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Park JE, You J, Kim RO, Kwon KY. Ameliorating freezing of gait with levodopa treatment: a lesson from an illustrative case of progressive supranuclear palsy. Acta Neurol Belg 2025; 125:845-848. [PMID: 39692973 DOI: 10.1007/s13760-024-02697-5] [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: 06/30/2024] [Accepted: 12/09/2024] [Indexed: 12/19/2024]
Affiliation(s)
- Jung E Park
- Department of Neurology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Republic of Korea
| | - Jihwan You
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Rae On Kim
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Kyum-Yil Kwon
- Department of Neurology, Soon-chun-hyang University Seoul Hospital, Soon-chun-hyang University School of Medicine, Seoul, Republic of Korea.
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea.
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Cho N, Kalia LV, Kalia SK. Re-examining the pathobiological basis of gait dysfunction in Parkinson's disease. Trends Neurosci 2025; 48:189-199. [PMID: 39884904 DOI: 10.1016/j.tins.2025.01.002] [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: 10/14/2024] [Revised: 12/23/2024] [Accepted: 01/14/2025] [Indexed: 02/01/2025]
Abstract
Parkinson's disease (PD) is a significant source of morbidity, especially with an aging population. Gait problems, particularly freezing of gait (FOG), remain a persistent issue, causing falls and reduced quality of life without consistent responses to therapies. PD and related symptoms have classically been attributed to dopamine deficiency secondary to substantia nigra degeneration from Lewy body (LB) and Lewy neurite (LN) infiltration. However, Lewy-related pathology is present in other areas of the brainstem and spinal cord that control gait function, yet these other circuits have not been routinely considered in the design of current therapeutic options. In this review, we summarize changes in brainstem and spinal cord circuits in individuals affected by PD and the implications for understanding of gait dysfunction in PD.
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Affiliation(s)
- Newton Cho
- Department of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Lorraine V Kalia
- Krembil Brain Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada; Department of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Department of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
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Artusi CA, Ledda C, Gallo S, Rinaldi D, Campisi C, Rousseau V, Thalamas C, Barbosa R, Ory-Magne F, Brefel-Courbon C, Rascol O, de Barros A, Harroch E, Zibetti M, Rizzone MG, Romagnolo A, Imbalzano G, Lopiano L, Houeto JL, Fabbri M. Subthalamic and nigral stimulation for freezing of gait in Parkinson's disease: Randomized pilot trial. JOURNAL OF PARKINSON'S DISEASE 2024; 14:1602-1613. [PMID: 39957196 DOI: 10.1177/1877718x241292315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2025]
Abstract
BACKGROUND Freezing of gait (FoG) is a debilitating symptom of Parkinson's disease (PD) with limited response to dopaminergic medication and subthalamic deep brain stimulation (STN-DBS). Substantia nigra pars reticulata (SNr) stimulation could improve FoG. OBJECTIVE To analyze the effect of combined STN-SNr stimulation at different frequencies on FoG. METHODS We performed a double-blind, cross-over, randomized pilot trial involving STN-DBS treated PD patients with FoG. Participants received: high-frequency (HF) STN-DBS (S), combined HF-STN and SNr stimulation (C1), and combined HF-STN and low-frequency (LF) SNr stimulation (C2), for one month each. The primary endpoint was the score change in the New-Freezing-of-Gait-Questionnaire (NFOG-Q). Secondary analyses were performed on motor complications, axial symptoms, daily living activities, psychiatric symptoms, sleep, and patient preference. RESULTS Fifteen patients received at least one combined stimulation. No significant difference in NFOG-Q scores was found between S, C1, and C2; one-third of patients showed a clinically significant improvement (≥8 points) with combined stimulations. Motor complications improved significantly with C1 and C2 (C1-S: 3.6 ± 3.8 vs. 4.9 ± 3.8, p = 0.046; C2-S: 2.7 ± 3.1 vs. 4.9 ± 3.8, p = 0.005). 80% of patients preferred the combined STN-SNr stimulation while blinded. All adverse events were manageable. CONCLUSIONS Our study did not prove a statistically significant improvement in NFOG-Q with STN-SNr stimulation; however, one-third of patients experienced a clinically meaningful FoG improvement, and the majority preferred to maintain STN-SNr stimulation. STN-SNr stimulation was both safe and effective in addressing motor complications and improving sleep quality, highlighting the importance of further exploration into the effects of combined STN-SNr stimulation.
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Affiliation(s)
- Carlo Alberto Artusi
- Department of Neurosciences Rita Levi Montalcini, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Claudia Ledda
- Department of Neurosciences Rita Levi Montalcini, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Silvia Gallo
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Domiziana Rinaldi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, Via di Grottarossa, 1035-00189, Rome, Italy
| | - Corrado Campisi
- Department of Neurosciences Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Vanessa Rousseau
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire et Faculté de Médecine de Toulouse, Toulouse, France
- Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament et Pharmacopôle Midi-Pyrénées, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- CIC INSERM 1436, Université et Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Claire Thalamas
- CIC INSERM 1436, Université et Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Raquel Barbosa
- Service de Neurologie, Centre Hospitalier Universitaire, Toulouse, France
- Centre Expert Parkinson de Toulouse, CHU, Toulouse, France
| | - Fabienne Ory-Magne
- Service de Neurologie, Centre Hospitalier Universitaire, Toulouse, France
- Centre Expert Parkinson de Toulouse, CHU, Toulouse, France
| | - Christine Brefel-Courbon
- Service de Neurologie, Centre Hospitalier Universitaire, Toulouse, France
- Centre Expert Parkinson de Toulouse, CHU, Toulouse, France
- France CHU de Toulouse, Université de Toulouse-Toulouse 3, INSERM, UMR1214 Toulouse NeuroImaging Centre "TONIC," Center of Excellence in Neurodegeneration, NeuroToul, Centre Expert Parkinson de Toulouse, Centre d'Investigation Clinique CIC1436, NS-Park/FCRIN Network, Services de Neurologie et de Pharmacologie Clinique, UMR 1048 Institute for Cardiovascular Diseases, Toulouse, France
| | - Olivier Rascol
- CIC INSERM 1436, Université et Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Centre Expert Parkinson de Toulouse, CHU, Toulouse, France
- France CHU de Toulouse, Université de Toulouse-Toulouse 3, INSERM, UMR1214 Toulouse NeuroImaging Centre "TONIC," Center of Excellence in Neurodegeneration, NeuroToul, Centre Expert Parkinson de Toulouse, Centre d'Investigation Clinique CIC1436, NS-Park/FCRIN Network, Services de Neurologie et de Pharmacologie Clinique, UMR 1048 Institute for Cardiovascular Diseases, Toulouse, France
| | - Amaury de Barros
- Department of Neurosurgery, Toulouse University Hospital, Toulouse, France
- INSERM, UMR1214 Toulouse NeuroImaging Centre "TONIC", Toulouse, France
| | - Estelle Harroch
- CIC INSERM 1436, Université et Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Centre Expert Parkinson de Toulouse, CHU, Toulouse, France
| | - Maurizio Zibetti
- Department of Neurosciences Rita Levi Montalcini, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Mario Giorgio Rizzone
- Department of Neurosciences Rita Levi Montalcini, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Alberto Romagnolo
- Department of Neurosciences Rita Levi Montalcini, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Gabriele Imbalzano
- Department of Neurosciences Rita Levi Montalcini, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Leonardo Lopiano
- Department of Neurosciences Rita Levi Montalcini, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Torino, Italy
| | - Jean Luc Houeto
- Department of Neurology, NS-Park/F-CRIN network, Limoges University Hospital; Inserm, U1094, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Limoges Cedex 01, France
| | - Margherita Fabbri
- CIC INSERM 1436, Université et Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Service de Neurologie, Centre Hospitalier Universitaire, Toulouse, France
- Centre Expert Parkinson de Toulouse, CHU, Toulouse, France
- France CHU de Toulouse, Université de Toulouse-Toulouse 3, INSERM, UMR1214 Toulouse NeuroImaging Centre "TONIC," Center of Excellence in Neurodegeneration, NeuroToul, Centre Expert Parkinson de Toulouse, Centre d'Investigation Clinique CIC1436, NS-Park/FCRIN Network, Services de Neurologie et de Pharmacologie Clinique, UMR 1048 Institute for Cardiovascular Diseases, Toulouse, France
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Xu SS, Zhu SG, Yuan CX, Zeng GL, Li XT, Liu RP, Huang SS, Zhang X, Wang JY. Case report: Levodopa challenge test is important in identifying dopamine-induced freezing of gait in patient with Parkinson's disease. Front Hum Neurosci 2024; 18:1464152. [PMID: 39296915 PMCID: PMC11408169 DOI: 10.3389/fnhum.2024.1464152] [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: 07/17/2024] [Accepted: 08/26/2024] [Indexed: 09/21/2024] Open
Abstract
Introduction Freezing of gait (FOG) is a disabling and heterogeneous symptom in patients with Parkinson's disease (PD). Among them, dopamine-induced FOG is rare and difficult to identify. The treatment of dopamine-induced FOG is complex. Case presentation We herein presented a case of PD patient who complicated with refractory FOG. It was identified as dopamine-induced FOG during levodopa challenge test. Her symptoms were alleviated after we reduced the total equivalent dosage of levodopa. Conclusion Our report emphasizes the importance of levodopa challenge test in identifying different types of FOG, which is very important for further adjusting treatment.
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Affiliation(s)
- Shan-Shan Xu
- Department of Neurology, Institute of Geriatric Neurology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shi-Guo Zhu
- Department of Neurology, Institute of Geriatric Neurology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Cheng-Xiang Yuan
- Department of Neurology, Institute of Geriatric Neurology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Guo-Ling Zeng
- Department of Neurology, Institute of Geriatric Neurology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiao-Tian Li
- Department of Neurology, Institute of Geriatric Neurology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Rong-Pei Liu
- Department of Neurology, Institute of Geriatric Neurology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shi-Shi Huang
- Department of Neurology, Institute of Geriatric Neurology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiong Zhang
- Department of Neurology, Institute of Geriatric Neurology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jian-Yong Wang
- Department of Neurology, Institute of Geriatric Neurology, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
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Gámez-Leyva G, Cubo E. Freezing of gait: pharmacological and surgical options. Curr Opin Neurol 2024; 37:394-399. [PMID: 38828625 DOI: 10.1097/wco.0000000000001278] [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: 06/05/2024]
Abstract
PURPOSE OF REVIEW The primary aim of this review is to describe and update the pathophysiological and relevant therapeutic strategies for freezing of gait (FoG) in patients with Parkinson's disease (PD). RECENT FINDINGS FoG presumably involves dysfunction of multiple cortical and subcortical components, including dopaminergic and nondopaminergic circuits. In this regard, levodopa and physical therapy represent the first-choice therapeutic options for PD patients with FoG. However, the relationship between FoG and levodopa is not fully predictable. For those patients with levodopa-resistant FoG, there is promising but still controversial data on the benefits of bilateral high-frequency transcranial magnetic stimulation and deep brain stimulation on the subthalamic nuclei, substantia nigra pars reticulata, pedunculopontine nucleus, and the Fields of Forel. On the other hand, general exercise, gait training with a treadmill, focus attention on gait training, and conventional physiotherapy have demonstrated moderate to large benefits in FoG. SUMMARY FOG requires different treatment strategies. The inclusion of adequate detection and prediction of FoG combined with double-blind, and statistically powered protocols are needed to improve patients' quality of life, the motor and nonmotor symptoms and societal burden associated with FoG.
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Affiliation(s)
| | - Esther Cubo
- Hospital Universitario Burgos
- Health Science Department, University of Burgos, Burgos, Spain
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Yang PK, Filtjens B, Ginis P, Goris M, Nieuwboer A, Gilat M, Slaets P, Vanrumste B. Automatic Detection and Assessment of Freezing of Gait Manifestations. IEEE Trans Neural Syst Rehabil Eng 2024; 32:2699-2708. [PMID: 39028610 DOI: 10.1109/tnsre.2024.3431208] [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: 07/21/2024]
Abstract
Freezing of gait (FOG) is an episodic and highly disabling symptom of Parkinson's disease (PD). Although described as a single phenomenon, FOG is heterogeneous and can express as different manifestations, such as trembling in place or complete akinesia. We aimed to analyze the efficacy of deep learning (DL) trained on inertial measurement unit data to classify FOG into both manifestations. We adapted and compared four state-of-the-art FOG detection algorithms for this task and investigated the advantages of incorporating a refinement model to address oversegmentation errors. We evaluated the model's performance in distinguishing between trembling and akinesia, as well as other forms of movement cessation (e.g., stopping and sitting), against gold-standard video annotations. Experiments were conducted on a dataset of eighteen PD patients completing a FOG-provoking protocol in a gait laboratory. Results showed our model achieved an F1 score of 0.78 and segment F1@50 of 0.75 in detecting FOG manifestations. Assessment of FOG severity was strong for trembling (ICC=0.86, [0.66,0.95]) and moderately strong for akinesia (ICC=0.78, [0.51,0.91]). Importantly, our model successfully differentiated FOG from other forms of movement cessation during 360-degree turning-in-place tasks. In conclusion, our study demonstrates that DL can accurately assess different types of FOG manifestations, warranting further investigation in larger and more diverse verification cohorts.
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Conde CI, Lang C, Baumann CR, Easthope CA, Taylor WR, Ravi DK. Triggers for freezing of gait in individuals with Parkinson's disease: a systematic review. Front Neurol 2023; 14:1326300. [PMID: 38187152 PMCID: PMC10771308 DOI: 10.3389/fneur.2023.1326300] [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: 10/23/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Background Freezing of Gait (FOG) is a motor symptom frequently observed in advanced Parkinson's disease. However, due to its paroxysmal nature and diverse presentation, assessing FOG in a clinical setting can be challenging. Before FOG can be fully investigated, it is critical that a reliable experimental setting is established in which FOG can be evoked in a standardized manner, but the efficacy of various gait tasks and triggers for eliciting FOG remains unclear. Objectives This study aimed to conduct a systematic review of the existing literature and evaluate the available evidence for the relationship between specific motor tasks, triggers, and FOG episodes in individuals with Parkinson's disease (PwPD). Methods We conducted a literature search on four online databases (PubMed, Web of Science, EMBASE, and Cochrane Library) using the keywords "Parkinson's disease," "Freezing of Gait", "triggers" and "tasks". A total of 128 articles met the inclusion criteria and were included in our analysis. Results The review found that a wide range of gait tasks were employed in studies assessing FOG among PD patients. However, three tasks (turning, dual tasking, and straight walking) emerged as the most frequently used. Turning (28%) appears to be the most effective trigger for eliciting FOG in PwPD, followed by walking through a doorway (14%) and dual tasking (10%). Conclusion This review thereby supports the utilisation of turning, especially a 360-degree turn, as a reliable trigger for FOG in PwPD. This finding could be beneficial to clinicians conducting clinical evaluations and researchers aiming to assess FOG in a laboratory environment.
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Affiliation(s)
| | - Charlotte Lang
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Christian R. Baumann
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland
- The LOOP Zurich – Medical Research Center, Zürich, Switzerland
| | - Chris A. Easthope
- The LOOP Zurich – Medical Research Center, Zürich, Switzerland
- Lake Lucerne Institute, Vitznau, Switzerland
- creneo Foundation – Center for Interdisciplinary Research, Vitznau, Switzerland
| | - William R. Taylor
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
- The LOOP Zurich – Medical Research Center, Zürich, Switzerland
| | - Deepak K. Ravi
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
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Mezzarobba S, Cosentino C, Putzolu M, Panuccio F, Fabbrini G, Valente D, Costi S, Galeoto G, Pelosin E. Assessment of the psychometric properties of the Italian version of the New Freezing of Gait Questionnaire (NFOG-Q-IT) in people with Parkinson disease: a validity and reliability study. Neurol Sci 2023; 44:3133-3140. [PMID: 37072581 PMCID: PMC10112304 DOI: 10.1007/s10072-023-06800-1] [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: 07/08/2022] [Accepted: 04/03/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Freezing of gait (FOG) in Parkinson's disease (PD) is a challenging clinical symptom to assess, due to its episodic nature. A valid and reliable tool is the New FOG Questionnaire (NFOG-Q) used worldwide to measure FOG symptoms in PD. OBJECTIVE The aim of this study was to translate, to culturally adapt, and to test the psychometric characteristics of the Italian version of the NFOG-Q (NFOG-Q-It). METHODS The translation and cultural adaptation was based on ISPOR TCA guidelines to finalize the 9-item NFOG-Q-It. Internal consistency was assessed in 181 Italian PD native speakers who experienced FOG using Cronbach's alpha. Cross-cultural analysis was tested using the Spearman's correlation between the NFOG-Q-It and the Modified Hoehn-Yahr Scale (M-H&Y). To assess construct validity, correlations among NFOG-Q-It, Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Falls Efficacy Scale-International (FES-I), the 6-min Walking Test (6MWT), the Mini Balance Evaluation System Test (Mini-BESTest) and the Short Physical Performance Battery (SPPB) were investigated. RESULTS The Italian N-FOGQ had high internal consistency (Cronbach's α = 0.859). Validity analysis showed significant correlations between NFOG-Q-IT total score and M-H&Y scores (r = 0.281 p < 0.001), MDS-UPDRS (r = 0.359 p < 0.001), FES-I (r = 0.230 p = 0.002), Mini BESTest (r = -0.256 p = 0.001) and 6MWT (r = -0.166 p = 0.026). No significant correlations were found with SPPB, MOCA and MMSE. CONCLUSION The NFOG-It is a valuable and reliable tool for assessing FOG symptoms, duration and frequency in PD subjects. Results provide the validity of NFOG-Q-It by reproducing and enlarging previous psychometric data.
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Affiliation(s)
- Susanna Mezzarobba
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Carola Cosentino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | | | - Francescaroberta Panuccio
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, CAP 00185, City Rome, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, CAP 00185, City Rome, Italy
- IRCSS Neuromed, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, CAP 00185, City Rome, Italy
- IRCSS Neuromed, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale - IRCCS Di Reggio Emilia, Via Risorgimento 80, 42123, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, Università Di Modena E Reggio Emilia, 41100, Modena, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, CAP 00185, City Rome, Italy.
- IRCSS Neuromed, Via Atinense, 18, 86077, Pozzilli, IS, Italy.
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
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Xu Y, Geng C, Tang T, Huang J, Hou Y. How to prevent cognitive overload in the walking-arithmetic dual task among patients with Parkinson's disease. BMC Neurol 2023; 23:205. [PMID: 37231372 DOI: 10.1186/s12883-023-03231-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Participants with Parkinson's disease (PD) may experience difficulty during certain dual-task (DT) tests. Thus, it is necessary to keep the cognitive load within the limits of their ability. OBJECTIVE To identify cognitive overload and its influence on the walking and auditory addition and subtraction (AAS, all values within the range of 0-20) DT performance of patients with PD. STUDY DESIGN A cross-sectional observational study with convenience sampling. SETTING Outpatient clinic of the Department of Neurology. SUBJECTS Sixteen patients with PD and 15 sex- and age- matched people elderly healthy controls (HCs). METHODS Verbal calculation responses and gait parameters were collected from the two groups in the 2-min single arithmetic task (2-min SAT), 2-min single walking task (2-min SWT), and 2-min walking-arithmetic dual task (2-min WADT). RESULTS The group differences in the lower-limb gait parameters increased in the 2-min WADT (P < 0.01), and those in the arm, trunk, and waist parameters did not change (P > 0.05). In the 2-min SAT, the calculation speed of the PD group was significantly lower than that of the HC group (P < 0.01). In the 2-min WADT, both groups made more errors (P < 0.05), especially the PD group (P = 0.00). PD group miscalculations occurred in the first half of the 2-min SAT but were uniformly distributed in the 2-min WADT. The HC group and PD group had subtraction self-correction rates of 31.25% and 10.25%, respectively. The PD group tended to make subtraction errors when the value of the first operand was 20 or 13.46 ± 2.60 and when the value of the second and third operands were 7.75 ± 2.51 (P = 0.3657) and 8.50 ± 4.04 (P = 0.170), respectively. CONCLUSIONS Cognitive overload was observed in patients with PD. This was mainly reflected in the failure of gait control and accurate calculation, indicated by gait parameters of the lower limbs and accuracy of calculation. To impose a constant cognitive load, the amount added or subtracted, especially in subtraction with borrowing, should not be mixed during a sequential arithmetic problem in the DT, and equations with the value of the first operand equal to 20 or approximately 13, the value of the second operand approximately 7, or the value of the third operand of approximately 9 should be excluded in the AAS DT. TRIAL REGISTRATION Clinical trial registration number: ChiCTR1800020158.
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Affiliation(s)
- Ying Xu
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 286 Guangji Road, Suzhou, Jiangsu, 215000, China
| | - Canru Geng
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 286 Guangji Road, Suzhou, Jiangsu, 215000, China
| | - Tong Tang
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 286 Guangji Road, Suzhou, Jiangsu, 215000, China
| | - Juanying Huang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Suzhou, Jiangsu, 215000, China.
| | - Ying Hou
- Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 286 Guangji Road, Suzhou, Jiangsu, 215000, China.
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Uehara A, Kawamoto H, Imai H, Shirai M, Sone M, Noda S, Sato S, Hattori N, Sankai Y. Gait improvement with wearable cyborg HAL trunk unit for parkinsonian patients: five case reports. Sci Rep 2023; 13:6962. [PMID: 37117241 PMCID: PMC10147720 DOI: 10.1038/s41598-023-33847-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
Cybernic treatment involves the generation of an interactive bio-feedback loop between an individual's nervous system and the worn cyborg Hybrid Assistive Limb (HAL); this treatment has been applied for several intractable neuromuscular disorders. Thus, it is of interest to determine its potential for parkinsonian patients. This study confirmed the feasibility of using a HAL trunk unit to improve parkinsonian gait disturbance. HAL establishes functional and physical synchronization with the wearer by providing lateral cyclic forces to the chest in the form of somatosensory and motor cues. To confirm the feasibility of its use for improving parkinsonian gait disturbances, we conducted experiments with three Parkinson's disease patients and two patients with progressive supranuclear palsy. During the experiments, the immediate effect of the intervention was assessed; all participants exhibited improvements in gait disturbance while wearing the HAL unit, and this improvement effect persisted without the HAL unit in two participants. Afterward, based on the assessment, we conducted a continuous intervention for one participant. In this intervention, the number of steps in the final experiment was significantly decreased compared with the initial state. These findings suggest that the proposed method is an option for treating parkinsonian patients to generate somatosensory and motor cues.
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Affiliation(s)
- Akira Uehara
- Faculty of Engineering, Information and Systems, University of Tsukuba, Ibaraki, 305-8573, Japan.
- Center for Cybernics Research, University of Tsukuba, Ibaraki, 305-8573, Japan.
| | - Hiroaki Kawamoto
- Faculty of Engineering, Information and Systems, University of Tsukuba, Ibaraki, 305-8573, Japan
- Center for Cybernics Research, University of Tsukuba, Ibaraki, 305-8573, Japan
| | - Hisamasa Imai
- Department of Neurology, Tokyo Rinkai Hospital, Tokyo, 134-0086, Japan
| | - Makoto Shirai
- Department of Rehabilitation, Limited Company Jin, Saitama, 341-0003, Japan
| | | | - Sachiko Noda
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, 113-8431, Japan
| | - Shigeto Sato
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, 113-8431, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, 113-8431, Japan
| | - Yoshiyuki Sankai
- Faculty of Engineering, Information and Systems, University of Tsukuba, Ibaraki, 305-8573, Japan
- Center for Cybernics Research, University of Tsukuba, Ibaraki, 305-8573, Japan
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