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Albrecht F, Johansson H, Ekman U, Poulakis K, Bezuidenhout L, Pereira JB, Franzén E. Investigating underlying brain structures and influence of mild and subjective cognitive impairment on dual-task performance in people with Parkinson's disease. Sci Rep 2024; 14:9513. [PMID: 38664471 PMCID: PMC11045833 DOI: 10.1038/s41598-024-60050-5] [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: 08/30/2023] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Cognitive impairment can affect dual-task abilities in Parkinson's disease (PD), but it remains unclear whether this is also driven by gray matter alterations across different cognitive classifications. Therefore, we investigated associations between dual-task performance during gait and functional mobility and gray matter alterations and explored whether these associations differed according to the degree of cognitive impairment. Participants with PD were classified according to their cognitive function with 22 as mild cognitive impairment (PD-MCI), 14 as subjective cognitive impairment (PD-SCI), and 20 as normal cognition (PD-NC). Multiple regression models associated dual-task absolute and interference values of gait speed, step-time variability, and reaction time, as well as dual-task absolute and difference values for Timed Up and Go (TUG) with PD cognitive classification. We repeated these regressions including the nucleus basalis of Meynert, dorsolateral prefrontal cortex, and hippocampus. We additionally explored whole-brain regressions with dual-task measures to identify dual-task-related regions. There was a trend that cerebellar alterations were associated with worse TUG dual-task in PD-SCI, but also with higher dual-task gait speed and higher dual-task step-time variability in PD-NC. After multiple comparison corrections, no effects of interest were significant. In summary, no clear set of variables associated with dual-task performance was found that distinguished between PD cognitive classifications in our cohort. Promising but non-significant trends, in particular regarding the TUG dual-task, do however warrant further investigation in future large-scale studies.
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Affiliation(s)
- Franziska Albrecht
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 52, Huddinge, Stockholm, Sweden.
- Medical Unit Occupational Therapy & Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden.
| | - Hanna Johansson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 52, Huddinge, Stockholm, Sweden
- Medical Unit Occupational Therapy & Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Stockholm, Sweden
| | - Urban Ekman
- Division of Neuro, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Medical Psychology, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Konstantinos Poulakis
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lucian Bezuidenhout
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 52, Huddinge, Stockholm, Sweden
| | - Joana B Pereira
- Division of Neuro, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Erika Franzén
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 52, Huddinge, Stockholm, Sweden
- Medical Unit Occupational Therapy & Physiotherapy, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Stockholm, Sweden
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Bernard JA. Cerebello-Hippocampal Interactions in the Human Brain: A New Pathway for Insights Into Aging. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01670-5. [PMID: 38438826 DOI: 10.1007/s12311-024-01670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Abstract
The cerebellum is recognized as being important for optimal behavioral performance across task domains, including motor function, cognition, and affect. Decades of work have highlighted cerebello-thalamo-cortical circuits, from both structural and functional perspectives. However, these circuits of interest have been primarily (though not exclusively) focused on targets in the cerebral cortex. In addition to these cortical connections, the circuit linking the cerebellum and hippocampus is of particular interest. Recently, there has been an increased interest in this circuit, thanks in large part to novel findings in the animal literature demonstrating that neuronal firing in the cerebellum impacts that in the hippocampus. Work in the human brain has provided evidence for interactions between the cerebellum and hippocampus, though primarily this has been in the context of spatial navigation. Given the role of both regions in cognition and aging, and emerging evidence indicating that the cerebellum is impacted in age-related neurodegenerative disease such as Alzheimer's, I propose that further attention to this circuit is warranted. Here, I provide an overview of cerebello-hippocampal interactions in animal models and from human imaging and outline the possible utility of further investigations to improve our understanding of aging and age-related cognitive decline.
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Affiliation(s)
- Jessica A Bernard
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, 77843-4235, USA.
- Texas A&M Institute for Neuroscience, Texas A&M University, College Station, TX, 77843-4235, USA.
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Taniguchi S, Marumoto K, Kajiyama Y, Revankar G, Inoue M, Yamamoto H, Kayano R, Mizuta E, Takahashi R, Shirahata E, Saeki C, Ozono T, Kimura Y, Ikenaka K, Mochizuki H. The validation of a Japanese version of the New Freezing of Gait Questionnaire (NFOG-Q). Neurol Sci 2024:10.1007/s10072-024-07405-y. [PMID: 38383749 DOI: 10.1007/s10072-024-07405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE This study aimed to develop a Japanese version of the New Freezing of Gait Questionnaire (NFOG-Q) and investigate its validity and reliability. METHODS After translating the NFOG-Q according to a standardised protocol, 56 patients with Parkinson's disease (PD) were administered it. Additionally, the MDS-UPDRS parts II and III, Hoehn and Yahr (H&Y) stage, and number of falls over 1 month were evaluated. Spearman's correlation coefficients (rho) were used to determine construct validity, and Cronbach's alpha (α) was used to examine reliability. RESULTS The interquartile range of the NFOG-Q scores was 10.0-25.3 (range 0-29). The NFOG-Q scores were strongly correlated with the MDS-UPDRS part II, items 2.12 (walking and balance), 2.13 (freezing), 3.11 (freezing of gait), and 3.12 (postural stability) and the postural instability and gait difficulty score (rho = 0.515-0.669), but only moderately related to the MDS-UPDRS item 3.10 (gait), number of falls, disease duration, H&Y stage, and time of the Timed Up-and-Go test (rho = 0.319-0.434). No significant correlations were observed between age and the time of the 10-m walk test. The internal consistency was excellent (α = 0.96). CONCLUSIONS The Japanese version of the NFOG-Q is a valid and reliable tool for assessing the severity of freezing in patients with PD.
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Affiliation(s)
- Seira Taniguchi
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Kohei Marumoto
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Koto, Shingu-Cho, Tatsuno, Hyogo, Japan
| | - Yuta Kajiyama
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Gajanan Revankar
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Michiko Inoue
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Koto, Shingu-Cho, Tatsuno, Hyogo, Japan
| | - Hiroshi Yamamoto
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Koto, Shingu-Cho, Tatsuno, Hyogo, Japan
| | - Rika Kayano
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Koto, Shingu-Cho, Tatsuno, Hyogo, Japan
| | - Eiji Mizuta
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Koto, Shingu-Cho, Tatsuno, Hyogo, Japan
| | - Ryuichi Takahashi
- Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Koto, Shingu-Cho, Tatsuno, Hyogo, Japan
| | - Emi Shirahata
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Chizu Saeki
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tatsuhiko Ozono
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yasuyoshi Kimura
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kensuke Ikenaka
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Quek DYL, Taylor N, Gilat M, Lewis SJG, Ehgoetz Martens KA. Effect of dopamine on limbic network connectivity at rest in Parkinson's disease patients with freezing of gait. Transl Neurosci 2024; 15:20220336. [PMID: 38708096 PMCID: PMC11066616 DOI: 10.1515/tnsci-2022-0336] [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: 12/22/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 05/07/2024] Open
Abstract
Background Freezing of gait (FOG) in Parkinson's disease (PD) has a poorly understood pathophysiology, which hinders treatment development. Recent work showed a dysfunctional fronto-striato-limbic circuitry at rest in PD freezers compared to non-freezers in the dopamine "OFF" state. While other studies found that dopaminergic replacement therapy alters functional brain organization in PD, the specific effect of dopamine medication on fronto-striato-limbic functional connectivity in freezers remains unclear. Objective To evaluate how dopamine therapy alters resting state functional connectivity (rsFC) of the fronto-striato-limbic circuitry in PD freezers, and whether the degree of connectivity change is related to freezing severity and anxiety. Methods Twenty-three PD FOG patients underwent MRI at rest (rsfMRI) in their clinically defined "OFF" and "ON" dopaminergic medication states. A seed-to-seed based analysis was performed between a priori defined limbic circuitry ROIs. Functional connectivity was compared between OFF and ON states. A secondary correlation analyses evaluated the relationship between Hospital Anxiety and Depression Scale (HADS)-Anxiety) and FOG Questionnaire with changes in rsFC from OFF to ON. Results PD freezers' OFF compared to ON showed increased functional coupling between the right hippocampus and right caudate nucleus, and between the left putamen and left posterior parietal cortex (PPC). A negative association was found between HADS-Anxiety and the rsFC change from OFF to ON between the left amygdala and left prefrontal cortex, and left putamen and left PPC. Conclusion These findings suggest that dopaminergic medication partially modulates the frontoparietal-limbic-striatal circuitry in PD freezers, and that the influence of medication on the amygdala, may be related to clinical anxiety in freezer.
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Affiliation(s)
- Dione Y. L. Quek
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Natasha Taylor
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Moran Gilat
- Neurorehabilitation Research Group (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Simon J. G. Lewis
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Kaylena A. Ehgoetz Martens
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, Australia
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Avenue West, WaterlooON, N2L3G1Canada
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DeGutis J, Aul C, Barthelemy OJ, Davis BL, Alshuaib S, Marin A, Kinger SB, Ellis TD, Cronin-Golomb A. Side of motor symptom onset predicts sustained attention deficits and motor improvements after attention training in Parkinson's disease. Neuropsychologia 2023; 190:108698. [PMID: 37806442 DOI: 10.1016/j.neuropsychologia.2023.108698] [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: 03/08/2023] [Revised: 08/28/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Parkinson's disease (PD) side of motor symptom onset has been associated with distinct cognitive deficits; individuals with left-side onset (LPD) show more visuospatial impairments, whereas those with right-side onset (RPD) show more verbal impairments. Non-spatial attention is a critical cognitive ability associated with motor functioning that is right hemisphere lateralized but has not been characterized with regard to PD side of onset. We compared individuals with LPD and RPD on non-spatial attention tasks and examined differential responses to a 4-week sustained attention training program. METHOD Participants included 9 with LPD and 12 with RPD, who performed both brief and extended go/no-go continuous performance tasks and an attentional blink task. Participants also engaged in an at-home sustained attention training program, Tonic and Phasic Alertness Training (TAPAT), 5 days/week for 4 weeks. We assessed cognitive and motor symptoms before and after training, and after a 4-week no-contact period. RESULTS At baseline, participants with LPD exhibited worse performance than those with RPD on the extended continuous performance task, indicating specific deficits in sustaining attention. Poorer attention was associated with worse clinical motor scores. Notably, side of onset had a significant effect on clinical motor changes after sustained attention training, with only LPD participants improving after training, and 4/9 showing clinically meaningful improvements. CONCLUSIONS Compared to RPD, participants with LPD had poorer sustained attention pre-training and were more likely to improve on clinical motor functioning after sustained attention training. These findings support mechanistic differences between LPD and RPD and suggest potential differential treatment approaches.
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Affiliation(s)
- Joseph DeGutis
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA; Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Courtney Aul
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA; Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, USA
| | - Olivier J Barthelemy
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Breanna L Davis
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Shaikhah Alshuaib
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Anna Marin
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Shraddha B Kinger
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Terry D Ellis
- Department of Physical Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
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Sun H, Gan C, Wang L, Ji M, Cao X, Yuan Y, Zhang H, Shan A, Gao M, Zhang K. Cortical Disinhibition Drives Freezing of Gait in Parkinson's Disease and an Exploratory Repetitive Transcranial Magnetic Stimulation Study. Mov Disord 2023; 38:2072-2083. [PMID: 37646183 DOI: 10.1002/mds.29595] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Dysfunction of the primary motor cortex, participating in regulation of posture and gait, is implicated in freezing of gait (FOG) in Parkinson's disease (PD). OBJECTIVE The aim was to reveal the mechanisms of "OFF-period" FOG (OFF-FOG) and "levodopa-unresponsive" FOG (ONOFF-FOG) in PD. METHODS We measured the transcranial magnetic stimulation (TMS) indicators and gait parameters in 21 healthy controls (HCs), 15 PD patients with ONOFF-FOG, 15 PD patients with OFF-FOG, and 15 PD patients without FOG (Non-FOG) in "ON" and "OFF" medication conditions. Difference of TMS indicators in the four groups and two conditions and its correlations with gait parameters were explored. Additionally, we explored the effect of 10 Hz repetitive TMS on gait and TMS indicators in ONOFF-FOG patients. RESULTS In "OFF" condition, short interval intracortical inhibition (SICI) exhibited remarkable attenuation in FOG patients (both ONOFF-FOG and OFF-FOG) compared to Non-FOG patients and HCs. The weakening of SICI correlated with impaired gait characteristics in FOG. However, in "ON" condition, SICI in ONOFF-FOG patients reduced compared to OFF-FOG patients. Pharmacological treatment significantly improved SICI and gait in OFF-FOG patients, and high-frequency repetitive TMS distinctly improved gait in ONOFF-FOG patients, accompanied by enhanced SICI. CONCLUSIONS Motor cortex disinhibition, represented by decreased SICI, is related to FOG in PD. Refractory freezing in ONOFF-FOG patients correlated with the their reduced SICI insensitive to dopaminergic medication. SICI can serve as an indicator of the severity of impaired gait characteristics in FOG and reflect treatments efficacy for FOG in PD patients. © 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)
- Huimin Sun
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Caiting Gan
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lina Wang
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Ji
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xingyue Cao
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yongsheng Yuan
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Heng Zhang
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Aidi Shan
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mengxi Gao
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kezhong Zhang
- Department of Neurology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
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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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Mahoney-Rafferty EC, Tucker HR, Akhtar K, Herlihy R, Audil A, Shah D, Gupta M, Kochman EM, Feustel PJ, Molho ES, Pilitsis JG, Shin DS. Assessing the Location, Relative Expression and Subclass of Dopamine Receptors in the Cerebellum of Hemi-Parkinsonian Rats. Neuroscience 2023; 521:1-19. [PMID: 37116741 DOI: 10.1016/j.neuroscience.2023.03.020] [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: 08/24/2022] [Revised: 03/06/2023] [Accepted: 03/17/2023] [Indexed: 04/30/2023]
Abstract
Parkinson's Disease (PD) is a neurodegenerative disease with loss of dopaminergic neurons in the nigrostriatal pathway resulting in basal ganglia (BG) dysfunction. This is largely why much of the preclinical and clinical research has focused on pathophysiological changes in these brain areas in PD. The cerebellum is another motor area of the brain. Yet, if and how this brain area responds to PD therapy and contributes to maintaining motor function fidelity in the face of diminished BG function remains largely unanswered. Limited research suggests that dopaminergic signaling exists in the cerebellum with functional dopamine receptors, tyrosine hydroxylase (TH) and dopamine transporters (DATs); however, much of this information is largely derived from healthy animals and humans. Here, we identified the location and relative expression of dopamine 1 receptors (D1R) and dopamine 2 receptors (D2R) in the cerebellum of a hemi-parkinsonian male rat model of PD. D1R expression was higher in PD animals compared to sham animals in both hemispheres in the purkinje cell layer (PCL) and granule cell layer (GCL) of the cerebellar cortex. Interestingly, D2R expression was higher in PD animals than sham animals mostly in the posterior lobe of the PCL, but no discernible pattern of D2R expression was seen in the GCL between PD and sham animals. To our knowledge, we are the first to report these findings, which may lay the foundation for further interrogation of the role of the cerebellum in PD therapy and/or pathophysiology.
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Affiliation(s)
- Emily C Mahoney-Rafferty
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Heidi R Tucker
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Kainat Akhtar
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Rachael Herlihy
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Aliyah Audil
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Dia Shah
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Megan Gupta
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Eliyahu M Kochman
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Paul J Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Eric S Molho
- Department of Neurology, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA; Department of Neurosurgery, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
| | - Damian S Shin
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA; Department of Neurology, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA.
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9
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Bayot M, Dujardin K, Gérard M, Braquet A, Tard C, Betrouni N, Defebvre L, Delval A. The contribution of executive control dysfunction to freezing of gait in Parkinson's disease. Clin Neurophysiol 2023; 152:75-89. [PMID: 37356311 DOI: 10.1016/j.clinph.2023.05.010] [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: 12/22/2022] [Revised: 03/16/2023] [Accepted: 05/06/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE An executive dysfunction is supposed to contribute to freezing of gait (FoG) in Parkinson's disease. We aimed to investigate at a behavioral and cortical levels whether an attentional load (particularly, a conflicting situation) can specifically impact preparation and execution phases of step initiation in parkinsonian patients with FoG. METHODS Fifteen patients with FoG, 16 without and 15 controls performed an adapted version of the Attention Network Test, with step initiation as response instead of the standard manual keypress. Kinetic and kinematic features of gait initiation as well as high-resolution electroencephalography were recorded during the task. RESULTS Patients with FoG presented an impaired executive control. Step execution time was longer in parkinsonian patients. However, the executive control effect on step execution time was not different between all groups. Compared to patients, controls showed a shorter step initiation-locked alpha desynchronization, and an earlier, more intense and shorter beta desynchronization over the sensorimotor cortex. Even though controls were faster, the induced alpha and beta activity associated with the effect of executive control didn't differ between patients and controls. CONCLUSIONS Tasks of conflict resolution lead to a comparable alteration of step initiation and its underlying brain activity in all groups. Links between executive control, gait initiation and FoG seem more complex than expected. SIGNIFICANCE This study questions the cognitive hypothesis in the pathophysiology of freezing of gait. Executive dysfunction is associated with FoG but is not the main causal mechanism since the interaction between attention and motor preparation didn't provoke FoG.
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Affiliation(s)
- Madli Bayot
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Clinical Neurophysiology, F-59000 Lille, France.
| | - Kathy Dujardin
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Neurology and Movement Disorders, F-59000 Lille, France.
| | - Morgane Gérard
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Clinical Neurophysiology, F-59000 Lille, France.
| | | | - Céline Tard
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Neurology and Movement Disorders, F-59000 Lille, France.
| | - Nacim Betrouni
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Clinical Neurophysiology, F-59000 Lille, France.
| | - Luc Defebvre
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Neurology and Movement Disorders, F-59000 Lille, France.
| | - Arnaud Delval
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Department of Clinical Neurophysiology, F-59000 Lille, France.
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10
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Espinoza AI, Scholl JL, Singh A. TMS Bursts Can Modulate Local and Networks Oscillations During Lower-Limb Movement. J Clin Neurophysiol 2023; 40:371-377. [PMID: 34560704 DOI: 10.1097/wnp.0000000000000896] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Lower-limb motor functions involve processing information via both motor and cognitive control networks. Measuring oscillations is a key element in communication within and between cortical networks during high-order motor functions. Increased midfrontal theta oscillations are related to improved lower-limb motor performances in patients with movement disorders. Noninvasive neuromodulation approaches have not been explored extensively to understand the oscillatory mechanism of lower-limb motor functions. This study aims to examine the effects of repetitive transcranial magnetic stimulation on local and network EEG oscillations in healthy elderly subjects. METHODS Eleven healthy elderly subjects (67-73 years) were recruited via advertisements, and they underwent both active and sham stimulation procedures in a random, counterbalanced design. Transcranial magnetic stimulation bursts (θ-transcranial magnetic stimulation; 4 pulses/second) were applied over the midfrontal lead (vertex) before a GO-Cue pedaling task, and signals were analyzed using time-frequency methods. RESULTS Transcranial magnetic stimulation bursts increase the theta activity in the local ( p = 0.02) and the associated network during the lower-limb pedaling task ( p = 0.02). Furthermore, after task-related transcranial magnetic stimulation burst sessions, increased resting-state alpha activity was observed in the midfrontal region ( p = 0.01). CONCLUSIONS This study suggests the ability of midfrontal transcranial magnetic stimulation bursts to directly modulate local and network oscillations in a frequency manner during lower-limb motor task. Transcranial magnetic stimulation burst-induced modulation may provide insights into the functional roles of oscillatory activity during lower-limb movement in normal and disease conditions.
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Affiliation(s)
| | - Jamie L Scholl
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, South Dakota, U.S.A. ; and
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota, U.S.A
| | - Arun Singh
- Center for Brain and Behavior Research, University of South Dakota, Vermillion, South Dakota, U.S.A. ; and
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota, U.S.A
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11
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Longhurst JK, Sreenivasan KR, Kim J, Cummings JL, John SE, Poston B, Cordes D, Rider JV, Landers MR. Cortical thickness is related to cognitive-motor automaticity and attention allocation in individuals with Alzheimer's disease: a regions of interest study. Exp Brain Res 2023; 241:1489-1499. [PMID: 37085647 DOI: 10.1007/s00221-023-06618-5] [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: 12/16/2022] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Abstract
Alzheimer's disease (AD) is characterized by a distinct pattern of cortical thinning and resultant changes in cognition and function. These result in prominent deficits in cognitive-motor automaticity. The relationship between AD-related cortical thinning and decreased automaticity is not well-understood. We aimed to investigate the relationship between cortical thickness regions-of-interest (ROI) and automaticity and attention allocation in AD using hypothesis-driven and exploratory approaches. We performed an ROI analysis of 46 patients with AD. Data regarding MR images, demographic characteristics, cognitive-motor dual task performance, and cognition were extracted from medical records. Cortical thickness was calculated from MR T1 images using FreeSurfer. Data from the dual task assessment was used to calculate the combined dual task effect (cDTE), a measure of cognitive-motor automaticity, and the modified attention allocation index (mAAI). Four hierarchical multiple linear regression models were conducted regressing cDTE and mAAI separately on (1) hypothesis-generated ROIs and (2) exploratory ROIs. For cDTE, cortical thicknesses explained 20.5% (p = 0.014) and 25.9% (p = 0.002) variability in automaticity in the hypothesized ROI and exploratory models, respectively. The dorsal lateral prefrontal cortex (DLPFC) (β = - 0.479, p = 0.018) and superior parietal cortex (SPC) (β = 0.467, p = 0.003), and were predictors of automaticity. For mAAI, cortical thicknesses explained 20.7% (p = 0.025) and 28.3% (p = 0.003) variability in attention allocation in the hypothesized ROI and exploratory models, respectively. Thinning of SPC and fusiform gyrus were associated with motor prioritization (β = - 0.405, p = 0.013 and β = - 0.632, p = 0.004, respectively), whereas thinning of the DLPFC was associated with cognitive prioritization (β = 0.523, p = 0.022). Cortical thinning in AD was related to cognitive-motor automaticity and task prioritization, particularly in the DLPFC and SPC. This suggests that these regions may play a primary role in automaticity and attentional strategy during dual-tasking.
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Affiliation(s)
- Jason K Longhurst
- Department of Physical Therapy and Athletic Training, Saint Louis University, 3437 Caroline Mall Suite 1026, Saint Louis, MO, 63104, USA.
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.
- Department of Physical Therapy, University of Nevada, Las Vegas, USA.
| | - Karthik R Sreenivasan
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
- Department of Brain Health, University of Nevada, Las Vegas, USA
| | - Jemma Kim
- Department of Physical Therapy and Athletic Training, Saint Louis University, 3437 Caroline Mall Suite 1026, Saint Louis, MO, 63104, USA
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, USA
| | - Samantha E John
- Department of Brain Health, University of Nevada, Las Vegas, USA
| | - Brach Poston
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, USA
| | - Dietmar Cordes
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
- Department of Brain Health, University of Nevada, Las Vegas, USA
- Department of Psychology and Neuroscience, University of Colorado, Boulder, USA
| | - John V Rider
- School of Occupational Therapy, Touro University, Henderson, NV, USA
| | - Merrill R Landers
- Department of Physical Therapy, University of Nevada, Las Vegas, USA
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12
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Ohara M, Hirata K, Hallett M, Matsubayashi T, Chen Q, Kina S, Shimano K, Hirakawa A, Yokota T, Hattori T. Long-term levodopa ameliorates sequence effect in simple, but not complex walking in early Parkinson's disease patients. Parkinsonism Relat Disord 2023; 108:105322. [PMID: 36822140 PMCID: PMC10082924 DOI: 10.1016/j.parkreldis.2023.105322] [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: 11/15/2022] [Revised: 01/28/2023] [Accepted: 02/09/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND The sequence effect (SE) is characterized by the progressive decrement of movements and is often observed in Parkinson's disease (PD) patients. While acute effect of levodopa does not ameliorate the SE, the effect of long-term levodopa treatment for the SE remains unknown. OBJECTIVE We aimed to elucidate the SEs during various gait conditions and their response to long-term levodopa treatment in drug-naïve PD patients. METHODS Nineteen drug-naïve PD patients and 21 healthy controls were enrolled. Gait parameters were measured via wearable inertial sensors in the following conditions:1) straight walking, 2) circular walking: walking a circle of 1 m diameter in a clock-wise direction for 3 laps, 3) straight or circular walking under cognitive-motor dual-task (serial 7s subtractions). PD patients were evaluated at baseline, within 1 h after intravenous administration of levodopa, and after one, three, and six months treatment with levodopa. The SE was measured by a linear regression slope by plotting consecutive stride lengths over steps. Patients were also separately analyzed depending on laterality of symptoms. RESULTS Long-term levodopa treatment ameliorated the SE only during single-task straight walking. The SE during circular walking was exacerbated after long-term levodopa treatment for right-side dominant patients. During dual-task straight walking, the SE at baseline was greater in right-side dominant PD patients. CONCLUSIONS The SE only during single-task straight walking can be ameliorated by long-term levodopa treatment. However, the SE may be exaggerated by cognitive motor interference or by asymmetrical stride length with/without long-term levodopa treatment, depending on the laterality of symptoms.
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Affiliation(s)
- Masahiro Ohara
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kosei Hirata
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Taiki Matsubayashi
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Qingmeng Chen
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoko Kina
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kaoru Shimano
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takaaki Hattori
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.
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13
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Johansson H, Folkerts AK, Hammarström I, Kalbe E, Leavy B. Effects of motor-cognitive training on dual-task performance in people with Parkinson's disease: a systematic review and meta-analysis. J Neurol 2023; 270:2890-2907. [PMID: 36820916 DOI: 10.1007/s00415-023-11610-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/24/2023]
Abstract
Motor-cognitive training in Parkinson's disease (PD) can positively affect gait and balance, but whether motor-cognitive (dual-task) performance improves is unknown. This meta-analysis, therefore, aimed to establish the current evidence on the effects of motor-cognitive training on dual-task performance in PD. Systematic searches were conducted in five databases and 11 studies with a total of 597 people (mean age: 68.9 years; mean PD duration: 6.8 years) were included. We found a mean difference in dual-task gait speed (0.12 m/s (95% CI 0.08, 0.17)), dual-task cadence (2.91 steps/min (95% CI 0.08, 5.73)), dual-task stride length (10.12 cm (95% CI 4.86, 15.38)) and dual-task cost on gait speed (- 8.75% (95% CI - 14.57, - 2.92)) in favor of motor-cognitive training compared to controls. The GRADE analysis revealed that the findings were based on high certainty evidence. Thus, we can for the first time systematically show that people with PD can improve their dual-task ability through motor-cognitive training.
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Affiliation(s)
- Hanna Johansson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, 14183, Stockholm, Sweden.
- Karolinska University Hospital, Theme Womens Health and Allied Health Professionals, Stockholm, Sweden.
| | - Ann-Kristin Folkerts
- Medical Psychology | Neuropsychology and Gender Studies, Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ida Hammarström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, 14183, Stockholm, Sweden
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies, Centre for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Breiffni Leavy
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, 14183, Stockholm, Sweden
- Karolinska University Hospital, Theme Womens Health and Allied Health Professionals, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Mariebergsgatan 22, 112 19, Stockholm, Sweden
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14
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Pu L, Liu T, Tang WC, Song C, Jin M, Ren L, Li T, Liang Z. Greater prefrontal activation during sitting toe tapping predicts severer freezing of gait in Parkinson's disease: an fNIRS study. Cereb Cortex 2023; 33:959-968. [PMID: 35348637 DOI: 10.1093/cercor/bhac114] [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: 11/22/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Previous studies have revealed that, compared with Parkinson's disease (PD) patients without freezing of gait (FoG), the ones with FoG showed greater prefrontal activation while doing lower-limb movements involving standing, walking and turning, which require both locomotor and balance control. However, the relation between FoG and pure locomotor control as well as its underlying mechanism remain unclear. METHODS A total of 56 PD subjects were recruited and allocated to PD-FoG and PD-noFoG subgroups, and 34 age-matched heathy adults were included as heathy control (HC). Functional near-infrared spectroscopy was used to measure their prefrontal activation in a sitting lower-limb movement task, wherein subjects were asked to sit and tap their right toes as big and as fast as possible. RESULTS Result of one-way ANOVA (Group: PD-FoG vs. PD-noFoG vs. HC) revealed greater activation in the right prefrontal cortex in the PD-FoG group than in the other 2 groups. Linear mixed-effects model showed consistent result. Furthermore, the right prefrontal activation positively correlated with the severity of FoG symptoms in PD-FoG patients. CONCLUSION These findings suggested that PD patients with FoG require additional cognitive resources to compensate their damaged automaticity in locomotor control, which is more pronounced in severe FoG patients than milder ones.
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Affiliation(s)
- Lanlan Pu
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road, Dalian, Liaoning 116011, China
| | - Tao Liu
- School of Health, Fujian Medical University, Xuefubei Road, Fuzhou 350122, Fujian, China.,School of Management, Shanghai University, Shangda Road, Shanghai 200444, China.,School of Management, Zhejiang University, Yuhangtang Road, Hangzhou 310058, Zhejiang, China
| | - William C Tang
- Department of Biomedical Engineering, University of California, Irvine 92697, CA, USA
| | - Chunli Song
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road, Dalian, Liaoning 116011, China
| | - Mingyan Jin
- School of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Linggong Road, Dalian 116024, Liaoning, China
| | - Lu Ren
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road, Dalian, Liaoning 116011, China
| | - Tao Li
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road, Dalian, Liaoning 116011, China
| | - Zhanhua Liang
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Zhongshan Road, Dalian, Liaoning 116011, China
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15
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Acute Hypobaric Hypoxia Exposure Causes Neurobehavioral Impairments in Rats: Role of Brain Catecholamines and Tetrahydrobiopterin Alterations. Neurochem Res 2023; 48:471-486. [PMID: 36205808 DOI: 10.1007/s11064-022-03767-x] [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: 07/11/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 02/07/2023]
Abstract
Hypoxia is a state in which the body or a specific part of the body is deprived of adequate oxygen supply at the tissue level. Sojourners involved in different activities at high altitudes (> 2500 m) face hypobaric hypoxia (HH) due to low oxygen in the atmosphere. HH is an example of generalized hypoxia, where the homeostasis of the entire body of an organism is affected and results in neurochemical changes. It is known that lower O2 levels affect catecholamines (CA), severely impairing cognitive and locomotor behavior. However, there is less evidence on the effect of HH-mediated alteration in brain Tetrahydrobiopterin (BH4) levels and its role in neurobehavioral impairments. Hence, this study aimed to shed light on the effect of acute HH on CA and BH4 levels with its neurobehavioral impact on Wistar rat models. After HH exposure, significant alteration of the CA levels in the discrete brain regions, viz., frontal cortex, hippocampus, midbrain, and cerebellum was observed. HH exposure significantly reduced spontaneous motor activity, motor coordination, and spatial memory. The present study suggests that the HH-induced behavioral changes might be related to the alteration of the expression pattern of CA and BH4-related genes and proteins in different rat brain regions. Overall, this study provides novel insights into the role of BH4 and CA in HH-induced neurobehavioral impairments.
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16
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Löfgren M, Sandström A, Bileviciute-Ljungar I, Mannerkorpi K, Gerdle B, Ernberg M, Fransson P, Kosek E. The effects of a 15-week physical exercise intervention on pain modulation in fibromyalgia: Increased pain-related processing within the cortico-striatal- occipital networks, but no improvement of exercise-induced hypoalgesia. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2023; 13:100114. [PMID: 36660198 PMCID: PMC9843267 DOI: 10.1016/j.ynpai.2023.100114] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/09/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023]
Abstract
Dysfunctional top-down pain modulation is a hallmark of fibromyalgia (FM) and physical exercise is a cornerstone in FM treatment. The aim of this study was to explore the effects of a 15-week intervention of strengthening exercises, twice per week, supervised by a physiotherapist, on exercise-induced hypoalgesia (EIH) and cerebral pain processing in FM patients and healthy controls (HC). FM patients (n = 59) and HC (n = 39) who completed the exercise intervention as part of a multicenter study were examined at baseline and following the intervention. Following the exercise intervention, FM patients reported a reduction of pain intensity, fibromyalgia severity and depression. Reduced EIH was seen in FM patients compared to HC at baseline and no improvement of EIH was seen following the 15-week resistance exercise intervention in either group. Furthermore, a subsample (Stockholm site: FM n = 18; HC n = 19) was also examined with functional magnetic resonance imaging (fMRI) during subjectively calibrated thumbnail pressure pain stimulations at baseline and following intervention. A significant main effect of exercise (post > pre) was observed both in FM patients and HC, in pain-related brain activation within left dorsolateral prefrontal cortex and caudate, as well as increased functional connectivity between caudate and occipital lobe bordering cerebellum (driven by the FM patients). In conclusion, the results indicate that 15-week resistance exercise affect pain-related processing within the cortico-striatal-occipital networks (involved in motor control and cognition), rather than directly influencing top-down descending pain inhibition. In alignment with this, exercise-induced hypoalgesia remained unaltered.
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Key Words
- AAL, Automated Anatomical Labeling
- ACR, American College of Rheumatology
- CNS, central nervous system
- CPM, conditioned pain modulation
- EIH, exercise-induced hypoalgesia
- Exercise induced hypoalgesia
- Exercise intervention
- FD, Frame-wise displacement
- FEW, family-wise error
- FIQ, Fibromyalgia Impact Questionnaire
- FM, fibromyalgia
- FOV, field of view
- FWHM, full-width-half-maximum
- Fibromyalgia
- Functional connectivity
- Functional magnetic resonance imaging (fMRI)
- GLM, general linear model
- HADS, Hospital Anxiety and Depression Scale
- HC, healthy controls
- MNI, Montreal Neurological Institute
- MVC, maximum voluntary contraction force
- NSAIDs, non-steroidal anti-inflammatory drugs
- P50, pressure stimuli corresponding to a pain rating of 50mm on a 100 mm VAS
- PPI, psychophysiological interaction
- PPTs, pressure pain thresholds
- Pressure pain
- RM, repetition maximum
- SM, stimulation maximum
- SPM, Statistical Parametric Mapping
- T1, longitudinal relaxation time
- T2, transverse relaxation time
- TR/TE, time repetition/time echo
- VAS, visual analogue scale
- VOI, volume of interest
- dlPFC, dorsolateral prefrontal cortex
- fMRI, functional magnetic resonance imaging
- rACC, rostral anterior cingulate cortex
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Affiliation(s)
- Monika Löfgren
- Department of Clinical Sciences, Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm SE-182 88, Sweden
| | - Angelica Sandström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm SE-171 77, Sweden,Department of Neuroradiology, Karolinska University Hospital, Stockholm SE-171 78, Sweden,Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm SE-182 88, Sweden
| | - Kaisa Mannerkorpi
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Physiotherapy Unit, Sahlgrenska Academy, Gothenburg University, Gothenburg SE- 413 90, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping SE-581 83, Sweden
| | - Malin Ernberg
- Department of Dental Medicine, Karolinska Institutet and Scandinavian Centre for Orofacial Neurosciences, Huddinge SE-141 04, Sweden
| | - Peter Fransson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm SE-171 77, Sweden,Department of Neuroradiology, Karolinska University Hospital, Stockholm SE-171 78, Sweden
| | - Eva Kosek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm SE-171 77, Sweden,Department of Neuroradiology, Karolinska University Hospital, Stockholm SE-171 78, Sweden,Department of Surgical Sciences, Uppsala University, Uppsala SE- 752 36, Sweden,Corresponding author at: Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, Stockholm SE-171 77, Sweden.
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17
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Zajac JA, Porciuncula F, Cavanaugh JT, McGregor C, Harris BA, Smayda KE, Awad LN, Pantelyat A, Ellis TD. Feasibility and Proof-of-Concept of Delivering an Autonomous Music-Based Digital Walking Intervention to Persons with Parkinson's Disease in a Naturalistic Setting. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1253-1265. [PMID: 37840504 PMCID: PMC10657706 DOI: 10.3233/jpd-230169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Reduced motor automaticity in Parkinson's disease (PD) negatively impacts the quality, intensity, and amount of daily walking. Rhythmic auditory stimulation (RAS), a clinical intervention shown to improve walking outcomes, has been limited by barriers associated with the need for ongoing clinician input. OBJECTIVE To assess the feasibility, proof-of-concept, and preliminary clinical outcomes associated with delivering an autonomous music-based digital walking intervention based on RAS principles to persons with PD in a naturalistic setting. METHODS Twenty-three persons with PD used the digital intervention independently for four weeks to complete five weekly 30-minute sessions of unsupervised, overground walking with music-based cues. The intervention progressed autonomously according to real-time gait sensing. Feasibility of independent use was assessed by examining participant adherence, safety, and experience. Intervention proof-of-concept was assessed by examining spatiotemporal metrics of gait quality, daily minutes of moderate intensity walking, and daily steps. Preliminary clinical outcomes were assessed following intervention completion. RESULTS Participants completed 86.4% of sessions and 131.1% of the prescribed session duration. No adverse events were reported. Gait speed, stride length, and cadence increased within sessions, and gait variability decreased (p < 0.05). Compared to baseline, increased daily moderate intensity walking (mean Δ= +21.44 minutes) and steps (mean Δ= +3,484 steps) occurred on designated intervention days (p < 0.05). Quality of life, disease severity, walking endurance, and functional mobility were improved after four weeks (p < 0.05). CONCLUSIONS Study findings supported the feasibility and potential clinical utility of delivering an autonomous digital walking intervention to persons with PD in a naturalistic setting.
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Affiliation(s)
- Jenna A. Zajac
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Franchino Porciuncula
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - James T. Cavanaugh
- Department of Physical Therapy, University of New England, Portland, ME, USA
| | - Colin McGregor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Louis N. Awad
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Alexander Pantelyat
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Terry D. Ellis
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
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18
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Feng H, Jiang Y, Lin J, Qin W, Jin L, Shen X. Cortical activation and functional connectivity during locomotion tasks in Parkinson's disease with freezing of gait. Front Aging Neurosci 2023; 15:1068943. [PMID: 36967824 PMCID: PMC10032375 DOI: 10.3389/fnagi.2023.1068943] [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: 10/13/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
Background Freezing of gait (FoG) is a severely disabling symptom in Parkinson's disease (PD). The cortical mechanisms underlying FoG during locomotion tasks have rarely been investigated. Objectives We aimed to compare the cerebral haemodynamic response during FoG-prone locomotion tasks in patients with PD and FoG (PD-FoG), patients with PD but without FoG (PD-nFoG), and healthy controls (HCs). Methods Twelve PD-FoG patients, 10 PD-nFoG patients, and 12 HCs were included in the study. Locomotion tasks included normal stepping, normal turning and fast turning ranked as three difficulty levels based on kinematic requirements and probability of provoking FoG. During each task, we used functional near-infrared spectroscopy to capture concentration changes of oxygenated haemoglobin (ΔHBO2) and deoxygenated haemoglobin (ΔHHB) that reflected cortical activation, and recorded task performance time. The cortical regions of interest (ROIs) were prefrontal cortex (PFC), supplementary motor area (SMA), premotor cortex (PMC), and sensorimotor cortex (SMC). Intra-cortical functional connectivity during each task was estimated based on correlation of ΔHBO2 between ROIs. Two-way multivariate ANOVA with task performance time as a covariate was conducted to investigate task and group effects on cerebral haemodynamic responses of ROIs. Z statistics of z-scored connectivity between ROIs were used to determine task and group effects on functional connectivity. Results PD-FoG patients spent a nearly significant longer time completing locomotion tasks than PD-nFoG patients. Compared with PD-nFoG patients, they showed weaker activation (less ΔHBO2) in the PFC and PMC. Compared with HCs, they had comparable ΔHBO2 in all ROIs but more negative ΔHHB in the SMC, whereas PD-nFoG showed SMA and PMC hyperactivity but more negative ΔHHB in the SMC. With increased task difficulty, ΔHBO2 increased in each ROI except in the PFC. Regarding functional connectivity during normal stepping, PD-FoG patients showed positive and strong PFC-PMC connectivity, in contrast to the negative PFC-PMC connectivity observed in HCs. They also had greater PFC-SMC connectivity than the other groups. However, they exhibited decreased SMA-SMC connectivity when task difficulty increased and had lower SMA-PMC connectivity than HCs during fast turning. Conclusion Insufficient compensatory cortical activation and depletion of functional connectivity during complex locomotion in PD-FoG patients could be potential mechanisms underlying FoG. Clinical trial registration Chinese clinical trial registry (URL: http://www.chictr.org.cn, registration number: ChiCTR2100042813).
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Affiliation(s)
- HongSheng Feng
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - YanNa Jiang
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - JinPeng Lin
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - WenTing Qin
- Department of Neurology and Neurological Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - LingJing Jin
- Department of Neurology and Neurological Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Xia Shen
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Rehabilitation Medicine Research Center, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Xia Shen,
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19
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Moreira-Neto A, Ugrinowitsch C, Coelho DB, de Lima-Pardini AC, Barbosa ER, Teixeira LA, Amaro E, Horak FB, Mancini M, Nucci MP, Silva-Batista C. Freezing of gait, gait initiation, and gait automaticity share a similar neural substrate in Parkinson's disease. Hum Mov Sci 2022; 86:103018. [DOI: 10.1016/j.humov.2022.103018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
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20
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Vitório R, Morris R, Das J, Walker R, Mancini M, Stuart S. Brain activity response to cues during gait in Parkinson’s disease: A study protocol. PLoS One 2022; 17:e0275894. [PMID: 36395190 PMCID: PMC9671304 DOI: 10.1371/journal.pone.0275894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
Various cueing strategies (internal and external) have been used to alleviate gait deficits in Parkinson’s disease (PD). However, it remains unclear which type of cueing strategy is most effective at different disease stages or with more severe walking impairment, such as freezing of gait (FOG). The underlying neural mechanisms of response to cueing are also unknown. This trial aims to: (i) determine brain activity response to cue stimulus (internal, visual, auditory or tactile) when walking in PD and; (ii) examine changes in brain activity to cues at different stages of PD. This ongoing single-site study uses an exploratory observational design, with laboratory application of cues for gait deficit. A total of 80 people with PD who meet the inclusion criteria will be enrolled. Participants are split into groups dependent on their disease stage (classified with the Hoehn and Yahr (H&Y) scale); n = 20 H&YI; n = 30 H&YII; n = 30 H&YIII. Within the H&Y stage II and III groups, we will also ensure recruitment of a sub-group of 15 individuals with FOG within each group. Participants perform walking tasks under several conditions: baseline walking without cues; randomized cued walking conditions [internal and external (visual, auditory and tactile) cues]. A combined functional near-infrared spectroscopy and electroencephalography system quantifies cortical brain activity while walking. Inertial sensors are used to assess gait. Primary outcome measures are cue-related changes in cortical brain activity while walking, including the relative change in cortical HbO2 and the power spectral densities at alpha (8-13Hz), beta (13-30Hz), delta (0.5-4Hz), theta (4-8Hz) and gamma (30-40Hz) frequency bandwidths. Secondary outcome measures are cue-related changes in spatiotemporal gait characteristics. Findings will enhance our understanding about the cortical responses to different cueing strategies and how they are influenced by PD progression and FOG status. This trial is registered at clinicaltrials.gov (NCT04863560; April 28, 2021, https://clinicaltrials.gov/ct2/show/NCT04863560).
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Affiliation(s)
- Rodrigo Vitório
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Rosie Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Julia Das
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Newcastle upon Tyne, United Kingdom
| | - Martina Mancini
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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21
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Siew-Pin Leuk J, Yow KE, Zi-Xin Tan C, Hendy AM, Kar-Wing Tan M, Hock-Beng Ng T, Teo WP. A meta-analytical review of transcranial direct current stimulation parameters on upper limb motor learning in healthy older adults and people with Parkinson's disease. Rev Neurosci 2022; 34:325-348. [PMID: 36138560 DOI: 10.1515/revneuro-2022-0073] [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: 06/14/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022]
Abstract
Current literature lacks consolidated evidence for the impact of stimulation parameters on the effects of transcranial direct current stimulation (tDCS) in enhancing upper limb motor learning. Hence, we aim to synthesise available methodologies and results to guide future research on the usage of tDCS on upper limb motor learning, specifically in older adults and Parkinson's disease (PD). Thirty-two studies (Healthy older adults, N = 526, M = 67.25, SD = 4.30 years; PD, N = 216, M = 66.62, SD = 6.25 years) were included in the meta-analysis. All included studies consisted of active and sham protocols. Random effect meta-analyses were conducted for (i) subjects (healthy older adults and PD); (ii) intensity (1.0, 1.5, 2 mA); (iii) electrode montage (unilateral anodal, bilateral anodal, unilateral cathodal); (iv) stimulation site (cerebellum, frontal, motor, premotor, SMA, somatosensory); (v) protocol (online, offline). Significant tDCS effect on motor learning was reported for both populations, intensity 1.0 and 2.0 mA, unilateral anodal and cathodal stimulation, stimulation site of the motor and premotor cortex, and both online and offline protocols. Regression showed no significant relationship between tDCS effects and density. The efficacy of tDCS is also not affected by the number of sessions. However, studies that reported only single session tDCS found significant negative association between duration with motor learning outcomes. Our findings suggest that different stimulation parameters enhanced upper limb motor learning in older adults and PD. Future research should combine tDCS with neuroimaging techniques to help with optimisation of the stimulation parameters, considering the type of task and population.
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Affiliation(s)
- Jessie Siew-Pin Leuk
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Kai-En Yow
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Clenyce Zi-Xin Tan
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Ashlee M Hendy
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences (SENS), Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Mika Kar-Wing Tan
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Tommy Hock-Beng Ng
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
| | - Wei-Peng Teo
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore
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22
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Attentional focus effect on dual-task walking in Parkinson's disease with and without freezing of gait. GeroScience 2022; 45:177-195. [PMID: 35726118 PMCID: PMC9886752 DOI: 10.1007/s11357-022-00606-3] [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: 10/14/2021] [Accepted: 06/07/2022] [Indexed: 02/03/2023] Open
Abstract
In Parkinson's disease, the optimal attentional focus strategy for dual-task walking may vary with freezing of gait (FOG), due to different severities of impaired automaticity. The study aimed to investigate (i) the immediate effect of attentional focus on dual-task walking in participants with and without FOG, and (ii) the training effect of attentional focus on walking, FOG, and falls. In experiment 1, FOG and non-FOG groups (16 participants each) performed a dual-task of holding two interlocking rings apart while walking, either without attention instruction or with instructions to focus attention internally or externally. Gait parameters and ring-touching times were measured. In experiment 2, 30 participants with FOG were randomized to 6 weeks of dual-task training with internal-focus or external-focus instruction. Before and after training, we recorded timed up-and-go (TUG) and TUG dual-task (TUGdt) in on-medication and off-medication states, and the numbers of FOG episodes and falls. The non-FOG group showed less step length variability and shorter ring-touching times with external-focus. The FOG group showed less step length variability, less cadence, increased gait velocity, and longer step lengths with internal-focus compared to external-focus and no-focus instructions. Both internal-focus and external-focus training reduced FOG and falls after intervention, but only internal-focus training reduced TUG and TUGdt in both on-medication and off-medication states. Our findings suggest external-focus would enhance walking automaticity and the concurrent task accuracy for non-freezers, whereas for freezers, internal-focus could increase gait stability and lead to a more positive effect on improving locomotion control and reducing falling risk.
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23
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Sigurdsson HP, Yarnall AJ, Galna B, Lord S, Alcock L, Lawson RA, Colloby SJ, Firbank MJ, Taylor J, Pavese N, Brooks DJ, O'Brien JT, Burn DJ, Rochester L. Gait‐Related Metabolic Covariance Networks at Rest in Parkinson's Disease. Mov Disord 2022; 37:1222-1234. [PMID: 35285068 PMCID: PMC9314598 DOI: 10.1002/mds.28977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/09/2022] Open
Abstract
Background Gait impairments are characteristic motor manifestations and significant predictors of poor quality of life in Parkinson's disease (PD). Neuroimaging biomarkers for gait impairments in PD could facilitate effective interventions to improve these symptoms and are highly warranted. Objective The aim of this study was to identify neural networks of discrete gait impairments in PD. Methods Fifty‐five participants with early‐stage PD and 20 age‐matched healthy volunteers underwent quantitative gait assessment deriving 12 discrete spatiotemporal gait characteristics and [18F]‐2‐fluoro‐2‐deoxyglucose‐positron emission tomography measuring resting cerebral glucose metabolism. A multivariate spatial covariance approach was used to identify metabolic brain networks that were related to discrete gait characteristics in PD. Results In PD, we identified two metabolic gait‐related covariance networks. The first correlated with mean step velocity and mean step length (pace gait network), which involved relatively increased and decreased metabolism in frontal cortices, including the dorsolateral prefrontal and orbital frontal, insula, supplementary motor area, ventrolateral thalamus, cerebellum, and cuneus. The second correlated with swing time variability and step time variability (temporal variability gait network), which included relatively increased and decreased metabolism in sensorimotor, superior parietal cortex, basal ganglia, insula, hippocampus, red nucleus, and mediodorsal thalamus. Expression of both networks was significantly elevated in participants with PD relative to healthy volunteers and were not related to levodopa dosage or motor severity. Conclusions We have identified two novel gait‐related brain networks of altered glucose metabolism at rest. These gait networks could serve as a potential neuroimaging biomarker of gait impairments in PD and facilitate development of therapeutic strategies for these disabling symptoms. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Hilmar P. Sigurdsson
- Translational and Clinical Research Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom
| | - Alison J. Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom
- Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne United Kingdom
| | - Brook Galna
- Translational and Clinical Research Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom
- Health Futures Institute Murdoch University Perth Australia
| | - Sue Lord
- Auckland University of Technology Auckland New Zealand
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom
| | - Rachael A. Lawson
- Translational and Clinical Research Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom
| | - Sean J. Colloby
- Translational and Clinical Research Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom
| | - Michael J. Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom
| | - John‐Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom
| | - Nicola Pavese
- Translational and Clinical Research Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom
- Department of Nuclear Medicine and PET Aarhus University Hospital Aarhus Denmark
| | - David J. Brooks
- Translational and Clinical Research Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom
- Department of Nuclear Medicine and PET Aarhus University Hospital Aarhus Denmark
| | - John T. O'Brien
- Department of Psychiatry University of Cambridge Cambridge United Kingdom
| | - David J. Burn
- Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United Kingdom
- Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne United Kingdom
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24
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Ehgoetz Martens KA, Matar E, Phillips JR, Shine JM, Grunstein RR, Halliday GM, Lewis SJG. Narrow doorways alter brain connectivity and step patterns in isolated REM sleep behaviour disorder. Neuroimage Clin 2022; 33:102958. [PMID: 35151040 PMCID: PMC8844611 DOI: 10.1016/j.nicl.2022.102958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/19/2022]
Abstract
iRBD had slower and more variable stepping compared to controls in this VR task. iRBD showed exaggerated responses when passing narrow compared to wide doorways iRBD had altered task-related brain connectivity which was correlated to motor deficits.
Background Motor impairments in those with isolated REM sleep behaviour disorder (iRBD) significantly increases the likelihood of developing Lewy body disease (e.g. Parkinson’s disease and Dementia with Lewy Bodies). Objective This study sought to explore the prodromal process of neurodegeneration by examining the neural signature underlying motor deficits in iRBD patients. Methods A virtual reality (VR) gait paradigm (which has previously been shown to elicit adaptive changes in gait performance whilst navigating doorways in Parkinson’s Disease - PD) was paired with fMRI to investigate whether iRBD patients demonstrated worsened motor performance and altered connectivity across frontoparietal, motor and basal ganglia networks compared to healthy controls. Forty participants (23 iRBD and 17 healthy controls) completed the virtual reality gait task whilst in the MRI scanner, and an additional cohort of 19 Early PD patients completed the behavioural virtual reality gait task. Results As predicted, iRBD patients demonstrated slower and more variable stepping compared to healthy control participants and demonstrated an exaggerated response when navigating narrow compared to wide doorways, a phenomenon characteristically seen in PD. The iRBD patients also demonstrated less BOLD signal change in the left posterior putamen and right mesencephalic locomotor region, as well as reduced functional connectivity between the frontoparietal network and the motor network, when navigating narrow versus wide doorways compared to healthy control participants. Conclusions Taken together, this study demonstrates that iRBD patients have altered task-related brain connectivity, which may represent the neural underpinnings of early motor impairments that are evident in iRBD.
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Affiliation(s)
- Kaylena A Ehgoetz Martens
- ForeFront Research Team, Brain and Mind Centre, University of Sydney, Australia; Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia; Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada.
| | - Elie Matar
- ForeFront Research Team, Brain and Mind Centre, University of Sydney, Australia; Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia; Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Joseph R Phillips
- ForeFront Research Team, Brain and Mind Centre, University of Sydney, Australia; Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia; School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia
| | - James M Shine
- ForeFront Research Team, Brain and Mind Centre, University of Sydney, Australia; Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia
| | - Ron R Grunstein
- ForeFront Research Team, Brain and Mind Centre, University of Sydney, Australia; Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Glenda M Halliday
- ForeFront Research Team, Brain and Mind Centre, University of Sydney, Australia
| | - Simon J G Lewis
- ForeFront Research Team, Brain and Mind Centre, University of Sydney, Australia; Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia; Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada; Sleep and Circadian Group (CIRUS), Woolcock Institute of Medical Research, University of Sydney and Royal Prince Alfred Hospital, Australia
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25
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Li R, Zou T, Wang X, Wang H, Hu X, Xie F, Meng L, Chen H. Basal ganglia atrophy-associated causal structural network degeneration in Parkinson's disease. Hum Brain Mapp 2022; 43:1145-1156. [PMID: 34792836 PMCID: PMC8764481 DOI: 10.1002/hbm.25715] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/09/2021] [Accepted: 11/02/2021] [Indexed: 01/18/2023] Open
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disease characterized by both motor and non-motor symptoms. A convergent pathophysiological hallmark of PD is an early selective vulnerability within the basal ganglia circuit. However, the causal interactions between basal ganglia atrophy and progressive structural network alterations in PD remain unaddressed. Here, we adopted voxel-based morphometry method to measure gray matter (GM) volume for each participant (n = 84 PD patients and n = 70 matched healthy controls). Patients were first divided into three stages according to the Hoehn and Yahr (H&Y) and the Part III of Unified Parkinson's Disease Rating Scale scores respectively to analyze the stage-specific GM atrophy patterns. Then, the modulation of early caudate atrophy over other brain structures was evaluated using the whole-brain voxel-wise and region-of-interest-wise causal structural covariance network approaches. We found that GM atrophy progressively expands from the basal ganglia to the angular gyrus, temporal areas, and eventually spreads through the subcortical-cortical networks as PD progresses. Notably, we identified a shared caudate-associated degeneration network including the basal ganglia, thalamus, cerebellum, sensorimotor cortex, and cortical association areas with the PD progressive factors. These findings suggest that the early structural vulnerability of basal ganglia in PD may play a pivotal role in the modulation of motor and non-motor circuits at the structural level. Our work provides evidence for a novel mechanism of network degeneration that underlies the pathology of PD and may have potential clinical applications in the development of early predictors of PD onset and progress.
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Affiliation(s)
- Rong Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Ting Zou
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Xuyang Wang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Hongyu Wang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Xiaofei Hu
- Department of Radiology, Southwest HospitalThird Military Medical University (Army Medical University)ChongqingChina
| | - Fangfang Xie
- Department of Radiology, Xiangya HospitalCentral South UniversityChangshaChina
| | - Li Meng
- Department of Radiology, Xiangya HospitalCentral South UniversityChangshaChina
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, High‐Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduChina
- Department of Radiology, Southwest HospitalThird Military Medical University (Army Medical University)ChongqingChina
- Sichuan Provincial Center for Mental Health, The Center of Psychosomatic Medicine of Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
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Lenormand D, Piolino P. In search of a naturalistic neuroimaging approach: Exploration of general feasibility through the case of VR-fMRI and application in the domain of episodic memory. Neurosci Biobehav Rev 2021; 133:104499. [PMID: 34914938 DOI: 10.1016/j.neubiorev.2021.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 12/22/2022]
Abstract
Virtual Reality (VR) is an increasingly widespread tool for research as it allows the creation of experiments taking place in multimodal and daily-life-like environments, while keeping a strong experimental control. Adding neuroimaging to VR leads to a better understanding of the underlying brain networks activated during a naturalistic task, whether for research purposes or rehabilitation. The present paper focuses on the specific use of concurrent VR and fMRI and its technical challenges and feasibility, with a brief examination of the general existing solutions. Following the PRISMA guidelines, the review investigates the particular case of how VR-fMRI has explored episodic memory so far, with a comparison of object- and place-based episodic memory. This review confirms the involvement of cerebral regions well-known to be implicated in episodic memory and unravels other regions devoted to bodily and narrative aspects of the self, promoting new avenues of research in the domain of naturalistic episodic memory. Future studies should develop more immersive and interactive virtual neuroimaging features to increase ecological and embodied neurocognition aspects.
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Affiliation(s)
- Diane Lenormand
- Université de Paris, MC(2)Lab, 71 avenue Edouard Vaillant, 92100, Boulogne-Billancourt, France.
| | - Pascale Piolino
- Université de Paris, MC(2)Lab, 71 avenue Edouard Vaillant, 92100, Boulogne-Billancourt, France; Institut Universitaire de France (IUF), Paris, France
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27
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Araújo-Silva F, Santinelli FB, Felipe I Imaizumi L, Silveira APB, Vieira LHP, Alcock L, Barbieri FA. Temporal dynamics of cortical activity and postural control in response to the first levodopa dose of the day in people with Parkinson's disease. Brain Res 2021; 1775:147727. [PMID: 34788638 DOI: 10.1016/j.brainres.2021.147727] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Our understanding of how balance control responds to levodopa over the course of a single day in people with Parkinson's disease (PD) is limited with the majority of studies focused on isolated comparisons of ON vs. OFF levodopa medication. OBJECTIVE To evaluate the temporal dynamics of postural control following the first levodopa dose of the day during a challenging standing task in a group of people with PD. METHODS Changes in postural control were evaluated by monitoring cortical activity (covering frontal, motor, parietal and occipital areas), body sway parameters (force platform), and lower limb muscle activity (tibialis anterior and gastrocnemius medialis) in 15 individuals with PD during a semi-tandem standing task. Participants were assessed during two 60 second trials every 30 minutes (ON-30 ON-60 etc.) for 3 hours after the first matinal dose (ON-180). RESULTS Compared to when tested OFF-medication, cortical activity was increased across all four regions from ON-60 to ON-120 with early increases in alpha and beta band activity observed at ON-30. Levodopa was associated with increased gastrocnemius medialis activity (ON-30 to ON-120) and ankle co-contraction (ON-60 to ON-120). Changes in body sway outcomes (particularly in the anterior-posterior direction) were evident from ON-60 to ON-120. CONCLUSIONS Our results reveal a 60-minute window within which postural control outcomes may be obtained that are different compared to OFF-state and remain stable (from 60-minutes to 120-minutes after levodopa intake). Identifying a window of opportunity for measurement when individuals are optimally medicated is important for observations in a clinical and research setting.
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Affiliation(s)
- Fabiana Araújo-Silva
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Felipe B Santinelli
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Luis Felipe I Imaizumi
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Aline P B Silveira
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Luiz H P Vieira
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne, UK
| | - Fabio A Barbieri
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil.
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28
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Maiti B, Rawson KS, Tanenbaum AB, Koller JM, Snyder AZ, Campbell MC, Earhart GM, Perlmutter JS. Functional Connectivity of Vermis Correlates with Future Gait Impairments in Parkinson's Disease. Mov Disord 2021; 36:2559-2568. [PMID: 34109682 PMCID: PMC8595492 DOI: 10.1002/mds.28684] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/20/2021] [Accepted: 05/18/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Dysfunction of cerebellar vermis contributes to gait abnormalities in multiple conditions and may play a key role in gait impairment in Parkinson's disease (PD). OBJECTIVE The purpose of this study was to investigate whether altered resting-state functional connectivity of the vermis relates to subsequent impairment of specific domains of gait in PD. METHODS We conducted morphometric and resting-state functional connectivity MRI analyses contrasting 45 PD and 32 age-matched healthy participants. Quantitative gait measures were acquired with a GAITRite walkway at varying intervals after functional connectivity data acquisition. RESULTS At baseline, PD participants had significantly altered functional connectivity between vermis and sensorimotor cortex compared with controls. Altered vermal functional connectivity with bilateral paracentral lobules correlated with subsequent measures of variability in stride length, step time, and single support time after controlling for confounding variables including the interval between imaging and gait measures. Similarly, altered functional connectivity between vermis and left sensorimotor cortex correlated with mean stride length and its variability. Vermis volume did not relate to any gait measure. PD participants did not differ from controls in vermis volume or cortical thickness at the site of significant regional clusters. Only altered lobule V:sensorimotor cortex functional connectivity correlated with subsequent gait measures in exploratory analyses involving all the other cerebellar lobules. CONCLUSIONS These results demonstrate that abnormal vermal functional connectivity with sensorimotor cortex, in the absence of relevant vermal or cortical atrophy, correlates with subsequent gait impairment in PD. Our data reflect the potential of vermal functional connectivity as a novel imaging biomarker of gait impairment in PD. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Baijayanta Maiti
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Kerri S. Rawson
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Aaron B. Tanenbaum
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Abraham Z. Snyder
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
- Department of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Meghan C. Campbell
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
- Department of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Gammon M. Earhart
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO
| | - Joel S. Perlmutter
- Department of Neurology, Washington University School of Medicine, St. Louis, MO
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
- Department of Radiology, Washington University School of Medicine, St. Louis, MO
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
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29
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Gilat M, Ginis P, Zoetewei D, De Vleeschhauwer J, Hulzinga F, D'Cruz N, Nieuwboer A. A systematic review on exercise and training-based interventions for freezing of gait in Parkinson's disease. NPJ Parkinsons Dis 2021; 7:81. [PMID: 34508083 PMCID: PMC8433229 DOI: 10.1038/s41531-021-00224-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/12/2021] [Indexed: 12/16/2022] Open
Abstract
Freezing of gait (FOG) in Parkinson's disease (PD) causes severe patient burden despite pharmacological management. Exercise and training are therefore advocated as important adjunct therapies. In this meta-analysis, we assess the existing evidence for such interventions to reduce FOG, and further examine which type of training helps the restoration of gait function in particular. The primary meta-analysis across 41 studies and 1838 patients revealed a favorable moderate effect size (ES = -0.37) of various training modalities for reducing subjective FOG-severity (p < 0.00001), though several interventions were not directly aimed at FOG and some included non-freezers. However, exercise and training also proved beneficial in a secondary analysis on freezers only (ES = -0.32, p = 0.007). We further revealed that dedicated training aimed at reducing FOG episodes (ES = -0.24) or ameliorating the underlying correlates of FOG (ES = -0.40) was moderately effective (p < 0.01), while generic exercises were not (ES = -0.14, p = 0.12). Relevantly, no retention effects were seen after cessation of training (ES = -0.08, p = 0.36). This review thereby supports the implementation of targeted training as a treatment for FOG with the need for long-term engagement.
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Affiliation(s)
- Moran Gilat
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium.
| | - Pieter Ginis
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Demi Zoetewei
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Joni De Vleeschhauwer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Femke Hulzinga
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Nicholas D'Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
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30
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Martini DN, Morris R, Madhyastha TM, Grabowski TJ, Oakley J, Hu SC, Zabetian CP, Edwards KL, Hiller A, Chung K, Ramsey K, Lapidus JA, Cholerton B, Montine TJ, Quinn JF, Horak FB. Relationships Between Sensorimotor Inhibition and Mobility in Older Adults With and Without Parkinson's Disease. J Gerontol A Biol Sci Med Sci 2021; 76:630-637. [PMID: 33252618 DOI: 10.1093/gerona/glaa300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Reduced cortical sensorimotor inhibition is associated with mobility and cognitive impairments in people with Parkinson's disease (PD) and older adults (OAs). However, there is a lack of clarity regarding the relationships among sensorimotor, cognitive, and mobility impairments. The purpose of this study was to determine how cortical sensorimotor inhibition relates to impairments in mobility and cognition in people with PD and OAs. METHOD Cortical sensorimotor inhibition was characterized with short-latency afferent inhibition (SAI) in 81 people with PD and 69 OAs. Six inertial sensors recorded single- and dual-task gait and postural sway characteristics during a 2-minute walk and a 1-minute quiet stance. Cognition was assessed across the memory, visuospatial, executive function, attention, and language domains. RESULTS SAI was significantly impaired in the PD compared to the OA group. The PD group preformed significantly worse across all gait and postural sway tasks. In PD, SAI significantly correlated with single-task foot strike angle and stride length variability, sway area, and jerkiness of sway in the coronal and sagittal planes. In OAs, SAI significantly related to single-task gait speed and stride length, dual-task stride length, and immediate recall (memory domain). No relationship among mobility, cognition, and SAI was observed. CONCLUSIONS Impaired SAI related to slower gait in OA and to increased gait variability and postural sway in people with PD, all of which have been shown to be related to increased fall risk.
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Affiliation(s)
- Douglas N Martini
- Department of Neurology, Oregon Health and Science University, Portland.,Department of Kinesiology, University of Massachusetts Amherst
| | - Rosie Morris
- Department of Neurology, Oregon Health and Science University, Portland
| | - Tara M Madhyastha
- Department of Radiology, University of Washington School of Medicine, Seattle
| | - Thomas J Grabowski
- Department of Radiology, University of Washington School of Medicine, Seattle
| | - John Oakley
- Department of Neurology, University of Washington School of Medicine, Seattle
| | - Shu-Ching Hu
- Department of Neurology, University of Washington School of Medicine, Seattle.,Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Cyrus P Zabetian
- Department of Neurology, University of Washington School of Medicine, Seattle.,Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Karen L Edwards
- Department of Epidemiology, University of California, Irvine
| | - Amie Hiller
- Department of Neurology, Oregon Health and Science University, Portland.,Portland Veterans Affairs Health Care System, Oregon
| | - Kathryn Chung
- Department of Neurology, Oregon Health and Science University, Portland.,Portland Veterans Affairs Health Care System, Oregon
| | - Katrina Ramsey
- Biostatistics & Design Program, Oregon Health and Science University, Portland
| | - Jodi A Lapidus
- Biostatistics & Design Program, Oregon Health and Science University, Portland.,School of Public Health, Oregon Health and Science University, Portland
| | - Brenna Cholerton
- Department of Pathology, Stanford University School of Medicine, Palo Alto, California
| | - Thomas J Montine
- Department of Pathology, Stanford University School of Medicine, Palo Alto, California
| | - Joseph F Quinn
- Department of Neurology, Oregon Health and Science University, Portland.,Portland Veterans Affairs Health Care System, Oregon
| | - Fay B Horak
- Department of Neurology, Oregon Health and Science University, Portland.,Portland Veterans Affairs Health Care System, Oregon
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31
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Quek DYL, Economou K, MacDougall H, Lewis SJG, Ehgoetz Martens KA. Validating a Seated Virtual Reality Threat Paradigm for Inducing Anxiety and Freezing of Gait in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:1443-1454. [PMID: 34057098 DOI: 10.3233/jpd-212619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although prior research has established that freezing of gait (FOG) in Parkinson's disease (PD) is associated with anxiety, only one study to date has directly manipulated anxiety levels to induce FOG. OBJECTIVE The current study aimed to replicate these previous findings and evaluate whether a seated version of a 'threat' virtual reality (VR) paradigm could induce anxiety and provoke FOG. METHODS Twenty-four PD patients with FOG were assessed across various threat conditions in both a walking VR paradigm (Experiment 1) and a seated VR paradigm (Experiment 2). Both paradigms manipulated the height (i.e., elevated vs ground) and width (wide vs narrow) of the planks participants were instructed to walk across. RESULTS Across both experiments, the Elevated + Narrow condition provoked significantly greater number of freezing episodes compared to all other conditions. Higher levels of self-reported anxiety were reported during the Elevated+Narrow condition compared to all other conditions in Experiment 1, and compared to the Ground condition in Experiment 2. CONCLUSION These findings confirm that anxiety contributes to FOG and validates the use of a seated VR threat paradigm for provoking anxiety-related freezing. This enables future studies to combine this paradigm with functional MRI to explore the neural correlates underlying the role of anxiety in FOG.
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Affiliation(s)
- Dione Y L Quek
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Australia
| | - Kristin Economou
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Australia
| | | | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Australia
| | - Kaylena A Ehgoetz Martens
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Australia.,Department of Kinesiology, University of Waterloo, Canada
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32
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Bhatt M, Mahana B, Ko JH, Kolesar TA, Kanitkar A, Szturm T. Computerized Dual-Task Testing of Gait Visuomotor and Cognitive Functions in Parkinson's Disease: Test-Retest Reliability and Validity. Front Hum Neurosci 2021; 15:706230. [PMID: 34335213 PMCID: PMC8320846 DOI: 10.3389/fnhum.2021.706230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mobility and cognitive impairments in Parkinson's disease (PD) often coexist and are prognostic of adverse health events. Consequently, assessment and training that simultaneously address both gait function and cognition are important to consider in rehabilitation and promotion of healthy aging. For this purpose, a computer game-based rehabilitation treadmill platform (GRP) was developed for dual-task (DT) assessment and training. OBJECTIVE The first objective was to establish the test-retest reliability of the GRP assessment protocol for DT gait, visuomotor and executive cognitive function in PD patients. The second objective was to examine the effect of task condition [single task (ST) vs. DT] and disease severity (stage 2 vs. stage 3) on gait, visuomotor and cognitive function. METHODS Thirty individuals aged 55 to 70 years, diagnosed with PD; 15 each at Hoehn and Yahr scale stage 2 (PD-2) and 3 (PD-3) performed a series of computerized visuomotor and cognitive game tasks while sitting (ST) and during treadmill walking (DT). A treadmill instrumented with a pressure mat was used to record center of foot pressure and compute the average and coefficient of variation (COV) of step time, step length, and drift during 1-min, speed-controlled intervals. Visuomotor and cognitive game performance measures were quantified using custom software. Testing was conducted on two occasions, 1 week apart. RESULTS With few exceptions, the assessment protocol showed moderate to high intraclass correlation coefficient (ICC) values under both ST and DT conditions for the spatio-temporal gait measures (average and COV), as well as the visuomotor tracking and cognitive game performance measures. A significant decline in gait, visuomotor, and cognitive game performance measures was observed during DT compared to ST conditions, and in the PD-3 compared to PD-2 groups. CONCLUSION The high to moderate ICC values along with the lack of systematic errors in the measures indicate that this tool has the ability to repeatedly record reliable DT interference (DTI) effects over time. The use of interactive digital media provides a flexible method to produce and evaluate DTI for a wide range of executive cognitive activities. This also proves to be a sensitive tool for tracking disease progression. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, identifier NCT03232996.
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Affiliation(s)
- Mayank Bhatt
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Bhuvan Mahana
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ji Hyun Ko
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB, Canada
| | - Tiffany A. Kolesar
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB, Canada
| | - Anuprita Kanitkar
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Tony Szturm
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
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33
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Szturm T, Kolesar TA, Mahana B, Goertzen AL, Hobson DE, Marotta JJ, Strafella AP, Ko JH. Changes in Metabolic Activity and Gait Function by Dual-Task Cognitive Game-Based Treadmill System in Parkinson's Disease: Protocol of a Randomized Controlled Trial. Front Aging Neurosci 2021; 13:680270. [PMID: 34149399 PMCID: PMC8211751 DOI: 10.3389/fnagi.2021.680270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/10/2021] [Indexed: 01/22/2023] Open
Abstract
Balance and gait impairments, and consequently, mobility restrictions and falls are common in Parkinson’s disease (PD). Various cognitive deficits are also common in PD and are associated with increased fall risk. These mobility and cognitive deficits are limiting factors in a person’s health, ability to perform activities of daily living, and overall quality of life. Community ambulation involves many dual-task (DT) conditions that require processing of several cognitive tasks while managing or reacting to sudden or unexpected balance challenges. DT training programs that can simultaneously target balance, gait, visuomotor, and cognitive functions are important to consider in rehabilitation and promotion of healthy active lives. In the proposed multi-center, randomized controlled trial (RCT), novel behavioral positron emission tomography (PET) brain imaging methods are used to evaluate the molecular basis and neural underpinnings of: (a) the decline of mobility function in PD, specifically, balance, gait, visuomotor, and cognitive function, and (b) the effects of an engaging, game-based DT treadmill walking program on mobility and cognitive functions. Both the interactive cognitive game tasks and treadmill walking require continuous visual attention, and share spatial processing functions, notably to minimize any balance disturbance or gait deviation/stumble. The ability to “walk and talk” normally includes activation of specific regions of the prefrontal cortex (PFC) and the basal ganglia (site of degeneration in PD). The PET imaging analysis and comparison with healthy age-matched controls will allow us to identify areas of abnormal, reduced activity levels, as well as areas of excessive activity (increased attentional resources) during DT-walking. We will then be able to identify areas of brain plasticity associated with improvements in mobility functions (balance, gait, and cognition) after intervention. We expect the gait-cognitive training effect to involve re-organization of PFC activity among other, yet to be identified brain regions. The DT mobility-training platform and behavioral PET brain imaging methods are directly applicable to other diseases that affect gait and cognition, e.g., cognitive vascular impairment, Alzheimer’s disease, as well as in aging.
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Affiliation(s)
- Tony Szturm
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Tiffany A Kolesar
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB, Canada
| | - Bhuvan Mahana
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Andrew L Goertzen
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
| | - Douglas E Hobson
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Antonio P Strafella
- Morton and Gloria Shulman Movement Disorder Unit, E. J. Safra Parkinson Disease Program, Neurology Division/Department of Medicine, Toronto Western Hospital, Krembil Brain Institute, University Health Network (UHN), Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, ON, Canada
| | - Ji Hyun Ko
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, MB, Canada
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34
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Peng X, Feng Y, Ji S, Amos JT, Wang W, Li M, Ai S, Qiu X, Dong Y, Ma D, Yao D, Valdes-Sosa PA, Ren P. Gait Analysis by Causal Decomposition. IEEE Trans Neural Syst Rehabil Eng 2021; 29:953-964. [PMID: 34029190 DOI: 10.1109/tnsre.2021.3082936] [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: 11/08/2022]
Abstract
Recent studies have investigated bilateral gaits based on the causality analysis of kinetic (or kinematic) signals recorded using both feet. However, these approaches have not considered the influence of their simultaneous causation, which might lead to inaccurate causality inference. Furthermore, the causal interaction of these signals has not been investigated within their frequency domain. Therefore, in this study we attempted to employ a causal-decomposition approach to analyze bilateral gait. The vertical ground reaction force (VGRF) signals of Parkinson's disease (PD) patients and healthy control (HC) individuals were taken as an example to illustrate this method. To achieve this, we used ensemble empirical mode decomposition to decompose the left and right VGRF signals into intrinsic mode functions (IMFs) from the high to low frequency bands. The causal interaction strength (CIS) between each pair of IMFs was then assessed through the use of their instantaneous phase dependency. The results show that the CISes between pairwise IMFs decomposed in the high frequency band of VGRF signals can not only markedly distinguish PD patients from HC individuals, but also found a significant correlation with disease progression, while other pairwise IMFs were not able to produce this. In sum, we found for the first time that the frequency specific causality of bilateral gait may reflect the health status and disease progression of individuals. This finding may help to understand the underlying mechanisms of walking and walking-related diseases, and offer broad applications in the fields of medicine and engineering.
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35
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Orcioli-Silva D, Vitório R, Nóbrega-Sousa P, Beretta VS, Conceição NRD, Oliveira AS, Pereira MP, Gobbi LTB. Cortical Activity Underlying Gait Improvements Achieved With Dopaminergic Medication During Usual Walking and Obstacle Avoidance in Parkinson Disease. Neurorehabil Neural Repair 2021; 35:406-418. [PMID: 33754884 DOI: 10.1177/15459683211000736] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dopaminergic medication improves gait in people with Parkinson disease (PD). However, it remains unclear if dopaminergic medication modulates cortical activity while walking. OBJECTIVE We investigated the effects of dopaminergic medication on cortical activity during unobstructed walking and obstacle avoidance in people with PD. METHODS A total of 23 individuals with PD, in both off (PDOFF) and on (PDON) medication states, and 30 healthy older adults (control group [CG]) performed unobstructed walking and obstacle avoidance conditions. Cortical activity was acquired through a combined functional near-infrared spectroscopy electroencephalography (EEG) system, along with gait parameters, through an electronic carpet. Prefrontal cortex (PFC) oxygenated hemoglobin (HbO2) and EEG absolute power from FCz, Cz, and CPz channels were calculated. RESULTS HbO2 concentration reduced for people with PDOFF during obstacle avoidance compared with unobstructed walking. In contrast, both people with PDON and the CG had increased HbO2 concentration when avoiding obstacles compared with unobstructed walking. Dopaminergic medication increased step length, step velocity, and β and γ power in the CPz channel, regardless of walking condition. Moreover, dopaminergic-related changes (ie, on-off) in FCz/CPz γ power were associated with dopaminergic-related changes in step length for both walking conditions. CONCLUSIONS PD compromises the activation of the PFC during obstacle avoidance, and dopaminergic medication facilitates its recruitment. In addition, PD medication increases sensorimotor integration during walking by increasing posterior parietal cortex (CPz) activity. Increased γ power in the CPz and FCz channels is correlated with step length improvements achieved with dopaminergic medication during unobstructed walking and obstacle avoidance in PD.
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Affiliation(s)
- Diego Orcioli-Silva
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Rodrigo Vitório
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Priscila Nóbrega-Sousa
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Victor Spiandor Beretta
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Núbia Ribeiro da Conceição
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | | | - Marcelo Pinto Pereira
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
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36
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Johansson H, Ekman U, Rennie L, Peterson DS, Leavy B, Franzén E. Dual-Task Effects During a Motor-Cognitive Task in Parkinson's Disease: Patterns of Prioritization and the Influence of Cognitive Status. Neurorehabil Neural Repair 2021; 35:356-366. [PMID: 33719728 PMCID: PMC8073879 DOI: 10.1177/1545968321999053] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
People with Parkinson’s disease (PD) experience greater difficulties during dual task (DT) walking compared to healthy controls, but factors explaining the variance in DT costs remain largely unknown. Additionally, as cognitive impairments are common in PD it is important to understand whether cognitive status influences the strategies used during DT paradigms. The study aimed to (1) explore DT costs on gait and cognition during DT walking, (2) investigate factors associated with DT costs, and (3) to investigate to what extent patterns of DT costs and prioritization differed according to cognitive status. A total of 93 people with Parkinson’s disease were examined when walking in single and DT conditions. Information regarding demographics, PD severity, mobility, and cognitive and affective symptoms was collected, and an extensive neuropsychological test battery was used to classify whether participants had mild cognitive impairment (PD MCI) or not (PD non-MCI). Dual task costs were observed across all gait domains except asymmetry. Cognitive status was associated with DT costs on both gait and cognition. Nonmotor experiences of daily living were further associated with DT cost on cognition, and TUG-cog associated with DT cost on gait. People with PD MCI had larger DT costs on gait than PD non-MCI. Strategies differed according to cognitive status, whereby PD MCI used a posture-second strategy, and PD non-MCI used a posture-first strategy. Once verified in future studies, these results can inform clinicians and researchers when tailoring DT training paradigms to the specific characteristics of people with PD.
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Affiliation(s)
- Hanna Johansson
- Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Urban Ekman
- Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Linda Rennie
- Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Daniel S Peterson
- Arizona State University, Phoenix, AZ, USA.,Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - Breiffni Leavy
- Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden.,Stockholm Sjukhem Foundation, Stockholm, Sweden
| | - Erika Franzén
- Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden.,Stockholm Sjukhem Foundation, Stockholm, Sweden
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37
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Ferrazzoli D, Ortelli P, Volpe D, Cucca A, Versace V, Nardone R, Saltuari L, Sebastianelli L. The Ties That Bind: Aberrant Plasticity and Networks Dysfunction in Movement Disorders-Implications for Rehabilitation. Brain Connect 2021; 11:278-296. [PMID: 33403893 DOI: 10.1089/brain.2020.0971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Movement disorders encompass various conditions affecting the nervous system. The pathological processes underlying movement disorders lead to aberrant synaptic plastic changes, which in turn alter the functioning of large-scale brain networks. Therefore, clinical phenomenology does not only entail motor symptoms but also cognitive and motivational disturbances. The result is the disruption of motor learning and motor behavior. Due to this complexity, the responsiveness to standard therapies could be disappointing. Specific forms of rehabilitation entailing goal-based practice, aerobic training, and the use of noninvasive brain stimulation techniques could "restore" neuroplasticity at motor-cognitive circuitries, leading to clinical gains. This is probably associated with modulations occurring at both molecular (synaptic) and circuitry levels (networks). Several gaps remain in our understanding of the relationships among plasticity and neural networks and how neurorehabilitation could promote clinical gains is still unclear. Purposes: In this review, we outline first the networks involved in motor learning and behavior and analyze which mechanisms link the pathological synaptic plastic changes with these networks' disruption in movement disorders. Therefore, we provide theoretical and practical bases to be applied for treatment in rehabilitation.
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Affiliation(s)
- Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Paola Ortelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Daniele Volpe
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
| | - Alberto Cucca
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy.,Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, NYU School of Medicine, New York, New York, USA.,Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital (SABES-ASDAA), Merano-Meran, Italy.,Department of Neurology, Christian Doppler Medical Center, Paracelsus University Salzburg, Salzburg, Austria
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
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Yun SJ, Lee HH, Lee WH, Lee SH, Oh BM, Seo HG. Effect of robot-assisted gait training on gait automaticity in Parkinson disease: A prospective, open-label, single-arm, pilot study. Medicine (Baltimore) 2021; 100:e24348. [PMID: 33592882 PMCID: PMC7870221 DOI: 10.1097/md.0000000000024348] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/17/2020] [Accepted: 12/27/2020] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Gait automaticity is reduced in patients with Parkinson disease (PD) due to impaired habitual control. The aim of this study was to investigate the effect of robot-assisted gait training (RAGT) on gait automaticity as well as gait speed and balance in patients with PD.This study was a prospective, open-label, single-arm, pilot study. We planned to recruit 12 patients with idiopathic PD. Participants received 12 sessions of RAGT using exoskeleton-type robotic device. Sessions were 45-minute each, 3 days a week, for 4 consecutive weeks using an exoskeleton-type gait robot. The primary outcome was the percentage of dual-task interference measured by the 10-Meter Walk Test (10MWT) under single and dual-task (cognitive and physical) conditions. Secondary outcomes were the Berg Balance Scale and Korean version of the Falls Efficacy Scale-International. All measures were evaluated before treatment (T0), after treatment (T1), and 1-month post-treatment (T2).Twelve patients were enrolled and 1 dropped out. Finally, 11 patients with idiopathic PD were analyzed. The mean age of 11 patients (5 males) was 66.46 ± 5.66 years, and disease duration was 112.91 ± 50.19 months. The Hoehn and Yahr stages were 2.5 in 8 patients and 3 in 3 patients. Linear mixed-effect model analysis showed a significant change over time only in single-task gait speed of the 10MWT (P = .007), but not in dual-task gait speed, dual-task interferences, and Korean version of the Falls Efficacy Scale-International. Cognitive dual-task interference significantly increased (P = .026) at T1, but not at T2 (P = .203). No significant changes were observed for physical dual-task interference at T1 and T2. Single-task gait speed of the 10MWT was significantly increased at T1 (P = .041), but not at T2 (P = .445). There were no significant changes in the dual-task gait speed of 10MWT. A significant improvement was observed in Berg Balance Scale score at T1 and T2 (P = .004 and P = .024, respectively).In this pilot study, despite improvement in walking speed and balance, gait automaticity in patients with PD was not improved by RAGT using an exoskeleton-type robot. Additional therapeutic components may be needed to improve gait automaticity using RAGT in patients with PD.
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Affiliation(s)
- Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital
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Vitorio R, Stuart S, Mancini M. Executive Control of Walking in People With Parkinson's Disease With Freezing of Gait. Neurorehabil Neural Repair 2020; 34:1138-1149. [PMID: 33155506 DOI: 10.1177/1545968320969940] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Walking abnormalities in people with Parkinson's disease (PD) are characterized by a shift in locomotor control from healthy automaticity to compensatory prefrontal executive control. Indirect measures of automaticity of walking (eg, step-to-step variability and dual-task cost) suggest that freezing of gait (FoG) may be associated with reduced automaticity of walking. However, the influence of FoG status on actual prefrontal cortex (PFC) activity during walking remains unclear. OBJECTIVE To investigate the influence of FoG status on automaticity of walking in people with PD. METHODS Forty-seven people with PD were distributed into 2 groups based on FoG status, which was assessed by the New Freezing of Gait Questionnaire: PD-FoG (n = 23; UPDRS-III = 35) and PD+FoG (n = 24; UPDRS-III = 43.1). Participants walked over a 9-m straight path (with a 180° turn at each end) for 80 seconds. Two conditions were tested off medication: single- and dual-task walking (ie, with a concomitant cognitive task). A portable functional near-infrared spectroscopy system recorded PFC activity while walking (including turns). Wearable inertial sensors were used to calculate spatiotemporal gait parameters. RESULTS PD+FoG had greater PFC activation during both single and dual-task walking than PD-FoG (P = .031). There were no differences in gait between PD-FoG and PD+FoG. Both groups decreased gait speed (P = .029) and stride length (P < .001) during dual-task walking compared with single-task walking. CONCLUSIONS These findings suggest that PD+FoG have reduced automaticity of walking, even in absence of FoG episodes. PFC activity while walking seems to be more sensitive than gait measures in identifying reduction in automaticity of walking in PD+FoG.
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Affiliation(s)
| | - Samuel Stuart
- Oregon Health & Science University, Portland, OR, USA.,Northumbria University, Newcastle upon Tyne, UK
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Shen YT, Yuan YS, Wang M, Zhi Y, Wang JW, Wang LN, Ma KW, Si QQ, Zhang KZ. Dysfunction in superior frontal gyrus associated with diphasic dyskinesia in Parkinson's disease. NPJ PARKINSONS DISEASE 2020; 6:30. [PMID: 33145398 PMCID: PMC7603392 DOI: 10.1038/s41531-020-00133-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/25/2020] [Indexed: 12/21/2022]
Abstract
Alterations in brain function in Parkinson's disease (PD) patients with diphasic dyskinesia have not been investigated. We aimed to explore the alterations in regional brain function. Each of 53 levodopa (LD)-treated PD patients had two resting-state functional magnetic resonance imaging (rs-fMRI) scans in the same morning, before and after taking LD. The regional homogeneity (ReHo) approach was used to reveal local synchronization changes. Two-way factorial repeated measures analysis of covariance, with group as a between-subject factor and LD effect as a within-subject factor, was performed to explore the two main effects and interaction. Interactive analysis was used to show outcomes that combined disease status and LD effect. Spearman's correlations were used to detect associations between interactive brain regions and severity of dyskinetic symptoms, assessed by the Unified Dyskinesia Rating Scale (UDyRS) scores, along with moderation analyses. There was no significant difference in the main group effect analysis. Significantly different clusters obtained from main LD effect analysis were in left caudate nucleus and putamen. ReHo values decreased in the caudate nucleus and increased in the putamen during the ON state after taking LD. Interaction between group and LD effect was found in left medial superior frontal gyrus (mSFG), where there were the lowest ReHo values, and was negatively correlated with UDyRS scores in the diphasic dyskinetic group during the ON state. The relationship was independent of LD dose. Abnormal local synchronization in the mSFG is closely associated with the development of diphasic dyskinesia in PD patients.
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Affiliation(s)
- Yu-Ting Shen
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Department of Neurology, Changshu No.1 People's Hospital, Suzhou, China
| | - Yong-Sheng Yuan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Zhi
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian-Wei Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li-Na Wang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ke-Wei Ma
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian-Qian Si
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ke-Zhong Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Vieira-Yano B, Martini DN, Horak FB, de Lima-Pardini A, Almeida F, Santana VP, Lima D, Batista AX, Marquesini R, Lira J, Barbosa ER, Corcos DM, Ugrinowitsch C, Silva-Batista C. The Adapted Resistance Training with Instability Randomized Controlled Trial for Gait Automaticity. Mov Disord 2020; 36:152-163. [PMID: 32955752 DOI: 10.1002/mds.28298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/06/2020] [Accepted: 08/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Deficits in the cerebellar locomotor region (CLR) have been associated with loss of gait automaticity in individuals with freezing of gait in Parkinson's disease (freezers); however, exercise interventions that restore gait automaticity in freezers are lacking. We evaluated the effects of the adapted resistance training with instability ([ARTI] complex exercises) compared with traditional motor rehabilitation (without complex exercises) on gait automaticity and attentional set-shifting. We also verified associations between gait automaticity change and CLR activation change previously published. METHODS Freezers were randomized either to the experimental group (ARTI, n = 17) or to the active control group (traditional motor rehabilitation, n = 15). Both training groups performed exercises 3 times a week for 12 weeks. Gait automaticity (dual-task and dual-task cost [DTC] on gait speed and stride length), single-task gait speed and stride length, attentional set-shifting (time between Trail Making Test parts B and A), and CLR activation during a functional magnetic resonance imaging protocol of simulated step initiation task were evaluated before and after interventions. RESULTS Both training groups improved gait parameters in single task (P < 0.05), but ARTI was more effective than traditional motor rehabilitation in improving DTC on gait speed, DTC on stride length, dual-task stride length, and CLR activation (P < 0.05). Changes in CLR activation were associated with changes in DTC on stride length (r = 0.68, P = 0.002) following ARTI. Only ARTI improved attentional set-shifting at posttraining (P < 0.05). CONCLUSIONS ARTI restores gait automaticity and improves attentional set-shifting in freezers attributed to the usage of exercises with high motor complexity. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Bianca Vieira-Yano
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil.,School of Arts, Sciences and Humanities, University of São Paulo, Sao Paulo, Brazil
| | - Douglas N Martini
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Filipe Almeida
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil
| | - Vagner P Santana
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil
| | - Daniel Lima
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil
| | - Alana X Batista
- Department of Radiology, University of São Paulo, São Paulo, Brazil
| | - Raquel Marquesini
- Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Jumes Lira
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil.,Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Egberto R Barbosa
- Movement Disorders Clinic, Department of Neurology, School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
| | - Carlos Ugrinowitsch
- Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Carla Silva-Batista
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil.,School of Arts, Sciences and Humanities, University of São Paulo, Sao Paulo, Brazil.,Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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42
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Effect of Parkinson's disease and two therapeutic interventions on muscle activity during walking: a systematic review. NPJ PARKINSONS DISEASE 2020; 6:22. [PMID: 32964107 PMCID: PMC7481232 DOI: 10.1038/s41531-020-00119-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Abstract
Gait deficits are a common feature of Parkinson’s disease (PD) and predictors of future motor and cognitive impairment. Understanding how muscle activity contributes to gait impairment and effects of therapeutic interventions on motor behaviour is crucial for identifying potential biomarkers and developing rehabilitation strategies. This article reviews sixteen studies that investigate the electromyographic (EMG) activity of lower limb muscles in people with PD during walking and reports on their quality. The weight of evidence establishing differences in motor activity between people with PD and healthy older adults (HOAs) is considered. Additionally, the effect of dopaminergic medication and deep brain stimulation (DBS) on modifying motor activity is assessed. Results indicated greater proximal and decreased distal activity of lower limb muscles during walking in individuals with PD compared to HOA. Dopaminergic medication was associated with increased distal lower limb muscle activity whereas subthalamic nucleus DBS increased activity of both proximal and distal lower limb muscles. Tibialis anterior was impacted most by the interventions. Quality of the studies was not strong, with a median score of 61%. Most studies investigated only distal muscles, involved small sample sizes, extracted limited EMG features and lacked rigorous signal processing. Few studies related changes in motor activity with functional gait measures. Understanding mechanisms underpinning gait impairment in PD is essential for development of personalised rehabilitative interventions. Recommendations for future studies include greater participant numbers, recording more functionally diverse muscles, applying multi-muscle analyses, and relating EMG to functional gait measures.
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43
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Martini DN, Morris R, Kelly VE, Hiller A, Chung KA, Hu SC, Zabetian CP, Oakley J, Poston K, Mata IF, Edwards KL, Lapidus JA, Grabowski TJ, Montine TJ, Quinn JF, Horak F. Sensorimotor Inhibition and Mobility in Genetic Subgroups of Parkinson's Disease. Front Neurol 2020; 11:893. [PMID: 33013627 PMCID: PMC7498564 DOI: 10.3389/fneur.2020.00893] [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: 05/22/2020] [Accepted: 07/13/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Mobility and sensorimotor inhibition impairments are heterogeneous in Parkinson's disease (PD). Genetics may contribute to this heterogeneity since the apolipoprotein (APOE) ε4 allele and glucocerebrosidase (GBA) gene variants have been related to mobility impairments in otherwise healthy older adult (OA) and PD cohorts. The purpose of this study is to determine if APOE or GBA genetic status affects sensorimotor inhibition and whether the relationship between sensorimotor inhibition and mobility differs in genetic sub-groups of PD. Methods: Ninety-three participants with idiopathic PD (53 non-carriers; 23 ε4 carriers; 17 GBA variants) and 72 OA (45 non-carriers; 27 ε4 carriers) had sensorimotor inhibition characterized by short-latency afferent inhibition. Mobility was assessed in four gait domains (pace/turning, rhythm, trunk, variability) and two postural sway domains (area/jerkiness and velocity) using inertial sensors. Results: Sensorimotor inhibition was worse in the PD than OA group, with no effect of genetic status. Gait pace/turning was slower and variability was higher (p < 0.01) in PD compared to OA. Postural sway area/jerkiness (p < 0.01) and velocity (p < 0.01) were also worse in the PD than OA group. Genetic status was not significantly related to any gait or postural sway domain. Sensorimotor inhibition was significantly correlated with gait variability (r = 0.27; p = 0.02) and trunk movement (r = 0.23; p = 0.045) in the PD group. In PD non-carriers, sensorimotor inhibition related to variability (r = 0.35; p = 0.010) and trunk movement (r = 0.31; p = 0.025). In the PD ε4 group, sensorimotor inhibition only related to rhythm (r = 0.47; p = 0.024), while sensorimotor inhibition related to pace/turning (r = -0.49; p = 0.046) and rhythm (r = 0.59; p = 0.013) in the PD GBA group. Sensorimotor inhibition was significantly correlated with gait pace/turning (r = -0.27; p = 0.04) in the OA group. There was no relationship between sensorimotor inhibition and postural sway. Conclusion: ε4 and GBA genetic status did not affect sensorimotor inhibition or mobility impairments in this PD cohort. However, worse sensorimotor inhibition was associated with gait variability in PD non-carriers, but with gait rhythm in PD ε4 carriers and with gait rhythm and pace in PD with GBA variants. Impaired sensorimotor inhibition had a larger effect on mobility in people with PD than OA and affected different domains of mobility depending on genetic status.
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Affiliation(s)
- Douglas N Martini
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Rosie Morris
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Valerie E Kelly
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Amie Hiller
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Portland Veterans Affairs Health Care System, Portland, OR, United States
| | - Kathryn A Chung
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Portland Veterans Affairs Health Care System, Portland, OR, United States
| | - Shu-Ching Hu
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States.,Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Cyrus P Zabetian
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States.,Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - John Oakley
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States
| | - Kathleen Poston
- Department of Neurology and Neurological Sciences, Stanford School of Medicine, Palo Alto, CA, United States
| | - Ignacio F Mata
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, United States.,Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.,Lerner Research Institute, Genomic Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Karen L Edwards
- Department of Epidemiology, University of California, Irvine, Irvine, CA, United States
| | - Jodi A Lapidus
- Biostatistics & Design Program, Oregon Health and Science University, Portland, OR, United States
| | - Thomas J Grabowski
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Thomas J Montine
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Joseph F Quinn
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Portland Veterans Affairs Health Care System, Portland, OR, United States
| | - Fay Horak
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
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44
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Weiss D, Schoellmann A, Fox MD, Bohnen NI, Factor SA, Nieuwboer A, Hallett M, Lewis SJG. Freezing of gait: understanding the complexity of an enigmatic phenomenon. Brain 2020; 143:14-30. [PMID: 31647540 DOI: 10.1093/brain/awz314] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 12/15/2022] Open
Abstract
Diverse but complementary methodologies are required to uncover the complex determinants and pathophysiology of freezing of gait. To develop future therapeutic avenues, we need a deeper understanding of the disseminated functional-anatomic network and its temporally associated dynamic processes. In this targeted review, we will summarize the latest advances across multiple methodological domains including clinical phenomenology, neurogenetics, multimodal neuroimaging, neurophysiology, and neuromodulation. We found that (i) locomotor network vulnerability is established by structural damage, e.g. from neurodegeneration possibly as result from genetic variability, or to variable degree from brain lesions. This leads to an enhanced network susceptibility, where (ii) modulators can both increase or decrease the threshold to express freezing of gait. Consequent to a threshold decrease, (iii) neuronal integration failure of a multilevel brain network will occur and affect one or numerous nodes and projections of the multilevel network. Finally, (iv) an ultimate pathway might encounter failure of effective motor output and give rise to freezing of gait as clinical endpoint. In conclusion, we derive key questions from this review that challenge this pathophysiological view. We suggest that future research on these questions should lead to improved pathophysiological insight and enhanced therapeutic strategies.
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Affiliation(s)
- Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Anna Schoellmann
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Michael D Fox
- Berenson-Allen Center, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Nicolaas I Bohnen
- Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Stewart A Factor
- Department of Neurology, Emory School of Medicine, Atlanta, GA, USA
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia
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45
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Martini DN, Parrington L, Stuart S, Fino PC, King LA. Gait Performance in People with Symptomatic, Chronic Mild Traumatic Brain Injury. J Neurotrauma 2020; 38:218-224. [PMID: 32495691 DOI: 10.1089/neu.2020.6986] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
There is a dearth of knowledge about how symptom severity affects gait in the chronic (>3 months) mild traumatic brain injury (mTBI) population despite up to 53% of people reporting persisting symptoms after mTBI. The aim of this investigation was to determine whether gait is affected in a symptomatic, chronic mTBI group and to assess the relationship between gait performance and symptom severity on the Neurobehavioral Symptom Inventory (NSI). Gait was assessed under single- and dual-task conditions using five inertial sensors in 57 control subjects and 65 persons with chronic mTBI (1.0 year from mTBI). The single- and dual-task gait domains of Pace, Rhythm, Variability, and Turning were calculated from individual gait characteristics. Dual-task cost (DTC) was calculated for each domain. The mTBI group walked (domain z-score mean difference, single-task = 0.70; dual-task = 0.71) and turned (z-score mean difference, single-task = 0.69; dual-task = 0.70) slower (p < 0.001) under both gait conditions, with less rhythm under dual-task gait (z-score difference = 0.21; p = 0.001). DTC was not different between groups. Higher NSI somatic subscore was related to higher single- and dual-task gait variability as well as slower dual-task pace and turning (p < 0.01). Persons with chronic mTBI and persistent symptoms exhibited altered gait, particularly under dual-task, and worse gait performance related to greater symptom severity. Future gait research in chronic mTBI should assess the possible underlying physiological mechanisms for persistent symptoms and gait deficits.
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Affiliation(s)
- Douglas N Martini
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,Veterans Affairs Portland Healthcare System, Portland, Oregon, USA
| | - Lucy Parrington
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,Veterans Affairs Portland Healthcare System, Portland, Oregon, USA
| | - Samuel Stuart
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,Veterans Affairs Portland Healthcare System, Portland, Oregon, USA.,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Peter C Fino
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah, USA
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,Veterans Affairs Portland Healthcare System, Portland, Oregon, USA
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Droby A, Maidan I, Jacob Y, Giladi N, Hausdorff JM, Mirelman A. Distinct Effects of Motor Training on Resting-State Functional Networks of the Brain in Parkinson’s Disease. Neurorehabil Neural Repair 2020; 34:795-803. [DOI: 10.1177/1545968320940985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background. Nigrostriatal dopaminergic loss is a hallmark of Parkinson’s disease (PD) pathophysiology, leading to motor Parkinsonism. Different intervention protocols have shown that motor and cognitive functions improvement in PD occur via the modulation of distinct motor and cognitive pathways. Objective. To investigate the effects of two motor training programs on the brains’ functional networks in PD patients. Methods. Thirty-seven PD patients were prospectively studied. All enrolled patients underwent either treadmill training (TT) (n = 19) or treadmill with virtual reality (TT + VR) (n = 18) for 6 weeks. Magnetic resonance imaging (MRI) scans (3 T) acquiring 3-dimensional T1-weighted and resting-state functional MRI (rs-fMRI) data sets were performed at baseline and after 6 weeks. Independent component analysis (ICA) was conducted, and functional connectivity (FC) changes within large-scale functional brain networks were examined. Results. In both groups, significant post-training FC decrease in striatal, limbic, and parietal regions within the basal ganglia network, executive control network, and frontal-striatal network, and significant FC increase in the caudate, and cingulate within the sensorimotor network (SMN) were observed. Moreover, a significant time × group interaction was detected where TT + VR training had greater effects on FC levels in the supplementary motor area (SMA) and right precentral gyrus within the SMN, and in the right middle frontal gyrus (MFG) within the cerebellar network. These FC alterations were associated with improved usual and dual-task walking performance. Conclusions. These results suggest that TT with-and-without the addition of a VR component affects distinct neural pathways, highlighting the potential for beneficial neural plasticity in PD. Such distinctive task-specific pathways may foster the facilitation of interventions tailored to the individual needs of PD patients. Registered at Clinicaltrials.gov number: NCT01732653.
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Affiliation(s)
- Amgad Droby
- Labratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement Cognition and Mobility (CMCM), Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
- Sagol School for Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Inbal Maidan
- Labratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement Cognition and Mobility (CMCM), Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
- Sagol School for Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Yael Jacob
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nir Giladi
- Labratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement Cognition and Mobility (CMCM), Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
- Sagol School for Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M. Hausdorff
- Labratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement Cognition and Mobility (CMCM), Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
- Sagol School for Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Rush University Medical Center, Chicago, IL, USA
| | - Anat Mirelman
- Labratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement Cognition and Mobility (CMCM), Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
- Sagol School for Neuroscience, Tel Aviv University, Tel Aviv, Israel
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47
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Miranda-Domínguez Ó, Ragothaman A, Hermosillo R, Feczko E, Morris R, Carlson-Kuhta P, Nutt JG, Mancini M, Fair D, Horak FB. Lateralized Connectivity between Globus Pallidus and Motor Cortex is Associated with Freezing of Gait in Parkinson's Disease. Neuroscience 2020; 443:44-58. [PMID: 32629155 DOI: 10.1016/j.neuroscience.2020.06.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 01/26/2023]
Abstract
Freezing of gait (FoG) is a brief, episodic absence or marked reduction of forward progression of the feet, despite the intention to walk, that is common in people with Parkinson's disease (PD). We hypothesized that not only motor, but higher level cognitive and attention areas may be impaired in freezers. In this study, we aimed to characterize differences in cortical and subcortical functional connectivity specific to FoG. We examined resting state neuroimaging and objective measures of FoG severity and gait from 103 individuals (28 PD + FoG, 36 PD - FoG and 39 healthy controls). Inertial sensors were used to quantify freezing severity and gait. Groups with and without FoG were matched on age, disease severity, cognitive status, and levodopa medication. MRI data was processed using surface-based registration. High-quality imaging data were used to characterize differences in connectivity specific to FoG using a pre-defined set of Regions of Interest (ROIs) and validated using whole-brain connectivity analysis. Associations between functional connectivity and objective measures of FoG were determined via predictive modeling using hold-out cross validation. We found that connectivity between the left globus pallidus (GP) and left somatosensory cortex and between two brain areas in the default and insular/vestibular networks exhibited significant differences specific to FoG and were also strong and significant predictors of FoG severity. Our findings suggest that the interplay among motor, default and vestibular areas of the left cortex are critical in the pathology of FoG.
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Affiliation(s)
- Óscar Miranda-Domínguez
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Anjanibhargavi Ragothaman
- Department of Biomedical Engineering, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Robert Hermosillo
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Eric Feczko
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Rosie Morris
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Patricia Carlson-Kuhta
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - John G Nutt
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Martina Mancini
- Department of Biomedical Engineering, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Damien Fair
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Advanced Imaging Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Fay B Horak
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Biomedical Engineering, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States.
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48
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Florio TM. Stereotyped, automatized and habitual behaviours: are they similar constructs under the control of the same cerebral areas? AIMS Neurosci 2020; 7:136-152. [PMID: 32607417 PMCID: PMC7321770 DOI: 10.3934/neuroscience.2020010] [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: 01/31/2020] [Accepted: 05/18/2020] [Indexed: 11/19/2022] Open
Abstract
Comprehensive knowledge about higher executive functions of motor control has been covered in the last decades. Critical goals have been targeted through many different technological approaches. An abundant flow of new results greatly progressed our ability to respond at better-posited answers to look more than ever at the challenging neural system functioning. Behaviour is the observable result of the invisible, as complex cerebral functioning. Many pathological states are approached after symptomatology categorisation of behavioural impairments is achieved. Motor, non-motor and psychiatric signs are greatly shared by many neurological/psychiatric disorders. Together with the cerebral cortex, the basal ganglia contribute to the expression of behaviour promoting the correct action schemas and the selection of appropriate sub-goals based on the evaluation of action outcomes. The present review focus on the basic classification of higher motor control functioning, taking into account the recent advances in basal ganglia structural knowledge and the computational model of basal ganglia functioning. We discuss about the basal ganglia capability in executing ordered motor patterns in which any single movement is linked to each other into an action, and many actions are ordered into each other, giving them a syntactic value to the final behaviour. The stereotypic, automatized and habitual behaviour's constructs and controls are the expression of successive stages of rule internalization and categorisation aimed in producing the perfect spatial-temporal control of motor command.
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Affiliation(s)
- Tiziana M Florio
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
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49
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Anand M, Diekfuss JA, Slutsky-Ganesh AB, Bonnette S, Grooms DR, Myer GD. Graphical interface for automated management of motion artifact within fMRI acquisitions: INFOBAR. SOFTWAREX 2020; 12:100598. [PMID: 33447655 PMCID: PMC7806167 DOI: 10.1016/j.softx.2020.100598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Independent Component Analysis-based Automatic Removal of Motion Artifacts (ICA-AROMA; Pruim et al., 2015) is a robust approach to remove brain activity related to head motion within functional magnetic resonance imaging (fMRI) datasets. However, ICA-AROMA requires command line implementation and customized code to batch process large datasets. We developed a cross-platform, open-source graphical user Interface for Batch processing fMRI datasets using ICA-AROMA (INFOBAR). INFOBAR allows a user to search directories, identify appropriate datasets, and batch execute ICA-AROMA. INFOBAR also has additional data processing options and visualization features to support all researchers interested in mitigating head motion artifact in post-processing using ICA-AROMA.
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Affiliation(s)
- Manish Anand
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jed A. Diekfuss
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Emory Sport Performance and Research Center, Flowery Branch, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Scott Bonnette
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute, Ohio University, Athens, OH, USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences & Professions, Ohio University, Athens, OH, USA
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences & Professions, Ohio University, Athens, OH, USA
| | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Emory Sport Performance and Research Center, Flowery Branch, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
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50
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Virtual reality in research and rehabilitation of gait and balance in Parkinson disease. Nat Rev Neurol 2020; 16:409-425. [DOI: 10.1038/s41582-020-0370-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
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