1
|
Graham L, Armitage J, Vitorio R, Das J, Barry G, Godfrey A, McDonald C, Walker R, Mancini M, Morris R, Stuart S. Visual Exploration While Walking With and Without Visual Cues in Parkinson's Disease: Freezer Versus Non-Freezer. Neurorehabil Neural Repair 2023; 37:734-743. [PMID: 37772512 PMCID: PMC10666478 DOI: 10.1177/15459683231201149] [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] [Indexed: 09/30/2023]
Abstract
BACKGROUND Visual cues can improve gait in Parkinson's disease (PD), including those experiencing freezing of gait (FOG). However, responses are variable and underpinning mechanisms remain unclear. Visuo-cognitive processing (measured through visual exploration) has been implicated in cue response, but this has not been comprehensively examined. OBJECTIVE To examine visual exploration and gait with and without visual cues in PD who do and do not self-report FOG, and healthy controls (HC). METHODS 17 HC, 21 PD without FOG, and 22 PD with FOG walked with and without visual cues, under single and dual-task conditions. Visual exploration (ie, saccade frequency, duration, peak velocity, amplitude, and fixation duration) was measured via mobile eye-tracking and gait (ie, gait speed, stride length, foot strike angle, stride time, and stride time variability) with inertial sensors. RESULTS PD had impaired gait compared to HC, and dual-tasking made gait variables worse across groups (all P < .01). Visual cues improved stride length, foot strike angle, and stride time in all groups (P < .01). Visual cueing also increased saccade frequency, but reduced saccade peak velocity and amplitude in all groups (P < .01). Gait improvement related to changes in visual exploration with visual cues in PD but not HC, with relationships dependent on group (FOG vs non-FOG) and task (single vs dual). CONCLUSION Visual cues improved visual exploration and gait outcomes in HC and PD, with similar responses in freezers and non-freezers. Freezer and non-freezer specific associations between cue-related changes in visual exploration and gait indicate different underlying visuo-cognitive processing within these subgroups for cue response.
Collapse
Affiliation(s)
- Lisa Graham
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Jordan Armitage
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Rodrigo Vitorio
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Julia Das
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Alan Godfrey
- Department of Computer and Information Science, Northumbria University, Newcastle, UK
| | | | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Rosie Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
2
|
Das J, Morris R, Barry G, Vitorio R, Oman P, McDonald C, Walker R, Stuart S. Exploring the feasibility of technological visuo-cognitive training in Parkinson's: Study protocol for a pilot randomised controlled trial. PLoS One 2022; 17:e0275738. [PMID: 36206239 PMCID: PMC9543984 DOI: 10.1371/journal.pone.0275738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 08/19/2022] [Indexed: 11/12/2022] Open
Abstract
Visual and cognitive dysfunction are common in Parkinson's disease and relate to balance and gait impairment, as well as increased falls risk and reduced quality of life. Vision and cognition are interrelated (termed visuo-cognition) which makes intervention complex in people with Parkinson's (PwP). Non-pharmacological interventions for visuo-cognitive deficits are possible with modern technology, such as combined mobile applications and stroboscopic glasses, but evidence for their effectiveness in PwP is lacking. We aim to investigate whether technological visuo-cognitive training (TVT) can improve visuo-cognitive function in PwP. We will use a parallel group randomised controlled trial to evaluate the feasibility and acceptability of TVT versus standard care in PwP. Forty PwP who meet our inclusion criteria will be randomly assigned to one of two visuo-cognitive training interventions. Both interventions will be carried out by a qualified physiotherapist in participants own homes (1-hour sessions, twice a week, for 4 weeks). Outcome measures will be assessed on anti-parkinsonian medication at baseline and at the end of the 4-week intervention. Feasibility of the TVT intervention will be assessed in relation to safety and acceptability of the technological intervention, compliance and adherence to the intervention and usability of equipment in participants homes. Additionally, semi structured interviews will be conducted to explore participants' experience of the technology. Exploratory efficacy outcomes will include change in visual attention measured using the Trail Making Test as well as changes in balance, gait, quality of life, fear of falling and levels of activity. This pilot study will focus on the feasibility and acceptability of TVT in PwP and provide preliminary data to support the design of a larger, multi-centre randomised controlled trial. This trial is registered at isrctn.com (ISRCTN46164906).
Collapse
Affiliation(s)
- Julia Das
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Rosie Morris
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Gill Barry
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Rodrigo Vitorio
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Paul Oman
- Department of Mathematics, Physics & Electrical Engineering, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Claire McDonald
- Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Samuel Stuart
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
- * E-mail:
| |
Collapse
|
3
|
Kou W, Wang X, Zheng Y, Zhao J, Cai H, Chen H, Sui B, Feng T. Freezing of gait in Parkinson’s disease is associated with the microstructural and functional changes of globus pallidus internus. Front Aging Neurosci 2022; 14:975068. [PMID: 36062153 PMCID: PMC9434315 DOI: 10.3389/fnagi.2022.975068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundFreezing of gait (FOG) is a common motor symptom in advanced Parkinson’s disease (PD). However, the pathophysiology mechanism of FOG is not fully understood. The purpose of this study was to investigate microstructural abnormalities in subcortical gray matter and alterations in functional connectivity of the nuclei with microstructural changes. In addition, the correlations between these microstructural and functional changes and the severity of FOG were measured.Materials and methodsTwenty-four patients with FOG (PD-FOG), 22 PD patients without FOG (PD-nFOG), and 27 healthy controls (HC) were recruited. FOG Questionnaire (FOGQ) and Gait and Falling Questionnaire (GFQ) were assessed, and Timed Up and Go (TUG) tests were performed in PD-FOG patients. All subjects underwent diffusion tensor imaging (DTI) and resting-state functional MRI scanning. The DTI measures, including fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD), were extracted and measured from basal ganglia, thalamus, and substantia nigra. The nuclei with microstructural alterations were selected as seed regions to perform the seed-based resting-state functional connectivity.ResultsThe MD and RD values of the right globus pallidus internus (GPi) were significantly higher in patients with PD-FOG compared with PD-nFOG patients and HC. In PD-FOG patients, the MD and RD values of the right GPi were significantly correlated with the time of the TUG test in both ON and OFF states. The MD values were also correlated with the GFQ scores in PD-FOG patients. Resting-state functional connectivity between the right GPi and left middle occipital gyri decreased significantly in PD-FOG patients compared to PD-nFOG patients, and was negatively correlated with GFQ scores as well as the time of ON state TUG in PD-FOG patients.ConclusionMicrostructural alterations in the right GPi and functional connectivity between the right GPi and visual cortex may be associated with the pathophysiological mechanisms of FOG in PD patients.
Collapse
Affiliation(s)
- Wenyi Kou
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuemei Wang
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanchu Zheng
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiajia Zhao
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huihui Cai
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huimin Chen
- Department of Neurology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Binbin Sui
- Tiantan Neuroimaging Center for Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Binbin Sui,
| | - Tao Feng
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Tao Feng,
| |
Collapse
|
4
|
Lirani-Silva E, Stuart S, Parrington L, Campbell K, King L. Saccade and Fixation Eye Movements During Walking in People With Mild Traumatic Brain Injury. Front Bioeng Biotechnol 2021; 9:701712. [PMID: 34805104 PMCID: PMC8602343 DOI: 10.3389/fbioe.2021.701712] [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: 04/28/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Clinical and laboratory assessment of people with mild traumatic brain injury (mTBI) indicate impairments in eye movements. These tests are typically done in a static, seated position. Recently, the use of mobile eye-tracking systems has been proposed to quantify subtle deficits in eye movements and visual sampling during different tasks. However, the impact of mTBI on eye movements during functional tasks such as walking remains unknown. Objective: Evaluate differences in eye-tracking measures collected during gait between healthy controls (HC) and patients in the sub-acute stages of mTBI recovery and to determine if there are associations between eye-tracking measures and gait speed. Methods: Thirty-seven HC participants and 67individuals with mTBI were instructed to walk back and forth over 10-m, at a comfortable self-selected speed. A single 1-min trial was performed. Eye-tracking measures were recorded using a mobile eye-tracking system (head-mounted infra-red Tobbii Pro Glasses 2, 100 Hz, Tobii Technology Inc. VA, United States). Eye-tracking measures included saccadic (frequency, mean and peak velocity, duration and distance) and fixation measurements (frequency and duration). Gait was assessed using six inertial sensors (both feet, sternum, right wrist, lumbar vertebrae and the forehead) and gait velocity was selected as the primary outcome. General linear model was used to compare the groups and association between gait and eye-tracking outcomes were explored using partial correlations. Results: Individuals with mTBI showed significantly reduced saccade frequency (p = 0.016), duration (p = 0.028) and peak velocity (p = 0.032) compared to the HC group. No significant differences between groups were observed for the saccade distance, fixation measures and gait velocity (p > 0.05). A positive correlation was observed between saccade duration and gait velocity only for participants with mTBI (p = 0.025). Conclusion: Findings suggest impaired saccadic eye movement, but not fixations, during walking in individuals with mTBI. These findings have implications in real-world function including return to sport for athletes and return to duty for military service members. Future research should investigate whether or not saccade outcomes are influenced by the time after the trauma and rehabilitation.
Collapse
Affiliation(s)
- Ellen Lirani-Silva
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, United Kingdom.,Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom
| | - Lucy Parrington
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Veterans Affairs Portland Oregon Health Care System, Portland, OR, United States
| | - Kody Campbell
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Veterans Affairs Portland Oregon Health Care System, Portland, OR, United States
| | - Laurie King
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Veterans Affairs Portland Oregon Health Care System, Portland, OR, United States
| |
Collapse
|
5
|
Nazmuddin M, van Dalen JW, Borra RJH, Stormezand GN, van der Horn HJ, van der Zee S, Boertien J, van Laar T. Postural and gait symptoms in de novo Parkinson's disease patients correlate with cholinergic white matter pathology. Parkinsonism Relat Disord 2021; 93:43-49. [PMID: 34784526 DOI: 10.1016/j.parkreldis.2021.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/26/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The postural instability gait difficulty motor subtype of patients with Parkinson's disease (PIGD-PD) has been associated with more severe cognitive pathology and a higher risk on dementia compared to the tremor-dominant subtype (TD-PD). Here, we investigated whether the microstructural integrity of the cholinergic projections from the nucleus basalis of Meynert (NBM) was different between these clinical subtypes. METHODS Diffusion-weighted imaging data of 98 newly-diagnosed unmedicated PD patients (44 TD-PD and 54 PIGD-PD subjects) and 10 healthy controls, were analysed using diffusion tensor imaging, focusing on the white matter tracts associated with cholinergic projections from the NBM (NBM-WM) as the tract-of-interest. Quantitative tract-based and voxel-based analyses were performed using FA and MD as the estimates of white matter integrity. RESULTS Voxel-based analyses indicated significantly lower FA in the frontal part of the medial and lateral NBM-WM tract of both hemispheres of PIGD-PD compared to TD-PD. Relative to healthy control, several clusters with significantly lower FA were observed in the frontolateral NBM-WM tract of both disease groups. Furthermore, significant correlations between the severity of the axial and gait impairment and NBM-WM FA and MD were found, which were partially mediated by NBM-WM state on subjects' attentional performance. CONCLUSIONS The PIGD-PD subtype shows a loss of microstructural integrity of the NBM-WM tract, which suggests that a loss of cholinergic projections in this PD subtype already presents in de novo PD patients.
Collapse
Affiliation(s)
- Muhammad Nazmuddin
- Department of Neurology, Parkinson Expertise Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Jan-Willem van Dalen
- Department of Neurology, Donders Institute for Brain, Behaviour, and Cognition, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neurology, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Ronald J H Borra
- Department of Radiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Gilles N Stormezand
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Harm Jan van der Horn
- Department of Neurology, Parkinson Expertise Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sygrid van der Zee
- Department of Neurology, Parkinson Expertise Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jeffrey Boertien
- Department of Neurology, Parkinson Expertise Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Teus van Laar
- Department of Neurology, Parkinson Expertise Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
6
|
Can a targeted home-based exercise programme improve turning characteristics in individuals with Parkinson's disease? Clin Biomech (Bristol, Avon) 2021; 89:105469. [PMID: 34474314 DOI: 10.1016/j.clinbiomech.2021.105469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/22/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Turns are often cited as a difficult task for individuals with Parkinson's disease and often lead to falls, however targeted exercise interventions may help to reduce this problem. This study examined the effects of a 10-week home-based exercise program focusing on turns which may be an exercise approach for improving mobility and reducing falls in individuals with Parkinson's disease. METHODS Turning and stepping characteristics were recorded using Inertial Measurement Units while participants performed a 180° standing turn. Eye movements were measured using a BlueGain electrooculography system. Clinical outcomes were assessed using the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Functional axial rotation-physical score and the Falls Efficacy Scale International. FINDINGS Twenty individuals with Parkinson's disease were matched by severity using the Modified Hoehn and Yahr scale and were randomly allocated to an exercise (n = 10) or control group (n = 10). Significant improvements were seen after 10 weeks in the exercise group only for; onset latency of body segments, step size, number of fast phase eye movements, the Movement Disorders Society-Unified Parkinson's Disease Rating Scale in motor and rigidity scores, Functional axial rotation-physical score and the Falls Efficacy Scale International. INTERPRETATION These results indicate that the home-based exercise programme targeting turning characteristics had positive effects on turning performance and clinical outcomes associated with falls in individuals with Parkinson's disease. These preliminary results support the notion that targeted home-based exercises may provide an effective intervention in this population.
Collapse
|
7
|
Trindade MFD, Viana RA. Effects of auditory or visual stimuli on gait in Parkinsonic patients: a systematic review. Porto Biomed J 2021; 6:e140. [PMID: 34368491 PMCID: PMC8341369 DOI: 10.1097/j.pbj.0000000000000140] [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: 11/21/2019] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND External stimuli can improve gait performance in Parkinsons Disease (PD): auditory stimuli can increase velocity and visual stimuli may act at step length. OBJECTIVE To systematize the scientific evidence about the effects of auditory or visual stimuli on gait in patients with PD. METHODS From January 2016 to December 2018, a systematic literature research was conducted in the PubMed/Medline and Web of Science databases. Study designs considered were randomized controlled trials (RCTs) and observational studies, which evaluated the effects of auditory or visual stimuli on gait in PD. The methodological quality was assessed by the Critical Appraisal Skills Program. RESULTS Five articles were included with 232 participants and a methodological rank of mean of 10.3 on the cohort studies (n = 3), 8 on the case control studies (n = 1), and 6 on the RCTs (n = 1). Although 3 evaluated the effects of auditory stimuli on gait in PD, 2 analyzed those of visual stimuli. Based on these, it was verified a significant improvement of diverse gait parameters. CONCLUSION The application of auditory or visual stimuli have beneficial effects on gait parameters. Further investigation is required.
Collapse
Affiliation(s)
| | - Rui A Viana
- Faculty of Health Sciences, Fernando Pessoa University
- Physical Medicine and Rehabilitation Department, Centro Hospitalar São João EPE, Porto, Portugal
| |
Collapse
|
8
|
Sarter M, Avila C, Kucinski A, Donovan E. Make a Left Turn: Cortico-Striatal Circuitry Mediating the Attentional Control of Complex Movements. Mov Disord 2021; 36:535-546. [PMID: 33615556 DOI: 10.1002/mds.28532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In movement disorders such as Parkinson's disease (PD), cholinergic signaling is disrupted by the loss of basal forebrain cholinergic neurons, as well as aberrant activity in striatal cholinergic interneurons (ChIs). Several lines of evidence suggest that gait imbalance, a key disabling symptom of PD, may be driven by alterations in high-level frontal cortical and cortico-striatal processing more typically associated with cognitive dysfunction. METHODS Here we describe the corticostriatal circuitry that mediates the cognitive-motor interactions underlying such complex movement control. The ability to navigate dynamic, obstacle-rich environments requires the continuous integration of information about the environment with movement selection and sequencing. The cortical-attentional processing of extero- and interoceptive cues requires modulation by cholinergic activity to guide striatal movement control. Cue-derived information is "transferred" to striatal circuitry primarily via fronto-striatal glutamatergic projections. RESULT Evidence from parkinsonian fallers and from a rodent model reproducing the dual cholinergic-dopaminergic losses observed in these patients supports the main hypotheses derived from this neuronal circuitry-guided conceptualization of parkinsonian falls. Furthermore, in the striatum, ChIs constitute a particularly critical node for the integration of cortical with midbrain dopaminergic afferents and thus for cues to control movements. CONCLUSION Procholinergic treatments that enhance or rescue cortical and striatal mechanisms may improve complex movement control in parkinsonian fallers and perhaps also in older persons suffering from gait disorders and a propensity for falls. © 2021 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Martin Sarter
- Department of Psychology & Neuroscience Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Cassandra Avila
- Department of Psychology & Neuroscience Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaron Kucinski
- Department of Psychology & Neuroscience Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Eryn Donovan
- Department of Psychology & Neuroscience Program, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
9
|
Reduction of falls in a rat model of PD falls by the M1 PAM TAK-071. Psychopharmacology (Berl) 2021; 238:1953-1964. [PMID: 33735392 PMCID: PMC7969347 DOI: 10.1007/s00213-021-05822-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/08/2021] [Indexed: 01/03/2023]
Abstract
RATIONALE In addition to the disease-defining motor symptoms, patients with Parkinson's disease (PD) exhibit gait dysfunction, postural instability, and a propensity for falls. These dopamine (DA) replacement-resistant symptoms in part have been attributed to loss of basal forebrain (BF) cholinergic neurons and, in interaction with striatal dopamine (DA) loss, to the resulting disruption of the attentional control of balance and complex movements. Rats with dual cholinergic-DA losses ("DL rats") were previously demonstrated to model PD falls and associated impairments of gait and balance. OBJECTIVES We previously found that the muscarinic M1-positive allosteric modulator (PAM) TAK-071 improved the attentional performance of rats with BF cholinergic losses. Here, we tested the hypotheses that TAK-071 reduces fall rates in DL rats. RESULTS Prior to DL surgery, female rats were trained to traverse a rotating straight rod as well as a rod with two zigzag segments. DL rats were refamiliarized with such traversals post-surgery and tested over 7 days on increasingly demanding testing conditions. TAK-071 (0.1, 0.3 mg/kg, p.o.) was administered prior to daily test sessions over this 7-day period. As before, DL rats fell more frequently than sham-operated control rats. Treatment of DL rats with TAK-071 reduced falls from the rotating rod and the rotating zigzag rod, specifically when the angled part of the zigzag segment, upon entering, was at a steep, near vertical angle. CONCLUSIONS TAK-071 may benefit complex movement control, specifically in situations which disrupt the patterning of forward movement and require the interplay between cognitive and motor functions to modify movement based on information about the state of dynamic surfaces, balance, and gait.
Collapse
|
10
|
Baker T, Pitman J, MacLellan MJ, Reed-Jones RJ. Visual Cues Promote Head First Strategies During Walking Turns in Individuals With Parkinson's Disease. Front Sports Act Living 2020; 2:22. [PMID: 33345016 PMCID: PMC7739666 DOI: 10.3389/fspor.2020.00022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/26/2020] [Indexed: 11/14/2022] Open
Abstract
Anticipatory eye movement promotes cranio-caudal sequencing during walking turns. Clinical groups, such as Parkinson's disease (PD), do not produce anticipatory eye movements, leading to increased risk of falls. Visual cues may promote anticipatory eye movement by guiding the eyes into the turn. This study examined if visual cues could train anticipatory eye movement. Ten neurotypical young adults and 6 adults with PD completed three blocks of walking trials. Trials were blocked by visual condition: non-cued baseline turns (5 trials), visually cued turns (10 trials), and non-cued post turns (5 trials). A Delsys Trigno (Delsys, Boston, MA) recorded horizontal saccades at 1024 Hz via electrooculography (EOG). Two Optotrak cameras (Northern Digital Inc., ON, Canada) captured body segment kinematics at 120 Hz. Initiation of segment rotation with respect to ipsilateral foot contact (IFC1) prior to the turn was calculated. Neurotypical young adults (NYA) produced typical cranio-caudal rotation sequences during walking turns. Eyes led (407 ms prior to IFC1), followed by the head (50 ms prior to IFC1), then trunk and pelvis. In contrast, PD produced no anticipatory eye or segment movement at baseline. During pre-trials the eyes moved 96 ms after IFC1 and segment movement was initiated by the pelvis followed by trunk and head segments. After visual cue training however, PD produced anticipatory eye movements 161 ms prior to IFC1, followed by the head 88 ms following IFC1 but ahead of trunk and pelvis onset. These results suggest visual cues assist in producing cranio-caudal control during walking turns in PD.
Collapse
Affiliation(s)
- Tyler Baker
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Jenna Pitman
- Department of Human Health and Nutritional Sciences, College of Biological Science, University of Guelph, Guelph, ON, Canada
| | - Michael James MacLellan
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Rebecca J Reed-Jones
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, PE, Canada
| |
Collapse
|
11
|
O'Keefe JA, Guan J, Robertson E, Biskis A, Joyce J, Ouyang B, Liu Y, Carnes D, Purcell N, Berry-Kravis E, Hall DA. The Effects of Dual Task Cognitive Interference and Fast-Paced Walking on Gait, Turns, and Falls in Men and Women with FXTAS. THE CEREBELLUM 2020; 20:212-221. [PMID: 33118140 DOI: 10.1007/s12311-020-01199-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 12/11/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a genetic neurodegenerative disorder characterized by cerebellar ataxia, tremor, and cognitive dysfunction. We examined the impact of dual-task (DT) cognitive-motor interference and fast-paced (FP) gait on gait and turning in FXTAS. Thirty participants with FXTAS and 35 age-matched controls underwent gait analysis using an inertial sensor-based 2-min walk test under three conditions: (1) self-selected pace (ST), (2) FP, and (3) DT with a concurrent verbal fluency task. Linear regression analyses were performed to assess the association between FXTAS diagnosis and gait and turn outcomes. Correlations between gait variables and fall frequency were also calculated. FXTAS participants had reduced stride length and velocity, swing time, and peak turn velocity and greater double limb support time and number of steps to turn compared to controls under all three conditions. There was greater dual task cost of the verbal fluency task on peak turn velocity in men with FXTAS compared to controls. Additionally, stride length variability was increased and cadence was reduced in FXTAS participants in the FP condition. Stride velocity variability under FP gait was significantly associated with the number of self-reported falls in the last year. Greater motor control requirements for turning likely made men with FXTAS more susceptible to the negative effects of DT cognitive interference. FP gait exacerbated gait deficits in the domains of rhythm and variability, and increased gait variability with FP was associated with increased falls. These data may inform the design of rehabilitation strategies in FXTAS.
Collapse
Affiliation(s)
- Joan A O'Keefe
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA.
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA.
| | - Joseph Guan
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Erin Robertson
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Alexandras Biskis
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Jessica Joyce
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Yuanqing Liu
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Danielle Carnes
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Nicollette Purcell
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Elizabeth Berry-Kravis
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
- Departments of Pediatrics and Biochemistry, Rush University Medical Center, Chicago, IL, USA
| | - Deborah A Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
| |
Collapse
|
12
|
Khobkhun F, Hollands K, Hollands M, Ajjimaporn A. Effectiveness of exercise-based rehabilitation for the treatment of axial rigidity in people with Parkinson’s disease: A Scoping Review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1816127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Fuengfa Khobkhun
- Brain and Behaviour Lab, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- College of Sports Science and Technology, Mahidol University, Nakhon Pathom, Thailand
- Department of Physical Therapy, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Kristen Hollands
- Centre for Health Sciences Research Allerton Building, University of Salford, Salford, UK
| | - Mark Hollands
- Brain and Behaviour Lab, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Amornpan Ajjimaporn
- College of Sports Science and Technology, Mahidol University, Nakhon Pathom, Thailand
| |
Collapse
|
13
|
Hardeman LES, Kal EC, Young WR, van der Kamp J, Ellmers TJ. Visuomotor control of walking in Parkinson's disease: Exploring possible links between conscious movement processing and freezing of gait. Behav Brain Res 2020; 395:112837. [PMID: 32739286 DOI: 10.1016/j.bbr.2020.112837] [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: 03/10/2020] [Revised: 07/10/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Changes in visual attention have been argued to influence freezing of gait (FOG) in people with Parkinson's Disease (PD). However, the specific visual search patterns of people with FOG pathology (PD + FOG) and potential underlying mechanisms are not well understood. The current study explored visual search behavior in PD + FOG while walking on a pathway featuring environmental features known to exacerbate FOG (e.g., narrow doorway and tripping hazards). Potential underpinning attentional mechanisms were also assessed, such as conscious movement processing. METHODS Visual search behavior of twelve people with PD + FOG tested in ON-state (Mage = 74.3) and twelve age-matched healthy controls (Mage = 72.5) were analyzed during a complex walking task. The task required participants to step over an obstacle and navigate through a narrow doorway, surrounded by clutter. RESULTS People with PD + FOG more frequently directed visual attention to ongoing and imminent steps compared to healthy controls (Mdn = 26% vs Mdn = 14%, respectively; p = 0.042). Self-reported conscious movement processing was also significantly higher in people with PD + FOG. The one participant who froze during the walking task fixated the future trip hazard (obstacle, approximately 6 steps ahead) almost exclusively during freezing trials (i.e., 60-100% of the trial). In contrast, during 'non-freeze' trials, this participant increased the duration of fixations towards ongoing and imminent steps. CONCLUSION Results suggest that people with PD + FOG strongly monitor/control ongoing and immediately upcoming stepping movements. However, prolonged fixations towards threats to future movements might prevent people with PD + FOG from processing the visual information needed to do this, thereby provoke freezing episodes.
Collapse
Affiliation(s)
- L E S Hardeman
- Faculty of Behavioral and Movement Sciences, VU University Amsterdam, Netherlands; College of Health, Medicine and Life Sciences, Brunel University London, UK
| | - E C Kal
- College of Health, Medicine and Life Sciences, Brunel University London, UK; Centre for Cognitive Neuroscience, Brunel University London, UK
| | - W R Young
- College of Health, Medicine and Life Sciences, Brunel University London, UK; School of Sport and Health Sciences, University of Exeter, UK
| | - J van der Kamp
- Faculty of Behavioral and Movement Sciences, VU University Amsterdam, Netherlands
| | - T J Ellmers
- College of Health, Medicine and Life Sciences, Brunel University London, UK; Centre for Cognitive Neuroscience, Brunel University London, UK.
| |
Collapse
|
14
|
Cheng KL, Lin LH, Chen PC, Chiang PL, Chen YS, Chen HL, Chen MH, Chou KH, Li SH, Lu CH, Lin WC. Reduced Gray Matter Volume and Risk of Falls in Parkinson's Disease with Dementia Patients: A Voxel-Based Morphometry Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155374. [PMID: 32722623 PMCID: PMC7432132 DOI: 10.3390/ijerph17155374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 01/10/2023]
Abstract
Purpose: Risk of falls is a common sequela affecting patients with Parkinson’s disease (PD). Although motor impairment and dementia are correlated with falls, associations of brain structure and cognition deficits with falls remain unclear. Material and Methods: Thirty-five PD patients with dementia (PDD), and 37 age- and sex-matched healthy subjects were recruited for this study. All participants received structural magnetic resonance imaging (MRI) scans, and disease severity and cognitive evaluations. Additionally, patient fall history was recorded. Regional structural differences between PDD with and without fall groups were performed using voxel-based morphometry processing. Stepwise logistic regression analysis was used to predict the fall risk in PDD patients. Results: The results revealed that 48% of PDD patients experienced falls. Significantly lower gray matter volume (GMV) in the left calcarine and right inferior frontal gyrus in PDD patients with fall compared to PDD patients without fall were noted. The PDD patients with fall exhibited worse UPDRS-II scores compared to PDD patients without fall and were negatively correlated with lower GMV in the left calcarine (p/r = 0.004/−0.492). Furthermore, lower GMV in the left calcarine and right inferior frontal gyrus correlated with poor attention and executive functional test scores. Multiple logistic regression analysis showed that the left calcarine was the only variable (p = 0.004, 95% CI = 0.00–0.00) negatively associated with the fall event. Conclusions: PDD patients exhibiting impaired motor function, lower GMV in the left calcarine and right inferior frontal gyrus, and notable cognitive deficits may have increased risk of falls.
Collapse
Affiliation(s)
- Kai-Lun Cheng
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung 402, Taiwan;
- School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Veterinary Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Li-Han Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (L.-H.L.); (P.-L.C.); (Y.-S.C.); (H.-L.C.); (M.-H.C.)
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan;
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (L.-H.L.); (P.-L.C.); (Y.-S.C.); (H.-L.C.); (M.-H.C.)
| | - Yueh-Sheng Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (L.-H.L.); (P.-L.C.); (Y.-S.C.); (H.-L.C.); (M.-H.C.)
| | - Hsiu-Ling Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (L.-H.L.); (P.-L.C.); (Y.-S.C.); (H.-L.C.); (M.-H.C.)
| | - Meng-Hsiang Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (L.-H.L.); (P.-L.C.); (Y.-S.C.); (H.-L.C.); (M.-H.C.)
| | - Kun-Hsien Chou
- Brain Research Center, National Yang-Ming University, Taipei 112, Taiwan;
- Institute of Neuroscience, National Yang-Ming University, Taipei 112, Taiwan
| | - Shau-Hsuan Li
- Department of Oncology and Hematology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan;
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan;
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (L.-H.L.); (P.-L.C.); (Y.-S.C.); (H.-L.C.); (M.-H.C.)
- Correspondence: ; Tel.: +886-7-731-7123
| |
Collapse
|
15
|
Complex Movement Control in a Rat Model of Parkinsonian Falls: Bidirectional Control by Striatal Cholinergic Interneurons. J Neurosci 2020; 40:6049-6067. [PMID: 32554512 DOI: 10.1523/jneurosci.0220-20.2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 01/18/2023] Open
Abstract
Older persons and, more severely, persons with Parkinson's disease (PD) exhibit gait dysfunction, postural instability and a propensity for falls. These dopamine (DA) replacement-resistant symptoms are associated with losses of basal forebrain and striatal cholinergic neurons, suggesting that falls reflect disruption of the corticostriatal transfer of movement-related cues and their striatal integration with movement sequencing. To advance a rodent model of the complex movement deficits of Parkinsonian fallers, here we first demonstrated that male and female rats with dual cortical cholinergic and striatal DA losses (DL rats) exhibit cued turning deficits, modeling the turning deficits seen in these patients. As striatal cholinergic interneurons (ChIs) are positioned to integrate movement cues with gait, and as ChI loss has been associated with falls in PD, we next used this task, as well as a previously established task used to reveal heightened fall rates in DL rats, to broadly test the role of ChIs. Chemogenetic inhibition of ChIs in otherwise intact male and female rats caused cued turning deficits and elevated fall rates. Spontaneous turning was unaffected. Furthermore, chemogenetic stimulation of ChIs in DL rats reduced fall rates and restored cued turning performance. Stimulation of ChIs was relatively more effective in rats with viral transfection spaces situated lateral to the DA depletion areas in the dorsomedial striatum. These results indicate that striatal ChIs are essential for the control of complex movements, and they suggest a therapeutic potential of stimulation of ChIs to restore gait and balance, and to prevent falls in PD.SIGNIFICANCE STATEMENT In persons with Parkinson's disease, gait dysfunction and the associated risk for falls do not benefit from dopamine replacement therapy and often result in long-term hospitalization and nursing home placement. Here, we first validated a new task to demonstrate impairments in cued turning behavior in rodents modeling the cholinergic-dopaminergic losses observed in Parkinsonian fallers. We then demonstrated the essential role of striatal cholinergic interneurons for turning behavior as well as for traversing dynamic surfaces and avoiding falls. Stimulation of these interneurons in the rat model rescued turning performance and reduced fall rates. Our findings indicate the feasibility of investigating the neuronal circuitry underling complex movement control in rodents, and that striatal cholinergic interneurons are an essential node of such circuitry.
Collapse
|
16
|
Neuropsychiatric aspects of Parkinson disease psychopharmacology: Insights from circuit dynamics. HANDBOOK OF CLINICAL NEUROLOGY 2020; 165:83-121. [PMID: 31727232 DOI: 10.1016/b978-0-444-64012-3.00007-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Parkinson disease (PD) is a neurodegenerative disorder with a complex pathophysiology characterized by the progressive loss of dopaminergic neurons within the substantia nigra. Persons with PD experience several motoric and neuropsychiatric symptoms. Neuropsychiatric features of PD include depression, anxiety, psychosis, impulse control disorders, and apathy. In this chapter, we will utilize the National Institutes of Mental Health Research Domain Criteria (RDoC) to frame and integrate observations from two prevailing disease constructions: neurotransmitter anomalies and circuit physiology. When there is available evidence, we posit how unified translational observations may have clinical relevance and postulate importance outside of PD. Finally, we review the limited evidence available for pharmacologic management of these symptoms.
Collapse
|
17
|
Camacho PB, Carbonari R, Shen S, Zadikoff C, Kramer AF, López-Ortiz C. Voluntary Saccade Training Protocol in Persons With Parkinson's Disease and Healthy Adults. Front Aging Neurosci 2019; 11:77. [PMID: 31024292 PMCID: PMC6459894 DOI: 10.3389/fnagi.2019.00077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Voluntary saccade function gradually decreases during both the progression of Parkinson's disease (PD) and neurologically healthy adult aging. Voluntary saccades display decreased length and increased saccade latency, duration, and the number of compensatory saccades in aging and PD. Saccades serve as the key eye movement for maintaining salient features of the visual environment on the high visual acuity fovea of the retina. Abnormal saccade behavior has been associated with freezing of gait in PD. We have not identified any studies that have investigated improvement in voluntary saccade function using voluntary saccade training. Objective: We report an experimental protocol that tests a training paradigm following the principle of specificity to improve voluntary saccade velocity and amplitude, while decreasing latency and the number of compensatory saccades. Methods: Persons with PD (n = 22) and persons with no known neurological disorders (n = 22) between the ages of 40 and 65 years will be recruited. In a randomized-block study design, all participants will perform voluntary saccades to targets in eight cardinal and intercardinal directions. In each of the eight sessions during the four-week intervention period, participants will train at three target amplitudes. Participants will perform 40 trials for each amplitude block, consisting of five randomly presented repetitions for each direction. Voluntary and reflexive saccades will be recorded pre- and post-intervention, along with clinical mobility assessment using the Movement Disorder Society Unified Parkinson's Disease Rating Scale. Mobility scores, the amplitude, latency, and duration of the first saccade, and the number of saccades to reach the fixation target will be analyzed using an ANOVA of mixed effects. Discussion: This protocol holds promise as a potential method to improve voluntary saccade function in persons with PD. Should persons with PD not improve on any outcome following the intervention, this lack of response may support the use of saccade assessment as a response biomarker for the diagnosis of PD. Trial Registration: This protocol was retrospectively registered at ISRCTN (ISRCTN.com) since July 25, 2018. The first participant was recruited March 12, 2016. The protocol identifier is 17784042. Descriptive Title: A two-arm, pre/post-protocol to compare the effects of a four-week voluntary saccade training intervention in persons with Parkinson's disease and healthy adults aged forty years or older.
Collapse
Affiliation(s)
- Paul B Camacho
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Ronald Carbonari
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Sa Shen
- Center on Health, Aging and Disability, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Cindy Zadikoff
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Arthur F Kramer
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, United States.,Center for Cognitive and Brain Health, Department of Psychology, Northeastern University, Boston, MA, United States
| | - Citlali López-Ortiz
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States.,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, United States.,Center on Health, Aging and Disability, University of Illinois at Urbana-Champaign, Champaign, IL, United States.,Joffrey Ballet Academy, The Official School of the Joffrey Ballet, Chicago, IL, United States
| |
Collapse
|
18
|
Stuart S, Parrington L, Martini D, Popa B, Fino PC, King LA. Validation of a velocity-based algorithm to quantify saccades during walking and turning in mild traumatic brain injury and healthy controls. Physiol Meas 2019; 40:044006. [PMID: 30943463 PMCID: PMC7608620 DOI: 10.1088/1361-6579/ab159d] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Saccadic (fast) eye movements are a routine aspect of neurological examination and are a potential biomarker of mild traumatic brain injury (mTBI). Objective measurement of saccades has become a prominent focus of mTBI research, as eye movements may be a useful assessment tool for deficits in neural structures or processes. However, saccadic measurement within mobile infra-red (IR) eye-tracker raw data requires a valid algorithm. The objective of this study was to validate a velocity-based algorithm for saccade detection in IR eye-tracking raw data during walking (straight ahead and while turning) in people with mTBI and healthy controls. APPROACH Eye-tracking via a mobile IR Tobii Pro Glasses 2 eye-tracker (100 Hz) was performed in people with mTBI (n = 10) and healthy controls (n = 10). Participants completed two walking tasks: straight walking (walking back and forth for 1 min over a 10 m distance), and walking and turning (turns course included 45°, 90° and 135° turns). Five trials per subject, for one-hundred total trials, were completed. A previously reported velocity-based saccade detection algorithm was adapted and validated by assessing agreement between algorithm saccade detections and the number of correct saccade detections determined from manual video inspection (ground truth reference). MAIN RESULTS Compared with video inspection, the IR algorithm detected ~97% (n = 4888) and ~95% (n = 3699) of saccades made by people with mTBI and controls, respectively, with excellent agreement to the ground truth (intra-class correlation coefficient2,1 = .979 to .999). SIGNIFICANCE This study provides a simple yet highly robust algorithm for the processing of mobile eye-tracker raw data in mTBI and controls. Future studies may consider validating this algorithm with other IR eye-trackers and populations.
Collapse
Affiliation(s)
- Samuel Stuart
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States of America. Veterans Affairs Portland Health Care System, Portland, OR, United States of America. Author to whom any correspondence should be addressed
| | | | | | | | | | | |
Collapse
|
19
|
Stuart S, Hickey A, Vitorio R, Welman K, Foo S, Keen D, Godfrey A. Eye-tracker algorithms to detect saccades during static and dynamic tasks: a structured review. Physiol Meas 2019; 40:02TR01. [DOI: 10.1088/1361-6579/ab02ab] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
20
|
O’Keefe JA, Robertson EE, Ouyang B, Carnes D, McAsey A, Liu Y, Swanson M, Bernard B, Berry-Kravis E, Hall DA. Cognitive function impacts gait, functional mobility and falls in fragile X-associated tremor/ataxia syndrome. Gait Posture 2018; 66:288-293. [PMID: 30243213 PMCID: PMC6342509 DOI: 10.1016/j.gaitpost.2018.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/28/2018] [Accepted: 09/07/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Executive function and information processing speed deficits occur in fragile X premutation carriers (PMC) with and without fragile X-associated tremor/ataxia syndrome (FXTAS). Gait is negatively impacted by cognitive deficits in many patient populations resulting in increased morbidity and falls but these relationships have not been studied in FXTAS. RESEARCH QUESTION We sought to investigate the associations between executive function and information processing speed and gait, turning and falls in PMC with and without FXTAS compared to healthy controls. METHODS Global cognition and the cognitive domains of information processing speed, attention, response inhibition, working memory and verbal fluency were tested with a neuropsychological test battery in 18 PMC with FXTAS, 15 PMC without FXTAS, and 27 controls. An inertial sensor based instrumented Timed Up and Go was employed to test gait, turns and functional mobility. RESULTS Lower information processing speed was significantly associated with shorter stride length, reflecting slower gait speed, in PMC with FXTAS (p = 0.0006) but not PMC without FXTAS or controls. Lower response inhibition was also significantly associated with slower turn-to-sit times in PMC with FXTAS (p = 0.034) but not in those without FXTAS or controls. Lower information processing speed (p = 0.012) and working memory (p = 0.004), were significantly correlated with a greater number of self-reported falls in the past year in FXTAS participants. SIGNIFICANCE This is the first study demonstrating that worse executive function and slower information processing speed is associated with reduced gait speed and functional mobility, as well as with a higher retrospective fall history in participants with FXTAS. This information may be important in the design of cognitive and motor interventions for this neurodegenerative disorder.
Collapse
Affiliation(s)
- Joan A. O’Keefe
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Erin E. Robertson
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Danielle Carnes
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL
| | - Andrew McAsey
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL
| | - Yuanqing Liu
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Maija Swanson
- Rush Medical College, Rush University Medical Center, Chicago, IL
| | - Bryan Bernard
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Elizabeth Berry-Kravis
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL,Department of Pediatrics, Rush University Medical Center, Chicago, IL,Department of Biochemistry, Rush University Medical Center, Chicago, IL
| | - Deborah A Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| |
Collapse
|
21
|
Wu CC, Cao B, Dali V, Gagliardi C, Barthelemy OJ, Salazar RD, Pomplun M, Cronin-Golomb A, Yazdanbakhsh A. Eye movement control during visual pursuit in Parkinson's disease. PeerJ 2018; 6:e5442. [PMID: 30155357 PMCID: PMC6109371 DOI: 10.7717/peerj.5442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/24/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Prior studies of oculomotor function in Parkinson's disease (PD) have either focused on saccades without considering smooth pursuit, or tested smooth pursuit while excluding saccades. The present study investigated the control of saccadic eye movements during pursuit tasksand assessed the quality of binocular coordinationas potential sensitive markers of PD. METHODS Observers fixated on a central cross while a target moved toward it. Once the target reached the fixation cross, observers began to pursue the moving target. To further investigate binocular coordination, the moving target was presented on both eyes (binocular condition), or on one eye only (dichoptic condition). RESULTS The PD group made more saccades than age-matched normal control adults (NC) both during fixation and pursuit. The difference between left and right gaze positions increased over time during the pursuit period for PD but not for NC. The findings were not related to age, as NC and young-adult control group (YC) performed similarly on most of the eye movement measures, and were not correlated with classical measures of PD severity (e.g., Unified Parkinson's Disease Rating Scale (UPDRS) score). DISCUSSION Our results suggest that PD may be associated with impairment not only in saccade inhibition, but also in binocular coordination during pursuit, and these aspects of dysfunction may be useful in PD diagnosis or tracking of disease course.
Collapse
Affiliation(s)
- Chia-Chien Wu
- Center for Computational Neuroscience and Neural Technology, Boston University, Boston, MA, USA
| | - Bo Cao
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Veena Dali
- Center for Computational Neuroscience and Neural Technology, Boston University, Boston, MA, USA
| | - Celia Gagliardi
- Center for Computational Neuroscience and Neural Technology, Boston University, Boston, MA, USA
| | | | - Robert D. Salazar
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Marc Pomplun
- Department of Computer Science, University of Massachusetts at Boston, Boston, MA, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Arash Yazdanbakhsh
- Center for Computational Neuroscience and Neural Technology, Boston University, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| |
Collapse
|
22
|
Srivastava A, Ahmad OF, Pacia CP, Hallett M, Lungu C. The Relationship between Saccades and Locomotion. J Mov Disord 2018; 11:93-106. [PMID: 30086615 PMCID: PMC6182301 DOI: 10.14802/jmd.18018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 04/26/2018] [Indexed: 12/11/2022] Open
Abstract
Human locomotion involves a complex interplay among multiple brain regions and depends on constant feedback from the visual system. We summarize here the current understanding of the relationship among fixations, saccades, and gait as observed in studies sampling eye movements during locomotion, through a review of the literature and a synthesis of the relevant knowledge on the topic. A significant overlap in locomotor and saccadic neural circuitry exists that may support this relationship. Several animal studies have identified potential integration nodes between these overlapping circuitries. Behavioral studies that explored the relationship of saccadic and gait-related impairments in normal conditions and in various disease states are also discussed. Eye movements and locomotion share many underlying neural circuits, and further studies can leverage this interplay for diagnostic and therapeutic purposes.
Collapse
Affiliation(s)
- Anshul Srivastava
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Omar F Ahmad
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Christopher Pham Pacia
- Department of Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
23
|
Hunt D, Stuart S, Nell J, Hausdorff JM, Galna B, Rochester L, Alcock L. Do people with Parkinson’s disease look at task relevant stimuli when walking? An exploration of eye movements. Behav Brain Res 2018; 348:82-89. [DOI: 10.1016/j.bbr.2018.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 01/27/2023]
|
24
|
Rostosky CM, Milosevic I. Gait Analysis of Age-dependent Motor Impairments in Mice with Neurodegeneration. J Vis Exp 2018:57752. [PMID: 29985360 PMCID: PMC6101764 DOI: 10.3791/57752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Motor behavior tests are commonly used to determine the functional relevance of a rodent model and to test newly developed treatments in these animals. Specifically, gait analysis allows recapturing disease relevant phenotypes that are observed in human patients, especially in neurodegenerative diseases that affect motor abilities such as Parkinson's disease (PD), Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), and others. In early studies along this line, the measurement of gait parameters was laborious and depended on factors that were hard to control (e.g., running speed, continuous running). The development of ventral plane imaging (VPI) systems made it feasible to perform gait analysis at a large scale, making this method a useful tool for the assessment of motor behavior in rodents. Here, we present an in-depth protocol of how to use kinematic gait analysis to examine the age-dependent progression of motor deficits in mouse models of neurodegeneration; mouse lines with decreased levels of endophilin, in which neurodegenerative damage progressively increases with age, are used as an example.
Collapse
Affiliation(s)
| | - Ira Milosevic
- European Neuroscience Institute (ENI); University Medical Center Göttigen (UMG);
| |
Collapse
|
25
|
Turcato AM, Godi M, Giardini M, Arcolin I, Nardone A, Giordano A, Schieppati M. Abnormal gait pattern emerges during curved trajectories in high-functioning Parkinsonian patients walking in line at normal speed. PLoS One 2018; 13:e0197264. [PMID: 29750815 PMCID: PMC5947908 DOI: 10.1371/journal.pone.0197264] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/30/2018] [Indexed: 12/22/2022] Open
Abstract
Background Several patients with Parkinson´s disease (PD) can walk normally along straight trajectories, and impairment in their stride length and cadence may not be easily discernible. Do obvious abnormalities occur in these high-functioning patients when more challenging trajectories are travelled, such as circular paths, which normally implicate a graded modulation in the duration of the interlimb gait cycle phases? Methods We compared a cohort of well-treated mildly to moderately affected PD patients to a group of age-matched healthy subjects (HS), by deliberately including HS spontaneously walking at the same speed of the patients with PD. All participants performed, in random order: linear and circular walking (clockwise and counter-clockwise) at self-selected speed. By means of pressure-sensitive insoles, we recorded walking speed, cadence, duration of single support, double support, swing phase, and stride time. Stride length-cadence relationships were built for linear and curved walking. Stride-to-stride variability of temporal gait parameters was also estimated. Results Walking speed, cadence or stride length were not different between PD and HS during linear walking. Speed, cadence and stride length diminished during curved walking in both groups, stride length more in PD than HS. In PD compared to HS, the stride length-cadence relationship was altered during curved walking. Duration of the double-support phase was also increased during curved walking, as was variability of the single support, swing phase and double support phase. Conclusion The spatio-temporal gait pattern and variability are significantly modified in well-treated, high-functioning patients with PD walking along circular trajectories, even when they exhibit no changes in speed in straight-line walking. The increased variability of the gait phases during curved walking is an identifying characteristic of PD. We discuss our findings in term of interplay between control of balance and of locomotor progression: the former is challenged by curved trajectories even in high-functioning patients, while the latter may not be critically affected.
Collapse
Affiliation(s)
- Anna Maria Turcato
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Marco Godi
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
- * E-mail:
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Antonio Nardone
- Centro Studi Attività Motorie, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Neurorehabilitation and Spinal Units, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Giordano
- Unit of Bioengineering, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Marco Schieppati
- Department of Exercise & Sports Science, International University of Health, Exercise and Sports, LUNEX University, Differdange, Luxembourg
| |
Collapse
|
26
|
Stuart S, Lord S, Galna B, Rochester L. Saccade frequency response to visual cues during gait in Parkinson's disease: the selective role of attention. Eur J Neurosci 2018; 47:769-778. [PMID: 29431890 DOI: 10.1111/ejn.13864] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 12/01/2022]
Abstract
Gait impairment is a core feature of Parkinson's disease (PD) with implications for falls risk. Visual cues improve gait in PD, but the underlying mechanisms are unclear. Evidence suggests that attention and vision play an important role; however, the relative contribution from each is unclear. Measurement of visual exploration (specifically saccade frequency) during gait allows for real-time measurement of attention and vision. Understanding how visual cues influence visual exploration may allow inferences of the underlying mechanisms to response which could help to develop effective therapeutics. This study aimed to examine saccade frequency during gait in response to a visual cue in PD and older adults and investigate the roles of attention and vision in visual cue response in PD. A mobile eye-tracker measured saccade frequency during gait in 55 people with PD and 32 age-matched controls. Participants walked in a straight line with and without a visual cue (50 cm transverse lines) presented under single task and dual-task (concurrent digit span recall). Saccade frequency was reduced when walking in PD compared to controls; however, visual cues ameliorated saccadic deficit. Visual cues significantly increased saccade frequency in both PD and controls under both single task and dual-task. Attention rather than visual function was central to saccade frequency and gait response to visual cues in PD. In conclusion, this study highlights the impact of visual cues on visual exploration when walking and the important role of attention in PD. Understanding these complex features will help inform intervention development.
Collapse
Affiliation(s)
- Samuel Stuart
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.,Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Sue Lord
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.,School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Brook Galna
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.,School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|