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Kazemi D, Chadeganipour AS, Dehghani M, Ghorbali F. Associations of dual-task walking costs with cognition in Parkinson's disease. Gait Posture 2024; 110:48-52. [PMID: 38484647 DOI: 10.1016/j.gaitpost.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Gait and cognition are closely associated in Parkinson's disease (PD), with specific cognitive domains being associated with different motor symptoms. By identifying gait parameters affected by cognition, clinicians can develop targeted interventions that address cognitive impairment, improve gait, and reduce the risk of injury in PD patients. RESEARCH QUESTION What gait parameters are affected by cognition in PD patients during dual-task walking, and how are these parameters related to cognitive function as measured by the Montreal Cognitive Assessment (MoCA)? METHODS 36 patients with available gait data and cognitive assessments were enrolled. Gait data of usual and dual-task walking sessions were recorded using lightweight wireless wearable sensors attached to trunk, lower, and upper extremities. Dual-task costs were calculated from usual and dual-task measures. Statistical analysis included non-parametric tests, Wilcoxon signed-rank test, Spearman's correlation, and stepwise linear regression models. RESULTS Walking speed, cadence, asymmetry in arm swing (ASA), between arms' amplitude symmetry (BAS), average stride time, and jerk of the acceleration movement of the legs were found to be affected during the dual-task walking session (P<0.05). Spearman's correlation showed significant correlations between MoCA scores and ASA (ρ=-0.469, P=0.036) and BAS (ρ=-0.448, P=0.036) costs. Stepwise linear regression models found that MoCA scores were significant predictors of BAS and ASA costs (P<0.05). SIGNIFICANCE This study found a significant association between global cognitive ability and several gait parameters costs under cognitive load caused by dual-task walking in PD patients. The study identified the gait parameters that were affected by cognitive load and found that MoCA scores were significant predictors of those gait parameters. Identifying gait parameters affected by cognition can lead to more targeted interventions for improving gait and reducing injury risk in PD patients.
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Affiliation(s)
- Danial Kazemi
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mina Dehghani
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Ghorbali
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
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2
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Foglia SD, Adams FC, Ramdeo KR, Drapeau CC, Turco CV, Tarnopolsky M, Ma J, Nelson AJ. Investigating the effects of dopamine on short- and long-latency afferent inhibition. J Physiol 2024; 602:2253-2264. [PMID: 38638084 DOI: 10.1113/jp286126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
Short- and long-latency afferent inhibition (SAI and LAI respectively) are phenomenon whereby the motor evoked potential induced by transcranial magnetic stimulation (TMS) is inhibited by a sensory afferent volley consequent to nerve stimulation. It remains unclear whether dopamine participates in the genesis or modulation of SAI and LAI. The present study aimed to determine if SAI and LAI are modulated by levodopa (l-DOPA). In this placebo-controlled, double-anonymized study Apo-Levocarb (100 mg l-DOPA in combination with 25 mg carbidopa) and a placebo were administered to 32 adult males (mean age 24 ± 3 years) in two separate sessions. SAI and LAI were evoked by stimulating the median nerve and delivering single-pulse TMS over the motor hotspot corresponding to the first dorsal interosseous muscle of the right hand. SAI and LAI were quantified before and 1 h following ingestion of drug or placebo corresponding to the peak plasma concentration of Apo-Levocarb. The results indicate that Apo-Levocarb increases SAI and does not significantly alter LAI. These findings support literature demonstrating increased SAI following exogenous dopamine administration in neurodegenerative disorders. KEY POINTS: Short- and long-latency afferent inhibition (SAI and LAI respectively) are measures of corticospinal excitability evoked using transcranial magnetic stimulation. SAI and LAI are reduced in conditions such as Parkinson's disease which suggests dopamine may be involved in the mechanism of afferent inhibition. 125 mg of Apo-Levocarb (100 mg dopamine) increases SAI but not LAI. This study increases our understanding of the pharmacological mechanism of SAI and LAI.
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Affiliation(s)
- Stevie D Foglia
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Faith C Adams
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Karishma R Ramdeo
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Chloe C Drapeau
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Claudia V Turco
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Tarnopolsky
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Aimee J Nelson
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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Irons JY, Williams A, Holland J, Jones J. An Exploration of People Living with Parkinson's Experience of Cardio-Drumming; Parkinson's Beats: A Qualitative Phenomenological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:514. [PMID: 38673425 PMCID: PMC11050379 DOI: 10.3390/ijerph21040514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/13/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
Research has shown that physical activity has a range of benefits for people living with Parkinson's (PLwP), improving muscle strength, balance, flexibility, and walking, as well as non-motor symptoms such as mood. Parkinson's Beats is a form of cardio-drumming, specifically adapted for PLwP, and requires no previous experience nor skills. Nineteen PLwP (aged between 55 and 80) took part in the regular Parkinson's Beats sessions in-person or online. Focus group discussions took place after twelve weeks to understand the impacts of Parkinson's Beats. Through the framework analysis, six themes and fifteen subthemes were generated. Participants reported a range of benefits of cardio-drumming, including improved fitness and movement, positive mood, the flow experience, and enhanced social wellbeing. A few barriers to participation were also reported. Future research is justified, and best practice guidelines are needed to inform healthcare professionals, PLwP and their care givers.
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Affiliation(s)
- J. Yoon Irons
- School of Psychology, College of Health, Psychology and Social Care, University of Derby, Derby DE22 1GB, UK
| | - Alison Williams
- Parkinson’s Scotland Office, 1/14 King James VI Business Centre, Friarton Road, Perth PH2 8DY, UK; (A.W.); (J.H.)
| | - Jo Holland
- Parkinson’s Scotland Office, 1/14 King James VI Business Centre, Friarton Road, Perth PH2 8DY, UK; (A.W.); (J.H.)
| | - Julie Jones
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen AB10 7QG, UK;
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Van Criekinge T, Sahu U, Bhatt T. Effect of Explicit Prioritization on Dual Tasks During Standing and Walking in People With Neurologic and Neurocognitive Disorders: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)00824-4. [PMID: 38401769 DOI: 10.1016/j.apmr.2024.02.714] [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: 10/05/2023] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES To examine the effectiveness of explicit task (ie, equal, motor or cognitive) prioritization during dual tasking (DT) in adults with neurologic and neurocognitive disorders (stroke, Parkinson disease [PD], multiple sclerosis, dementia, Alzheimer disease, and mild cognitive impairment). DATA SOURCE A systematic search in 4 databases (PubMed, Web of Science, Embase, and Cochrane Central) yielded 1138 unique studies published up to 2023. STUDY SELECTION Forty-one experimental studies were selected that assessed the effect of explicit prioritization instructions on both motor and cognitive performance during dual-tasks related to standing and walking in selected populations. Primary outcome measures were walking speed and response accuracy. Availability of data allowed us to perform a meta-analysis on 27 of the 41 articles by using inverse variance with a random effects model. DATA EXTRACTION The data including design, subject characteristics, motor and cognitive tasks, prioritization, motor and cognitive outcomes, instructions, and key findings were extracted. Two assessors rated the selected studies for risk of bias and quality using the Quality Assessment Tools of the National Institutes of Health. DATA SYNTHESIS This study examined 1535 adults who were asked to perform motor-cognitive DT in standing or walking, including 381 adults with stroke, 526 with PD, 617 with multiple sclerosis, 10 with dementia, 9 with Alzheimer disease, and 8 with mild cognitive impairment. During all prioritization instructions, participants slowed down during DT (standardized mean difference (SMD)equal=0.43; SMDmotor=0.78; SMDcognitive=0.69, P<.03) while maintaining similar response accuracy (SMDequal=0.12; SMDmotor=0.23; SMDcognitive=-.01, P>.05). However, considerable between-group heterogeneity was observed resulting in different motor and cognitive responses between pathologies. CONCLUSION Motor prioritization was achieved in adults with PD and stroke, unlike adults with neurocognitive disorders who were negatively affected by any type DT prioritizing. The reported within-group heterogeneity revealed that effects of explicit task prioritization are dependent on motor and cognitive task complexity, and the type of instructions. Recommendations are provided to ensure accurate use of instructions during DT paradigms.
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Affiliation(s)
| | - Upasana Sahu
- Department of Physical Therapy, College of Applied Health and Sciences, University of Illinois at Chicago, Chicago, IL
| | - Tanvi Bhatt
- Department of Physical Therapy, College of Applied Health and Sciences, University of Illinois at Chicago, Chicago, IL.
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Giannakou E, Fotiadou S, Gourgoulis V, Mavrommatis G, Aggelousis N. A Comparative Analysis of Symmetry Indices for Spatiotemporal Gait Features in Early Parkinson's Disease. Neurol Int 2023; 15:1129-1139. [PMID: 37755361 PMCID: PMC10535875 DOI: 10.3390/neurolint15030070] [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: 07/19/2023] [Revised: 08/19/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023] Open
Abstract
This study compared the five most commonly used equations for calculating gait symmetry in discrete variables among Parkinson's disease patients. Twelve patients (five women and seven men) performed ten consecutive gait trials on a 10 m walkway. Gait data were collected using eight optoelectronic cameras (100 fr/s). The analysis focused on various spatiotemporal parameters, including cadence, step time, stride time, single support, double support, walking speed, step length, stride length, step width, and foot angle. Five symmetry indices were calculated for each trial rather than averaging the ten recorded trials. The variability in and reliability of each symmetry equation were assessed using the coefficient of variation (CV) and intraclass correlation coefficient (ICC), respectively. Additionally, Bland-Altman plots were produced to visualize the agreement between each pair of methods for each spatiotemporal parameter. The results revealed that the symmetry ratio method exhibited lower variability and higher reliability compared with the other four indices across all spatiotemporal gait parameters. However, it was found that the reliability of a single trial was generally poor, regardless of the symmetry calculation formula used. Therefore, we recommend basing measurements of gait asymmetry in Parkinson's disease on multiple trials.
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Affiliation(s)
- Erasmia Giannakou
- Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (E.G.); (S.F.); (V.G.)
| | - Styliani Fotiadou
- Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (E.G.); (S.F.); (V.G.)
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Vassilios Gourgoulis
- Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (E.G.); (S.F.); (V.G.)
| | - Georgios Mavrommatis
- Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece;
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (E.G.); (S.F.); (V.G.)
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Law NY, Li JX. Effects of a 12-week online Tai Chi intervention on gait and postural stability in individuals with Parkinson's disease. SPORTS MEDICINE AND HEALTH SCIENCE 2023; 5:239-244. [PMID: 37753420 PMCID: PMC10518795 DOI: 10.1016/j.smhs.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 06/08/2023] [Accepted: 07/08/2023] [Indexed: 09/28/2023] Open
Abstract
Parkinson's disease (PD) affects gait and postural stability. Tai Chi (TC) is recommended for PD for management of the condition, however biomechanical understanding to its effects on gait and postural stability is limited. This study aimed to examine the effects of an online 12-week biomechanical-based TC intervention on gait and posture in people with PD. Fifteen individuals in early-stage PD were recruited (Hoehn & Yahr stages 1-2). The TC intervention program was 60 min session, three times weekly for 12 weeks. The pre- and post-intervention test in obstacle crossing, timed-up-and-go (TUG) test, and single leg standing (SLS) with eyes open (EO) and closed (EC) were conducted. Gait speed, crossing stride length, clearance height of the heel and toe, anterior-posterior (AP) and medial-lateral (ML) displacement and velocity of the center of mass (COM) and separation of the COM-center of pressure (COP) were analyzed. The participants significantly improved their pre-vs. post-TC intervention performance on TUG test (p = 0.002). During obstacle crossing, the participants significantly increased crossing stride length of the trailing foot, increased AP COM displacement and decreased ML COM-COP separation (p < 0.05); the maximal dorsiflexion angle of the leading limb significantly increased and maximal plantarflexion angle of the trailing limb significantly decreased (p < 0.05). A 12-week biomechanical-based online TC training was effective towards improvement of gait and postural stability among people in the early-stage of PD. The TC program and online training could be applied for management of PD.
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Affiliation(s)
- Nok-Yeung Law
- School of Human Kinetics, University of Ottawa, Canada
| | - Jing Xian Li
- School of Human Kinetics, University of Ottawa, Canada
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7
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Longhurst JK, Rider JV, Cummings JL, John SE, Poston B, Landers MR. Cognitive-motor dual-task interference in Alzheimer's disease, Parkinson's disease, and prodromal neurodegeneration: A scoping review. Gait Posture 2023; 105:58-74. [PMID: 37487365 DOI: 10.1016/j.gaitpost.2023.07.277] [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: 11/22/2021] [Revised: 12/20/2022] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Cognitive-motor interference (CMI) is a common deficit in Alzheimer's (AD) disease and Parkinson's disease (PD) and may have utility in identification of prodromal neurodegeneration. There is lack of consensus regarding measurement of CMI resulting from dual task paradigms. RESEARCH QUESTION How are individuals with AD, PD, and prodromal neurodegeneration impacted by CMI as measured by dual-task (DT) performance? METHODS A systematic literature search was performed in six datasets using the PRISMA guidelines. Studies were included if they had samples of participants with AD, PD, or prodromal neurodegeneration and reported at least one measure of cognitive-motor DT performance. RESULTS 4741 articles were screened and 95 included as part of this scoping review. Articles were divided into three non-mutually exclusive groups based on diagnoses, with 26 articles in AD, 56 articles in PD, and 29 articles in prodromal neurodegeneration, and results presented accordingly. SIGNIFICANCE Individuals with AD and PD are both impacted by CMI, though the impact is likely different for each disease. We found a robust body of evidence regarding the utility of measures of DT performance in the detection of subtle deficits in prodromal AD and some signals of utility in prodromal PD. There are several key methodological challenges related to DT paradigms for the measurement of CMI in neurodegeneration. Overall, DT paradigms show good potential as a clinical method to probe specific brain regions, networks, and function; however, task selection and effect measurement should be carefully considered.
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Affiliation(s)
- Jason K Longhurst
- Department of Physical Therapy and Athletic Training, Saint Louis University, 3437 Caroline St. Suite, 1011 St. Louis, MO, USA.
| | - John V Rider
- School of Occupational Therapy, Touro University Nevada, Henderson, NV, USA; Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA.
| | | | - Samantha E John
- Department of Brain Health, University of Nevada, Las Vegas, NV, USA.
| | - Brach Poston
- Department of Kinesiology and Nutrition, University of Nevada, Las Vegas, NV, USA.
| | - Merrill R Landers
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA.
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Law NY, Li JX, Zhu Q, Nantel J. Effects of a biomechanical-based Tai Chi program on gait and posture in people with Parkinson's disease: study protocol for a randomized controlled trial. Trials 2023; 24:241. [PMID: 37386473 DOI: 10.1186/s13063-023-07146-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: 05/22/2021] [Accepted: 02/08/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is associated with changes in gait and posture, which increases the rate of falls and injuries in this population. Tai Chi (TC) training enhances the movement capacity of patients with PD. However, the understanding of the effect of TC training on gait and postural stability in PD is lacking. This study aims to examine the effect of biomechanical-based TC training on dynamic postural stability and its relationship with walking performance. METHODS/DESIGN A single-blind, randomized control trial of 40 individuals with early-stage PD was conducted (Hoehn and Yahr stages 1 to 3). Patients with PD will be randomly assigned to either the TC or control group. The TC group will participate in a biomechanical-based TC training program that is formed based on the movement analysis of TC and will be practiced thrice a week for 12 weeks. The control group will be required to engage in at least 60 min of regular physical activity (PA) on their own for three times per week for 12 weeks. The primary and secondary outcomes will be assessed at baseline and at 6 and 12 weeks after commencing the study protocol. The primary outcome measures will include dynamic postural stability indicated by the center of mass and center of pressure separation distance and clearance distance of the heel and toe measured during fixed-obstacle crossing. The secondary measures are gait speed, cadence, step length during level surface walking (simple task), and fixed-obstacle crossing (challenging task). The Unified Parkinson's Disease Rating Scale, single leg-stance test with eyes open and closed, and three cognitive scores (Stroop Test, Trail Making Test Part B, and the Wisconsin Card Sorting Test) were also employed. DISCUSSION This protocol could lead to the development of a biomechanics TC training program for the improvement of gait and postural stability among individuals with PD. The program could enhance the understanding of the effect of TC training on gait and postural stability and could help improve or preserve the postural stability, self-confidence, and active participation in social activities of the participants, thus enhancing their overall quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT04644367. Registered on 25 November 2020.
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Affiliation(s)
- Nok-Yeung Law
- Schools of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - Jing Xian Li
- Schools of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
| | - Qingguang Zhu
- Research Institute of Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Julie Nantel
- Schools of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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Nosaka S, Imada K, Saita K, Okamura H. Prefrontal activation during dual-task seated stepping and walking performed by subacute stroke patients with hemiplegia. Front Neurosci 2023; 17:1169744. [PMID: 37214400 PMCID: PMC10196001 DOI: 10.3389/fnins.2023.1169744] [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: 02/20/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023] Open
Abstract
Objectives This study examined prefrontal cortex (PFC) activation during dual-task seated stepping and walking performed by subacute stroke patients with hemiplegia and evaluated the relationship between PFC activation, frontal lobe functions, and dual-task interference. Methods Patients with functional ambulation category (FAC) scores ≤ 2 comprised the seated stepping task group. Those with FAC scores > 2 comprised the walking task group. There were 11 patients in the seated stepping task group (mean age, 65.3±12.2 years; age range, 55-73.5 years; 7 male and 4 female patients; time since stroke onset, 45.7±9.9 days) and 11 patients in the walking task group (mean age, 65.6±15.2 years; age range, 49.5-74.5 years; 7 male and 4 female patients; time since stroke onset, 57.5±18.3 days). Both groups completed the Frontal Assessment Battery (FAB). The seated stepping task group performed the following three tasks: cognitive task (CT), normal seated stepping (NSS), and dual-task seated stepping (DTSS). The walking task group completed the following tasks: CT, normal walking (NW), and dual-task walking (DTW). The CT was a letter fluency task; this letter fluency task was simultaneously performed during seated stepping (DTSS) and walking (DTW). Changes in the oxygenated hemoglobin (O2Hb) concentration and deoxygenated hemoglobin concentration during the tasks were measured using near-infrared spectroscopy (Pocket NIRS HM; Dynasense Inc., Japan). The number of steps, walking speed, and percentage of correct responses to the CT were recorded. Results The results showed that DTSS activated the PFC significantly more than performing a single task and that NSS was associated with a significantly higher difference in the hemoglobin concentration when compared to that associated with the CT, which was a single task. In the walking task group, PFC activation was significantly higher during DTW, NW, and CT (in that order), and O2Hb concentrations were significantly higher in the contralesional hemisphere than in the ipsilesional hemisphere during all tasks. Associations between PFC activation, FAB scores, and dual-task interference in the seated task group indicated significant positive correlations between FAB scores and cognitive performance with dual-task interference. Conclusion DTSS may be an effective means of activating the PFC of patients with difficulty walking.
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Affiliation(s)
- Shinnosuke Nosaka
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Kinkai Rehabilitation Hospital, Yonago, Japan
| | - Ken Imada
- Kinkai Rehabilitation Hospital, Yonago, Japan
| | - Kazuya Saita
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hitoshi Okamura
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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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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11
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Kirk C, Zia Ur Rehman R, Galna B, Alcock L, Ranciati S, Palmerini L, Garcia-Aymerich J, Hansen C, Schaeffer E, Berg D, Maetzler W, Rochester L, Del Din S, Yarnall AJ. Can Digital Mobility Assessment Enhance the Clinical Assessment of Disease Severity in Parkinson's Disease? JOURNAL OF PARKINSON'S DISEASE 2023; 13:999-1009. [PMID: 37545259 PMCID: PMC10578274 DOI: 10.3233/jpd-230044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Real-world walking speed (RWS) measured using wearable devices has the potential to complement the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS III) for motor assessment in Parkinson's disease (PD). OBJECTIVE Explore cross-sectional and longitudinal differences in RWS between PD and older adults (OAs), and whether RWS was related to motor disease severity cross-sectionally, and if MDS-UPDRS III was related to RWS, longitudinally. METHODS 88 PD and 111 OA participants from ICICLE-GAIT (UK) were included. RWS was evaluated using an accelerometer at four time points. RWS was aggregated within walking bout (WB) duration thresholds. Between-group-comparisons in RWS between PD and OAs were conducted cross-sectionally, and longitudinally with mixed effects models (MEMs). Cross-sectional association between RWS and MDS-UPDRS III was explored using linear regression, and longitudinal association explored with MEMs. RESULTS RWS was significantly lower in PD (1.04 m/s) in comparison to OAs (1.10 m/s) cross-sectionally. RWS significantly decreased over time for both cohorts and decline was more rapid in PD by 0.02 m/s per year. Significant negative relationship between RWS and the MDS-UPDRS III only existed at a specific WB threshold (30 to 60 s, β= - 3.94 points, p = 0.047). MDS-UPDRS III increased significantly by 1.84 points per year, which was not related to change in RWS. CONCLUSION Digital mobility assessment of gait may add unique information to quantify disease progression remotely, but further validation in research and clinical settings is needed.
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Affiliation(s)
- Cameron Kirk
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rana Zia Ur Rehman
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Janssen Research & Development, High Wycombe, UK
| | - Brook Galna
- School of Allied Health (Exercise Science) / Health Futures Institute, Murdoch University, Perth, Australia
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Healthand Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle upon Tyne, UK
| | - Saverio Ranciati
- Department of Statistical Science “Paolo Fortunati”, University of Bologna, Bologna, Italy
| | - Luca Palmerini
- Department of Electrical, Electronic and Information Engineering, “Guglielmo Marconi”, University of Bologna, Bologna, Italy
- Health Sciences and Technologies—Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain
- University Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiologica y Salud Publica (CIBERESP), Barcelona, Spain
| | - Clint Hansen
- Department of Neurology, Christian-Albrecht-University Kiel, Kiel, Germany
| | - Eva Schaeffer
- Department of Neurology, Christian-Albrecht-University Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrecht-University Kiel, Kiel, Germany
- German Centre of Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrecht-University Kiel, Kiel, Germany
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Healthand Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundations Trust, Newcastle upon Tyne, UK
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Healthand Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle upon Tyne, UK
| | - Alison J. Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Healthand Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundations Trust, Newcastle upon Tyne, UK
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12
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Geritz J, Welzel J, Hansen C, Maetzler C, Hobert MA, Elshehabi M, Knacke H, Aleknonytė-Resch M, Kudelka J, Bunzeck N, Maetzler W. Cognitive parameters can predict change of walking performance in advanced Parkinson's disease - Chances and limits of early rehabilitation. Front Aging Neurosci 2022; 14:1070093. [PMID: 36620765 PMCID: PMC9813446 DOI: 10.3389/fnagi.2022.1070093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Links between cognition and walking performance in patients with Parkinson's disease (PD), which both decline with disease progression, are well known. There is lack of knowledge regarding the predictive value of cognition for changes in walking performance after individualized therapy. The aim of this study is to identify relevant predictive cognitive and affective parameters, measurable in daily clinical routines, for change in quantitative walking performance after early geriatric rehabilitation. Methods Forty-seven acutely hospitalized patients with advanced PD were assessed at baseline (T1) and at the end (T2) of a 2-week early rehabilitative geriatric complex treatment (ERGCT). Global cognitive performance (Montreal Cognitive Assessment, MoCA), EF and divided attention (Trail Making Test B minus A, delta TMT), depressive symptoms, and fear of falling were assessed at T1. Change in walking performance was determined by the difference in quantitative walking parameters extracted from a sensor-based movement analysis over 20 m straight walking in single (ST, fast and normal pace) and dual task (DT, with secondary cognitive, respectively, motor task) conditions between T1 and T2. Bayesian regression (using Bayes Factor BF10) and multiple linear regression models were used to determine the association of non-motor characteristics for change in walking performance. Results Under ST, there was moderate evidence (BF10 = 7.8, respectively, BF10 = 4.4) that lower performance in the ∆TMT at baseline is associated with lower reduction of step time asymmetry after treatment (R 2 adj = 0.26, p ≤ 0.008, respectively, R 2 adj = 0.18, p ≤ 0.009). Under DT walking-cognitive, there was strong evidence (BF10 = 29.9, respectively, BF10 = 27.9) that lower performance in the ∆TMT is associated with more reduced stride time and double limb support (R 2 adj = 0.62, p ≤ 0.002, respectively, R 2 adj = 0.51, p ≤ 0.009). There was moderate evidence (BF10 = 5.1) that a higher MoCA total score was associated with increased gait speed after treatment (R 2 adj = 0.30, p ≤ 0.02). Discussion Our results indicate that the effect of ERGT on change in walking performance is limited for patients with deficits in EF and divided attention. However, these patients also seem to walk more cautiously after treatment in walking situations with additional cognitive demand. Therefore, future development of individualized treatment algorithms is required, which address individual needs of these vulnerable patients.
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Affiliation(s)
- Johanna Geritz
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany,Department of Psychology, University of Lübeck, Lübeck, Germany,*Correspondence: Johanna Geritz,
| | - Julius Welzel
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Markus A. Hobert
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Morad Elshehabi
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Henrike Knacke
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Jennifer Kudelka
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nico Bunzeck
- Department of Psychology, University of Lübeck, Lübeck, Germany,Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
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Zhang X, Fan W, Yu H, Li L, Chen Z, Guan Q. Single- and dual-task gait performance and their diagnostic value in early-stage Parkinson's disease. Front Neurol 2022; 13:974985. [PMID: 36313494 PMCID: PMC9615249 DOI: 10.3389/fneur.2022.974985] [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: 06/21/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Gait parameters are considered potential diagnostic markers of Parkinson's disease (PD). We aimed to 1) assess the gait impairment in early-stage PD and its related factors in the single-task (ST) and dual-task (DT) walking tests and 2) evaluate and compare the diagnostic value of gait parameters for early-stage PD under ST and DT conditions. Methods A total of 97 early-stage PD patients and 41 healthy controls (HC) were enrolled at Hwa Mei hospital. Gait parameters were gathered and compared between the two groups in the ST and DT walking test, controlling for covariates. Utilizing the receiver operating characteristic curve, diagnostic parameters were investigated. Results In the ST walking test, significantly altered gait patterns could be observed in early-stage PD patients in all domains of gait, except for asymmetry (P < 0.05). Compared to the ST walking test, the early-stage PD group performed poorly in the DT walking test in the pace, rhythm, variability and postural control domain (P < 0.05). Older, heavier subjects, as well as those with lower height, lower level of education and lower gait velocity, were found to have a poorer gait performance (P < 0.05). Stride length (AUC = 0.823, sensitivity, 68.0%; specificity, 85.4%; P < 0.001) and heel strike angle (AUC = 0.796, sensitivity, 71.1%; specificity, 80.5%; P < 0.001) could distinguish early-stage PD patients from HCs with moderate accuracy, independent of covariates. The diagnostic accuracy of gait parameters under ST conditions were statistically noninferior to those under DT conditions(P>0.05). Combining all gait parameters with diagnostic values under ST and DT walking test, the predictive power significantly increased with an AUC of 0.924 (sensitivity, 85.4%; specificity, 92.7%; P < 0.001). Conclusion Gait patterns altered in patients with early-stage PD but the gait symmetry remained preserved. Stride length and heel strike angle were the two most prominent gait parameters of altered gait in early-stage of PD that could serve as diagnostic markers of early-stage PD. Our findings are helpful to understand the gait pattern of early-stage PD and its related factors and can be conducive to the development of new diagnostic tools for early-stage PD.
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Affiliation(s)
| | | | | | | | - Zhaoying Chen
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Qiongfeng Guan
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
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Uribe P, Fuentes N, Álvarez-Ruf J, Cornejo I, Mariman JJ. Differentiation of the motor cost associated with cognitive tasks in Parkinson's disease: a dual-task study. Eur J Neurosci 2022; 56:5106-5115. [PMID: 35962541 DOI: 10.1111/ejn.15792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/25/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
Parkinson's disease is a neurodegenerative condition associated with motor and cognitive impairments. While the execution of dual cognitive-motor tasks imposes a cost on gait velocity, it has been barely determined if the gait deterioration depends on the specific cognitive domain involved in the dual-task. Twenty-four subjects (twelve patients with Parkinson's disease and twelve healthy subjects) carried out a single task (gait alone) and several dual tasks where the concurrent second task was the Trail Making Test (Part A) and the six tasks of the Frontal Assessment Battery. Gait variables were measured by accelerometry via smartphone. Data analysis included analysis of variance and exploratory factorial analysis. Both groups showed a similar gait performance, except for velocity, where patients exhibited a bradykinetic profile. The dual-task during the Trail Making Test showed the highest motor cost. Frontal Assessment Battery's tasks as conceptualization, mental flexibility, and motor programming showed a higher motor cost than the other tasks (sensibility to interference, inhibitory control, and environmental autonomy). The factorial analysis applied to the motor costs confirmed two profiles, grouping those related to the dorsolateral prefrontal cortex (mental flexibility and motor programming tasks) in an independent factor. Among cognitive functions, attention is critical for gait control in Parkinson's disease and healthy elderly people. The interference posed by several executive operations suggests a specific competition in prefrontal regions that support dual tasks. Moreover, the higher cost for Parkinson's disease patients emphasizes the cognitive decline and compensatory cognitive strategy for gait control related to attention and executive functions.
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Affiliation(s)
- Paula Uribe
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
| | - Natalia Fuentes
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
| | - Joel Álvarez-Ruf
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile.,Laboratorio de Biomecánica Clínica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Carrera de Kinesiología, Santiago, Chile
| | - Isabel Cornejo
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile.,Liga Chilena contra el Mal de Parkinson, Santiago, Chile
| | - Juan J Mariman
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile.,Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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15
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Geritz J, Welzel J, Hansen C, Maetzler C, Hobert MA, Elshehabi M, Sobczak A, Kudelka J, Stiel C, Hieke J, Alpes A, Bunzeck N, Maetzler W. Does Executive Function Influence Walking in Acutely Hospitalized Patients With Advanced Parkinson's Disease: A Quantitative Analysis. Front Neurol 2022; 13:852725. [PMID: 35928127 PMCID: PMC9344922 DOI: 10.3389/fneur.2022.852725] [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: 01/11/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionIt is well-known that, in Parkinson's disease (PD), executive function (EF) and motor deficits lead to reduced walking performance. As previous studies investigated mainly patients during the compensated phases of the disease, the aim of this study was to investigate the above associations in acutely hospitalized patients with PD.MethodsA total of seventy-four acutely hospitalized patients with PD were assessed with the delta Trail Making Test (ΔTMT, TMT-B minus TMT-A) and the Movement Disorder Society-revised version of the motor part of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS III). Walking performance was assessed with wearable sensors under single (ST; fast and normal pace) and dual-task (DT; walking and checking boxes as the motor secondary task and walking and subtracting seven consecutively from a given three-digit number as the cognitive secondary task) conditions over 20 m. Multiple linear regression and Bayes factor BF10 were performed for each walking parameter and their dual-task costs while walking (DTC) as dependent variables and also included ΔTMT, MDS-UPDRS III, age, and gender.ResultsUnder ST, significant negative effects of the use of a walking aid and MDS-UPDRS III on gait speed and at a fast pace on the number of steps were observed. Moreover, depending on the pace, the use of a walking aid, age, and gender affected step time variability. Under walking-cognitive DT, a resolved variance of 23% was observed in the overall model for step time variability DTC, driven mainly by age (β = 0.26, p = 0.09). Under DT, no other significant effects could be observed. ΔTMT showed no significant associations with any of the walking conditions.DiscussionThe results of this study suggest that, in acutely hospitalized patients with PD, reduced walking performance is mainly explained by the use of a walking aid, motor symptoms, age, and gender, and EF deficits surprisingly do not seem to play a significant role. However, these patients with PD should avoid walking-cognitive DT situations, as under this condition, especially step time variability, a parameter associated with the risk of falling in PD worsens.
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Affiliation(s)
- Johanna Geritz
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Psychology and Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- *Correspondence: Johanna Geritz
| | - Julius Welzel
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Markus A. Hobert
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Morad Elshehabi
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Alexandra Sobczak
- Department of Psychology and Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Jennifer Kudelka
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christopher Stiel
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Johanne Hieke
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Annekathrin Alpes
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nico Bunzeck
- Department of Psychology and Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
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Li Z, Wang T, Shen M, Song T, He J, Guo W, Wang Z, Zhuang J. Comparison of Wuqinxi Qigong with Stretching on Single- and Dual-Task Gait, Motor Symptoms and Quality of Life in Parkinson’s Disease: A Preliminary Randomized Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138042. [PMID: 35805699 PMCID: PMC9265753 DOI: 10.3390/ijerph19138042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/03/2022] [Accepted: 06/21/2022] [Indexed: 11/22/2022]
Abstract
The objective of this study was to investigate the therapeutic effect of Wuqinxi Qigong vs. stretching on single- and dual-task gait, motor symptoms, and quality of life in people with mild and moderate Parkinson’s disease (PD). This single-blind, randomized control trial included 40 participants with idiopathic PD who were randomized into the Wuqinxi Qigong (WQ) group or stretching group. Participants completed 12 weeks (two sessions/week) of intervention. The primary outcomes were gait parameters when performing single-task (comfortable pace) and dual-task (obstacle crossing, serial-3 subtraction and backward digit span) walking, including gait speed, stride length, and double support percentage. The secondary outcomes were ratings from the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), results of the timed-up-and-go test (TUGT), results of the Mini-Balance Evaluation Systems Test (MiniBESTest), and responses from the 39-item Parkinson’s Disease Questionnaire (PDQ-39). All measures were assessed pre- and post-intervention. The WQ group demonstrated increased gait speed (p = 0.000) during the single task, and increased stride length (p = 0.001, p = 0.021) during the single-task and serial-3 subtraction task. Double support percentage significantly decreased (p = 0.004) in the WQ group during the obstacle crossing task, and also decreased (p = 0.045) in the stretching group during the single-task. TUGT (p = 0.005), MiniBESTest (p = 0.023) and PDQ-39 (p = 0.043) in the WQ group significantly improved, and both groups showed significant improvement in MDS-UPDRS after intervention. Wuqinxi Qigong is an effective method to improve single- and dual-task gait. While both exercises improve motor symptoms, Wuqinxi Qigong results in better mobility, balance and quality of life compared to stretching alone.
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Affiliation(s)
- Zhenlan Li
- School of Sport Science, Shanghai University of Sport, Shanghai 200438, China; (Z.L.); (T.W.); (T.S.); (J.H.)
- Department of Rehabilitation Sciences, Ningbo College of Health Sciences, Ningbo 315100, China
| | - Tian Wang
- School of Sport Science, Shanghai University of Sport, Shanghai 200438, China; (Z.L.); (T.W.); (T.S.); (J.H.)
| | - Mengyue Shen
- School of Martial Arts, Shanghai University of Sport, Shanghai 200438, China; (M.S.); (W.G.); (Z.W.)
| | - Tao Song
- School of Sport Science, Shanghai University of Sport, Shanghai 200438, China; (Z.L.); (T.W.); (T.S.); (J.H.)
- School of Physical Education, Jianghan University, Wuhan 430056, China
| | - Jie He
- School of Sport Science, Shanghai University of Sport, Shanghai 200438, China; (Z.L.); (T.W.); (T.S.); (J.H.)
| | - Wei Guo
- School of Martial Arts, Shanghai University of Sport, Shanghai 200438, China; (M.S.); (W.G.); (Z.W.)
| | - Zhen Wang
- School of Martial Arts, Shanghai University of Sport, Shanghai 200438, China; (M.S.); (W.G.); (Z.W.)
| | - Jie Zhuang
- School of Sport Science, Shanghai University of Sport, Shanghai 200438, China; (Z.L.); (T.W.); (T.S.); (J.H.)
- Correspondence:
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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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18
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Treadmill training and physiotherapy similarly improve dual task gait performance: a randomized-controlled trial in Parkinson's disease. J Neural Transm (Vienna) 2022; 129:1189-1200. [PMID: 35697942 PMCID: PMC9463305 DOI: 10.1007/s00702-022-02514-4] [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: 03/08/2022] [Accepted: 05/09/2022] [Indexed: 12/02/2022]
Abstract
Motor-cognitive dual tasks are used to investigate the interplay between gait and cognition. Dual task walking in patients with Parkinson’s disease (PD) results in decreased gait speed and more importantly in an increased fall risk. There is evidence that physical training may improve gait during dual task challenge. Physiotherapy and treadmill walking are known to improve single task gait. The aim of this study was to investigate the impact of individualized physiotherapy or treadmill training on gait during dual task performance. 105 PD patients were randomly assigned to an intervention group (physiotherapy or treadmill). Both groups received 10 individual interventional sessions of 25 min each and additional group therapy sessions for 14 days. Primary outcome measure was the dual task gait speed. Secondary outcomes were additional gait parameters during dual task walking, UPDRS-III, BBS and walking capacity. All gait parameters were recorded using sensor-based gait analysis. Gait speed improved significantly by 4.2% (treadmill) and 8.3% (physiotherapy). Almost all secondary gait parameters, UPDRS-III, BBS, and walking capacity improved significantly and similarly in both groups. However, interaction effects were not observed. Both interventions significantly improved gait in patients with mild to moderate PD. However, treadmill walking did not show significant benefits compared to individualized physiotherapy. Our data suggest that both interventions improve dual task walking and therefore support safe and independent walking. This result may lead to more tailored therapeutic preferences.
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Hill A, Nantel J. Sensitivity of discrete symmetry metrics: Implications for metric choice. PLoS One 2022; 17:e0268581. [PMID: 35588125 PMCID: PMC9119531 DOI: 10.1371/journal.pone.0268581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/02/2022] [Indexed: 11/18/2022] Open
Abstract
Gait asymmetry is present in several pathological populations, including those with Parkinson’s disease, Huntington’s disease, and stroke survivors. Previous studies suggest that commonly used discrete symmetry metrics, which compare single bilateral variables, may not be equally sensitive to underlying effects of asymmetry, and the use of a metric with low sensitivity could result in unnecessarily low statistical power. The purpose of this study was to provide a comprehensive assessment of the sensitivity of commonly used discrete symmetry metrics to better inform design of future studies. Monte Carlo simulations were used to estimate the statistical power of each symmetry metric at a range of asymmetry magnitudes, group/condition variabilities, and sample sizes. Power was estimated by repeated comparison of simulated symmetric and asymmetric data with a paired t-test, where the proportion of significant results is equivalent to the power. Simulation results confirmed that not all common discrete symmetry metrics are equally sensitive to reference effects of asymmetry. Multiple symmetry metrics exhibit equivalent sensitivities, but the most sensitive discrete symmetry metric in all cases is a bilateral difference (e.g. left—right). A ratio (e.g. left/right) has poor sensitivity when group/condition variability is not small, but a log-transformation produces increased sensitivity. Additionally, two metrics which included an absolute value in their definitions showed increased sensitivity when the absolute value was removed. Future studies should consider metric sensitivity when designing analyses to reduce the possibility of underpowered research.
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Affiliation(s)
- Allen Hill
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Nantel
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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20
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Ogata T, Hashiguchi H, Hori K, Hirobe Y, Ono Y, Sawada H, Inaba A, Orimo S, Miyake Y. Foot Trajectory Features in Gait of Parkinson’s Disease Patients. Front Physiol 2022; 13:726677. [PMID: 35600314 PMCID: PMC9114796 DOI: 10.3389/fphys.2022.726677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
Parkinson’s disease (PD) is a progressive neurological disorder characterized by movement disorders, such as gait instability. This study investigated whether certain spatial features of foot trajectory are characteristic of patients with PD. The foot trajectory of patients with mild and advanced PD in on-state and healthy older and young individuals was estimated from acceleration and angular velocity measured by inertial measurement units placed on the subject’s shanks, just above the ankles. We selected six spatial variables in the foot trajectory: forward and vertical displacements from heel strike to toe-off, maximum clearance, and change in supporting leg (F1 to F3 and V1 to V3, respectively). Healthy young individuals had the greatest F2 and F3 values, followed by healthy older individuals, and then mild PD patients. Conversely, the vertical displacements of mild PD patients were larger than the healthy older individuals. Still, those of healthy older individuals were smaller than the healthy young individuals except for V3. All six displacements of the advanced PD patients were smaller than the mild PD patients. To investigate features in foot trajectories in detail, a principal components analysis and soft-margin kernel support vector machine was used in machine learning. The accuracy in distinguishing between mild PD patients and healthy older individuals and between mild and advanced PD patients was 96.3 and 84.2%, respectively. The vertical and forward displacements in the foot trajectory was the main contributor. These results reveal that large vertical displacements and small forward ones characterize mild and advanced PD patients, respectively.
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Affiliation(s)
- Taiki Ogata
- Department of Computer Science, Tokyo Institute of Technology, Yokohama, Japan
- *Correspondence: Taiki Ogata,
| | - Hironori Hashiguchi
- Department of Computational Intelligence and System Science, Tokyo Institute of Technology, Yokohama, Japan
| | - Koyu Hori
- Department of Computational Intelligence and System Science, Tokyo Institute of Technology, Yokohama, Japan
| | - Yuki Hirobe
- Department of Computer Science, Tokyo Institute of Technology, Yokohama, Japan
| | - Yumi Ono
- Department of Computer Science, Tokyo Institute of Technology, Yokohama, Japan
| | - Hiroyuki Sawada
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Akira Inaba
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Satoshi Orimo
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Yoshihiro Miyake
- Department of Computer Science, Tokyo Institute of Technology, Yokohama, Japan
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Brahms M, Heinzel S, Rapp M, Mückstein M, Hortobágyi T, Stelzel C, Granacher U. The acute effects of mental fatigue on balance performance in healthy young and older adults - A systematic review and meta-analysis. Acta Psychol (Amst) 2022; 225:103540. [PMID: 35245722 DOI: 10.1016/j.actpsy.2022.103540] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/29/2022] [Accepted: 02/17/2022] [Indexed: 12/26/2022] Open
Abstract
Cognitive resources contribute to balance control. There is evidence that mental fatigue reduces cognitive resources and impairs balance performance, particularly in older adults and when balance tasks are complex, for example when trying to walk or stand while concurrently performing a secondary cognitive task. We conducted a systematic literature search in PubMed (MEDLINE), Web of Science and Google Scholar to identify eligible studies and performed a random effects meta-analysis to quantify the effects of experimentally induced mental fatigue on balance performance in healthy adults. Subgroup analyses were computed for age (healthy young vs. healthy older adults) and balance task complexity (balance tasks with high complexity vs. balance tasks with low complexity) to examine the moderating effects of these factors on fatigue-mediated balance performance. We identified 7 eligible studies with 9 study groups and 206 participants. Analysis revealed that performing a prolonged cognitive task had a small but significant effect (SMDwm = -0.38) on subsequent balance performance in healthy young and older adults. However, age- and task-related differences in balance responses to fatigue could not be confirmed statistically. Overall, aggregation of the available literature indicates that mental fatigue generally reduces balance in healthy adults. However, interactions between cognitive resource reduction, aging and balance task complexity remain elusive.
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Affiliation(s)
- Markus Brahms
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany.
| | - Stephan Heinzel
- Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Michael Rapp
- University of Potsdam, Research Focus Cognitive Sciences, Division of Social and Preventive Medicine, Am Neuen Palais 10, 14469 Potsdam, Germany
| | - Marie Mückstein
- International Psychoanalytic University, Stromstraße 1, 10555 Berlin, Germany
| | - Tibor Hortobágyi
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Sport Biology, Institute of Sport Sciences and Physical Education, University of Pécs, Pécs, Hungary; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Christine Stelzel
- International Psychoanalytic University, Stromstraße 1, 10555 Berlin, Germany
| | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
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22
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Sánchez-Rodríguez A, Tirnauca C, Salas-Gómez D, Fernández-Gorgojo M, Martínez-Rodríguez I, Sierra M, González-Aramburu I, Stan D, Gutierrez-González A, Meissner JM, Andrés-Pacheco J, Rivera-Sánchez M, Sánchez-Peláez MV, Sánchez-Juan P, Infante J. Sensor-based gait analysis in the premotor stage of LRRK2 G2019S-associated Parkinson's disease. Parkinsonism Relat Disord 2022; 98:21-26. [PMID: 35421781 DOI: 10.1016/j.parkreldis.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION There is a need for biomarkers to monitor the earliest phases of Parkinson's disease (PD), especially in premotor stages. Here, we studied whether there are early gait alterations in carriers of the G2019S mutation of LRRK2 that can be detected by means of an inertial sensor system. METHODS Twenty-one idiopathic PD patients, 20 LRRK2-G2019S PD, 27 asymptomatic carriers of LRRK2-G2019S mutation (AsG2019S) and 36 controls walked equipped with 16 lightweight inertial sensors in three different experiments: i/normal gait, ii/fast gait and iii/dual-task gait. In the AsG2019S group, DaT-SPECT (123I-ioflupane) with semi-quantitative analysis was carried out. Motor and cognitive performance were evaluated using MDS-UPDRS-III and MoCA scales. We employed neural network techniques to classify individuals based on their walking patterns. RESULTS PD patients and controls showed differences in speed, stride length and arm swing amplitude, variability and asymmetry in all three tasks (p < 0.01). In the AsG2019S group, the only differences were detected during fast walking, with greater step time on the non-dominant side (p < 0.05), lower step/stride time variability (p < 0.01) and lower step time asymmetry (p < 0.01). DaT uptake showed a significant correlation with step time during fast walking on the non-dominant side (r = -0.52; p < 0.01). The neural network was able to differentiate between AsG2019S and healthy controls with an accuracy rate of 82.5%. CONCLUSION Our sensor-based analysis did not detect substantial and robust changes in the gait of LRRK2-G2019S asymptomatic mutation carriers. Nonetheless, step or stride time during fast walking, supported by the observed correlation with striatal DaT binding deserves consideration as a potential biomarker in future studies.
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Affiliation(s)
- Antonio Sánchez-Rodríguez
- Neurology Service, Hospital Universitario de Cabueñes, Gijón, Spain; Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Cristina Tirnauca
- Departamento de Matemáticas, Estadística y Computación. Universidad de Cantabria, Santander, Spain
| | - Diana Salas-Gómez
- Gimbernat-Cantabria Research Unit (SUIGC), University Schools Gimbernat-Cantabria, Attached to the University of Cantabria, Torrelavega, Spain
| | - Mario Fernández-Gorgojo
- Gimbernat-Cantabria Research Unit (SUIGC), University Schools Gimbernat-Cantabria, Attached to the University of Cantabria, Torrelavega, Spain
| | - Isabel Martínez-Rodríguez
- Nuclear Medicine Department, Molecular Imaging Group (IDIVAL). University Hospital Marqués de Valdecilla, Santander, Spain
| | - María Sierra
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain; Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Isabel González-Aramburu
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain; Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Diana Stan
- Departamento de Matemáticas, Estadística y Computación. Universidad de Cantabria, Santander, Spain
| | - Angela Gutierrez-González
- Nuclear Medicine Department, Molecular Imaging Group (IDIVAL). University Hospital Marqués de Valdecilla, Santander, Spain
| | - Johannes M Meissner
- Departamento de Matemáticas, Estadística y Computación. Universidad de Cantabria, Santander, Spain
| | - Javier Andrés-Pacheco
- Nuclear Medicine Department, Molecular Imaging Group (IDIVAL). University Hospital Marqués de Valdecilla, Santander, Spain
| | - María Rivera-Sánchez
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | - Pascual Sánchez-Juan
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain; Alzheimer's Centre Reina Sofia-CIEN Foundation, 28031, Madrid, Spain
| | - Jon Infante
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Spain; Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Departamento de Medicina y Psiquiatría. Universidad de Cantabria, Santander, Spain.
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23
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Petrucci MN, Amundsen-Huffmaster S, Chung JW, Hsiao-Wecksler ET, MacKinnon CD. Can People with Parkinson's Disease Self-Trigger Gait Initiation? A Comparison of Cueing Strategies. JOURNAL OF PARKINSON'S DISEASE 2022; 12:607-619. [PMID: 34806616 DOI: 10.3233/jpd-212732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND An external cue can markedly improve gait initiation in people with Parkinson's disease (PD) and is often used to overcome freezing of gait (FOG). It is unknown if the effects of external cueing are comparable if the imperative stimulus is triggered by the person receiving the cue (self-triggered) or an external source. OBJECTIVE Two experiments were conducted to compare the effects of self- versus externally triggered cueing on anticipatory postural adjustments (APAs) during gait initiation in people with PD. METHODS In experiment 1, 10 individuals with PD and FOG initiated gait without a cue or in response to a stimulus triggered by the experimenter or by the participant. Experiment 2 compared self- versus externally triggered cueing across three groups: healthy young adults (n = 16), healthy older adults (n = 11), and a group with PD (n = 10). RESULTS Experiment 1: Externally triggered cues significantly increased APA magnitudes compared to uncued stepping, but not when the same cue was self-triggered. Experiment 2: APAs were not significantly improved with a self-triggered cue compared to un-cued stepping in both the PD and healthy older adult groups, but the young adults showed a significant facilitation of APA magnitude. CONCLUSION The effectiveness of an external cue on gait initiation in people with PD and older adults is critically dependent upon whether the source of the trigger is endogenous (self-produced) or exogenous (externally-generated). These results may explain why cueing interventions that rely upon self-triggering of the stimulus are often ineffective in people with PD.
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Affiliation(s)
- Matthew N Petrucci
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | | | - Jae Woo Chung
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Elizabeth T Hsiao-Wecksler
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Colum D MacKinnon
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
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24
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Use of Wearable Sensors to Assess the Effects of Performing a Cognitive Task on Sensory Integration of Balance in Healthy Individuals. SENSORS 2022; 22:s22072776. [PMID: 35408390 PMCID: PMC9003408 DOI: 10.3390/s22072776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/01/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023]
Abstract
This study investigated the effects of performing a cognitive task on the sensory integration of balance in healthy individuals. Ten subjects (five F/five M; 21.5 ± 2.17 years; 69.9 ± 3.4 inches; 155.6 ± 26.1 lbs; Caucasian), without known balance issues, performed the modified Clinical Test of Sensory Interaction of Balance (mCTSIB) with and without a cognitive task. The cognitive task involved counting down in threes from a randomly assigned number between 95 and 100. Postural sway area and postural sway jerk were assessed through the use of inertial sensors placed around the subjects’ lower lumbar region. Each subject performed four trials for the four conditions of the mCTSIB: eyes open firm (EOFirm), eyes closed firm (ECFirm), eyes open foam (EOFoam), and eyes closed foam (ECFoam). We tested the effect of performing a cognitive task on the sensory integration of balance. We hypothesized that sensory cognitive interaction would be more apparent for more complex conditions and would be better assessed with postural sway jerk compared to postural sway area measure. With the addition of a cognitive task for the mCTSIB: (1) postural sway area increased in the baseline condition, i.e., EOFirm (p < 0.05), but did not increase in the most difficult condition, i.e., ECFoam; (2) postural sway jerk increased in all conditions of the mCTSIB (p < 0.05); (3) cognitive performance did not deteriorate across conditions of the mCTSIB. Postural sway jerk was shown to be a more sensitive measure in detecting the effect of a cognitive task on sensory integration for postural control. Overall, inertial sensors can be used to reliably assess postural sway differences related to sensory−cognitive integration.
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25
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Mylius V, Maes L, Negele K, Schmid C, Sylvester R, Brook CS, Brugger F, Perez-Lloret S, Bansi J, Aminian K, Paraschiv-Ionescu A, Gonzenbach R, Brugger P. Dual-Task Treadmill Training for the Prevention of Falls in Parkinson's Disease: Rationale and Study Design. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:774658. [PMID: 36188827 PMCID: PMC9397829 DOI: 10.3389/fresc.2021.774658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022]
Abstract
Various factors, such as fear of falling, postural instability, and altered executive function, contribute to the high risk of falling in Parkinson's disease (PD). Dual-task training is an established method to reduce this risk. Motor-perceptual task combinations typically require a patient to walk while simultaneously engaging in a perceptual task. Motor-executive dual-tasking (DT) combines locomotion with executive function tasks. One augmented reality treadmill training (AR-TT) study revealed promising results of a perceptual dual-task training with a markedly reduced frequency of falls especially in patients with PD. We here propose to compare the effects of two types of concurrent tasks, perceptual and executive, on high-intensity TT). Patients will be trained with TT alone, in combination with an augmented reality perceptual DT (AR-TT) or with an executive DT (Random Number Generation; RNG-TT). The results are expected to inform research on therapeutic strategies for the training of balance in PD.
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Affiliation(s)
- Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- *Correspondence: Veit Mylius
| | - Laura Maes
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Katrin Negele
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Christine Schmid
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Ramona Sylvester
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | | | - Florian Brugger
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Santiago Perez-Lloret
- Biomedical Research Center (CAECIHS-UAI), National Research Council (CONICET), Buenos Aires, Argentina
- Facultad de Medicina, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
- Departamento de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Jens Bansi
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
- Department of Health, Physiotherapy, OST–Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, EPFL, Lausanne, Switzerland
| | | | - Roman Gonzenbach
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
| | - Peter Brugger
- Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland
- Department of Psychiatry, University of Zurich, Zurich, Switzerland
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26
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Nosaka S, Imada K, Okamura H. Effects of Cognitive Dysfunction and Dual Task on Gait Speed and Prefrontal Cortex Activation in Community-Dwelling Older Adults. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2022; 29:284-296. [PMID: 33355045 DOI: 10.1080/13825585.2020.1866156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
We aimed to determine how prefrontal cortex activation and gait speed during walking is affected by cognitive dysfunction and dual-tasking. Eleven and 14 participants were included in the MOCA-J (Japanese version of the Montreal Cognitive Assessment score) < 26 (age, 76.0 ± 5.7 years; sex, six men and five women) and the MOCA-J ≥ 26 groups (age 73.9 ± 4.3 years; sex, seven men and seven women), respectively. We measured prefrontal cortex oxygenated hemoglobin (oxy-Hb) levels (using Pocket NIRS HM), and gait speed during normal and dual-task walking (a letter fluency task was added). The oxy-Hb levels were significantly lower in the MOCA-J < 26 group than in the MOCA-J ≥ 26 group during dual-task walking. The gait speed was significantly lower during dual-task walking, compared with normal walking, in the MOCA-J < 26group.These results may have been influenced by the compensatory mechanisms in the frontal lobe.
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Affiliation(s)
- Shinnosuke Nosaka
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Kinkai Rehabilitation Hospital, Yonago, Japan
| | - Ken Imada
- Kinkai Rehabilitation Hospital, Yonago, Japan
| | - Hitoshi Okamura
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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27
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Salchow-Hömmen C, Skrobot M, Jochner MCE, Schauer T, Kühn AA, Wenger N. Review-Emerging Portable Technologies for Gait Analysis in Neurological Disorders. Front Hum Neurosci 2022; 16:768575. [PMID: 35185496 PMCID: PMC8850274 DOI: 10.3389/fnhum.2022.768575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/07/2022] [Indexed: 01/29/2023] Open
Abstract
The understanding of locomotion in neurological disorders requires technologies for quantitative gait analysis. Numerous modalities are available today to objectively capture spatiotemporal gait and postural control features. Nevertheless, many obstacles prevent the application of these technologies to their full potential in neurological research and especially clinical practice. These include the required expert knowledge, time for data collection, and missing standards for data analysis and reporting. Here, we provide a technological review of wearable and vision-based portable motion analysis tools that emerged in the last decade with recent applications in neurological disorders such as Parkinson's disease and Multiple Sclerosis. The goal is to enable the reader to understand the available technologies with their individual strengths and limitations in order to make an informed decision for own investigations and clinical applications. We foresee that ongoing developments toward user-friendly automated devices will allow for closed-loop applications, long-term monitoring, and telemedical consulting in real-life environments.
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Affiliation(s)
- Christina Salchow-Hömmen
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matej Skrobot
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Magdalena C E Jochner
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Schauer
- Control Systems Group, Technische Universität Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Charité-Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases, DZNE, Berlin, Germany
| | - Nikolaus Wenger
- Department of Neurology With Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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28
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Factors Influencing Habitual Physical Activity in Parkinson’s Disease: Considering the Psychosocial State and Wellbeing of People with Parkinson’s and Their Carers. SENSORS 2022; 22:s22030871. [PMID: 35161617 PMCID: PMC8837970 DOI: 10.3390/s22030871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 01/27/2023]
Abstract
Participating in habitual physical activity (HPA) may slow onset of dependency and disability for people with Parkinson’s disease (PwP). While cognitive and physical determinants of HPA are well understood, psychosocial influences are not. This pilot study aimed to identify psychosocial factors associated with HPA to guide future intervention development. Sixty-four PwP participated in this study; forty had carer informants. PwP participants wore a tri-axial accelerometer on the lower back continuously for seven days at two timepoints (18 months apart), measuring volume, pattern and variability of HPA. Linear mixed effects analysis identified relationships between demographic, clinical and psychosocial data and HPA from baseline to 18 months. Key results in PwP with carers indicated that carer anxiety and depression were associated with increased HPA volume (p < 0.01), while poorer carer self-care was associated with reduced volume of HPA over 18 months (p < 0.01). Greater carer strain was associated with taking longer walking bouts after 18 months (p < 0.01). Greater carer depression was associated with lower variability of HPA cross-sectionally (p = 0.009). This pilot study provides preliminary novel evidence that psychosocial outcomes from PwP’s carers may impact HPA in Parkinson’s disease. Interventions to improve HPA could target both PwP and carers and consider approaches that also support psychosocial wellbeing.
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29
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Oh C. Single-Task or Dual-Task? Gait Assessment as a Potential Diagnostic Tool for Alzheimer's Dementia. J Alzheimers Dis 2021; 84:1183-1192. [PMID: 34633320 PMCID: PMC8673517 DOI: 10.3233/jad-210690] [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] [Indexed: 12/30/2022]
Abstract
Background: A person’s gait performance requires the integration of sensorimotor and cognitive systems. Therefore, a person’s gait may be influenced by concurrent cognitive load such as simultaneous talking. Although it has been known that gait performance of people with Alzheimer’s dementia (AD) is compromised when they attempt a dual-task walking task, it is unclear if using a dual-task gait performance during an AD assessment yields higher diagnostic accuracy. Objective: This study was designed to compare the predictive power for AD of dual-task gait performance in an AD assessment to that of single-task gait performance. Methods: Participants (14 with AD and 15 healthy controls) walked across the GAITRite© Portable Walkway mat under three different cognitive load conditions: no simultaneous cognitive load, walking while counting numbers by ones, and walking while completing category naming. Results: Multiple logistic regression revealed that the gait performance under a dual-task condition (i.e., concurrent counting or category naming) increased the proportion of variance explained by the FAP, SL, and DST, of the incidence of AD. Conclusion: Dual-task walking and talking may be a more effective diagnostic feature than single-task walking in a comprehensive AD diagnostic assessment.
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Affiliation(s)
- Chorong Oh
- School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH, USA
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30
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Tosserams A, Wit L, Sturkenboom IHWM, Nijkrake MJ, Bloem BR, Nonnekes J. Perception and Use of Compensation Strategies for Gait Impairment by Persons With Parkinson Disease. Neurology 2021; 97:e1404-e1412. [PMID: 34497067 PMCID: PMC8520387 DOI: 10.1212/wnl.0000000000012633] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Gait impairments are common and disabling in Parkinson disease (PD). Applying compensation strategies helps to overcome these gait deficits. Clinical observations suggest that the efficacy of different compensation strategies varies depending on both individual patient characteristics and the context in which the strategies are applied. This has never been investigated systematically, hampering the ability of clinicians to provide a more personalized approach to gait rehabilitation. We had 3 aims: (1) to evaluate patients' awareness and actual use of compensation categories for gait impairments in PD, (2) to investigate the patient-rated efficacy of the various compensation strategies and whether this efficacy depends on the context in which the strategies are applied, and (3) to explore differences in the efficacy between subgroups based on sex, age, disease duration, freezing status, and ability to perform a dual task. METHODS A survey was conducted among 4,324 adults with PD and self-reported disabling gait impairments. RESULTS The main findings are as follows: (1) compensation strategies for gait impairments are commonly used by persons with PD, but their awareness of the full spectrum of available strategies is limited; (2) the patient-rated efficacy of compensation strategies is high but varies depending on the context in which they are applied; and (3) compensation strategies are useful for all types of patients with PD, but the efficacy of the different strategies varies per person. DISCUSSION The choice of compensation strategies for gait impairment in PD should be tailored to the individual patient and to the context in which the strategy needs to be applied. CLASSIFICATION OF EVIDENCE This data provides Class IV evidence that compensation strategies are an effective treatment for gait impairment in patients with PD.
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Affiliation(s)
- Anouk Tosserams
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands.
| | - Lisanne Wit
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Ingrid H W M Sturkenboom
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Maarten J Nijkrake
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Jorik Nonnekes
- From the Department of Neurology (A.T., B.R.B.) and Department of Rehabilitation (A.T., L.W., I.H.W.M.S., M.J.N., J.N.), Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre; and Department of Rehabilitation (J.N.), Sint Maartenskliniek, Nijmegen, the Netherlands
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31
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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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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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Freidle M, Johansson H, Lebedev AV, Ekman U, Lövdén M, Franzén E. Measuring implicit sequence learning and dual task ability in mild to moderate Parkinson´s disease: A feasibility study. PLoS One 2021; 16:e0251849. [PMID: 34019565 PMCID: PMC8139474 DOI: 10.1371/journal.pone.0251849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 05/05/2021] [Indexed: 11/18/2022] Open
Abstract
We investigated the feasibility aspects of two choice reaction time tasks designed to assess implicit sequence learning and dual task ability in individuals with mild to moderate Parkinson’s disease in comparison to healthy individuals. Twelve individuals with mild to moderate Parkinson’s disease and 12 healthy individuals, all ≥ 60 years of age, were included. A serial reaction time task was used as a measure of implicit sequence learning and a similar task but with the addition of a simple counting task, was used as a measure of dual task ability. We have present thorough descriptive statistics of the data but we have refrained from any inferential statistics due to the small sample size. All participants understood the task instructions and the difficulty level of both tasks was deemed acceptable. There were indications of task fatigue that demand careful choices for how best to analyse the data from such tasks in future trials. Ceiling effects were present in several accuracy outcomes, but not in the reaction time outcomes. Overall, we found both tasks to be feasible to use in samples of individuals with mild to moderate Parkinson’s disease and healthy older individuals.
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Affiliation(s)
- Malin Freidle
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Hanna Johansson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | | | - Urban Ekman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Allied Health Professionals Function, Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Lövdén
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Gothenburg University, Gothenburg, Sweden
| | - Erika Franzén
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Allied Health Professionals Function, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- R&D Unit, Stockholms Sjukhem, Stockholm, Sweden
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Vitorio R, Hasegawa N, Carlson-Kuhta P, Nutt JG, Horak FB, Mancini M, Shah VV. Dual-Task Costs of Quantitative Gait Parameters While Walking and Turning in People with Parkinson's Disease: Beyond Gait Speed. JOURNAL OF PARKINSONS DISEASE 2021; 11:653-664. [PMID: 33386812 DOI: 10.3233/jpd-202289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is a lack of recommendations for selecting the most appropriate gait measures of Parkinson's disease (PD)-specific dual-task costs to use in clinical practice and research. OBJECTIVE We aimed to identify measures of dual-task costs of gait and turning that best discriminate performance in people with PD from healthy individuals. We also investigated the relationship between the most discriminative measures of dual-task costs of gait and turning with disease severity and disease duration. METHODS People with mild-to-moderate PD (n = 144) and age-matched healthy individuals (n = 79) wore 8 inertial sensors while walking under single and dual-task (reciting every other letter of the alphabet) conditions. Outcome measures included 26 objective measures within four gait domains (upper/lower body, turning and variability). The area under the curve (AUC) from the receiver-operator characteristic plot was calculated to compare discriminative ability of dual-task costs on gait across outcome measures. RESULTS PD-specific, dual-task interference was identified for arm range of motion, foot strike angle, turn velocity and turn duration. Arm range of motion (AUC = 0.73) and foot strike angle (AUC = 0.68) had the largest AUCs across dual-task costs measures and they were associated with disease severity and/or disease duration. In contrast, the most commonly used dual-task gait measure, gait speed, showed an AUC of only 0.54. CONCLUSION Findings suggest that people with PD rely more than healthy individuals on executive-attentional resources to control arm swing, foot strike, and turning, but not gait speed. The dual-task costs of arm range of motion best discriminated people with PD from healthy individuals.
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Affiliation(s)
- Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Naoya Hasegawa
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | | | - John G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
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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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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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Oh C, Morris RJ, LaPointe LL, Stierwalt JAG. Spatial-Temporal Parameters of Gait Associated With Alzheimer Disease: A Longitudinal Analysis. J Geriatr Psychiatry Neurol 2021; 34:46-59. [PMID: 32129132 DOI: 10.1177/0891988720901779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Alzheimer's disease (AD) is one of the biggest social and medical concerns in the aging world. A dual task of walking and talking is a particularly practical means to assess AD considering the cognitive and behavioral changes that characterize the disease. The purpose of the study was to assess the effect of the dual task of walking and talking on people with early stage AD under differing cognitive load levels of talking. Participants (9 women and 5 men, mean age (years) = 78.03, standard deviation [SD] = 12.06) with mild or moderate AD (mean Dementia Rating Scale 2 score = 88.14, SD = 7.07) completed 12 monthly walking sessions under no, low, or high cognitive load. They also completed the low and high cognitive load tasks while seated. Linear mixed-effects modeling revealed that values in the Functional Ambulation Profile, stride length, and velocity decreased as tasks became more complex and double support time increased at the same rate. The walking and seated conditions comparison indicated that participants' performance on both low and high cognitive tasks was poor when they were walking rather than seated. The results show that people with early stage AD exhibited gait impairments that increased over time and when completing tasks with greater cognitive load.
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Affiliation(s)
- Chorong Oh
- School of Rehabilitation and Communication Sciences, 1354Ohio University, Athens, OH, USA
| | - Richard J Morris
- School of Communication Science and Disorders, 7823Florida State University, Tallahassee, FL, USA
| | - Leonard L LaPointe
- School of Communication Science and Disorders, 7823Florida State University, Tallahassee, FL, USA
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Ehrhardt A, Hostettler P, Widmer L, Reuter K, Petersen JA, Straumann D, Filli L. Fall-related functional impairments in patients with neurological gait disorder. Sci Rep 2020; 10:21120. [PMID: 33273488 PMCID: PMC7712911 DOI: 10.1038/s41598-020-77973-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/17/2020] [Indexed: 11/08/2022] Open
Abstract
Falls are common in patients with neurological disorders and are a primary cause of injuries. Nonetheless, fall-associated gait characteristics are poorly understood in these patients. Objective, quantitative gait analysis is an important tool to identify the principal fall-related motor characteristics and to advance fall prevention in patients with neurological disorders. Fall incidence was assessed in 60 subjects with different neurological disorders. Patients underwent a comprehensive set of functional assessments including instrumented gait analysis, computerized postural assessments and clinical walking tests. Determinants of falls were assessed by binary logistic regression analysis and receiver operator characteristics (ROC). The best single determinant of fallers was a step length reduction at slow walking speed reaching an accuracy of 67.2% (ROC AUC: 0.669; p = 0.027). The combination of 4 spatio-temporal gait parameters including step length and parameters of variability and asymmetry were able to classify fallers and non-fallers with an accuracy of 81.0% (ROC AUC: 0.882; p < 0.001). These findings suggest significant differences in specific spatio-temporal gait parameters between fallers and non-fallers among neurological patients. Fall-related impairments were mainly identified for spatio-temporal gait characteristics, suggesting that instrumented, objective gait analysis is an important tool to estimate patients' fall risk. Our results highlight pivotal fall-related walking deficits that might be targeted by future rehabilitative interventions that aim at attenuating falls.
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Affiliation(s)
- Angela Ehrhardt
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Pascal Hostettler
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Lucas Widmer
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Katja Reuter
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Dominik Straumann
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Linard Filli
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Swiss Center for Clinical Movement Analysis (SCMA), Balgrist Campus AG, Zurich, Switzerland
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Castro-Chavira SA, Gorecka MM, Vasylenko O, Rodríguez-Aranda C. Effects of dichotic listening on gait domains of healthy older adults during dual-tasking: An exploratory observational study. Hum Mov Sci 2020; 75:102720. [PMID: 33260002 DOI: 10.1016/j.humov.2020.102720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Identification of the cognitive mechanisms behind gait changes in aging is a prime endeavor in gerontology and geriatrics. For this reason, we have implemented a new dual-task paradigm where an auditory attentional task is performed during over-ground walking. Dichotic listening assesses spontaneous attention and voluntary attention directed to right and left-ear. The uniqueness of dichotic listening relies on its requirements that vary in difficulty and recruitment of resources from whole brain to one brain hemisphere. When used in dual-tasking, asymmetric effects on certain gait parameters have been reported. OBJECTIVES The present study aims to acquire a more global understanding on how dichotic listening affects gait domains. Specifically, we aimed to understand how spontaneous vs lateralized auditory attention altered the Principal Component Analysis (PCA) structure of gait in healthy older adults. METHODS Seventy-eight healthy older adults (mean age: 71.1 years; 44 women and 34 men) underwent the Bergen dichotic listening test while walking. As this study only focuses on the effects of the cognitive task on gait, only dual-task costs for gait were calculated and entered into the PCA analyses. We explored the PCA structure for the effects on bilateral gait parameters (i.e., both limbs together) as well as on lateralized gait parameters (i.e, separate parameters by limb). We first established gait domains during single-task walking. Then, dual-task cost scores for gait were entered in a series of PCAs. RESULTS Results from the PCAs for bilateral gait parameters showed limited alterations on gait structure. In contrast, PCAs for lateralized data demonstrated modifications of the gait structure during dichotic listening. The PCAs corresponding for all dichotic listening conditions showed different factor solutions ranging between 4 and 6 factors that explained between 73.8% to 80% of the total variance. As a whole, all conditions had an impact on "pace", "pace variability" and "base of support variability" domains. In the spontaneous attention condition, a six-factor solution explaining 78.3% of the variance showed asymmetrical disruptions on the PCA structure. When attention was focused to right-ear, a five-factor solution explaining 89% of the variance and similar to baseline was found. When attention was directed to left-ear, a four-factor solution explaining 73.8% of the variance was found with symmetrical impact on all factors. CONCLUSIONS These findings demonstrate for the first time that specific facets of attentional control affects gait domains both symmetrically and asymmetrically in healthy older adults.
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Affiliation(s)
- Susana A Castro-Chavira
- Department of Psychology, University of Tromsø, The Arctic University of Norway; Tromsø, Norway
| | - Marta M Gorecka
- Department of Psychology, University of Tromsø, The Arctic University of Norway; Tromsø, Norway
| | - Olena Vasylenko
- Department of Psychology, University of Tromsø, The Arctic University of Norway; Tromsø, Norway
| | - Claudia Rodríguez-Aranda
- Department of Psychology, University of Tromsø, The Arctic University of Norway; Tromsø, Norway.
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Onder H, Ozyurek O. The impact of distinct cognitive dual-tasks on gait in Parkinson's disease and the associations with the clinical features of Parkinson's disease. Neurol Sci 2020; 42:2775-2783. [PMID: 33150515 DOI: 10.1007/s10072-020-04874-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
AIMS To investigate the impact of distinct cognitive dual-task abilities in patients with Parkinson's disease (PD) and compare the impact of these dual-tasks in association with the severity of PD and its clinical features. MATERIALS AND METHODS Modified Hoehn and Yahr Scale, UPDRS, and Standardized Mini-Mental State Examination (SMMSE) were evaluated in all PD patients. The subtype of PD and the presence of freezing of gait (FOG) were also evaluated. The Timed Up and Go (TUG) test was applied under single- and dual-task conditions including the digit span-forwards, digit span-backwards, delayed recall memory, counting down the days, counting backwards from 20, and animal fluency tests. RESULTS Most of the cognitive dual-tasks resulted in deterioration in gait performance in our PD subjects. Remarkably, the completion time of TUG duration under single- and dual-task of counting down days was higher in the FOG (+) PD subjects (p = 0.008, p = 0.050, respectively). Besides, the TUG duration under the dual-task of counting down days was found to be positively correlated with the UPDRS-motor scores and FOG scores. CONCLUSION We think that the concurrent execution of the dual-task of counting down days, which requires complex attentional skills, may disturb gait via a mechanism of overloading of the attentional reserves proceeding gait which is already defective in PD subjects. The neural correlate of this domain and its significance in performing dual-tasks in PD should be investigated in future large-scale studies. The results of these studies may provide substantial perspectives regarding the pathophysiology of gait disturbance in PD.
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Affiliation(s)
- Halil Onder
- Department of Neurology, Yozgat City Hospital, Yozgat, Turkey.
| | - Ozge Ozyurek
- Department of Psychology, Yozgat City Hospital, Yozgat, Turkey
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Chang HC, Chen CC, Weng YH, Chiou WD, Chang YJ, Lu CS. The efficacy of cognitive-cycling dual-task training in patients with early-stage Parkinson's disease: A pilot study. NeuroRehabilitation 2020; 47:415-426. [PMID: 33136071 DOI: 10.3233/nre-203090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent studies have suggested that cognitive-motor dual-task (DT) training might improve gait performance, locomotion automaticity, balance, and cognition in patients with Parkinson's disease (PD). OBJECTIVE We aimed to investigate the efficacy of cognitive-cycling DT training in patients with early-stage PD. METHODS Participants were scheduled to perform cognitive tasks simultaneously with the cycling training twice per week for eight weeks for a total of 16 sessions during their on-states. Clinical assessments were conducted using the unified Parkinson's disease rating scale (UPDRS), modified Hoehn and Yahr stage, Timed Up and Go (TUG) test, gait and cognitive performances under dual-task paradigm, the new freezing of gait questionnaire, Schwab and England Activities of Daily Living scale, 39-item Parkinson's disease questionnaire, and cognitive performance. RESULTS Thirteen eligible patients were enrolled in the study. The mean age was 60.64±5.32 years, and the mean disease duration was 7.02±3.23 years. Twelve PD patients completed 16 serial cognitive-cycling sessions for two months. After 16 sessions of training (T2), the UPDRS III scores improved significantly in both the off- and on-states, and TUG were significantly less than those at pretraining (T0). During both the single-task and the DT situations, gait performance and spatial memory cognitive performance significantly improved from T0 to T2. CONCLUSION The present study demonstrated that cognitive-cycling DT training improves the motor functions, gait and cognitive performances of PD patients.
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Affiliation(s)
- Hsiu-Chen Chang
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Professor Lu Neurological Clinic, Taoyuan, Taiwan
| | - Chiung-Chu Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsin Weng
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wei-Da Chiou
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Physical Rehabilitation, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Ya-Ju Chang
- Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Song Lu
- Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Professor Lu Neurological Clinic, Taoyuan, Taiwan
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Teo WP, Rantalainen T, Nuzum N, Valente L, Macpherson H. Altered prefrontal cortex responses in older adults with subjective memory complaints and dementia during dual-task gait: An fNIRS study. Eur J Neurosci 2020; 53:1324-1333. [PMID: 32979289 DOI: 10.1111/ejn.14989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 12/01/2022]
Abstract
People with cognitive impairments show deficits during physical performances such as gait, in particular during cognitively challenging conditions (i.e. dual-task gait [DTG]). However, it is unclear if people at risk of dementia, such as those with subjective memory complaints (SMC), also display gait and central deficits associated with DTG. In this study, we investigated the effects of single- and dual-task gait (STG and DTG), on left prefrontal cortex (PFC) activation in elderly people with subjective memory complaints (SMC) and Dementia. A total of 58 older adults (aged 65-94 years; 26 Healthy; 23 SMC; 9 Dementia) were recruited. Gait spatiotemporal characteristics (i.e. stride velocity and length) were assessed using an instrumented walkway during STG and DTG. Single-channel functional near-infrared spectroscopy over the left PFC was used to measure changes in oxyhaemoglobin (O2 Hb) during gait. Stride velocity and length during STG (all p < .05) and DTG (all p < .000) were significantly impaired in people with Dementia compared to Healthy and SMC individuals. No differences were observed between Healthy and SMC. For STG, a greater increase in O2 Hb (p < .05) was observed in those with Dementia compared to the Healthy and SMC, while no differences were observed between Healthy and SMC. A significant increase and decline in O2 Hb was observed during DTG in the SMC and Dementia groups, respectively, compared to Healthy. Our findings indicate an altered pattern of cerebral haemodynamic response of the left PFC in DTG in people with SMC and Dementia, which may suggest that central changes precede functional impairments in people with SMC.
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Affiliation(s)
- Wei-Peng Teo
- Physical Education and Sports Science Academic Group (PESS), National Institute of Education, Nanyang Technological University, Singapore.,Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Vic., Australia
| | - Timo Rantalainen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Nathan Nuzum
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Vic., Australia
| | - Leah Valente
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Vic., Australia
| | - Helen Macpherson
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Vic., Australia
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Çekok K, Kahraman T, Duran G, Dönmez Çolakoğlu B, Yener G, Yerlikaya D, Genç A. Timed Up and Go Test With a Cognitive Task: Correlations With Neuropsychological Measures in People With Parkinson's Disease. Cureus 2020; 12:e10604. [PMID: 33123423 PMCID: PMC7584288 DOI: 10.7759/cureus.10604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The Timed Up and Go (TUG) test is a simple and widely used clinical test for the assessment of lower extremity function, balance, mobility, and fall risk in various populations. The TUG has been found as a valid and reliable measure in people with Parkinson’s disease (PD). Besides, the addition of a cognitive task to the TUG (TUG-cognitive) enhances predictive validity related to fall risk in people with PD. However, further investigation is needed about the correlations of the TUG-cognitive test with neuropsychological measures in people with PD. Methods Thirty-three people with PD [modified Hoehn and Yahr scale, median (min-max)=2.5 (1.0-3.0)] participated in this cross-sectional study. The TUG was administered in the traditional way and with a cognitive task (counting backward by three from any number between 20 and 100). Neuropsychological measures included the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), and the Simple Reaction Time (SRT) test for stepping. The self-reported number of falls in the last six months was also recorded. Results The TUG-cognitive [13.1 (SD=8.5) seconds] was significantly longer than the TUG-traditional [12.2 (SD=8.1) seconds] (p<0.01). The TUG-cognitive significantly correlated with the MoCA [(rho=-0.712), TMT part A (TMT-A; rho=0.722), TMT part B (TMT-B; rho=0.694), SRT (rho=0.794), and number of falls (rho=0.960)] (p<0.01). The TUG-traditional also significantly correlated with the MoCA (rho=-0.682), TMT-A (rho=0.684), TMT-B (rho=0.746), SRT (rho=0.755), and number of falls (rho=0.702) (p<0.01). Conclusion Both the TUG-cognitive and TUG-traditional strongly correlated with neuropsychological measures; while the correlations were slightly stronger for the TUG-cognitive, the difference was not significant. The TUG-cognitive can be used in the clinical practice as a simple and more informative alternative to the TUG-traditional in people with PD.
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Affiliation(s)
- Kübra Çekok
- Physical Therapy, Medical Park Hospital, Izmir, TUR.,Physical Therapy, Graduate School of Health Sciences, Dokuz Eylül University, Izmir, TUR
| | - Turhan Kahraman
- Physiotherapy and Rehabilitation, Izmir Katip Celebi University, Izmir, TUR
| | - Gözde Duran
- Physical Medicine and Rehabilitation, Graduate School of Health Sciences, Dokuz Eylül University, Izmir, TUR
| | | | - Görsev Yener
- Neurology, Dokuz Eylül University, Izmir, TUR.,Izmir Biomedicine and Genome Center, Dokuz Eylül University, Izmir, TUR
| | | | - Arzu Genç
- Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, TUR
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Dagan M, Herman T, Bernad-Elazari H, Gazit E, Maidan I, Giladi N, Mirelman A, Manor B, Hausdorff JM. Dopaminergic therapy and prefrontal activation during walking in individuals with Parkinson's disease: does the levodopa overdose hypothesis extend to gait? J Neurol 2020; 268:658-668. [PMID: 32902733 DOI: 10.1007/s00415-020-10089-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/24/2022]
Abstract
The "levodopa-overdose hypothesis" posits that dopaminergic replacement therapy (1) increases performance on tasks that depend on the nigrostriatal-pathway (e.g., motor-control circuits), yet (2) decreases performance on tasks that depend upon the mesocorticolimbic-pathway (e.g., prefrontal cortex, PFC). Previous work in Parkinson's disease (PD) investigated this model while focusing on cognitive function. Here, we evaluated whether this model applies to gait in patients with PD and freezing of gait (FOG). Forty participants were examined in both the OFF anti-Parkinsonian medication state (hypo-dopaminergic) and ON state (hyper-dopaminergic) while walking with and without the concurrent performance of a serial subtraction task. Wireless functional near-infrared spectroscopy measured PFC activation during walking. Consistent with the "overdose-hypothesis", performance on the subtraction task decreased (p = 0.027) after dopamine intake. Moreover, the effect of walking condition on PFC activation depended on the dopaminergic state (i.e., interaction effect p = 0.001). Gait significantly improved after levodopa administration (p < 0.001). Nonetheless, PFC activation was higher (p = 0.013) in this state than in the OFF state during usual-walking. This increase in PFC activation in the ON state suggests that dopamine treatment interfered with PFC functioning. Otherwise, PFC activation, putatively a reflection of cognitive compensation, should have decreased. Moreover, in contrast to the OFF state, in the ON state, PFC activation failed to increase (p = 0.313) during dual-tasking, perhaps due to a "ceiling effect". These findings extend the "levodopa-overdose hypothesis" and suggest that it also applies to gait in PD patients. While dopaminergic therapy improves certain aspects of motor performance, optimal treatment should consider the "double-edged sword" of levodopa.
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Affiliation(s)
- Moria Dagan
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Talia Herman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hagar Bernad-Elazari
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Gazit
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Inbal Maidan
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Giladi
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brad Manor
- Harvard Medical School, Boston, MA, USA.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel. .,Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Orthopedic Surgery, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
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Delafontaine A, Hansen C, Marolleau I, Kratzenstein S, Gouelle A. Effect of a Concurrent Cognitive Task, with Stabilizing Visual Information and Withdrawal, on Body Sway Adaptation of Parkinsonian's Patients in an Off-Medication State: A Controlled Study. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5059. [PMID: 32899926 PMCID: PMC7571225 DOI: 10.3390/s20185059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 12/23/2022]
Abstract
Background: In persons with Parkinson's disease (pwPD) any additional somatosensory or distractor interference can influence the posture. When deprivation of vision and dual-task are associated, the effect on biomechanical performance is less consistent. The aim of this study was to evaluate the role of the visual deprivation and a cognitive task on the static balance in earlier stage PD subjects. Methods: Fifteen off-medication state pwPD (9 women and 6 men), 67.7 ± 7.3 years old, diagnosed PD since 5.4 ± 3.4 years, only Hoehn and Yahr state 2 and fifteen young control adults (7 women and 8 men) aged 24.9 ± 4.9 years, performed semi-tandem task under four randomized experimental conditions: eyes opened single-task, eyes closed single-task, eyes opened dual-task and eyes closed dual-task. The center of pressure (COP) was measured using a force plate and electromyography signals (EMG) of the ankle/hip muscles were recorded. Traditional parameters, including COP pathway length, ellipse area, mediolateral/anteroposterior root-mean-square and non-linear measurements were computed. The effect of vision privation, cognitive task, and vision X cognitive was investigated by a 2 (eyes opened/eyes closed) × 2 (postural task alone/with cognitive task) repeated-measures ANOVA after application of a Bonferroni pairwise correction for multiple comparisons. Significant interactions were further analyzed using post-hoc tests. Results: In pwPD, both COP pathway length (p < 0.01), ellipse area (p < 0.01) and mediolateral/anteroposterior root-mean-square (p < 0.01) were increased with the eyes closed, while the dual-task had no significant effect when compared to the single-task condition. Comparable results were observed in the control group for who COP pathway was longer in all conditions compared to eyes opened single-task (p < 0.01) and longer in conditions with eyes closed compared to eyes opened dual-task (p < 0.01). Similarly, all differences in EMG activity of pwPD were exclusively observed between eyes opened vs. eyes closed conditions, and especially for the forward leg's soleus (p < 0.01) and backward tibialis anterior (p < 0.01). Conclusions: These results in pwPD without noticeable impairment of static balance encourage the assessment of both visual occlusion and dual-task conditions when the appearance of significant alteration during the dual-task could reveal the subtle worsening onset of the balance control.
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Affiliation(s)
- Arnaud Delafontaine
- CIAMS, University Paris-Sud, Université Paris-Saclay, 91405 Orsay, France;
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, 24098 Kiel, Germany;
| | - Iris Marolleau
- CIAMS, University Paris-Sud, Université Paris-Saclay, 91405 Orsay, France;
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Stefan Kratzenstein
- CAU Motion Lab, Kiel University, Olshausenstraße 74, 24098 Kiel, Germany;
- Institute of Sport Science, Kiel University, Olshausenstraße 74, 24098 Kiel, Germany
| | - Arnaud Gouelle
- ProtoKinetics, Havertown, PA 19083, USA;
- Laboratory Performance, Santé, Métrologie, Société (PSMS), UFR STAPS, 51100 Reims, France
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The Effect of a Secondary Task on Kinematics during Turning in Parkinson’s Disease with Mild to Moderate Impairment. Symmetry (Basel) 2020. [DOI: 10.3390/sym12081284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients with Parkinson’s disease (PD) show typical gait asymmetries. These peculiar motor impairments are exacerbated by added cognitive and/or mechanical loading. However, there is scarce literature that chains these two stimuli. The aim of this study was to investigate the combined effects of a dual task (cognitive task) and turning (mechanical task) on the spatiotemporal parameters in mild to moderate PD. Participants (nine patients with PD and nine controls (CRs)) were evaluated while walking at their self-selected pace without a secondary task (single task), and while repeating the days of the week backwards (dual task) along a straight direction and a 60° and 120° turn. As speculated, in single tasking, PD patients preferred to walk with a shorter stride length (p < 0.05) but similar timing parameters, compared to the CR group; in dual tasking, both groups walked slower with shorter strides. As the turn angle increased, the speed will be reduced (p < 0.001), whereas the ground–foot contact will become greater (p < 0.001) in all the participants. We showed that the combination of a simple cognitive task and a mechanical task (especially at larger angles) could represent an important training stimulus in PD at the early stages of the pathology.
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Penko AL, Streicher MC, Dey T, Rosenfeldt AB, Alberts JL. Parkinson's gait kinematics deteriorates across multiple cognitive domains under dual-task paradigms. Clin Neurol Neurosurg 2020; 197:106083. [PMID: 32683199 DOI: 10.1016/j.clineuro.2020.106083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/09/2020] [Accepted: 07/09/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The symptoms of Parkinson's disease (PD) in many circumstances lead to gait dysfunction which contribute to decreased mobility, reduced quality of life, and increased risk of falling. Dual-task conditions have been shown to amplify gait dysfunction from a spatiotemporal parameter standpoint; however, less is known regarding gait joint kinematics under dual-task conditions in PD, specifically across multiple cognitive domains. The purpose of this project was to systematically characterize lower extremity joint kinematics in individuals with mild-moderate PD under dual-task paradigms across multiple cognitive domains. PATIENTS AND METHODS Twenty-three individuals with idiopathic Parkinson's disease participated in this observational study evaluating hip, knee, and ankle joint kinematics while walking on a self-paced treadmill under dual-task conditions that taxed memory, attention, verbal fluency, and information processing. RESULTS Gait velocity and range of motion at the ankle, knee, and hip decreased (p < 0.05) under all of the dual-task conditions. Hip kinematics were affected to a greater extent than the ankle and knee, with reduction in flexion and extension during all timestamps of the gait cycle (p < 0.05) under all dual-task conditions. CONCLUSION The worsening of gait kinematics under dual-task conditions regardless of the aspect of cognition being challenged suggest that information processing and motor output are unable to withstand dual-task loads without consequence. These study results provide insight for target areas to focus on during therapeutic interventions in order to help minimize gait kinematic decrements observed under dual-task conditions.
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Affiliation(s)
- Amanda L Penko
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | | | - Tanujit Dey
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Anson B Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA; Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA.
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Cosentino G, Tassorelli C, Prunetti P, Todisco M, De Icco R, Avenali M, Minafra B, Zangaglia R, Valentino F, Pacchetti C, Bertino G, Mauramati S, Fresia M, Alfonsi E. Reproducibility and reaction time of swallowing as markers of dysphagia in parkinsonian syndromes. Clin Neurophysiol 2020; 131:2200-2208. [PMID: 32702534 DOI: 10.1016/j.clinph.2020.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/16/2020] [Accepted: 06/28/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate reproducibility and reaction time of oropharyngeal swallowing in patients with Parkinson's disease (PD) and atypical parkinsonisms (APs). METHODS We enrolled 19 patients with PD, 30 with APs, and 20 healthy subjects. Presence and severity of dysphagia were assessed with clinical and fiberoptic endoscopic evaluations of swallowing. Reproducibility of the oral and pharyngeal phases of swallowing were respectively assessed by calculating the 'similarity index' of the electromyography activity of the submental/suprahyoid muscles and of the laryngeal-pharyngeal mechanogram during consecutive swallows. These were performed both 'on command' and spontaneously. The swallowing reaction time was also recorded. RESULTS Reproducibility of the oral phase of swallowing was reduced in patients with dysphagia, mainly when swallowing 'on command'. Swallowing reaction time was prolonged in dysphagic patients. These electrophysiological parameters did not vary among different parkinsonian syndromes and correlated with dysphagia severity. CONCLUSIONS Increased variability of oral swallowing automatisms and abnormal sensorimotor integration may be of relevance for the pathophysiology of dysphagia in parkinsonian syndromes. SIGNIFICANCE The electrophysiological assessment represents a valuable tool to investigate swallowing alterations in parkinsonian syndromes. It may also provide useful insights into clinical severity and pathophysiology of dysphagia, giving clues for the choice of the best therapeutic approach.
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Affiliation(s)
- Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Paolo Prunetti
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Massimiliano Todisco
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy; Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Micol Avenali
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Brigida Minafra
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberta Zangaglia
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Francesca Valentino
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giulia Bertino
- Department of Otolaryngology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Simone Mauramati
- Department of Otolaryngology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Mauro Fresia
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Enrico Alfonsi
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
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di Biase L, Di Santo A, Caminiti ML, De Liso A, Shah SA, Ricci L, Di Lazzaro V. Gait Analysis in Parkinson's Disease: An Overview of the Most Accurate Markers for Diagnosis and Symptoms Monitoring. SENSORS (BASEL, SWITZERLAND) 2020; 20:E3529. [PMID: 32580330 PMCID: PMC7349580 DOI: 10.3390/s20123529] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022]
Abstract
The aim of this review is to summarize that most relevant technologies used to evaluate gait features and the associated algorithms that have shown promise to aid diagnosis and symptom monitoring in Parkinson's disease (PD) patients. We searched PubMed for studies published between 1 January 2005, and 30 August 2019 on gait analysis in PD. We selected studies that have either used technologies to distinguish PD patients from healthy subjects or stratified PD patients according to motor status or disease stages. Only those studies that reported at least 80% sensitivity and specificity were included. Gait analysis algorithms used for diagnosis showed a balanced accuracy range of 83.5-100%, sensitivity of 83.3-100% and specificity of 82-100%. For motor status discrimination the gait analysis algorithms showed a balanced accuracy range of 90.8-100%, sensitivity of 92.5-100% and specificity of 88-100%. Despite a large number of studies on the topic of objective gait analysis in PD, only a limited number of studies reported algorithms that were accurate enough deemed to be useful for diagnosis and symptoms monitoring. In addition, none of the reported algorithms and technologies has been validated in large scale, independent studies.
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Affiliation(s)
- Lazzaro di Biase
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy; (A.D.S.); (M.L.C.); (A.D.L.); (L.R.); (V.D.L.)
| | - Alessandro Di Santo
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy; (A.D.S.); (M.L.C.); (A.D.L.); (L.R.); (V.D.L.)
| | - Maria Letizia Caminiti
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy; (A.D.S.); (M.L.C.); (A.D.L.); (L.R.); (V.D.L.)
| | - Alfredo De Liso
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy; (A.D.S.); (M.L.C.); (A.D.L.); (L.R.); (V.D.L.)
| | - Syed Ahmar Shah
- Usher Institute, Edinburgh Medical School: Molecular, Genetic and Population Health Sciences, The University of Edinburgh, EH16 4UX Edinburgh, UK;
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy; (A.D.S.); (M.L.C.); (A.D.L.); (L.R.); (V.D.L.)
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy; (A.D.S.); (M.L.C.); (A.D.L.); (L.R.); (V.D.L.)
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San Martín Valenzuela C, Dueñas Moscardó L, López-Pascual J, Serra-Añó P, Tomás JM. Interference of functional dual-tasks on gait in untrained people with Parkinson's disease and healthy controls: a cross-sectional study. BMC Musculoskelet Disord 2020; 21:396. [PMID: 32571284 PMCID: PMC7310477 DOI: 10.1186/s12891-020-03431-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 06/16/2020] [Indexed: 12/03/2022] Open
Abstract
Background In Parkinson’s disease (PD) population, performing secondary tasks while walking further deteriorates gait and restrict mobility in functional contexts of daily life. This study (1) analyzed the interference of functional cognitive and motor secondary task on untrained people with PD and (2) compared their walking with healthy subjects. Methods Forty people with PD (aged 66.72 [7.5] years, Hoehn and Yahr stage I-II-III, on-medication) composed the PD group (PDG) and 43 participants (aged 66.60 [8.75] years) formed the group of healthy counterparts (HG). Gait was evaluated through spatiotemporal, kinematic and kinetic outcomes in five conditions: single task (ST) and visual, verbal, auditory and motor dual-task (DT). Results The velocity, stride length, and braking force performance of both groups was statistically higher in the ST condition than in verbal, auditory and motor DT (p < .05), and inferior in double support time and midstance force (p < .05). The same pattern was observed when compared the ST and visual DT condition, where participants showed a significantly higher stride length, double support time and braking force in the ST (p < .05). In addition, the PDG exhibited a significant shorter double support time and midstance force, and showed a higher braking force in the visual DT than in the verbal DT (p < .05). Similarly, the PDG showed a wider stride in the visual DT than in the motor DT condition (p < .05). PDG participants had a significantly lower performance than the HG in all the variables analyzed except for the maximum hip extension in the stance phase (p > .05). Conclusions: In untrained participants with PD, verbal and motor secondary tasks affect gait significantly, while auditory and visual tasks interfere to a lesser extent. Untrained people with PD have a poorer gait performance than their healthy counterparts, but in different grades according to the analyzed variables. Trial registration The data in this paper are part of a single-blind, randomized, controlled trial and correspond to the evaluations performed before a physical rehabilitation program, retrospectively registered with the number at clinicaltrial.govNCT04038866.
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Affiliation(s)
- Constanza San Martín Valenzuela
- Unit of Personal Autonomy, Dependency and Mental Disorder Assessment, Faculty of Medicine, Blasco Ibáñez, 15, 46010, Valencia, Spain.,Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street, 5, 46010, Valencia, Spain.,UBIC Reseach Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street, 5, 46010, Valencia, Spain.,Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Lirios Dueñas Moscardó
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street, 5, 46010, Valencia, Spain
| | - Juan López-Pascual
- Biomechanics Institute of Valencia, Polytechnic University of Valencia, Camino de Vera, s/n, 46022, Valencia, Spain
| | - Pilar Serra-Añó
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street, 5, 46010, Valencia, Spain. .,UBIC Reseach Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag Street, 5, 46010, Valencia, Spain.
| | - José M Tomás
- Department of Behavioral Sciences Methodology, Faculty of Psychology, University of Valencia, Blasco Ibánez Avenue, 13, 46010, Valencia, Spain
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