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Palazzo F, Nardi A, Lamouchideli N, Caronti A, Alashram A, Padua E, Annino G. The effect of age, sex and a firm-textured surface on postural control. Exp Brain Res 2021; 239:2181-2191. [PMID: 33988736 PMCID: PMC8282579 DOI: 10.1007/s00221-021-06063-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 02/13/2021] [Indexed: 12/21/2022]
Abstract
In previous studies, the influence of plantar sensation has been examined using various textured surfaces with different stiffness materials to assess static balance. This study investigated the effects of a Firm Textured Surface (FTS) along with age and sex-related influences on postural control under different visual conditions. Forty subjects (20 elderly, 10 males, mean age 68.30, 10 females, mean age 68.00, and 20 young people, 10 males, mean age 25.45, 10 females, mean age 27.30) participated in this study maintained a quiet standing on FTS, foam and firm surfaces with eyes open and closed. The center of pressure displacement (CoPDISP), CoP velocity (CoPVEL), and sway velocity of the CoP in anteroposterior (AP) and mediolateral (ML) direction (VA/P and VM/L) were measured. FTS was associated with lower postural sway measures in both the groups with eyes open and closed. However, the foam surface showed the worst results in all postural parameters under all experimental conditions. Separate four-way ANOVAs were applied to each dependent variable. The main effects of surface (p < 0.0001), vision (p < 0.0001) and age (p < 0.0001 for CoPDISP, CoPVEL and VA/P; p = 0.0003 for VM/L) were significant in each of the four fitted models. Sex was never significant, either as a main effect or an interaction with other experimental factors. Eyes open were able to reduce the negative effects of the foam surfaces but without vision the proprioceptive sensory system cues of the body state become more important for maintaining balance. A good stimulation with rigid texture should be considered as relief to reduce the physiological-related decline of afferent information with age.
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Affiliation(s)
- Francesco Palazzo
- School of Human Movement Science, Faculty of Medicine and Surgery, University of Rome ''Tor Vergata'', Via Giovanna Garzoni 39, 00133, Rome, CAP, Italy.
| | - Alessandra Nardi
- Department of Mathematics, University of Rome "Tor Vergata", Rome, Italy
| | - Niloofar Lamouchideli
- School of Human Movement Science, Faculty of Medicine and Surgery, University of Rome ''Tor Vergata'', Via Giovanna Garzoni 39, 00133, Rome, CAP, Italy
| | - Alfio Caronti
- School of Human Movement Science, Faculty of Medicine and Surgery, University of Rome ''Tor Vergata'', Via Giovanna Garzoni 39, 00133, Rome, CAP, Italy
| | - Anas Alashram
- PhD School of Neuroscience, Faculty of Medicine and Surgery, University of Rome ''Tor Vergata'', Rome, Italy
| | - Elvira Padua
- School of Human Movement Science, Faculty of Medicine and Surgery, University of Rome ''Tor Vergata'', Via Giovanna Garzoni 39, 00133, Rome, CAP, Italy.,Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Giuseppe Annino
- School of Human Movement Science, Faculty of Medicine and Surgery, University of Rome ''Tor Vergata'', Via Giovanna Garzoni 39, 00133, Rome, CAP, Italy.,Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.,Department of Medicine Systems, University of Rome ''Tor Vergata'', Rome, Italy
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2
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Vaugoyeau M, Cignetti F, Eusebio A, Azulay JP. Subthalamic Deep Brain Stimulation Modulates Proprioceptive Integration in Parkinson's Disease During a Postural Task. Neuroscience 2020; 437:207-214. [PMID: 32339627 DOI: 10.1016/j.neuroscience.2020.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 01/15/2023]
Abstract
Defective proprioceptive integration may play a role in the pathophysiology of motor symptoms in Parkinson's disease (PD). Dysfunction related to proprioceptively-evoked postural reactions in PD patients is still a controversial issue, with only a limited number of studies to date and mostly discordant results. The aims of the present study were (1) to determine whether or not the proprioceptive defect in PD underlies postural impairment and (2) whether or not deep brain stimulation of the subthalamic nucleus (STN-DBS) affects proprioceptive integration. We examined proprioceptive integration during a postural task in 13 PD patients and 12 age-matched control subjects, using a muscle-tendon vibration paradigm. Analysis of the center of pressure displacement and kinematic data indicates a greater degree of postural destabilization and a reduced ability to maintain a vertical orientation in PD. We found a significant positive effect of STN-DBS on these postural features. Our findings indicate that Parkinson patients, even in the absence of any clinical evidence of instability, falls, or freezing, use proprioceptive information for postural control less efficiently than healthy subjects. Furthermore, STN-DBS was found to improve proprioceptive integration, with positive impacts on postural orientation and balance.
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Affiliation(s)
- M Vaugoyeau
- CNRS, Aix Marseille Univ, LNC UMR 7291, Marseille, France; CNRS, Aix Marseille Univ, Fédération 3C FR 3512, Marseille, France.
| | - F Cignetti
- Univ. Grenoble Alpes, CNRS, TIMC-IMAG, F-38000 Grenoble, France
| | - A Eusebio
- CNRS, Aix Marseille Univ, UMR 7289, Aix Marseille Université, CNRS, 13385, Marseille, France; Aix Marseille Univ, APHM, CHU Timone, Department of Neurology and Movement Disorders, Marseille, France
| | - J P Azulay
- CNRS, Aix Marseille Univ, LNC UMR 7291, Marseille, France; CNRS, Aix Marseille Univ, Fédération 3C FR 3512, Marseille, France; Aix Marseille Univ, APHM, CHU Timone, Department of Neurology and Movement Disorders, Marseille, France
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3
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Koeglsperger T, Palleis C, Hell F, Mehrkens JH, Bötzel K. Deep Brain Stimulation Programming for Movement Disorders: Current Concepts and Evidence-Based Strategies. Front Neurol 2019; 10:410. [PMID: 31231293 PMCID: PMC6558426 DOI: 10.3389/fneur.2019.00410] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/04/2019] [Indexed: 11/16/2022] Open
Abstract
Deep brain stimulation (DBS) has become the treatment of choice for advanced stages of Parkinson's disease, medically intractable essential tremor, and complicated segmental and generalized dystonia. In addition to accurate electrode placement in the target area, effective programming of DBS devices is considered the most important factor for the individual outcome after DBS. Programming of the implanted pulse generator (IPG) is the only modifiable factor once DBS leads have been implanted and it becomes even more relevant in cases in which the electrodes are located at the border of the intended target structure and when side effects become challenging. At present, adjusting stimulation parameters depends to a large extent on personal experience. Based on a comprehensive literature search, we here summarize previous studies that examined the significance of distinct stimulation strategies for ameliorating disease signs and symptoms. We assess the effect of adjusting the stimulus amplitude (A), frequency (f), and pulse width (pw) on clinical symptoms and examine more recent techniques for modulating neuronal elements by electrical stimulation, such as interleaving (Medtronic®) or directional current steering (Boston Scientific®, Abbott®). We thus provide an evidence-based strategy for achieving the best clinical effect with different disorders and avoiding adverse effects in DBS of the subthalamic nucleus (STN), the ventro-intermedius nucleus (VIM), and the globus pallidus internus (GPi).
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Affiliation(s)
- Thomas Koeglsperger
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Carla Palleis
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Franz Hell
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, Martinsried, Germany
| | - Jan H Mehrkens
- Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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Szlufik S, Kloda M, Friedman A, Potrzebowska I, Gregier K, Mandat T, Przybyszewski A, Dutkiewicz J, Figura M, Habela P, Koziorowski D. The Neuromodulatory Impact of Subthalamic Nucleus Deep Brain Stimulation on Gait and Postural Instability in Parkinson's Disease Patients: A Prospective Case Controlled Study. Front Neurol 2018; 9:906. [PMID: 30429820 PMCID: PMC6220087 DOI: 10.3389/fneur.2018.00906] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/08/2018] [Indexed: 01/20/2023] Open
Abstract
Background: Subthalamic nucleus deep brain stimulation (STN-DBS) has been an established method in improvement of motor disabilities in Parkinson's disease (PD) patients. It has been also claimed to have an impact on balance and gait disorders in PD patients, but the previous results are conflicting. Objective: The aim of this prospective controlled study was to evaluate the impact of STN-DBS on balance disorders in PD patients in comparison with Best-Medical-Therapy (BMT) and Long-term-Post-Operative (POP) group. Methods: DBS-group consisted of 20 PD patients (8F, 12M) who underwent bilateral STN DBS. POP-group consisted of 14 post-DBS patients (6F, 8M) in median 30 months-time after surgery. Control group (BMT-group) consisted of 20 patients (11F, 9M) who did not undergo surgical intervention. UPDRS III scale and balance tests (Up And Go Test, Dual Task- Timed Up And Go Test, Tandem Walk Test) and posturography parameters were measured during 3 visits in 9 ± 2months periods (V1, V2, V3) 4 phases of treatment (BMT-ON/OFF, DBS-ON/OFF). Results: We have observed the slowdown of gait and postural instability progression in first 9 post-operative months followed by co-existent enhancement of balance disorders in next 9-months evaluation (p < 0.05) in balance tests (Up and Go, TWT) and in posturography examination parameters (p < 0.05). The effect was not observed neither in BMT-group nor POP-group (p > 0.05): these groups revealed constant progression of static and dynamic instability (p > 0.05). Conclusions: STN-DBS can have modulatory effect on static and dynamic instability in PD patients: it can temporarily improve balance disorders. mainly during first 9 post-operative months, but with possible following deterioration of the symptoms in next post-operative months.
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Affiliation(s)
- Stanislaw Szlufik
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Maria Kloda
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland.,Department of Rehabilitation, II Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Friedman
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Iwona Potrzebowska
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland.,Department of Rehabilitation, II Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Kacper Gregier
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Mandat
- Department of Neurosurgery, Maria Sklodowska Curie Memorial Oncology Center, Warsaw, Warsaw, Poland
| | - Andrzej Przybyszewski
- Department of Informatics, Polish Japanese Academy of Information Technology, Warsaw, Poland
| | - Justyna Dutkiewicz
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Monika Figura
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Habela
- Department of Informatics, Polish Japanese Academy of Information Technology, Warsaw, Poland
| | - Dariusz Koziorowski
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
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5
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Effects of deep brain stimulation on balance and gait in patients with Parkinson's disease: A systematic neurophysiological review. Neurophysiol Clin 2015; 45:371-88. [DOI: 10.1016/j.neucli.2015.07.001] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 06/23/2015] [Accepted: 07/16/2015] [Indexed: 12/17/2022] Open
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Fasano A, Aquino CC, Krauss JK, Honey CR, Bloem BR. Axial disability and deep brain stimulation in patients with Parkinson disease. NATURE REVIEWS. NEUROLOGY 2015. [PMID: 25582445 DOI: 10.1038/nrneurol.2014.252.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Axial motor signs-including gait impairment, postural instability and postural abnormalities-are common and debilitating symptoms in patients with advanced Parkinson disease. Dopamine replacement therapy and physiotherapy provide, at best, partial relief from axial motor symptoms. In carefully selected candidates, deep brain stimulation (DBS) of the subthalamic nucleus or globus pallidus internus is an established treatment for 'appendicular' motor signs (limb tremor, bradykinesia and rigidity). However, the effects of DBS on axial signs are much less clear, presumably because motor control of axial and appendicular functions is mediated by different anatomical-functional pathways. Here, we discuss the successes and failures of DBS in managing axial motor signs. We systematically address a series of common clinical questions associated with the preoperative phase, during which patients presenting with prominent axial signs are considered for DBS implantation surgery, and the postoperative phase, in particular, the management of axial motor signs that newly develop as postoperative complications, either acutely or with a delay. We also address the possible merits of new targets-including the pedunculopontine nucleus area, zona incerta and substantia nigra pars reticulata-to specifically alleviate axial symptoms. Supported by a rapidly growing body of evidence, this practically oriented Review aims to support decision-making in the management of axial symptoms.
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Affiliation(s)
- Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst Street, 7 Mc412, Toronto, ON M5T 2S8, Canada
| | - Camila C Aquino
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst Street, 7 Mc412, Toronto, ON M5T 2S8, Canada
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Christopher R Honey
- Division of Neurosurgery at the University of British Columbia, 8105-2775 Laurel Street, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, PO Box 9101, 6500 HB Nijmegen, Netherlands
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7
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Abstract
Axial motor signs-including gait impairment, postural instability and postural abnormalities-are common and debilitating symptoms in patients with advanced Parkinson disease. Dopamine replacement therapy and physiotherapy provide, at best, partial relief from axial motor symptoms. In carefully selected candidates, deep brain stimulation (DBS) of the subthalamic nucleus or globus pallidus internus is an established treatment for 'appendicular' motor signs (limb tremor, bradykinesia and rigidity). However, the effects of DBS on axial signs are much less clear, presumably because motor control of axial and appendicular functions is mediated by different anatomical-functional pathways. Here, we discuss the successes and failures of DBS in managing axial motor signs. We systematically address a series of common clinical questions associated with the preoperative phase, during which patients presenting with prominent axial signs are considered for DBS implantation surgery, and the postoperative phase, in particular, the management of axial motor signs that newly develop as postoperative complications, either acutely or with a delay. We also address the possible merits of new targets-including the pedunculopontine nucleus area, zona incerta and substantia nigra pars reticulata-to specifically alleviate axial symptoms. Supported by a rapidly growing body of evidence, this practically oriented Review aims to support decision-making in the management of axial symptoms.
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8
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Palazzo F, Caronti A, Lebone P, Proietti A, Panzarino M, Annino G. Effects of stimulating surface during static upright posture in the elderly. Somatosens Mot Res 2014; 32:61-6. [PMID: 25296245 DOI: 10.3109/08990220.2014.958217] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aimed to investigate the influence of three stimulating surfaces based on center of pressure (CoP), anteroposterior sway velocity (V(A/P)), and medio-lateral sway velocity (V(M/L)) of 40 elderly subjects. CoP and V(M/L) showed a significant decrease in all visual conditions only in the stimulating surface whereas V(A/P) showed a significant decrease only on the same surface with eyes open. Results confirm the importance of multisensory stimulation in postural control in the elderly.
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Affiliation(s)
- Francesco Palazzo
- School of PhD in "Advanced Sciences and Technologies in Rehabilitation Medicine and Sports", University of Rome "Tor Vergata" , Rome , Italy and
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9
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de Kam D, Nonnekes J, Oude Nijhuis LB, Geurts ACH, Bloem BR, Weerdesteyn V. Dopaminergic medication does not improve stepping responses following backward and forward balance perturbations in patients with Parkinson’s disease. J Neurol 2014; 261:2330-7. [DOI: 10.1007/s00415-014-7496-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 09/04/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022]
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10
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Altuğ F, Acar F, Acar G, Cavlak U. The effects of brain stimulation of subthalamic nucleus surgery on gait and balance performance in Parkinson disease. A pilot study. Arch Med Sci 2014; 10:733-8. [PMID: 25276158 PMCID: PMC4175774 DOI: 10.5114/aoms.2012.31371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 03/12/2012] [Accepted: 05/11/2012] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by tremor, rigidity and bradykinesia. Gait and postural difficulties supersede tremor, rigidity and bradykinesia as drivers of disease burden in patients with advanced PD. The aim of this study was to describe the effects of deep brain stimulation of the subthalamic nucleus on gait ability and balance performance in patients with PD. MATERIAL AND METHODS We studied 19 consecutive patients who underwent bilateral stimulation of the subthalamic nucleus. Patients were evaluated preoperatively and at the 5(th) day and 6(th) month after surgery. Timed Up and Go Test, 12 m Walking Test, Chair Stand Test and Berg Balance Scale (BBS) were used to assess mobility and balance performance. Unified Parkinson's Disease Rating Scale (UPDRS III) and Hoehn and Yahr Scale were also used. RESULTS All the patients' mobility ability and balance performance improved after surgery (p < 0.05). At the 6th month after surgery, the Timed Up and Go Test scores were decreased from 56.05 ±42.52 to 21.47 ±20.36, the 12 m Walking Test scores were decreased from 100.44 ±66.44 to 28.84 ±19.79, the Chair Stand Test scores were increased from 4.00 ±4.66 to 11.68 ±4.43 and the BBS score was increased from 12.84 ±6.89 to 38.89 ±8.79. UPDRS total scores were significantly improved 6 months after surgery (p < 0.001). UPDRS total scores were decreased from 98.26 ±37.69 to 39.36 ±18.85. The Hoehn and Yahr Scale score was significantly decreased after surgery (p < 0.05). CONCLUSIONS Surgical therapy is an effective treatment to improve gait ability and balance performance in Parkinson's patients.
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Affiliation(s)
- Filiz Altuğ
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Feridun Acar
- Department of Neurosurgery, Pamukkale University, Denizli, Turkey
| | - Göksemin Acar
- Department of Neurology, Pamukkale University, Denizli, Turkey
| | - Uğur Cavlak
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
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Maetzler W, Nieuwhof F, Hasmann SE, Bloem BR. Emerging therapies for gait disability and balance impairment: promises and pitfalls. Mov Disord 2014; 28:1576-86. [PMID: 24132846 DOI: 10.1002/mds.25682] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/13/2013] [Accepted: 08/13/2013] [Indexed: 12/31/2022] Open
Abstract
Therapeutic management of gait and balance impairment during aging and neurodegeneration has long been a neglected topic. This has changed considerably during recent years, for several reasons: (1) an increasing recognition that gait and balance deficits are among the most relevant determinants of an impaired quality of life and increased mortality for affected individuals; (2) the arrival of new technology, which has allowed for new insights into the anatomy and functional (dis)integrity of gait and balance circuits; and (3) based in part on these improved insights, the development of new, more specific treatment strategies in the field of pharmacotherapy, deep brain surgery, and physiotherapy. The initial experience with these emerging treatments is encouraging, although much work remains to be done. The objective of this narrative review is to discuss several promising developments in the field of gait and balance treatment. We also address several pitfalls that can potentially hinder a fast and efficient continuation of this vital progress. Important issues that should be considered in future research include a clear differentiation between gait and balance as two distinctive targets for treatment and recognition of compensatory mechanisms as a separate target for therapeutic intervention.
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Affiliation(s)
- Walter Maetzler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DNZE), Tübingen, Germany
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12
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Mohapatra S, Kukkar KK, Aruin AS. Support surface related changes in feedforward and feedback control of standing posture. J Electromyogr Kinesiol 2014; 24:144-52. [PMID: 24268589 PMCID: PMC3947041 DOI: 10.1016/j.jelekin.2013.10.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 10/09/2013] [Accepted: 10/26/2013] [Indexed: 11/28/2022] Open
Abstract
The aim of the study was to investigate the effect of different support surfaces on feedforward and feedback components of postural control. Nine healthy subjects were exposed to external perturbations applied to their shoulders while standing on a rigid platform, foam, and wobble board with eyes open or closed. Electrical activity of nine trunk and leg muscles and displacements of the center of pressure were recorded and analyzed during the time frames typical of feedforward and feedback postural adjustments. Feedforward control of posture was characterized by earlier activation of anterior muscles when the subjects stood on foam compared to a wobble board or a firm surface. In addition, the magnitude of feedforward muscle activity was the largest when the foam was used. During the feedback control, anterior muscles were activated prior to posterior muscles irrespective of the nature of surface. Moreover, the largest muscle activity was seen when the supporting surface was foam. Maximum CoP displacement occurred when subjects were standing on a rigid surface. Altering support surface affects both feedforward and feedback components of postural control. This information should be taken into consideration in planning rehabilitation interventions geared towards improvement of balance.
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Affiliation(s)
- Sambit Mohapatra
- University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Komal K Kukkar
- University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Alexander S Aruin
- University of Illinois at Chicago, Chicago, IL 60612, United States.
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13
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Gorniak SL, McIntyre CC, Alberts JL. Bimanual force coordination in Parkinson's disease patients with bilateral subthalamic deep brain stimulation. PLoS One 2013; 8:e78934. [PMID: 24244388 PMCID: PMC3823934 DOI: 10.1371/journal.pone.0078934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/25/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Studies of bimanual actions similar to activities of daily living (ADLs) are currently lacking in evaluating fine motor control in Parkinson's disease patients implanted with bilateral subthalamic deep brain stimulators. We investigated basic time and force characteristics of a bimanual task that resembles performance of ADLs in a group of bilateral subthalamic deep brain stimulation (DBS) patients. METHODS Patients were evaluated in three different DBS parameter conditions off stimulation, on clinically derived stimulation parameters, and on settings derived from a patient-specific computational model. Model-based parameters were computed as a means to minimize spread of current to non-motor regions of the subthalamic nucleus via Cicerone Deep Brain Stimulation software. Patients were evaluated off parkinsonian medications in each stimulation condition. RESULTS The data indicate that DBS parameter state does not affect most aspects of fine motor control in ADL-like tasks; however, features such as increased grip force and grip symmetry varied with the stimulation state. In the absence of DBS parameters, patients exhibited significant grip force asymmetry. Overall UPDRS-III and UPDRS-III scores associated with hand function were lower while patients were experiencing clinically-derived or model-based parameters, as compared to the off-stimulation condition. CONCLUSION While bilateral subthalamic DBS has been shown to alleviate gross motor dysfunction, our results indicate that DBS may not provide the same magnitude of benefit to fine motor coordination.
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Affiliation(s)
- Stacey L. Gorniak
- Department of Health and Human Performance, University of Houston, Houston, Texas, United States of America
- Centers for Neuromotor and Biomechanics Research and Neuro-Engineering and Cognitive Science, University of Houston, Houston, Texas, United States of America
- * E-mail:
| | - Cameron C. McIntyre
- Department of Biomedical Engineering and Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, United States of America
- Cleveland Functional Electrical Stimulation Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Jay L. Alberts
- Department of Biomedical Engineering and Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, United States of America
- Cleveland Functional Electrical Stimulation Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
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14
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Deep brain stimulation amplitude alters posture shift velocity in Parkinson's disease. Cogn Neurodyn 2012; 6:325-32. [PMID: 24995048 DOI: 10.1007/s11571-012-9201-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 03/02/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is now widely used to alleviate symptoms of Parkinson's disease (PD). The specific aim of this study was to identify posture control measures that may be used to improve selection of DBS parameters in the clinic and this was carried out by changing the DBS stimulation amplitude. A dynamic posture shift paradigm was used to assess posture control in 4 PD STN-DBS subjects. Each subject was tested at 4 stimulation amplitude settings. Movements of the center of pressure and the position of the pelvis were monitored and several quantitative indices were calculated. The presence of any statistically significant changes in several normalized indices due to reduced/no stimulation was tested using the one-sample t test. The peak velocity and the average movement velocity during the initial and mid phases of movement towards the target posture were substantially reduced. These results may be explained in terms of increased akinesia and bradykinesia due to altered stimulation conditions. Thus, the dynamic posture shift paradigm may be an effective tool to quantitatively characterize the effects of DBS on posture control and should be further investigated as a tool for selection of DBS parameters in the clinic.
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15
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Stimulation of the subthalamic nucleus improves velocity of ballistic movements in Parkinson’s disease. Neuroreport 2012; 23:390-4. [DOI: 10.1097/wnr.0b013e3283525b39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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St George RJ, Nutt JG, Burchiel KJ, Horak FB. A meta-regression of the long-term effects of deep brain stimulation on balance and gait in PD. Neurology 2010; 75:1292-9. [PMID: 20921515 DOI: 10.1212/wnl.0b013e3181f61329] [Citation(s) in RCA: 200] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Deep brain stimulation (DBS) alleviates the cardinal Parkinson disease (PD) symptoms of tremor, rigidity, and bradykinesia. However, its effects on postural instability and gait disability (PIGD) are uncertain. Contradictory findings may be due to differences the in stimulation site and the length of time since DBS surgery. This prompted us to conduct the first meta-regression of long-term studies of bilateral DBS in the subthalamic nucleus (STN) and globus pallidus interna (GPi). RESULTS Eleven articles reported a breakdown of the Unified Parkinson's Disease Rating Scale score before and beyond 3 years postsurgery (mean 4.5 years). Random effects meta-regression revealed that DBS initially improved PIGD compared to the OFF medicated state before surgery, but performance declined over time and extrapolation showed subjects would reach presurgery levels 9 years postsurgery. ON medication, DBS improved PIGD over and above the effect of medication before surgery. Nevertheless, for the STN group, PIGD progressively declined and was worse than presurgery function within 2 years. In contrast, GPi patients showed no significant long-term decline in PIGD in the medicated state. Improvements in cardinal signs with DBS at both sites were maintained across 5 years in the OFF and ON medication states. CONCLUSIONS DBS alone does not offer the same improvement to PIGD as it does to the cardinal symptoms, suggesting axial and distal control are differentially affected by DBS. GPi DBS in combination with levodopa seemed to preserve PIGD better than did STN DBS, although more studies of GPi DBS and randomized controls are needed.
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Affiliation(s)
- R J St George
- Department of Neurology, Oregon Health & Sciences University, 505 NW 185 Avenue, Beaverton, OR 97006, USA.
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Nilsson MH, Fransson PA, Jarnlo GB, Magnusson M, Rehncrona S. The effects of high frequency subthalamic stimulation on balance performance and fear of falling in patients with Parkinson's disease. J Neuroeng Rehabil 2009; 6:13. [PMID: 19405954 PMCID: PMC2683854 DOI: 10.1186/1743-0003-6-13] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 04/30/2009] [Indexed: 11/23/2022] Open
Abstract
Background Balance impairment is one of the most distressing symptoms in Parkinson's disease (PD) even with pharmacological treatment (levodopa). A complementary treatment is high frequency stimulation in the subthalamic nucleus (STN). Whether STN stimulation improves postural control is under debate. The aim of this study was to explore the effects of STN stimulation alone on balance performance as assessed with clinical performance tests, subjective ratings of fear of falling and posturography. Methods Ten patients (median age 66, range 59–69 years) with bilateral STN stimulation for a minimum of one year, had their anti-PD medications withdrawn overnight. Assessments were done both with the STN stimulation turned OFF and ON (start randomized). In both test conditions, the following were assessed: motor symptoms (descriptive purposes), clinical performance tests, fear of falling ratings, and posturography with and without vibratory proprioceptive disturbance. Results STN stimulation alone significantly (p = 0.002) increased the scores of the Berg balance scale, and the median increase was 6 points. The results of all timed performance tests, except for sharpened Romberg, were significantly (p ≤ 0.016) improved. The patients rated their fear of falling as less severe, and the total score of the Falls-Efficacy Scale(S) increased (p = 0.002) in median with 54 points. All patients completed posturography when the STN stimulation was turned ON, but three patients were unable to do so when it was turned OFF. The seven patients with complete data showed no statistical significant difference (p values ≥ 0.109) in torque variance values when comparing the two test situations. This applied both during quiet stance and during the periods with vibratory stimulation, and it was irrespective of visual input and sway direction. Conclusion In this sample, STN stimulation alone significantly improved the results of the clinical performance tests that mimic activities in daily living. This improvement was further supported by the patients' ratings of fear of falling, which were less severe with the STN stimulation turned ON. Posturography could not be performed by three out of the ten patients when the stimulation was turned OFF. The posturography results of the seven patients with complete data showed no significant differences due to STN stimulation.
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Affiliation(s)
- Maria H Nilsson
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.
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Visser J, Allum J, Carpenter M, Esselink R, Limousin-Dowsey P, Honegger F, Borm G, Bloem B. Effect of subthalamic nucleus deep brain stimulation on axial motor control and protective arm responses in Parkinson's disease. Neuroscience 2008; 157:798-812. [DOI: 10.1016/j.neuroscience.2008.09.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 09/16/2008] [Accepted: 09/17/2008] [Indexed: 11/15/2022]
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Frenklach A, Louie S, Koop MM, Bronte-Stewart H. Excessive postural sway and the risk of falls at different stages of Parkinson's disease. Mov Disord 2008; 24:377-85. [PMID: 18972546 DOI: 10.1002/mds.22358] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Anna Frenklach
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California 94305-5327, USA
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Subthalamic nucleus stimulation and levodopa-resistant postural instability in Parkinson's disease. J Neurol 2008; 255:205-10. [PMID: 18274810 DOI: 10.1007/s00415-008-0636-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 04/04/2007] [Accepted: 04/25/2007] [Indexed: 10/22/2022]
Abstract
We examined the effect of bilateral subthalamic nucleus stimulation on levodopa-resistant balance impairment in 14 patients with Parkinson's disease and 18 matched controls. Instability was quantitatively assessed using standardized multidirectional dynamic posturography. Patients were tested after taking a suprathreshold dose of levodopa, both with stimulators turned on and off. Patients with stimulators turned off were more unstable than controls following backward directed perturbations. Overall, patients' instability did not improve with STN stimulation, and considerable inter-individual variability was noted. Of note, marked levodopa- resistant axial motor symptoms before surgery correlated with an adverse treatment effect. We conclude that STN stimulation does not alleviate levodopa-resistant postural instability in Parkinson's disease.
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Fransson PA, Gomez S, Patel M, Johansson L. Changes in multi-segmented body movements and EMG activity while standing on firm and foam support surfaces. Eur J Appl Physiol 2007; 101:81-9. [PMID: 17503068 DOI: 10.1007/s00421-007-0476-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2007] [Indexed: 10/23/2022]
Abstract
Postural control ensures stability during both static posture and locomotion by initiating corrective adjustments in body movement. This is particularly important when the conditions of the support surface change. We investigated the effects of standing on a compliant foam surface using 12 normal subjects (mean age 26 years) in terms of: linear movements at the head, shoulder, hip and knee; EMG activity of the tibialis anterior and gastrocnemius muscles and torques towards the support surface. As subjects repeated the trials with eyes open or closed, we were also able to determine the effects of vision on multi-segmented body movements during standing upon different support surface conditions. As expected, EMG activity, torque variance values and body movements at all measured positions increased significantly when standing on foam compared with the firm surface. Linear knee and hip movements increased more, relative to shoulder and head movements while standing on foam. Vision stabilized the head and shoulder movements more than hip and knee movements while standing on foam support surface. Moreover, vision significantly reduced the tibialis anterior EMG activity and torque variance during the trials involving foam. In conclusion, the foam support surface increased corrective muscle and torque activity, and changed the firm-surface multi-segmented body movement pattern. Vision improved the ability of postural control to handle compliant surface conditions. Several essential features of postural control have been found from recording movements from multiple points on the body, synchronized with recording torque and EMG.
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Affiliation(s)
- P A Fransson
- Department of Otorhinolaryngology Head and Neck surgery, Clinical Sciences, Lund, Lund University, Lund, Sweden.
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Visser JE, Voermans NC, Oude Nijhuis LB, van der Eijk M, Nijk R, Munneke M, Bloem BR. Quantification of trunk rotations during turning and walking in Parkinson's disease. Clin Neurophysiol 2007; 118:1602-6. [PMID: 17452124 DOI: 10.1016/j.clinph.2007.03.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Revised: 02/22/2007] [Accepted: 03/12/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop a reliable, objective and sensitive measure of axial trunk rotations in PD, which can be applied in an ambulatory setting. METHODS To quantify turning motion, two angular velocity transducers attached to the lower back measured angular velocity of the trunk in the yaw plane (i.e., around the longitudinal axis) and the roll plane (i.e., medio-lateral movements) in freely moving subjects who were instructed to walk and make various types of turning movements. RESULTS Turn duration was longer in PD patients compared to controls. Peak yaw and peak roll angular velocities were lower in PD patients compared to controls during all turning tasks. CONCLUSIONS This new approach to measure trunk sway during a simple turning task might serve as an instrument to objectively quantify turning while walking in PD. SIGNIFICANCE It proves difficult to objectively assess turning performance based upon history taking or clinical examination alone. Objective and easy measurement of axial turning in PD might be used for clinical evaluation, but also in a domestic setting as outcome measure in intervention studies. Further research should focus on the clinical relevance of the new quantitative approach described in this paper, e.g., to detect freezing of gait episodes.
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Affiliation(s)
- Jasper E Visser
- Department of Neurology, Radboud University Nijmegen Medical Centre, Parkinson Center Nijmegen, Nijmegen, The Netherlands
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Laser literature watch. Photomed Laser Surg 2006; 24:537-71. [PMID: 16942439 DOI: 10.1089/pho.2006.24.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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