal-spatial gait parameters, and disease progression. METHODS A literature search was conducted in PubMed, Scopus, ProQuest, Web of Science, and EBSCOhost up to February 2023. Cross-sectional studies evaluating parameters of arm swing (AS) and ASA were included. Methodological quality was assessed using the Critical Appraisal Checklist, and the quality of the evidence was measured with a modified Grading of Recommendations Assessment, Development, and Evaluation. RESULTS Fourteen studies were included in the systematic review (1130 participants). Irrespective of the medication phase (ON or OFF) and the type of walk test employed, the meta-analysis showed moderate-quality evidence that individuals with PD have increased ASA amplitude (SMD = 0.84; 95% CI: 0.69, 0.99; I²= 0%).Very low-quality evidence suggests higher ASA velocity (SMD=0.64; 95% CI: 0.24, 1.05; I²=59%) and lower AS amplitude on both the most affected (ES = -1.99, 95% CI: -3.04, -0.94, I2: 91%) and the least affected sides (ES = -0.75, 95% CI: -1.05, -0.44; I²=66%). Meta-regression indicated that ASA is inversely related to disease duration (Z: -2.4892, P< 0.05) and motor symptoms progression (Z: -2.1336, P< 0.05). CONCLUSIONS Regardless of the medication phase and the type of walk test employed, individuals with PD exhibited greater ASA and decreased AS amplitude than healthy individuals. ASA decreases as the disease progresses and symptoms worsen.
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Affiliation(s)
- Jessica Espinoza-Araneda
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Department of Human Movement Sciences, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Cristian Caparrós-Manosalva
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Department of Human Movement Sciences, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Paula M Caballero
- Department of Human Movement Sciences, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Maira J da Cunha
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, UFCSPA, Porto Alegre, RS, Brazil
| | - Ritchele R Marchese
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, UFCSPA, Porto Alegre, RS, Brazil
| | - Aline S Pagnussat
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, UFCSPA, Porto Alegre, RS, Brazil.
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24
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Mizrahi-Kliger A, Ganguly K. Spinal stimulation for unfreezing gait in Parkinson's disease. Nat Med 2023; 29:2713-2715. [PMID: 37932549 DOI: 10.1038/s41591-023-02604-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
| | - Karunesh Ganguly
- Department of Neurology, University of California, San Francisco, CA, USA.
- Neurology and Rehabilitation Service, San Francisco VA Health Care System, San Francisco, CA, USA.
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25
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Gong NJ, Clifford GD, Esper CD, Factor SA, McKay JL, Kwon H. Classifying Tremor Dominant and Postural Instability and Gait Difficulty Subtypes of Parkinson's Disease from Full-Body Kinematics. SENSORS (BASEL, SWITZERLAND) 2023; 23:8330. [PMID: 37837160 PMCID: PMC10575216 DOI: 10.3390/s23198330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
Characterizing motor subtypes of Parkinson's disease (PD) is an important aspect of clinical care that is useful for prognosis and medical management. Although all PD cases involve the loss of dopaminergic neurons in the brain, individual cases may present with different combinations of motor signs, which may indicate differences in underlying pathology and potential response to treatment. However, the conventional method for distinguishing PD motor subtypes involves resource-intensive physical examination by a movement disorders specialist. Moreover, the standardized rating scales for PD rely on subjective observation, which requires specialized training and unavoidable inter-rater variability. In this work, we propose a system that uses machine learning models to automatically and objectively identify some PD motor subtypes, specifically Tremor-Dominant (TD) and Postural Instability and Gait Difficulty (PIGD), from 3D kinematic data recorded during walking tasks for patients with PD (MDS-UPDRS-III Score, 34.7 ± 10.5, average disease duration 7.5 ± 4.5 years). This study demonstrates a machine learning model utilizing kinematic data that identifies PD motor subtypes with a 79.6% F1 score (N = 55 patients with parkinsonism). This significantly outperformed a comparison model using classification based on gait features (19.8% F1 score). Variants of our model trained to individual patients achieved a 95.4% F1 score. This analysis revealed that both temporal, spectral, and statistical features from lower body movements are helpful in distinguishing motor subtypes. Automatically assessing PD motor subtypes simply from walking may reduce the time and resources required from specialists, thereby improving patient care for PD treatments. Furthermore, this system can provide objective assessments to track the changes in PD motor subtypes over time to implement and modify appropriate treatment plans for individual patients as needed.
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Affiliation(s)
- N. Jabin Gong
- School of Computer Science, College of Computing, Georgia Institute of Technology, Atlanta, GA 30332, USA;
| | - Gari D. Clifford
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA 30322, USA (J.L.M.)
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30322, USA
| | - Christine D. Esper
- Jean and Paul Amos Parkinson’s Disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA 30322, USA; (C.D.E.); (S.A.F.)
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson’s Disease and Movement Disorders Program, Department of Neurology, School of Medicine, Emory University, Atlanta, GA 30322, USA; (C.D.E.); (S.A.F.)
| | - J. Lucas McKay
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA 30322, USA (J.L.M.)
| | - Hyeokhyen Kwon
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA 30322, USA (J.L.M.)
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26
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Venuto CS, Smith G, Herbst K, Zielinski R, Yung NC, Grosset DG, Dorsey ER, Kieburtz K. Predicting Ambulatory Capacity in Parkinson's Disease to Analyze Progression, Biomarkers, and Trial Design. Mov Disord 2023; 38:1774-1785. [PMID: 37363815 PMCID: PMC10615710 DOI: 10.1002/mds.29519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND In Parkinson's disease (PD), gait and balance is impaired, relatively resistant to available treatment and associated with falls and disability. Predictive models of ambulatory progression could enhance understanding of gait/balance disturbances and aid in trial design. OBJECTIVES To predict trajectories of ambulatory abilities from baseline clinical data in early PD, relate trajectories to clinical milestones, compare biomarkers, and evaluate trajectories for enrichment of clinical trials. METHODS Data from two multicenter, longitudinal, observational studies were used for model training (Tracking Parkinson's, n = 1598) and external testing (Parkinson's Progression Markers Initiative, n = 407). Models were trained and validated to predict individuals as having a "Progressive" or "Stable" trajectory based on changes of ambulatory capacity scores from the Movement Disorders Society Unified Parkinson's Disease Rating Scale parts II and III. Survival analyses compared time-to-clinical milestones and trial outcomes between predicted trajectories. RESULTS On external evaluation, a support vector machine model predicted Progressive trajectories using baseline clinical data with an accuracy, weighted-F1 (proportionally weighted harmonic mean of precision and sensitivity), and sensitivity/specificity of 0.735, 0.799, and 0.688/0.739, respectively. Over 4 years, the predicted Progressive trajectory was more likely to experience impaired balance, loss of independence, impaired function and cognition. Baseline dopamine transporter imaging and select biomarkers of neurodegeneration were significantly different between predicted trajectory groups. For an 18-month, randomized (1:1) clinical trial, sample size savings up to 30% were possible when enrollment was enriched for the Progressive trajectory versus no enrichment. CONCLUSIONS It is possible to predict ambulatory abilities from clinical data that are associated with meaningful outcomes in people with early PD. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Charles S. Venuto
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Greta Smith
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Konnor Herbst
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Robert Zielinski
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Biostatistics, Brown University, Providence, RI, USA
| | - Norman C.W. Yung
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Donald G. Grosset
- School of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - E. Ray Dorsey
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Karl Kieburtz
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
- Department of Neurology, University of Rochester, Rochester, NY, USA
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Camicioli R, Morris ME, Pieruccini‐Faria F, Montero‐Odasso M, Son S, Buzaglo D, Hausdorff JM, Nieuwboer A. Prevention of Falls in Parkinson's Disease: Guidelines and Gaps. Mov Disord Clin Pract 2023; 10:1459-1469. [PMID: 37868930 PMCID: PMC10585979 DOI: 10.1002/mdc3.13860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/28/2023] [Accepted: 07/08/2023] [Indexed: 10/24/2023] Open
Abstract
Background People living with Parkinson's disease (PD) have a high risk for falls. Objective To examine gaps in falls prevention targeting people with PD as part of the Task Force on Global Guidelines for Falls in Older Adults. Methods A Delphi consensus process was used to identify specific recommendations for falls in PD. The current narrative review was conducted as educational background with a view to identifying gaps in fall prevention. Results A recent Cochrane review recommended exercises and structured physical activities for PD; however, the types of exercises and activities to recommend and PD subgroups likely to benefit require further consideration. Freezing of gait, reduced gait speed, and a prior history of falls are risk factors for falls in PD and should be incorporated in assessments to identify fall risk and target interventions. Multimodal and multi-domain fall prevention interventions may be beneficial. With advanced or complex PD, balance and strength training should be administered under supervision. Medications, particularly cholinesterase inhibitors, show promise for falls prevention. Identifying how to engage people with PD, their families, and health professionals in falls education and implementation remains a challenge. Barriers to the prevention of falls occur at individual, environmental, policy, and health system levels. Conclusion Effective mitigation of fall risk requires specific targeting and strategies to reduce this debilitating and common problem in PD. While exercise is recommended, the types and modalities of exercise and how to combine them as interventions for different PD subgroups (cognitive impairment, freezing, advanced disease) need further study.
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Affiliation(s)
- Richard Camicioli
- Department of Medicine (Neurology) and Neuroscience and Mental Health InstituteUniversity of AlbertaEdmontonAlbertaCanada
| | - Meg E. Morris
- La Trobe University, Academic and Research Collaborative in Health & HealthscopeMelbourneVictoriaAustralia
| | - Frederico Pieruccini‐Faria
- Gait and Brain Lab, Parkwood InstituteLawson Health Research InstituteLondonOntarioCanada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
| | - Manuel Montero‐Odasso
- Gait and Brain Lab, Parkwood InstituteLawson Health Research InstituteLondonOntarioCanada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
| | - Surim Son
- Gait and Brain Lab, Parkwood InstituteLawson Health Research InstituteLondonOntarioCanada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
| | - David Buzaglo
- Center for the Study of Movement, Cognition and Mobility, Neurological InstituteTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological InstituteTel Aviv Sourasky Medical CenterTel AvivIsrael
- Department of Physical Therapy, Faculty of Medicine, Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
- Rush Alzheimer's Disease Center and Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy)KU LeuvenLeuvenBelgium
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Ramdhani RA, Watts J, Kline M, Fitzpatrick T, Niethammer M, Khojandi A. Differential spatiotemporal gait effects with frequency and dopaminergic modulation in STN-DBS. Front Aging Neurosci 2023; 15:1206533. [PMID: 37842127 PMCID: PMC10570440 DOI: 10.3389/fnagi.2023.1206533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Objective The spatiotemporal gait changes in advanced Parkinson's disease (PD) remain a treatment challenge and have variable responses to L-dopa and subthalamic deep brain stimulation (STN-DBS). The purpose of this study was to determine whether low-frequency STN-DBS (LFS; 60 Hz) elicits a differential response to high-frequency STN-DBS (HFS; 180 Hz) in spatiotemporal gait kinematics. Methods Advanced PD subjects with chronic STN-DBS were evaluated in both the OFF and ON medication states with LFS and HFS stimulation. Randomization of electrode contact pairs and frequency conditions was conducted. Instrumented Stand and Walk assessments were carried out for every stimulation/medication condition. LM-ANOVA was employed for analysis. Results Twenty-two PD subjects participated in the study, with a mean age (SD) of 63.9 years. Significant interactions between frequency (both LFS and HFS) and electrode contact pairs (particularly ventrally located contacts) were observed for both spatial (foot elevation, toe-off angle, stride length) and temporal (foot speed, stance, single limb support (SLS) and foot swing) gait parameters. A synergistic effect was also demonstrated with L-dopa and both HFS and LFS for right SLS, left stance, left foot swing, right toe-off angle, and left arm range of motion. HFS produced significant improvement in trunk and lumbar range of motion compared to LFS. Conclusion The study provides evidence of synergism of L-dopa and STN-DBS on lower limb spatial and temporal measures in advanced PD. HFS and LFS STN-DBS produced equivalent effects among all other tested lower limb gait features. HFS produced significant trunk and lumbar kinematic improvements.
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Affiliation(s)
- Ritesh A. Ramdhani
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Jeremy Watts
- Department of Industrial and Systems Engineering, University of Tennessee, Knoxville, TN, United States
| | - Myriam Kline
- Center for Neurosciences, Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, United States
| | - Toni Fitzpatrick
- Center for Neurosciences, Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, United States
| | - Martin Niethammer
- Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Center for Neurosciences, Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, United States
| | - Anahita Khojandi
- Department of Industrial and Systems Engineering, University of Tennessee, Knoxville, TN, United States
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Packer E, Debelle H, Bailey HGB, Ciravegna F, Ireson N, Evers J, Niessen M, Shi JQ, Yarnall AJ, Rochester L, Alcock L, Del Din S. Translating digital healthcare to enhance clinical management: a protocol for an observational study using a digital health technology system to monitor medication adherence and its effect on mobility in people with Parkinson's. BMJ Open 2023; 13:e073388. [PMID: 37666560 PMCID: PMC10481731 DOI: 10.1136/bmjopen-2023-073388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION In people with Parkinson's (PwP) impaired mobility is associated with an increased falls risk. To improve mobility, dopaminergic medication is typically prescribed, but complex medication regimens result in suboptimal adherence. Exploring medication adherence and its impact on mobility in PwP will provide essential insights to optimise medication regimens and improve mobility. However, this is typically assessed in controlled environments, during one-off clinical assessments. Digital health technology (DHT) presents a means to overcome this, by continuously and remotely monitoring mobility and medication adherence. This study aims to use a novel DHT system (DHTS) (comprising of a smartphone, smartwatch and inertial measurement unit (IMU)) to assess self-reported medication adherence, and its impact on digital mobility outcomes (DMOs) in PwP. METHODS AND ANALYSIS This single-centre, UK-based study, will recruit 55 participants with Parkinson's. Participants will complete a range of clinical, and physical assessments. Participants will interact with a DHTS over 7 days, to assess self-reported medication adherence, and monitor mobility and contextual factors in the real world. Participants will complete a motor complications diary (ON-OFF-Dyskinesia) throughout the monitoring period and, at the end, a questionnaire and series of open-text questions to evaluate DHTS usability. Feasibility of the DHTS and the motor complications diary will be assessed. Validated algorithms will quantify DMOs from IMU walking activity. Time series modelling and deep learning techniques will model and predict DMO response to medication and effects of contextual factors. This study will provide essential insights into medication adherence and its effect on real-world mobility in PwP, providing insights to optimise medication regimens. ETHICS AND DISSEMINATION Ethical approval was granted by London-142 Westminster Research Ethics Committee (REC: 21/PR/0469), protocol V.2.4. Results will be published in peer-reviewed journals. All participants will provide written, informed consent. TRIAL REGISTRATION NUMBER ISRCTN13156149.
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Affiliation(s)
- Emma Packer
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Héloïse Debelle
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Harry G B Bailey
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Fabio Ciravegna
- Dipartimento di Informatica, Università di Torino, Torino, Italy
| | - Neil Ireson
- Department of Computer Science and INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK
| | | | | | - Jian Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, Guangdong, China
- National Center for Applied Mathematics, Shenzhen, Guangdong, China
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Based at The Newcastle upon Tyne Hospitals NHS Foundation Trust, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Based at The Newcastle upon Tyne Hospitals NHS Foundation Trust, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
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Monaghan PG, Monaghan AS, Hooyman A, Fling BW, Huisinga JM, Peterson DS. Using the Instrumented Sway System (ISway) to Identify and Compare Balance Domain Deficits in People With Multiple Sclerosis. Arch Phys Med Rehabil 2023; 104:1456-1464. [PMID: 37037293 PMCID: PMC10524722 DOI: 10.1016/j.apmr.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/27/2023] [Accepted: 02/24/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To develop a multiple sclerosis (MS)-specific model of balance and examine differences between (1) MS and neurotypical controls and (2) people with MS (PwMS) with (MS-F) and without a fall history (MS-NF). DESIGN AND SETTING A cross-sectional study was conducted at the Gait and Balance Laboratory at the University of Kansas Medical Center. Balance was measured from the instrumented sway system (ISway) assessment. PARTICIPANTS In total, 118 people with relapsing-remitting MS (MS-F=39; MS-NF=79) and 46 age-matched neurotypical controls. INTERVENTION Not applicable. OUTCOME MEASURES A total of 22 sway measures obtained from the ISway were entered into an exploratory factor analysis to identify underlying balance domains. The model-derived balance domains were compared between (1) PwMS and age-matched, neurotypical controls and (2) MS-F and MS-NF. RESULTS Three distinct balance domains were identified: (1) sway amplitude and velocity, (2) sway frequency and jerk mediolateral, and (3) sway frequency and jerk anteroposterior, explaining 81.66% of balance variance. PwMS exhibited worse performance (ie, greater amplitude and velocity of sway) in the sway velocity and amplitude domain compared to age-matched neurotypical controls (P=.003). MS-F also exhibited worse performance in the sway velocity and amplitude domain compared to MS-NF (P=.046). The anteroposterior and mediolateral sway frequency and jerk domains were not different between PwMS and neurotypical controls nor between MS-F and MS-NF. CONCLUSIONS This study identified a 3-factor, MS-specific balance model, demonstrating that PwMS, particularly those with a fall history, exhibit disproportionate impairments in sway amplitude and velocity. Identifying postural stability outcomes and domains that are altered in PwMS and clinically relevant (eg, related to falls) would help isolate potential treatment targets.
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Affiliation(s)
| | | | - Andrew Hooyman
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ
| | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO
| | - Jessie M Huisinga
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, KS
| | - Daniel S Peterson
- College of Health Solutions, Arizona State University, Phoenix, AZ; Phoenix VA Health Care Center, Phoenix, AZ.
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Qian Y, Fu X, Zhang H, Yang Y, Wang G. Comparative efficacy of 24 exercise types on postural instability in adults with Parkinson's disease: a systematic review and network meta-analysis. BMC Geriatr 2023; 23:522. [PMID: 37641007 PMCID: PMC10463698 DOI: 10.1186/s12877-023-04239-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE To compare, rank and evaluate the 24 exercise types that improve postural instability in patients with Parkinson's disease (PD). METHODS We searched the data in PubMed, MEDLINE, Embase, PsycINFO, Cochrane library, and Web of Science from their inception date to January 23, 2023. Randomized controlled trials (RCTs) that aimed at determining the effectiveness of physical activity interventions on postural instability in adults with PD. This review focused on different balance outcome categories: (a) balance test batteries (BBS); (b) static steady-state balance (sSSB); (c) dynamic steady-state balance (dSSB); (d) proactive balance (PB); (e) reactive balance (RB). RESULTS Among 10,474 records, 199 studies (patients = 9523) were eligible for qualitative synthesis. The random-effects NMA model revealed that the following exercise training modalities had the highest p score of being best when compared with control group: body-weight support treadmill training (BWS_TT) for BBS (p score = 0.97; pooled standardised mean difference (95% CI): 1.56 (0.72 to 2.39)) and dSSB (1.00; 1.53 (1.07 to 2.00)), aquatic exercise (AQE) for sSSB (0.85; 0.94 (0.33 to 1.54)), Pilates for PB (0.95; 1.42 (0.59 to 2.26)). Balance and gait training with the external cue or attention (BGT_ECA) and robotic assisted gait balance (RA_GT) had similar superior effects in improving RB. The confidence in evidence was often low according to Confidence in Network Meta-Analysis. CONCLUSIONS There is low quality evidence that BWS_TT, AQE, Pilates, BGT_ECA and RA_GT are possibly the most effective treatments, pending outcome of interest, for adults with PD.
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Affiliation(s)
- Yujia Qian
- School of Sports Science and Physical Education, Nanjing Normal University, Nanjing, China
| | - Xueying Fu
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Henan University, 85 Minglun Rd, Shunhe District, Kaifeng City, 475001, China
| | - Haoyang Zhang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Henan University, 85 Minglun Rd, Shunhe District, Kaifeng City, 475001, China
| | - Yong Yang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Chaohu University, No. 1 Xuefu Road, Chaohu Economic Development Zone, Hefei, Anhui Province, 238000, China.
| | - Guotuan Wang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Henan University, 85 Minglun Rd, Shunhe District, Kaifeng City, 475001, China.
- School of Physical Education and Health, Krasnoyarsk State Pedagogical University named after V.P. Astafyev Street. Ada Lebedeva, House 89, Krasnoyarsk City, 660049, Russia.
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Legutke BR, Gobbi LTB, Orcioli-Silva D, Santos PCRD, Moraca GAG, Vitório R, Beretta VS. Transcranial direct current stimulation suggests not improving postural control during adapted tandem position in people with Parkinson's disease: A pilot study. Behav Brain Res 2023; 452:114581. [PMID: 37453515 DOI: 10.1016/j.bbr.2023.114581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Balance impairments in people with Parkinson's disease (PD) demonstrated mainly in challenging postural tasks, such as increased body oscillation may be attributed to the deficits in the brain structures functionality involved in postural control (e.g., motor cortex, midbrain, and brainstem). Although promising results, the effect of transcranial direct current stimulation (tDCS) on postural control in people with PD is unclear, especially in objective measures such as the center of pressure (CoP) parameters. Thus, we analyzed the effects of a single session of tDCS on the CoP parameters during the adapted tandem position in people with PD. METHODS Nineteen people with PD participated in this crossover, randomized, and double-blind study. Anodal tDCS was applied over the primary motor cortex in two conditions of stimulation (2 mA/active and sham) on two different days for 20 min immediately before the postural control evaluation. Participants remained standing in an adapted tandem position for the postural control assessment for 30 s (three trials). CoP parameters were acquired by a force plate. RESULTS No significant differences were demonstrated between stimulation conditions (p-value range = 0.15-0.89). CONCLUSIONS Our results suggested that a single session of tDCS with 2 mA does not improve the postural control of people with PD during adapted tandem.
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Affiliation(s)
- Beatriz Regina Legutke
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Campinas (UNICAMP), School of Applied Sciences (FCA), Laboratory of Applied Sport Physiology (LAFAE), Limeira, Brazil
| | - Paulo Cezar Rocha Dos Santos
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Israel; The Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel
| | - Gabriel Antonio Gazziero Moraca
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Rodrigo Vitório
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil; São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, São Paulo, Brazil.
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Tosserams A, Bloem BR, Nonnekes J. Compensation Strategies for Gait Impairments in Parkinson's Disease: From Underlying Mechanisms to Daily Clinical Practice. Mov Disord Clin Pract 2023; 10:S56-S62. [PMID: 37637990 PMCID: PMC10448134 DOI: 10.1002/mdc3.13616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/22/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anouk Tosserams
- Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
| | - Jorik Nonnekes
- Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
- Department of RehabilitationSint MaartenskliniekNijmegenThe Netherlands
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Hafer JF, Vitali R, Gurchiek R, Curtze C, Shull P, Cain SM. Challenges and advances in the use of wearable sensors for lower extremity biomechanics. J Biomech 2023; 157:111714. [PMID: 37423120 PMCID: PMC10529245 DOI: 10.1016/j.jbiomech.2023.111714] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/23/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
The use of wearable sensors for the collection of lower extremity biomechanical data is increasing in popularity, in part due to the ease of collecting data and the ability to capture movement outside of traditional biomechanics laboratories. Consequently, an increasing number of researchers are facing the challenges that come with utilizing the data captured by wearable sensors. These challenges include identifying/calculating meaningful measures from unfamiliar data types (measures of acceleration and angular velocity instead of positions and joint angles), defining sensor-to-segment alignments for calculating traditional biomechanics metrics, using reduced sensor sets and machine learning to predict unmeasured signals, making decisions about when and how to make algorithms freely available, and developing or replicating methods to perform basic processing tasks such as recognizing activities of interest or identifying gait events. In this perspective article, we present our own approaches to common challenges in lower extremity biomechanics research using wearable sensors and share our perspectives on approaching several of these challenges. We present these perspectives with examples that come mostly from gait research, but many of the concepts also apply to other contexts where researchers may use wearable sensors. Our goal is to introduce common challenges to new users of wearable sensors, and to promote dialogue amongst experienced users towards best practices.
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Affiliation(s)
- Jocelyn F Hafer
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States.
| | - Rachel Vitali
- Department of Mechanical Engineering, University of Iowa, Iowa City, IA, United States
| | - Reed Gurchiek
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Carolin Curtze
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, United States
| | - Peter Shull
- State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, China
| | - Stephen M Cain
- Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, WV, United States
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Wu H, Wu C, Qin J, Zhou C, Tan S, DuanMu X, Guan X, Bai X, Guo T, Wu J, Chen J, Wen J, Cao Z, Gao T, Gu L, Huang P, Zhang B, Xu X, Zhang M. Functional connectome predicting individual gait function and its relationship with molecular architecture in Parkinson's disease. Neurobiol Dis 2023:106216. [PMID: 37385459 DOI: 10.1016/j.nbd.2023.106216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023] Open
Abstract
Gait impairment is a common symptom of Parkinson's disease (PD), but its neural signature remains unclear due to the interindividual variability of gait performance. Identifying a robust gait-brain correlation at the individual level would provide insight into a generalizable neural basis of gait impairment. In this context, this study aimed to detect connectome that can predict individual gait function of PD, and follow-up analyses assess the molecular architecture underlying the connectome by relating it to the neurotransmitter-receptor/transporter density maps. Resting-state functional magnetic resonance imaging was used to detect the functional connectome, and gait function was assessed via a 10 m-walking test. The functional connectome was first detected within drug-naive patients (N = 48) by using connectome-based predictive modeling following cross-validation and then successfully validated within drug-managed patients (N = 30). The results showed that the motor, subcortical, and visual networks played an important role in predicting gait function. The connectome generated from patients failed to predict the gait function of 33 normal controls (NCs) and had distinct connection patterns compared to NCs. The negative connections (connection negatively correlated with 10 m-walking-time) pattern of the PD connectome was associated with the density of the D2 receptor and VAChT transporter. These findings suggested that gait-associated functional alteration induced by PD pathology differed from that induced by aging degeneration. The brain dysfunction related to gait impairment was more commonly found in regions expressing more dopaminergic and cholinergic neurotransmitters, which may aid in developing targeted treatments.
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Affiliation(s)
- Haoting Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Chenqing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jianmei Qin
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Sijia Tan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xiaojie DuanMu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xueqin Bai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jingwen Chen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jiaqi Wen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Zhengye Cao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Ting Gao
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Luyan Gu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China.
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Han T, Liu Q, Hu Y, Wang Y, Xue K. Effect of Pro-kin visual feedback balance training on balance function of individuals with early Parkinson's disease: a randomized controlled pilot trial. Afr Health Sci 2023; 23:582-588. [PMID: 38223579 PMCID: PMC10782303 DOI: 10.4314/ahs.v23i2.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Parkinson's disease (PD) is the second most common neurodegenerative disease. Patients often present with balance dysfunction. Several studies have applied visual feedback training to stroke patients and demonstrated significant improvement. However, the application of visual feedback balance training in PD patients has not been reported. Objective To observe the effects of visual feedback balance training combined with conventional rehabilitation training on the balance function of patients with early PD. Methods Fifty patients with early PD were randomly divided into control group and observation group. The control group received conventional rehabilitation training, including body position transfer, weight shifting, movement in all directions and gait training. The observation group were added with visual feedback balance training on the basis of the training above. All patients were trained 5 times per week for 4 weeks. Berg Balance Scale (BBS), Time Up-and-Go test (TUG) and Pro-Kin balance training instrument were used to evaluate the balance function of patients before and after treatment, and the balance function were compared between the two groups. Results The BBS and TUG scores of the observation group and the control group were improved significantly (P<0.01), and the BBS and TUG scores of the observation group were improved more obviously than control group (P<0.01). The length and area of eye open and closed condition in the observation group and the control group were significantly reduced compared with those before training (P<0.01), and the degree of reduction in the observation group was more obvious (P<0.01). The length and area of the observation group and the control group before and after training when eye open were smaller than those when eye closed (P<0.01). Conclusion The conventional rehabilitation therapy can improve the balance function of PD patients, but the combination of visual feedback balance training and conventional rehabilitation therapy can improve the balance function more significantly.
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Affiliation(s)
- Tingting Han
- Sino-French Department of Neurological Rehabilitation, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Qian Liu
- Cerebrovascular Disease Center, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yaguang Hu
- Department of Pharmacy, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Yuxia Wang
- Department of Respiratory Medicine, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Kangying Xue
- Vaccination Hub, Monash Health, Melbourne, Victoria, Australia
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37
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Morris R, Martini DN, Kelly VE, Smulders K, Ramsey K, Hiller A, Chung KA, Hu SC, Zabetian CP, Poston KL, Mata IF, Edwards KL, Lapidus J, Cholerton B, Montine TJ, Quinn JF, Horak F. Gait and balance in apolipoprotein Ɛ4 allele carriers in older adults and Parkinson's disease. Clin Park Relat Disord 2023; 9:100201. [PMID: 37252677 PMCID: PMC10209874 DOI: 10.1016/j.prdoa.2023.100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/09/2023] [Accepted: 05/14/2023] [Indexed: 05/31/2023] Open
Abstract
Background Gait and balance impairments are among the most troublesome and heterogeneous in Parkinson's disease (PD). This heterogeneity may, in part, reflect genetic variation. The apolipoprotein E (APOE) gene has three major allelic variants (ε2, ε3 and ε4). Previous work has demonstrated that older adult (OA) APOE ε4 carriers demonstrate gait deficits. This study compared gait and balance measures between APOE ε4 carriers and non-carriers in both OA and PD. Methods 334 people with PD (81 APOE ε4 carriers and 253 non-carriers) and 144 OA (41 carriers and 103 non-carriers) were recruited. Gait and balance were assessed using body-worn inertial sensors. Two-way analyses of covariance (ANCOVA) compared gait and balance characteristics between APOE ε4 carriers and non-carriers in people with PD and OA, controlling for age, gender, and testing site. Results Gait and balance were worse in people with PD compared to OA. However, there were no differences between APOE ε4 carriers and non-carriers in either the OA or PD group. In addition, there were no significant group (OA/PD) by APOE ε4 status (carrier/non-carrier) interaction effects for any measures of gait or balance. Conclusions Although we found expected impairments in gait and balance in PD compared to OA, gait and balance characteristics did not differ between APOE ε4 carriers and non-carriers in either group. While APOE status did not impact gait and balance in this cross-sectional study, future work is needed to determine whether progression of gait and balance deficits is faster in PD APOE Ɛ4 carriers.
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Affiliation(s)
- Rosie Morris
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - Douglas N. Martini
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Valerie E. Kelly
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Katrijn Smulders
- Sint Maartenskliniek Research Department, Nijmegen, the Netherlands
| | - Katrina Ramsey
- School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Amie Hiller
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Kathryn A. Chung
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Shu-Ching Hu
- Sint Maartenskliniek Research Department, Nijmegen, the Netherlands
- Portland Veterans Affairs Health Care System, Portland, OR, USA
| | - Cyrus P. Zabetian
- Sint Maartenskliniek Research Department, Nijmegen, the Netherlands
- Portland Veterans Affairs Health Care System, Portland, OR, USA
| | - Kathleen L. Poston
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ignacio F. Mata
- Sint Maartenskliniek Research Department, Nijmegen, the Netherlands
- Portland Veterans Affairs Health Care System, Portland, OR, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Karen L. Edwards
- Department of Neurology and Neurological Sciences, Stanford School of Medicine, Palo Alto, CA, US
| | - Jodi Lapidus
- School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Brenna Cholerton
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Thomas J. Montine
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Joseph F. Quinn
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Fay Horak
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, USA
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38
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Antonini A, Reichmann H, Gentile G, Garon M, Tedesco C, Frank A, Falkenburger B, Konitsiotis S, Tsamis K, Rigas G, Kostikis N, Ntanis A, Pattichis C. Toward objective monitoring of Parkinson's disease motor symptoms using a wearable device: wearability and performance evaluation of PDMonitor ®. Front Neurol 2023; 14:1080752. [PMID: 37260606 PMCID: PMC10228366 DOI: 10.3389/fneur.2023.1080752] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/27/2023] [Indexed: 06/02/2023] Open
Abstract
Parkinson's disease (PD) is characterized by a variety of motor and non-motor symptoms. As disease progresses, fluctuations in the response to levodopa treatment may develop, along with emergence of freezing of gait (FoG) and levodopa induced dyskinesia (LiD). The optimal management of the motor symptoms and their complications, depends, principally, on the consistent detection of their course, leading to improved treatment decisions. During the last few years, wearable devices have started to be used in the clinical practice for monitoring patients' PD-related motor symptoms, during their daily activities. This work describes the results of 2 multi-site clinical studies (PDNST001 and PDNST002) designed to validate the performance and the wearability of a new wearable monitoring device, the PDMonitor®, in the detection of PD-related motor symptoms. For the studies, 65 patients with Parkinson's disease and 28 healthy individuals (controls) were recruited. Specifically, during the Phase I of the first study, participants used the monitoring device for 2-6 h in a clinic while neurologists assessed the exhibited parkinsonian symptoms every half hour using the Unified Parkinson's Disease Rating Scale (UPDRS) Part III, as well as the Abnormal Involuntary Movement Scale (AIMS) for dyskinesia severity assessment. The goal of Phase I was data gathering. On the other hand, during the Phase II of the first study, as well as during the second study (PDNST002), day-to-day variability was evaluated, with patients in the former and with control subjects in the latter. In both cases, the device was used for a number of days, with the subjects being unsupervised and free to perform any kind of daily activities. The monitoring device produced estimations of the severity of the majority of PD-related motor symptoms and their fluctuations. Statistical analysis demonstrated that the accuracy in the detection of symptoms and the correlation between their severity and the expert evaluations were high. As a result, the studies confirmed the effectiveness of the system as a continuous telemonitoring solution, easy to be used to facilitate decision-making for the treatment of patients with Parkinson's disease.
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Affiliation(s)
- Angelo Antonini
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitat Dresden, Dresden, Germany
| | - Giovanni Gentile
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Michela Garon
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Chiara Tedesco
- Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
| | - Anika Frank
- Department of Neurology, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitat Dresden, Dresden, Germany
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Bjoern Falkenburger
- Department of Neurology, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universitat Dresden, Dresden, Germany
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Spyridon Konitsiotis
- Department of Neurology, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantinos Tsamis
- Department of Neurology, University Hospital of Ioannina and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | | | | | | | - Constantinos Pattichis
- Department of Computer Science and Biomedical Engineering Research Centre, University of Cyprus, Nicosia, Cyprus
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Al-Kassmy J, Sun C, Huot P. 5-HT 1A agonists for levodopa-induced dyskinesia in Parkinson's disease. Neurodegener Dis Manag 2023; 13:101-112. [PMID: 37140165 DOI: 10.2217/nmt-2022-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Levodopa is the most effective agent for treating the symptoms of Parkinson's disease (PD). However, levodopa-induced dyskinesia remains a significant complication that manifests after few years of treatment, for which therapeutic options remain limited. Several agonists of the serotonin type 1A (5-HT1A) receptor with varying levels of efficacy and interaction at other sites, have been tested in the clinic. Clinical trials testing 5-HT1A agonists have yielded inconsistent results in alleviating dyskinesia, especially that the antidyskinetic benefit observed was often accompanied by an adverse effect on motor function. In this article, we summarize and analyze the various clinical trials performed with 5-HT1A agonists in PD patients with dyskinesia and offer perspectives on the future of this class of agents in PD.
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Affiliation(s)
- Jawad Al-Kassmy
- Royal College of Surgeons in Ireland, School of Medicine, Dublin, Ireland
| | - Christine Sun
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, H3A 2B4, Canada
| | - Philippe Huot
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro), Montreal, QC, H3A 2B4, Canada
- Movement Disorder Clinic, Division of Neurology, Department of Neurosciences, McGill University Health Centre, Montreal, QC, H3A 2B4, Canada
- Department of Neurology & Neurosurgery, McGill University, Montreal, QC, H3A 2B4, Canada
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Kung CF, Lai YR, Chiu WC, Lien CY, Huang CC, Cheng BC, Lin WC, Chen YS, Yu CC, Chiang YF, Guo YR, Chen YH, Lu CH. Effectiveness of Center of Pressure Trajectory as Anticipatory Postural Adjustment Measurement in Parkinson's Disease With Freezing of Gait History. Neurorehabil Neural Repair 2023; 37:240-250. [PMID: 37083157 DOI: 10.1177/15459683231166934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Evidence showed that patients with Parkinson's disease (PD) who have a history of freezing of gait (FOG) have hypometric anticipatory postural adjustment (APA) during gait initiation (GI) compared to PD without FOG. OBJECTIVES This study aimed to test the feasibility of center of pressure (COP) displacement during GI as the measure of APA in PD with and without a history of FOG. METHODS Patients with PD underwent COP trajectory measurements, including duration, length, velocity, and acceleration in different phases of APA (APA1, APA2a, APA2, and LOC), as well as evaluation of New Freezing of Gait Questionnaire (NFOG-Q), Tinetti balance and gait score, and Postural Instability and Gait Difficulty (PIGD) score in the on and off medication states. RESULTS The duration (seconds) of APA2a, APA2b, and LOC were highest while velocity in mediolateral direction (X) (m/s), including APA1, APA2a, APA2b, and LOC showed lowest in PD with FOG. Velocity in the mediolateral direction in different phases of APA increased in patients with FOG after dopaminergic therapy. APA2a (seconds) and APA2b (X) (m/s) were significantly associated with NFOG-Q part II, APA2b (X) (m/s) was significantly associated with NFOG-Q part III, and APA2a (seconds) was significantly associated with Tinetti balance and gait and PIGD score. CONCLUSIONS PD with FOG history showed a favorable response of APAs to dopaminergic replacement. The APA parameters by COP trajectory, especially lateral COP shift toward the stance foot (APA2b (X) (m/s) and APA2a (seconds)) are surrogate markers to assess PD with FOG history.
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Affiliation(s)
- Chien-Feng Kung
- Department of Intelligent Commerce, National Kaohsiung University of Science and Technology, Kaohsiung
| | - Yun-Ru Lai
- Departments of Neurology, Chang Gung University College of Medicine, Kaohsiung
- Departments of Hyperbaric Oxygen Therapy Center, Chang Gung University College of Medicine, Kaohsiung
| | - Wen-Chan Chiu
- Departments of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung
| | - Chia-Yi Lien
- Departments of Neurology, Chang Gung University College of Medicine, Kaohsiung
| | - Chih-Cheng Huang
- Departments of Neurology, Chang Gung University College of Medicine, Kaohsiung
| | - Ben-Chung Cheng
- Departments of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung
| | - Wei-Che Lin
- Departments of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Yueh-Sheng Chen
- Departments of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Chiun-Chieh Yu
- Departments of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Yi-Fang Chiang
- Departments of Neurology, Chang Gung University College of Medicine, Kaohsiung
| | - Yan-Ru Guo
- Department of Intelligent Commerce, National Kaohsiung University of Science and Technology, Kaohsiung
| | - Yin-Hong Chen
- Department of Intelligent Commerce, National Kaohsiung University of Science and Technology, Kaohsiung
| | - Cheng-Hsien Lu
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung
- Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China
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Kenzo Fujioka Shida T, Eunice Neves de Oliveira C, da Silva Fragoso de Campos D, Los Angeles E, Bernardo C, Dos Santos de Oliveira L, Cupertino Salloum E Silva L, Magalhães Novaes T, Shokur S, Bouri M, Boari Coelho D. Effect of freezing of gait and dopaminergic medication in the biomechanics of lower limbs in the gait of patients with Parkinson's disease compared to neurologically healthy. Neurosci Lett 2023; 806:137250. [PMID: 37061024 DOI: 10.1016/j.neulet.2023.137250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023]
Abstract
INTRODUCTION This study aims to evaluate the effects of medication, and the freezing of gait (FoG) on the kinematic and kinetic parameters of gait in people with Parkinson's disease (pwPD) compared to neurologically healthy. METHODS Twenty-two people with a clinical diagnosis of idiopathic PD in ON and OFF medication (11 FoG), and 18 healthy participants (control) were selected from two open data sets. All participants walked on the floor on a 10-meter-long walkway. The joint kinematic and ground reaction forces (GRF) variables of gait and the clinical characteristics were compared: (1) PD with FoG (pwFoG) and PD without FoG (pwoFoG) in the ON condition and control; (2) PD with FoG and PD without FoG in the OFF condition and control; (3) Group (PD with FoG and PD without FoG) and Medication. RESULTS (1) FoG mainly affects distal joints, such as the ankle and knee; (2) PD ON showed changes in the range of motion of both distal and proximal joints, which may explain the increase in step length and gait speed expected with the use of L-Dopa; and (3) the medication showed improvements in the kinematic and kinetic parameters of the gait of people with pwFoG and pwoFoG equally; (4) pwPD showed a smaller second peak of the vertical component of the GRF than the control. CONCLUSION The presence of FoG mainly affects distal joints, such as the ankle and knee. PD presents a lower application of GRF during the impulse period than healthy people, causing lower gait performances.
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Affiliation(s)
| | | | | | - Emanuele Los Angeles
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Claudionor Bernardo
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, SP, Brazil
| | | | | | - Thayna Magalhães Novaes
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Solaiman Shokur
- École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland; The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Mohamed Bouri
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Daniel Boari Coelho
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, SP, Brazil; Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil.
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Rusz J, Krupička R, Vítečková S, Tykalová T, Novotný M, Novák J, Dušek P, Růžička E. Speech and gait abnormalities in motor subtypes of de-novo Parkinson's disease. CNS Neurosci Ther 2023. [PMID: 36942517 DOI: 10.1111/cns.14158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/23/2023] Open
Abstract
AIM To investigate the presence and relationship of temporal speech and gait parameters in patients with postural instability/gait disorder (PIGD) and tremor-dominant (TD) motor subtypes of Parkinson's disease (PD). METHODS Speech samples and instrumented walkway system assessments were acquired from a total of 60 de-novo PD patients (40 in TD and 20 in PIGD subtype) and 40 matched healthy controls. Objective acoustic vocal assessment of seven distinct speech timing dimensions was related to instrumental gait measures including velocity, cadence, and stride length. RESULTS Compared to controls, PIGD subtype showed greater consonant timing abnormalities by prolonged voice onset time (VOT) while also shorter stride length during both normal walking and dual task, while decreased velocity and cadence only during dual task. Speaking rate was faster in PIGD than TD subtype. In PIGD subtype, prolonged VOT correlated with slower gait velocity (r = -0.56, p = 0.01) and shorter stride length (r = -0.59, p = 0.008) during normal walking, whereas relationships were also found between decreased cadence in dual task and irregular alternating motion rates (r = -0.48, p = 0.04) and prolonged pauses (r = -0.50, p = 0.03). No correlation between speech and gait was detected in TD subtype. CONCLUSION Our findings suggest that speech and gait rhythm disorder share similar underlying pathomechanisms specific for PIGD subtype.
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Affiliation(s)
- Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
- Department of Neurology & ARTORG Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Radim Krupička
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Slávka Vítečková
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Tereza Tykalová
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Michal Novotný
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Jan Novák
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
- Department of Anthropology and Human Genetics, Faculty of Science, Charles University, Prague, Czechia
| | - Petr Dušek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
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García-Muñoz C, González-García P, Casuso-Holgado MJ, Martínez-Calderón J, Heredia-Rizo AM. Are movement-based mindful exercises (QIGONG, TAI CHI, AND YOGA) beneficial for stroke and Parkinson's disease? A scoping review. Complement Ther Med 2023; 72:102912. [PMID: 36565791 DOI: 10.1016/j.ctim.2022.102912] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/04/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To synthesize evidence from systematic reviews on the effects of qigong, tai chi, and yoga in people with neurological diseases. METHODS A systematic search was conducted in PubMed, PsycINFO, Embase, CINAHL and Cochrane Library until September 2022. Methodological quality was assessed using the AMSTAR 2 tool. A qualitative synthesis of included reviews and meta-analyses was performed. Citation matrices and the corrected covered area were used to explore the overlap of randomized controlled trials among reviews. RESULTS Nineteen systematic reviews (containing 74 trials and 80 meta-analyses) in people with Parkinson's disease (PD) or stroke were included. The critical domains of the AMSTAR 2 were not satisfied in more than half of the reviews, and only 4 evaluated the certainty of the evidence. The overlap was very high (21.7%) and high (11%) for tai chi studies in PD and stroke, respectively. In people with PD, qigong, yoga, and tai chi can improve balance, with tai chi being beneficial to increase functional mobility. For stroke patients, tai chi was better than controls to enhance motor function and independence, but not for health-related quality of life and quality of sleep. Findings on balance, walking ability and depression were inconclusive in stroke population. CONCLUSIONS Qigong, tai chi, and yoga appear to be effective to improve balance performance in people with PD. Tai chi practice enhances motor function and independency in stroke patients.
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Affiliation(s)
- Cristina García-Muñoz
- Departamento de Enfermería y Fisioterapia, Facultad de Enfermería y Fisioterapia, Universidad de Cádiz, Avda. Ana de Viya 52, 11009 Cádiz, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
| | - Paula González-García
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain..
| | - María Jesús Casuso-Holgado
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
| | - Javier Martínez-Calderón
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
| | - Alberto Marcos Heredia-Rizo
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
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Herbers C, Schroeder J, Lu C, Geng H, Zhang R, Mehregan J, Malakowsky K, Erdman A, Johnson MD, Cooper SE. Dopamine replacement therapy normalizes reactive step length to postural perturbations in Parkinson's disease. Gait Posture 2023; 101:95-100. [PMID: 36773480 PMCID: PMC10023411 DOI: 10.1016/j.gaitpost.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Postural instability is one of the most disabling motor symptoms of Parkinson's disease (PD) given its association with falls and loss of independence. Previous studies have assessed biomechanical measures of reactive stepping in response to perturbations, showing that individuals with PD exhibit inadequate postural responses to regain balance. RESEARCH QUESTION Does dopamine replacement therapy normalize step length in response to balance perturbations? METHODS In this study, we estimated reactive step length, to a postural perturbation, retrospectively from a dataset of frontal plane video using 2D motion tracking and direct linear transform methods. We compared two perturbation methods: support surface translation and shoulder pull (the clinical standard) in 14 individuals with PD and 13 without PD (on and off medication), with and without partial body weight support (BWS). The primary outcome was the length of the first step taken to regain balance after the perturbation analyzed with mixed effects ANOVA, with post hoc analysis of anteroposterior (AP) and mediolateral (ML) components. RESULTS PD OFF medication exhibited shorter reactive step length compared to PD ON and compared to control groups for the surface translation perturbations, but no significant difference was observed for the shoulder pull perturbations. SIGNIFICANCE Dopamine replacement therapy affects step length in response to perturbation more robustly for surface translations than for a pull by the shoulders.
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Affiliation(s)
- Cara Herbers
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Joseph Schroeder
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Chiahao Lu
- Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Helen Geng
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Raymond Zhang
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jessica Mehregan
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kada Malakowsky
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Arthur Erdman
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Matthew D Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Scott E Cooper
- Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA.
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45
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Leroy T, Baggen RJ, Lefeber N, Herssens N, Santens P, De Letter M, Maes L, Bouche K, Van Bladel A. Effects of Oral Levodopa on Balance in People with Idiopathic Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023; 13:3-23. [PMID: 36617752 PMCID: PMC9912739 DOI: 10.3233/jpd-223536] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Balance impairment is a frequent cause of morbidity and mortality in people with Parkinson's disease (PD). As opposed to the effects of appendicular motor symptoms, the effects of Levodopa on balance impairment in idiopathic PD are less clear. OBJECTIVE To review the literature on the effects of oral Levodopa on clinical balance test performance, posturography, step initiation, and responses to perturbation in people with idiopathic PD (PwPD). METHODS A systematic search of three scientific databases (Pubmed, Embase, and Web of Science) was conducted in accordance with PRISMA guidelines. For the pilot meta-analysis, standardized mean differences with 95% confidence intervals were calculated using an inverse variance random effects model. Data not suitable for implementation in the meta-analysis (missing means or standard deviations, and non-independent outcomes) were analyzed narratively. RESULTS A total of 2772 unique studies were retrieved, of which 18 met the eligibility criteria and were analyzed, including data of 710 idiopathic PwPD. Levodopa had a significant positive effect on the Berg Balance Scale, the Push and Release test, and jerk and frequency parameters during posturography. In contrast, some significant negative effects on velocity-based sway parameters were found during posturography and step initiation. However, Levodopa had no significant effect on most step initiation- and all perturbation parameters. CONCLUSION The effects of Levodopa on balance in PwPD vary depending on the outcome parameters and patient inclusion criteria. A systematic approach with well-defined outcome parameters, and prespecified, sensitive and reliable tests is needed in future studies to unravel the effects of oral Levodopa on balance.
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Affiliation(s)
- Tim Leroy
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Remco J. Baggen
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Correspondence to: Dr. Remco Baggen, Department of Rehabilitation Sciences, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, 9000 Gent, Belgium. E-mail:
| | - Nina Lefeber
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nolan Herssens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany
| | - Patrick Santens
- Department of Neurology, Ghent University Hospital, Ghent, Belgium,Research Group BrainComm, Ghent University, Ghent, Belgium
| | - Miet De Letter
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Research Group BrainComm, Ghent University, Ghent, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Katie Bouche
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Anke Van Bladel
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
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Gait Event Prediction Using Surface Electromyography in Parkinsonian Patients. Bioengineering (Basel) 2023; 10:bioengineering10020212. [PMID: 36829706 PMCID: PMC9951979 DOI: 10.3390/bioengineering10020212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Gait disturbances are common manifestations of Parkinson's disease (PD), with unmet therapeutic needs. Inertial measurement units (IMUs) are capable of monitoring gait, but they lack neurophysiological information that may be crucial for studying gait disturbances in these patients. Here, we present a machine learning approach to approximate IMU angular velocity profiles and subsequently gait events using electromyographic (EMG) channels during overground walking in patients with PD. We recorded six parkinsonian patients while they walked for at least three minutes. Patient-agnostic regression models were trained on temporally embedded EMG time series of different combinations of up to five leg muscles bilaterally (i.e., tibialis anterior, soleus, gastrocnemius medialis, gastrocnemius lateralis, and vastus lateralis). Gait events could be detected with high temporal precision (median displacement of <50 ms), low numbers of missed events (<2%), and next to no false-positive event detections (<0.1%). Swing and stance phases could thus be determined with high fidelity (median F1-score of ~0.9). Interestingly, the best performance was obtained using as few as two EMG probes placed on the left and right vastus lateralis. Our results demonstrate the practical utility of the proposed EMG-based system for gait event prediction, which allows the simultaneous acquisition of an electromyographic signal to be performed. This gait analysis approach has the potential to make additional measurement devices such as IMUs and force plates less essential, thereby reducing financial and preparation overheads and discomfort factors in gait studies.
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47
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Su ZH, Patel S, Gavine B, Buchanan T, Bogdanovic M, Sarangmat N, Green AL, Bloem BR, FitzGerald JJ, Antoniades CA. Deep Brain Stimulation and Levodopa Affect Gait Variability in Parkinson Disease Differently. Neuromodulation 2023; 26:382-393. [PMID: 35562261 DOI: 10.1016/j.neurom.2022.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/07/2022] [Accepted: 02/06/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Both dopaminergic medication and subthalamic nucleus (STN) deep brain stimulation (DBS) can improve the amplitude and speed of gait in Parkinson disease (PD), but relatively little is known about their comparative effects on gait variability. Gait irregularity has been linked to the degeneration of cholinergic neurons in the pedunculopontine nucleus (PPN). OBJECTIVES The STN and PPN have reciprocal connections, and we hypothesized that STN DBS might improve gait variability by modulating PPN function. Dopaminergic medication should not do this, and we therefore sought to compare the effects of medication and STN DBS on gait variability. MATERIALS AND METHODS We studied 11 patients with STN DBS systems on and off with no alteration to their medication, and 15 patients with PD without DBS systems on and off medication. Participants walked for two minutes in each state, wearing six inertial measurement units. Variability has previously often been expressed in terms of SD or coefficient of variation over a testing session, but these measures conflate long-term variability (eg, gradual slowing, which is not necessarily pathological) with short-term variability (true irregularity). We used Poincaré analysis to separate the short- and long-term variability. RESULTS DBS decreased short-term variability in lower limb gait parameters, whereas medication did not have this effect. In contrast, STN DBS had no effect on arm swing and trunk motion variability, whereas medication increased them, without obvious dyskinesia. CONCLUSIONS Our results suggest that STN DBS acts through a nondopaminergic mechanism to reduce gait variability. We believe that the most likely explanation is the retrograde activation of cholinergic PPN projection neurons.
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Affiliation(s)
- Zi H Su
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Salil Patel
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Bronwyn Gavine
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Marko Bogdanovic
- Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | | | - Alexander L Green
- Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Bastiaan R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - James J FitzGerald
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Chrystalina A Antoniades
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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48
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Morelli N. Effect and Relationship of Gait on Subcortical Local Field Potentials in Parkinson's Disease: A Systematic Review. Neuromodulation 2023; 26:271-279. [PMID: 36244929 DOI: 10.1016/j.neurom.2022.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/19/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Developments in deep brain stimulation (DBS) technology have enabled the ability to detect local field potentials (LFPs) in Parkinson disease (PD). Gait dysfunction is one of the most prevalent deficits seen in PD. However, no consensus has been reached on the effect of gait on LFPs and the relationship between LFPs and clinical measures of gait. The objective of this systematic review was to synthesize existing research regarding the relationship between gait dysfunction and LFPs in PD. METHODS A systematic search of the literature yielded a total of ten articles, including 132 patients with PD, which met the criteria for inclusion. RESULTS Beta frequency band measures showed low-to-strong correlation to clinical gait measures (r = -0.50 to 0.82). Two studies found decreased beta power during gait; one found increased beta frequency peaks during gait; and one found higher beta power during dual-task gait than during single-task gait. One of the three studies comparing patients with and without freezing found significantly increased beta burst duration and power during gait in freezers compared with nonfreezers. All studies showed moderate-to-high methodologic quality. CONCLUSIONS This review highlights the need to consider the effect of gait on LFP recordings, particularly when used to guide DBS programming. Although sample sizes were small, it appears LFPs are associated to and modulated by gait in patients with PD. This evidence suggests that LFPs have the potential to be used as a biomarker of gait dysfunction in PD.
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49
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Langer A, Lucke-Paulig L, Gassner L, Krüger R, Weiss D, Gharabaghi A, Zach H, Maetzler W, Hobert MA. Additive Effect of Dopaminergic Medication on Gait Under Single and Dual-Tasking Is Greater Than of Deep Brain Stimulation in Advanced Parkinson Disease With Long-Duration Deep Brain Stimulation. Neuromodulation 2023; 26:364-373. [PMID: 35227581 DOI: 10.1016/j.neurom.2022.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/10/2021] [Accepted: 01/04/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Patients with advanced Parkinson disease (PD) often experience problems with mobility, including walking under single- (ST) and dual-tasking (DT) conditions. The effects of deep brain stimulation in the subthalamic nucleus (DBS) versus dopaminergic medication (Med) on these conditions are not well investigated. MATERIALS AND METHODS We used two ST and two DT-gait paradigms to evaluate the effect of DBS and dopaminergic medication on gait parameters in 14 PD patients (mean age 66 ± 8 years) under DBSOFF/MedON, DBSON/MedOFF, and DBSON/MedON conditions. They performed standardized 20-meter walks with convenient and fast speed. To test DT capabilities, they performed a checking-boxes and a subtraction task during fast-paced walking. Quantitative gait analysis was performed using a tri-axial accelerometer (Dynaport, McRoberts, The Netherlands). Dual-task costs (DTC) of gait parameters and secondary task performance were compared intraindividually between DBSOFF/MedON vs DBSON/MedON, and DBSON/MedOFF vs DBSON/MedON to estimate responsiveness. RESULTS Dopaminergic medication increased gait speed and cadence at convenient speed. It increased cadence and decreased number of steps at fast speed, and improved DTC of cadence during the checking boxes and DTC of cadence and number of steps during the subtraction tasks. DBS only improved DTC of cadence during the checking boxes and DTC of gait speed during the subtraction task. CONCLUSION Dopaminergic medication showed larger additional effects on temporal gait parameters under ST and DT conditions in advanced PD than DBS. These results, after confirmation in independent studies, should be considered in the medical management of advanced PD patients with gait and DT deficits.
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Affiliation(s)
- Agnes Langer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Lara Lucke-Paulig
- Center for Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tuebingen, Tuebingen, Germany; Department of Endocrinology, Diabetology and Geriatrics, Stuttgart General Hospital, Bad Cannstatt, Germany
| | - Lucia Gassner
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, Vienna, Austria; Royal Melbourne Institute of Technology, Melbourne, Australia; HTA Austria - Austrian Institute for Health Technology Assessment GmbH, Vienna, Austria
| | - Rejko Krüger
- Center for Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tuebingen, Tuebingen, Germany; Luxembourg Institute of Health, Strassen, Luxembourg; Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Daniel Weiss
- Center for Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tuebingen, Tuebingen, Germany
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, University Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Heidemarie Zach
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Walter Maetzler
- Center for Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tuebingen, Tuebingen, Germany; Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Markus A Hobert
- Center for Neurology, Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tuebingen, Tuebingen, Germany; Department of Neurology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel, Kiel, Germany.
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50
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Shah VV, McNames J, Carlson‐Kuhta P, Nutt JG, El‐Gohary M, Sowalsky K, Mancini M, Horak FB. Effect of Levodopa and Environmental Setting on Gait and Turning Digital Markers Related to Falls in People with Parkinson's Disease. Mov Disord Clin Pract 2023; 10:223-230. [PMID: 36825056 PMCID: PMC9941945 DOI: 10.1002/mdc3.13601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022] Open
Abstract
Background It is unknown whether medication status (off and on levodopa) or laboratory versus home settings plays a role in discriminating fallers and non-fallers in people with Parkinson's disease (PD). Objectives To investigate which specific digital gait and turning measures, obtained with body-worn sensors, best discriminated fallers from non-fallers with PD in the clinic and during daily life. Methods We recruited 34 subjects with PD (17 fallers and 17 non-fallers based on the past 6 month's falls). Subjects wore three inertial sensors attached to both feet and the lumbar region in the laboratory for a 3-minute walking task (both off and on levodopa) and during daily life activities for a week. We derived 24 digital (18 gait and 6 turn) measures from the 3-minute walk and from daily life. Results In clinic, none of the gait and turning measures collected during on levodopa state were significantly different between fallers and non-fallers. In contrast, digital measures collected in the off levodopa state were significantly different between groups, (average turn velocity, average number of steps to complete a turn, and variability of gait speed, P < 0.03). During daily life, the variability of average turn velocity (P = 0.023) was significantly different in fallers than non-fallers. Last, the average number of steps to complete a turn was significantly correlated with the patient-reported outcomes. Conclusions Digital measures of turning, but not gait, were different in fallers compared to non-fallers with PD, in the laboratory when off medication and during a daily life.
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Affiliation(s)
- Vrutangkumar V. Shah
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- APDM Wearable Technologies, a Clario companyPortlandOregonUSA
| | - James McNames
- APDM Wearable Technologies, a Clario companyPortlandOregonUSA
- Department of Electrical and Computer EngineeringPortland State UniversityPortlandOregonUSA
| | | | - John G. Nutt
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | | | | | - Martina Mancini
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - Fay B. Horak
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- APDM Wearable Technologies, a Clario companyPortlandOregonUSA
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