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Bath JE, Wang DD. Unraveling the threads of stability: A review of the neurophysiology of postural control in Parkinson's disease. Neurotherapeutics 2024; 21:e00354. [PMID: 38579454 PMCID: PMC11000188 DOI: 10.1016/j.neurot.2024.e00354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/07/2024] Open
Abstract
Postural instability is a detrimental and often treatment-refractory symptom of Parkinson's disease. While many existing studies quantify the biomechanical deficits among various postural domains (static, anticipatory, and reactive) in this population, less is known regarding the neural network dysfunctions underlying these phenomena. This review will summarize current studies on the cortical and subcortical neural activities during postural responses in healthy subjects and those with Parkinson's disease. We will also review the effects of current therapies, including neuromodulation and feedback-based wearable devices, on postural instability symptoms. With recent advances in implantable devices that allow chronic, ambulatory neural data collection from patients with Parkinson's disease, combined with sensors that can quantify biomechanical measurements of postural responses, future work using these devices will enable better understanding of the neural mechanisms of postural control. Bridging this knowledge gap will be the critical first step towards developing novel neuromodulatory interventions to enhance the treatment of postural instability in Parkinson's disease.
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Affiliation(s)
- Jessica E Bath
- Department of Physical Therapy & Rehabilitation Science, University of California, San Francisco, USA; Department of Neurological Surgery, University of California, San Francisco, USA
| | - Doris D Wang
- Department of Neurological Surgery, University of California, San Francisco, USA.
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Monaghan AS, Ofori E, Fling BW, Peterson DS. Associating white matter microstructural integrity and improvements in reactive stepping in people with Parkinson's Disease. Brain Imaging Behav 2024:10.1007/s11682-024-00867-w. [PMID: 38530517 DOI: 10.1007/s11682-024-00867-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/28/2024]
Abstract
Reactive steps are rapid responses after balance challenges. People with Parkinson's Disease (PwPD) demonstrate impaired reactive stepping, increasing fall-risk. Although PwPD can improve steps through practice, the neural mechanisms contributing to improved reactive stepping are poorly understood. This study investigated white-matter correlates of responsiveness to reactive step training in PwPD. In an eighteen-week multiple-baseline study, participants (n = 22) underwent baseline assessments (B1 and B2 two-weeks apart), a two-week training protocol, and post-training assessments immediately (P1) and two-months (P2) post-training. Assessments involved three backward reactive step trials, measuring anterior-posterior margin of stability (AP MOS), step length, and step latency. Tract-Based Spatial Statistics correlated white-matter integrity (fractional anisotropy (FA) and radial diffusivity (RD)) with retained (P2-B2) and immediate improvements (P1-B2) in stepping. Significant and sustained improvements in step length and AP MOS were observed. Greater retention of step length improvement correlated with increased FA in the left anterior thalamic radiation (ATR), left posterior thalamic radiation (PTR), left superior longitudinal fasciculus (SLF), and right inferior longitudinal fasciculus (ILF). Step latency retention was associated with lower RD in the left posterior corona radiata and left PTR. Immediate improvements in AP MOS correlated with increased FA of the right ILF, right SLF, and right corticospinal tract. Immediate step length improvements were associated with increased FA in right and left ATR and right SLF. These findings highlight the importance of white-matter microstructural integrity in motor learning and retention processes in PD and could aid in identifying individuals with PD who would benefit most from balance rehabilitation.
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Affiliation(s)
- Andrew S Monaghan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Edward Ofori
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
- Molecular, Cellular and Integrative Neurosciences Program, Colorado State University, Fort Collins, USA
| | - Daniel S Peterson
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
- Phoenix VA Health Care Center, Phoenix, AZ, USA.
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Monaghan AS, Hooyman A, Dibble LE, Mehta SH, Peterson DS. Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease. J Neurol Phys Ther 2024:01253086-990000000-00061. [PMID: 38489661 DOI: 10.1097/npt.0000000000000471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND AND PURPOSE Reactive balance training improves reactive postural control in people with Parkinson disease (PwPD). However, the extent to which reactive balance training generalizes to a novel, unpracticed reactive balance task is unknown. This study aimed to determine whether reactive training stepping through support surface translations can be generalized to an unpracticed, instrumented tether-release task. METHODS Twenty-five PwPD (70.52 years ± 7.15; Hoehn and Yahr range 1-3) completed a multiple baseline, open-label, uncontrolled pre-post intervention study. Stepping was trained through a 2-week (6-session) intervention with repeated support surface translations. Performance on an untrained tether-release task (generalization task) was measured at 2 baseline assessments (B1 and B2, 2 weeks apart), immediately after the intervention (P1), and 2 months after training (P2). The tether-release task outcomes were the anterior-posterior margin of stability (MOS), step length, and step latency during backward and forward steps. RESULTS After support surface translation practice, tether-release stepping performance improved in MOS, step length, and step latency for both backward and forward steps compared to baseline (P < 0.05). Improvements in MOS and step length during backward and forward steps in the tether-release task, respectively, were related to stepping changes in the practiced task. However, the improvements in the generalization task were not retained for 2 months. DISCUSSION AND CONCLUSIONS These findings support short-term generalization from trained balance tasks to novel, untrained tasks. These findings contribute to our understanding of the effects and generalization of reactive step training in PwPD. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at http://links.lww.com/JNPT/A465).
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Affiliation(s)
- Andrew S Monaghan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, Georgia (A.S.M.); School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona (A.H.); Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah (L.E.D.); Department of Neurology, Mayo Clinic, Scottsdale, Arizona (S.H.M.); College of Health Solutions, Arizona State University, Tempe, Arizona (D.S.P.); and Phoenix VA Health Care Center, Phoenix, Arizona (D.S.P.)
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Valente HB, Gervazoni NDL, Laurino MJL, Stoco-Oliveira MC, Ribeiro F, de Carvalho AC, Vanderlei LCM, Garner DM. Monitoring autonomic responses in Parkinson's disease individuals: non-linear and chaotic global metrics of heart rate variability. Int J Neurosci 2024:1-11. [PMID: 38433652 DOI: 10.1080/00207454.2024.2325020] [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: 08/07/2023] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
AIM To examine and compare the autonomic responses, as assessed through the non-linear and chaotic global metrics of heart rate variability in two groups: the Parkinson's Disease Group (PDG) and the Control Group (CG), both at rest and during an active tilt test. METHODS The study encompassed 46 participants (PDG: n = 23; 73.73 ± 7.28 years old; CG: n = 23; 70.17 ± 8.20 years old). Initial data collection involved the acquisition of participant's characteristics. The autonomic modulation was estimated both at rest and during the active tilt test. For this assessment, we computed non-linear indices derived from five entropies (Approximate, Sample, Shannon, Renyi, Tsallis), Detrended Fluctuation Analysis and the seven chaotic global metrics (hsCFP1-hsCFP7). RESULTS At rest, the PDG exhibited lower values of hsCFP3 (0.818 ± 0.116 vs. 0.904 ± 0.065; p < 0.05) and Sample Entropy (0.720 ± 0.149 vs. 0.799 ± 0.171; p < 0.05). During the test, the PDG demonstrated lower values of ApEn, while the CG presented lower values of SampEn, hsCFP1, hsCFP3, hsCFP7, and higher values of hsCFP5. An interaction was observed, indicating that hsCFP1 and hsCFP3 exhibit differential behavior for the CG and PDG in response to the test. CONCLUSION subjects with PD exhibited reduced complexity of the RR interval series at rest, and a diminished autonomic response to the active tilt test when compared with the CG. The test, together with non-linear indices, may serve for assessing the Autonomic Nervous System in individuals with PD in a clinical setting. The interpretation of these data should be approached with caution, given the possible influences of pharmacotherapies and the inclusion of diabetic participants.
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Affiliation(s)
- Heloisa Balotari Valente
- Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Universidade Estadual Paulista "Júlio de Mesquita Filho", Presidente Prudente, Brazil
| | - Natacha de Lima Gervazoni
- Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Universidade Estadual Paulista "Júlio de Mesquita Filho", Presidente Prudente, Brazil
| | - Maria Júlia Lopez Laurino
- Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Universidade Estadual Paulista "Júlio de Mesquita Filho", Presidente Prudente, Brazil
| | - Mileide Cristina Stoco-Oliveira
- Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Universidade Estadual Paulista "Júlio de Mesquita Filho", Presidente Prudente, Brazil
| | - Felipe Ribeiro
- Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Universidade Estadual Paulista "Júlio de Mesquita Filho", Presidente Prudente, Brazil
| | - Augusto Cesinando de Carvalho
- Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Universidade Estadual Paulista "Júlio de Mesquita Filho", Presidente Prudente, Brazil
| | - Luiz Carlos Marques Vanderlei
- Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Universidade Estadual Paulista "Júlio de Mesquita Filho", Presidente Prudente, Brazil
| | - David M Garner
- Cardiorespiratory Research Group, Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Jasimi Zindashti N, Rahmati Z, Mohebbi A, Behzadipour S. A neuromechanical model characterizing the motor planning and posture control in the voluntary lean in Parkinson's disease. J Neuroeng Rehabil 2024; 21:25. [PMID: 38360634 PMCID: PMC10870456 DOI: 10.1186/s12984-024-01321-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Abstract
Parkinson's disease targets patients' cognitive and motor abilities, including postural control. Many studies have been carried out to introduce mathematical models for a better understanding of postural control in such patients and the relation between the model parameters and the clinical assessments. So far, these studies have addressed this connection merely in static tests, such as quiet stance. The aim of this study is to develop a model for voluntary lean, and as such, identify the model parameters for both PD patients and healthy subjects from experimental data. The proposed model comprises planning and control sections. The model parameters for the planning section were extracted from the time response characteristics. Parameters for the control section were identified based on the spatial characteristics of the center-of-pressure (COP) response using an optimization process. 24 PD patients along with 24 matched healthy subjects participated in the study. The results showed a significant difference between the two groups in terms of temporal parameters for the planning section. This difference emphasizes bradykinesia as an essential symptom of PD. Also, differences were found for the postural control section. In all directions, the proportional gain of the feedback controller was significantly larger in PD patients; however, the gain of the feedforward controller was significantly smaller in PD patients. Furthermore, the control gains were strongly correlated with the clinical scales (Functional Reach Test and Unified Parkinson's Disease Rating Scale) in certain directions. In conclusion, the new model helps to better understand and quantify some PD symptoms in voluntary lean tasks.
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Affiliation(s)
- Niromand Jasimi Zindashti
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
- Djawad Movafaghian Research Center in Rehab Technologies, Sharif University of Technology, Tehran, Iran
| | - Zahra Rahmati
- Djawad Movafaghian Research Center in Rehab Technologies, Sharif University of Technology, Tehran, Iran
| | - Abolfazl Mohebbi
- Department of Mechanical Engineering, École Polytechnique de Montréal, Montréal, Quebec, Canada
| | - Saeed Behzadipour
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.
- Djawad Movafaghian Research Center in Rehab Technologies, Sharif University of Technology, Tehran, Iran.
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Monaghan AS, Hooyman A, Dibble LE, Mehta SH, Peterson DS. Stability Changes in Fall-Prone Individuals With Parkinson Disease Following Reactive Step Training. J Neurol Phys Ther 2024; 48:46-53. [PMID: 37259190 DOI: 10.1097/npt.0000000000000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND PURPOSE Poor reactive steps may lead to falls in people with Parkinson disease (PwPD). However, whether reactive steps can be improved in PwPD at risk for falls or whether step training reduces falls remains unclear. This study aimed to determine whether 2 weeks of reactive step training result in (1) immediate and retained improvements in stepping and (2) fewer prospective falls in PwPD at fall risk. METHODS Twenty-five PwPD (70.52 years ± 7.15; Hoehn & Yahr range 1-3) at risk for falls completed a multiple baseline, open-label, uncontrolled pre-/postintervention study. Stepping performance was assessed at 2 baseline assessments (B1 and B2) followed by a 2-week, 6-session training protocol. Stepping was assessed immediately (P1) and 2 months after training (P2). Primary outcomes were anterior-posterior margin of stability (MOS), step length, and step latency during backward stepping. Fall frequency was measured for 2 months before and after training. RESULTS MOS during backward steps was significantly larger (better) after training ( P < 0.001, d = 0.83), and improvements were retained for 2 months ( P = 0.04, d = 0.66). Step length was not statistically significant different after training ( P = 0.13, d = 0.46) or at follow-up ( P = 0.08, d = 0.62), although effect sizes were medium and large, respectively. Step latency improved after initial exposure ( P = 0.01, d = 0.60) but not following training ( P = 0.43, d = 0.35). Twelve participants experienced fewer falls after training than before (10 = no change, 5 = increase; P = 0.12). Greater improvements in MOS were related to fewer falls ( P = 0.04). DISCUSSION AND CONCLUSIONS Two weeks of reactive step training resulted in immediate and retained improvements in some reactive stepping outcomes in PwPD at risk for falls and may reduce fall risk. Reactive step training may be a viable approach to reduce falls in PwPD.
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Affiliation(s)
- Andrew S Monaghan
- College of Health Solutions, Arizona State University, Phoenix (A.S.M., D.S.P.); School of Biological and Health Systems Engineering, Arizona State University, Tempe (A.H.); Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City (L.E.D.); Mayo Clinic, Scottsdale, Arizona (S.H.M.); and Phoenix VA Health Care Center, Phoenix, Arizona (D.S.P.)
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Heß T, Themann P, Oehlwein C, Milani TL. Does Impaired Plantar Cutaneous Vibration Perception Contribute to Axial Motor Symptoms in Parkinson's Disease? Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation. Brain Sci 2023; 13:1681. [PMID: 38137129 PMCID: PMC10742284 DOI: 10.3390/brainsci13121681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To investigate whether impaired plantar cutaneous vibration perception contributes to axial motor symptoms in Parkinson's disease (PD) and whether anti-parkinsonian medication and subthalamic nucleus deep brain stimulation (STN-DBS) show different effects. METHODS Three groups were evaluated: PD patients in the medication "on" state (PD-MED), PD patients in the medication "on" state and additionally "on" STN-DBS (PD-MED-DBS), as well as healthy subjects (HS) as reference. Motor performance was analyzed using a pressure distribution platform. Plantar cutaneous vibration perception thresholds (VPT) were investigated using a customized vibration exciter at 30 Hz. RESULTS Motor performance of PD-MED and PD-MED-DBS was characterized by greater postural sway, smaller limits of stability ranges, and slower gait due to shorter strides, fewer steps per minute, and broader stride widths compared to HS. Comparing patient groups, PD-MED-DBS showed better overall motor performance than PD-MED, particularly for the functional limits of stability and gait. VPTs were significantly higher for PD-MED compared to those of HS, which suggests impaired plantar cutaneous vibration perception in PD. However, PD-MED-DBS showed less impaired cutaneous vibration perception than PD-MED. CONCLUSIONS PD patients suffer from poor motor performance compared to healthy subjects. Anti-parkinsonian medication in tandem with STN-DBS seems to be superior for normalizing axial motor symptoms compared to medication alone. Plantar cutaneous vibration perception is impaired in PD patients, whereas anti-parkinsonian medication together with STN-DBS is superior for normalizing tactile cutaneous perception compared to medication alone. Consequently, based on our results and the findings of the literature, impaired plantar cutaneous vibration perception might contribute to axial motor symptoms in PD.
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Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Peter Themann
- Department of Neurology and Parkinson, Clinic at Tharandter Forest, 09633 Halsbruecke, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L. Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
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Rahmati Z, Behzadipour S, Taghizadeh G. Margins of postural stability in Parkinson's disease: an application of control theory. Front Bioeng Biotechnol 2023; 11:1226876. [PMID: 37781528 PMCID: PMC10539597 DOI: 10.3389/fbioe.2023.1226876] [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: 05/22/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction: Postural instability is a restrictive feature in Parkinson's disease (PD), usually assessed by clinical or laboratory tests. However, the exact quantification of postural stability, using stability theorems that take into account human dynamics, is still lacking. We investigated the feasibility of control theory and the Nyquist stability criterion-gain margin (GM) and phase margin (PM)-in discriminating postural instability in PD, as well as the effects of a balance-training program. Methods: Center-of-pressure (COP) data of 40 PD patients before and after a 4-week balance-training program, and 20 healthy control subjects (HCs) (Study1) as well as COP data of 20 other PD patients at four time points during a 6-week balance-training program (Study2), collected in two earlier studies, were used. COP was recorded in four tasks, two on a rigid surface and two on foam, both with eyes open and eyes closed. A postural control model (an inverted pendulum with a Proportional-integral-derivative (PID) controller and time delay) was fitted to the COP data to subject-specifically identify the model parameters thereby calculating |GM| and PM for each subject in each task. Results: PD patients had a smaller margin of stability (|GM| and PM) compared with HCs. Particularly, patients, unlike HCs, showed a drastic drop in PM on foam. Clinical outcomes and margins of stability improved in patients after balance training. |GM| improved early in week 4, followed by a plateau during the rest of the training. In contrast, PM improved late (week 6) in a relatively continuous-progression form. Conclusion: Using fundamental stability theorems is a promising technique for the standardized quantification of postural stability in various tasks.
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Affiliation(s)
- Zahra Rahmati
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Saeed Behzadipour
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
- Djawad Movafaghian Research Center in Neurorehab Technologies, Sharif University of Technology, Tehran, Iran
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Foster Vander Elst O, Foster NHD, Vuust P, Keller PE, Kringelbach ML. The Neuroscience of Dance: A Conceptual Framework and Systematic Review. Neurosci Biobehav Rev 2023; 150:105197. [PMID: 37100162 DOI: 10.1016/j.neubiorev.2023.105197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 04/13/2023] [Accepted: 04/21/2023] [Indexed: 04/28/2023]
Abstract
Ancient and culturally universal, dance pervades many areas of life and has multiple benefits. In this article, we provide a conceptual framework and systematic review, as a guide for researching the neuroscience of dance. We identified relevant articles following PRISMA guidelines, and summarised and evaluated all original results. We identified avenues for future research in: the interactive and collective aspects of dance; groove; dance performance; dance observation; and dance therapy. Furthermore, the interactive and collective aspects of dance constitute a vital part of the field but have received almost no attention from a neuroscientific perspective so far. Dance and music engage overlapping brain networks, including common regions involved in perception, action, and emotion. In music and dance, rhythm, melody, and harmony are processed in an active, sustained pleasure cycle giving rise to action, emotion, and learning, led by activity in specific hedonic brain networks. The neuroscience of dance is an exciting field, which may yield information concerning links between psychological processes and behaviour, human flourishing, and the concept of eudaimonia.
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Affiliation(s)
- Olivia Foster Vander Elst
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Denmark; Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, UK.
| | | | - Peter Vuust
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Denmark
| | - Peter E Keller
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Denmark; The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Australia
| | - Morten L Kringelbach
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Denmark; Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, UK; Department of Psychiatry, University of Oxford, UK
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Kwon DY, Kwon Y, Choi JA, Ko J, Kim JW. Quantitative Analysis of Postural Balance in Faller and Nonfaller Patients with Parkinson's Disease. PARKINSON'S DISEASE 2023; 2023:9688025. [PMID: 37383299 PMCID: PMC10299878 DOI: 10.1155/2023/9688025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/30/2023]
Abstract
Background Postural instability has been identified as a fall risk factor with a significant impact on the quality of life of patients with Parkinson's disease (PD). The aim of this study was to compare the center of pressure (COP) between faller and nonfaller patients with PD during static standing. Methods Thirty-two faller patients and 32 nonfaller patients with PD participated in this study. All patients performed the static balance test on a force plate. COP data were recorded during quiet standing. Mean distance, sway area, mean velocity, mean frequency, and peak power were derived from the COP data. Statistical analysis was performed using independent t-tests to compare faller and nonfaller patients. Results Fallers presented a greater average distance, wider sway area, faster average speed, and greater peak power than nonfallers (p < 0.05). In contrast, no significant group differences were observed in peak frequency and mean frequency (p > 0.05). Conclusions Although falls occur during dynamic activities, our study demonstrated that even a safe and simple static postural balance test could significantly differentiate between faller and nonfaller patients. Thus, these results suggest that quantitatively assessed static postural sway variables would be useful for distinguishing prospective fallers among PD patients.
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Affiliation(s)
- Do Young Kwon
- Department of Neurology, Korea University College of Medicine, Ansan-si 15355, Republic of Korea
| | - Yuri Kwon
- Department of Biomedical Engineering, Konkuk University, Chungju-si, Chungcheongbuk-do 27478, Republic of Korea
- Research Institute of Biomedical Engineering, Konkuk University, Chungju-si, Chungcheongbuk-do 27478, Republic of Korea
| | - Ji-An Choi
- Department of Biomedical Engineering, Konkuk University, Chungju-si, Chungcheongbuk-do 27478, Republic of Korea
| | - Junghyuk Ko
- Division of Mechanical Engineering, College of Engineering, Korea Maritime and Ocean University, Busan 49112, Republic of Korea
| | - Ji-Won Kim
- Department of Biomedical Engineering, Konkuk University, Chungju-si, Chungcheongbuk-do 27478, Republic of Korea
- Research Institute of Biomedical Engineering, Konkuk University, Chungju-si, Chungcheongbuk-do 27478, Republic of Korea
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Benjamin RS, Cushing SL, Blakeman AW, Campos JL, Papsin BC, Gordon KA. Evaluating the use of a balance prosthesis during balance perturbations in children and young adults with cochleovestibular dysfunction. Sci Rep 2023; 13:9721. [PMID: 37322114 PMCID: PMC10272120 DOI: 10.1038/s41598-023-36613-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
Study objectives were to: (1) quantify stability in children and young adults using cochlear implants with concurrent cochleovestibular dysfunction (CI-V) during balance perturbations and (2) to assess effects of an auditory head-referencing device (BalanCI) on their stability. The BalanCI provides auditory feedback via cochlear implants to cue posture and potentially avoid falling in children with CI-V. It was hypothesized that children and young adults with CI-V respond with larger movements to floor perturbations than typically-developing peers (controls) and that BalanCI use decreases these movements. Motion in response to treadmill perturbations was captured by markers on the head, torso, and feet in eight CI-V and 15 control participants. Stability (area under the curve of motion displacement) and peak displacement latencies were measured. The CI-V group demonstrated less stability and slower responses than the control group during medium and large backwards perturbations (p's < 0.01). In the CI-V group, BalanCI use improved stability during large backwards perturbations (p < 0.001), but worsened stability during large sideways perturbations (p's < 0.001). Children and young adults with CI-V move more to remain upright during perturbations than typically-developing peers. The BalanCI has potential to aid physical/vestibular therapy in children with CIs who have poor balance.
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Affiliation(s)
- Rebecca S Benjamin
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada
| | - Sharon L Cushing
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Alan W Blakeman
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer L Campos
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Blake C Papsin
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Karen A Gordon
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
- Department of Communication Disorders, Hospital for Sick Children, Toronto, ON, Canada.
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12
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Heß T, Oehlwein C, Milani TL. Anticipatory Postural Adjustments and Compensatory Postural Responses to Multidirectional Perturbations-Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease. Brain Sci 2023; 13:brainsci13030454. [PMID: 36979264 PMCID: PMC10046463 DOI: 10.3390/brainsci13030454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Postural instability is one of the most restricting motor symptoms for patients with Parkinson's disease (PD). While medication therapy only shows minor effects, it is still unclear whether medication in conjunction with deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves postural stability. Hence, the aim of this study was to investigate whether PD patients treated with medication in conjunction with STN-DBS have superior postural control compared to patients treated with medication alone. METHODS Three study groups were tested: PD patients on medication (PD-MED), PD patients on medication and on STN-DBS (PD-MED-DBS), and healthy elderly subjects (HS) as a reference. Postural performance, including anticipatory postural adjustments (APA) prior to perturbation onset and compensatory postural responses (CPR) following multidirectional horizontal perturbations, was analyzed using force plate and electromyography data. RESULTS Regardless of the treatment condition, both patient groups showed inadequate APA and CPR with early and pronounced antagonistic muscle co-contractions compared to healthy elderly subjects. Comparing the treatment conditions, study group PD-MED-DBS only showed minor advantages over group PD-MED. In particular, group PD-MED-DBS showed faster postural reflexes and tended to have more physiological co-contraction ratios. CONCLUSION medication in conjunction with STN-DBS may have positive effects on the timing and amplitude of postural control.
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Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
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13
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Lu C, Louie KH, Stutz AM, MacKinnon CD, Cooper SE. Postural instability in Parkinson's disease assessed with clinical "pull test" and standardized postural perturbations: effect of medication and body weight support. J Neurol 2023; 270:386-393. [PMID: 36100730 DOI: 10.1007/s00415-022-11375-6] [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: 05/19/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This experiment tested if balance performance differed between a standardized treadmill surface perturbation task and a clinical pull test and was affected by medication or the presence of body weight support in people with Parkinson's disease (PD). METHODS Twenty-seven individuals were tested (14 PD in both ON- and OFF-medication states). Clinical pull test and rapid forward (backward fall) translations of the support surface were applied to induce postural reactions requiring at least 1 step to restore balance. The effects of pull type (clinical vs. treadmill), partial bodyweight support (0 vs 20% body weight) and group (control, PD ON-meds and PD OFF-meds) on reactive stepping as well as practice/learning effect were examined. The number of steps taken and the first step duration were entered in linear repeated-measures mixed-effect models separately. RESULTS The effects of pull type, group, and bodyweight support were all significant in both metrics, as was ON- vs. OFF-medication. A significant interaction term (group x pull type) was found in the first step duration, showing that the group difference was greater in treadmill compared to the clinical pull test. A significant practice effect was also observed within and across testing sessions. CONCLUSIONS A standardized treadmill perturbation performed slightly better than the classical pull test in distinguishing between groups, and partial weight support did not substantially degrade the test's performance to detect the balance deficits in people with PD.
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Affiliation(s)
- Chiahao Lu
- Department of Neurology, University of Minnesota, 516E. 717 Delaware Building. 717 Delaware St. SE, Minneapolis, MN, 55414, USA.
| | - Kenneth H Louie
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55414, USA
- Department of Neurological Surgery, University of California, San Francisco, CA, 94143, USA
| | - Amber M Stutz
- Department of Neurology, University of Minnesota, 516E. 717 Delaware Building. 717 Delaware St. SE, Minneapolis, MN, 55414, USA
- Neurology, Sanford Brain and Spine Center, Fargo, ND, 58103, USA
| | - Colum D MacKinnon
- Department of Neurology, University of Minnesota, 516E. 717 Delaware Building. 717 Delaware St. SE, Minneapolis, MN, 55414, USA
| | - Scott E Cooper
- Department of Neurology, University of Minnesota, 516E. 717 Delaware Building. 717 Delaware St. SE, Minneapolis, MN, 55414, USA
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14
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Ünlüer NÖ, Ozkan T, Sari YA, Karadağ YS. Investigation of the relationship between trunk position sense and balance, functional mobility, fear of falling, and disease stage in Parkinson's disease. Ir J Med Sci 2022:10.1007/s11845-022-03192-7. [PMID: 36251108 DOI: 10.1007/s11845-022-03192-7] [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: 08/24/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Parameters related to trunk control such as balance disorders, mobility problems, and falling are frequently observed in patients with Parkinson's disease (PD). However, to provide a stable foundation for movement, trunk stability requires appropriate adequate position sense. The aim of the study was to examine the relationship between trunk position sense, balance, functional mobility, fear of falling, and disease stage in patients with PD. METHODS The study was conducted in 41 patients with PD (16 female and 25 male). Trunk position sense was assessed with a digital inclinometer, balance with functional reach test, Berg balance scale and one-leg stand test, functional mobility with timed up and go test, fear of falling with activity-specific balance confidence scale, and disease stage with Modified Hoehn and Yahr Scale (MHYS). All patients were tested during the "on" phase following drug therapy. RESULTS Repositioning error degree was related with MHYS, Berg balance scale, right and left one-leg stand test, forward functional reach test, timed up and go test, timed up and go test-cognitive and activity-specific balance confidence scale results in patients with PD (r = - 0.363/ - 0.609, p < 0.05 for all). CONCLUSION It was shown in the study that trunk position sense was associated with disease stage, balance level, functional mobility, and fear of falling in patients with PD. These results suggest that trunk position sense is more important to plan effective rehabilitation program for development and protection of disease stage, balance level, functional mobility, and fear of falling in patients with PD.
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Affiliation(s)
- Nezehat Özgül Ünlüer
- Faculty of Health Science, Physiotherapy and Rehabilitation, Ankara Yıldırım Beyazıt University, 06760, Ankara, Turkey.
| | - Taskin Ozkan
- Physiotherapy Program, Vocational School of Health Services, Giresun University, Giresun, Turkey
| | - Yasemin Ateş Sari
- Faculty of Health Science, Physiotherapy and Rehabilitation, Ankara Yıldırım Beyazıt University, 06760, Ankara, Turkey
| | - Yesim Sücüllü Karadağ
- Department of Neurology, Health Science University, Ankara City Hospital, Ankara, Turkey
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15
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Costa EDC, Santinelli FB, Moretto GF, Figueiredo C, von Ah Morano AE, Barela JA, Barbieri FA. A multiple domain postural control assessment in people with Parkinson's disease: traditional, non-linear, and rambling and trembling trajectories analysis. Gait Posture 2022; 97:130-136. [PMID: 35932689 DOI: 10.1016/j.gaitpost.2022.07.250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/06/2022] [Accepted: 07/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postural impairment is one of the most debilitating symptoms in people with Parkinson's disease (PD), which show faster and more variable oscillation during quiet stance than neurologically healthy individuals. Despite the center of pressure parameters can characterize PD's body sway, they are limited to uncover underlying mechanisms of postural stability and instability. RESEARCH QUESTION Do a multiple domain analysis, including postural adaptability and rambling and trembling components, explain underlying postural stability and instability mechanisms in people with PD? METHOD Twenty-four individuals (12 people with PD and 12 neurologically healthy peers) performed three 60-s trials of upright quiet standing on a force platform. Traditional and non-linear parameters (Detrended Fluctuation Analysis- DFA and Multiscale Entropy- MSE) and rambling and trembling trajectories were calculated for anterior-posterior (AP) and medial-lateral (ML) directions. RESULTS PDG's postural control was worse compared to CG, displaying longer displacement, higher velocity, and RMS. Univariate analyses revealed largely longer displacement and RMS only for the AP direction and largely higher velocity for both AP and ML directions. Also, PD individuals showed lower AP complexity, higher AP and ML DFA, and increased AP and ML displacement, velocity, and RMS of rambling and trembling components compared to neurologically healthy individuals. SIGNIFICANCE Based upon these results, people with PD have a lower capacity to adapt posture and impaired both rambling and trembling components compared to neurologically healthy individuals. These findings provide new insights to explain the larger, faster, and more variable sway in people with PD.
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Affiliation(s)
- Elisa de Carvalho Costa
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - Felipe Balistieri Santinelli
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Gabriel Felipe Moretto
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - Caique Figueiredo
- São Paulo State University (Unesp), School of Technology and Sciences, Department of Physical Education, Physical Education, Exercise and Immunometabolism Research Group, Presidente Prudente, SP, Brazil
| | - Ana Elisa von Ah Morano
- São Paulo State University (Unesp), School of Technology and Sciences, Department of Physical Education, Physical Education, Exercise and Immunometabolism Research Group, Presidente Prudente, SP, Brazil
| | - José Angelo Barela
- São Paulo State University (Unesp) - Institute of Biosciences, Department of Physical Education, Campus Rio Claro, SP, Brazil
| | - Fabio Augusto Barbieri
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil.
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16
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Beretta VS, Santos PCR, Orcioli-Silva D, Jaimes DAR, Pereira MP, Barbieri FA, Gobbi LTB. Cumulative additional information does not improve the neuromuscular control during postural responses to perturbations in postural instability/gait disorders subtype of Parkinson's disease. Exp Gerontol 2022; 166:111892. [PMID: 35811017 DOI: 10.1016/j.exger.2022.111892] [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: 02/03/2022] [Revised: 06/15/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Postural response impairments in postural instability and gait disorders (PIGD) subtype patients may be attributed to Parkinson's disease (PD)-deterioration in central-set (programing/modulating of central outputs during motor responses). Although additional information improves some PD motor impairments, an unanswered question is whether additional information can benefit postural response in PIGD subtype. OBJECTIVE To analyze the effect of cumulative additional information on postural responses after perturbation in PIGD and neurologically healthy older adults (CG). METHODS Perturbations were applied in 16 PIGD and 19 CG by the support-base translation. Participants performed 3 blocks of 5 trials without additional information (B1-B3, Day 1) and 5 trials of each cumulative additional information (C1-C4, Day 2): information about perturbation (C1), visual (C2), verbal (C3), and somatosensory information (C4). Electromyography and center of pressure (CoP) parameters were analyzed by ANOVAs with Group (PIGD × CG) and Block (B1 × B2 × B3) and with Group (PIGD × CG) and Condition (B3 × C1 × C2 × C3 × C4). RESULTS PIGD decreased the range of CoP in B3 while CG decreased both range of CoP and the integral of antagonist's muscle activity (iEMG) in B2. Also, PIGD decreased the recovery time in C4 while CG increased the iEMG of agonist's muscle in C2 and antagonist's muscle in all conditions except C2. CONCLUSION Additional information provided before postural control assessment influences the postural response in PIGD and CG differently. PIGD demonstrated inflexibility of central-set in modulating the neuromuscular control regardless of additional information. CG presents a flexible system evidenced by the increase of agonist muscle iEMG when provided visual information.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Paulo Cezar Rocha Santos
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Israel
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Campinas (UNICAMP), School of Applied Sciences (FCA), Laboratory of Applied Sport Physiology (LAFAE), Limeira, Brazil
| | - Diego Alejandro Rojas Jaimes
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of San Buenaventura Medellin, Graduate Program in Physical Education and Sports, Medellín, Colombia
| | - Marcelo Pinto Pereira
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Fabio Augusto Barbieri
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
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Valente HB, Gervazoni NDL, Laurino MJL, Vanzella LM, Stoco-Oliveira MC, Rodrigues MV, André LB, Ribeiro F, de Carvalho AC, Vanderlei LCM. Autonomic and cardiorespiratory responses to the active tilt test in individuals with Parkinson disease: cross-sectional study. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:689-698. [PMID: 36254441 PMCID: PMC9685817 DOI: 10.1055/s-0042-1755225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND The Parkinson disease (PD) is frequently associated with autonomic dysfunctions. However, data regarding the influence of PD on the autonomic responses to postural changes is limited. OBJECTIVE To analyze and compare the autonomic responses, evaluated through linear and non-linear methods of heart rate variability, and cardiorespiratory parameters in two groups: Parkinson disease (PDG) and control (CG), at rest and during the active tilt test. METHODS A total of 48 participants were analyzed (PDG: n = 25;73.40 ± 7.01 years / CG: n = 23;70.17 ± 8.20 years). The autonomic modulation and cardiorespiratory parameters were evaluated at rest and during the active tilt test. To assess the autonomic modulation the linear indices, at the time (rMSSD, SDNN) and frequency (LF, HF, LF/HF) domains, and the non-linear indices, obtained through the Poincaré plot (SD1, SD2, SD1/SD2), were calculated. The cardiorespiratory parameters evaluated were heart rate (HR), systolic (SBP), and diastolic blood pressure (DBP), peripheral oxygen saturation (SpO2), and respiratory rate. RESULTS At rest, the PDG presented significantly lower values of rMSSD, SDNN, LF, HF, SD1, SD2, and DBP, and higher values of SpO2. During test, in the PD group, modifications were observed in HR, and SBP, besides a reduced parasympathetic response, and an increased global modulation. The qualitative analysis of the Poincaré plot showed that the PDG has a lower dispersion of the RR intervals during rest and the active tilt test. CONCLUSION Individuals with PD present reduced global variability and parasympathetic modulation at rest, and reduced parasympathetic response and damage in HR regulation when performing the active tilt test, compared with controls.
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Affiliation(s)
- Heloisa Balotari Valente
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Natacha de Lima Gervazoni
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Maria Júlia Lopez Laurino
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Laís Manata Vanzella
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Mileide Cristina Stoco-Oliveira
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Mariana Viana Rodrigues
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Larissa Borba André
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Felipe Ribeiro
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Augusto Cesinando de Carvalho
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Luiz Carlos Marques Vanderlei
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
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Licen T, Rakusa M, Bohnen NI, Manganotti P, Marusic U. Brain Dynamics Underlying Preserved Cycling Ability in Patients With Parkinson's Disease and Freezing of Gait. Front Psychol 2022; 13:847703. [PMID: 35783714 PMCID: PMC9244145 DOI: 10.3389/fpsyg.2022.847703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Parkinson's disease (PD) is generally associated with abnormally increased beta band oscillations in the cortico-basal ganglia loop during walking. PD patients with freezing of gait (FOG) exhibit a more distinct, prolonged narrow band of beta oscillations that are locked to the initiation of movement at ∼18 Hz. Upon initiation of cycling movements, this oscillation has been reported to be weaker and rather brief in duration. Due to the suppression of the overall beta band power during cycling and its continuous nature of the movement, cycling is considered to be less demanding for cortical networks compared to walking, including reduced need for sensorimotor processing, and thus unimpaired continuous cycling motion. Furthermore, cycling has been considered one of the most efficient non-pharmacological therapies with an influence on the subthalamic nucleus (STN) beta rhythms implicative of the deep brain stimulation effects. In the current review, we provide an overview of the currently available studies and discuss the underlying mechanism of preserved cycling ability in relation to the FOG in PD patients. The mechanisms are presented in detail using a graphical scheme comparing cortical oscillations during walking and cycling in PD.
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Affiliation(s)
- Teja Licen
- Faculty of Medicine, Institute of Sports Medicine Maribor, University of Maribor, Maribor, Slovenia
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
| | - Martin Rakusa
- Division of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Nicolaas I. Bohnen
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, United States
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI, United States
- Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Trieste, Italy
| | - Uros Marusic
- Faculty of Medicine, Institute of Sports Medicine Maribor, University of Maribor, Maribor, Slovenia
- Department of Health Sciences, Alma Mater Europaea—ECM, Maribor, Slovenia
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Impact of pathological conditions on postural reflex latency and adaptability following unpredictable perturbations: A systematic review and meta-analysis. Gait Posture 2022; 95:149-159. [PMID: 35500364 DOI: 10.1016/j.gaitpost.2022.04.014] [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: 12/03/2021] [Revised: 04/01/2022] [Accepted: 04/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pathological conditions can impair responses to postural perturbations and increase risk of falls. RESEARCH QUESTION To what extent are postural reflexes impaired in people with pathological conditions and can exercise interventions shorten postural reflexes? METHODS MEDLINE, EMBASE, Scopus, SportDiscus and Web of Science were systematically searched for articles comparing muscle activation onset latency in people with pathological conditions to healthy controls following unpredictable perturbations including the effect of exercise interventions (registration: CRD42020170861). RESULTS Fifty-three articles were included for systematic review. Significant delays in muscle activity onset following perturbations were evident in people with multiple sclerosis (n = 7, mean difference [MD]: 22 ms, 95% confidence interval [CI]: 11, 33), stroke (n = 10, MD: 34 ms, 95% CI: 19, 49), diabetes (n = 2, MD: 19 ms, 95% CI: 10, 27), HIV (n = 3, MD: 9 ms, 95% CI: 4, 14), incomplete spinal cord injury (n = 2, MD: 57 ms, 95% CI: 33, 80) and back and knee pain (n = 7, MD: 12 ms, 95% CI: 6, 18), but not in people with Parkinson's disease (n = 10) or cerebellar dysfunction (n = 4). Following exercise interventions, the paretic limb of stroke survivors (n = 3) displayed significantly faster muscle activation onset latency compared to pre-exercise (MD: -13 ms, 95% CI: -24, -4), with no significant changes in Parkinson's disease (n = 3). CONCLUSIONS This systematic review demonstrated that postural reflexes are significantly delayed in people with multiple sclerosis (+22 ms), stroke (+34 ms), diabetes (+19 ms), HIV (+9 ms), incomplete spinal cord injury (+57 ms), back and knee pain (+12 ms); pathological conditions characterized by impaired sensation or neural function. In contrast, timing of postural reflexes was not impaired in people with Parkinson's disease and cerebellar dysfunction, confirming the limited involvement of supraspinal structures. The meta-analysis showed exercise interventions can significantly shorten postural reflex latencies in stroke survivors (-14 ms), but more research is needed to confirm this finding and in people with other pathological conditions.
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Stoco-Oliveira MC, Valente HB, Vanzella LM, André LB, Rodrigues MV, Vanderlei FM, Carvalho ACD, Vanderlei LCM. Does length of time since diagnosis in Parkinson's disease influence heart rate variability? A cross-sectional study. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:593-600. [PMID: 35613209 DOI: 10.1590/0004-282x-anp-2021-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intrinsic changes in Parkinson's disease (PD) affect the autonomic nervous system, and the disease course can aggravate the initial condition. Although the impact of time since disease onset on autonomic modulation has already been studied in other populations, this has not yet been investigated in PD. OBJECTIVE To investigate the impact of the length of time since diagnosis on the cardiac autonomic modulation of individuals with PD and compare with healthy individuals. METHODS Fifty participants were divided into three groups: a control group (CG; n = 24) and two groups with PD, divided according to the median length of time since diagnosis (median = 5.5 years): below the median (PG1; n = 13) and above the median (PG2; n = 13). To evaluate cardiac autonomic modulation, heart rate was obtained beat-to-beat in the supine position over a 30-min period, and heart rate variability (HRV) indices were calculated using linear methods in the time and frequency domains. RESULTS There were no significant differences in HRV indices between the PG groups, or between the three groups regarding Mean RR, LFun, HFun and LF/HF ratio. Significant reductions in the RMSSD, SDNN, pNN50, LFms2 and HFms2 indices were observed in PG1 and PG2, compared with CG. CONCLUSIONS The cardiac autonomic modulation of individuals with PD was not influenced by the time since diagnosis. However, reduced parasympathetic and global modulation were observed in these individuals, compared with controls. These results emphasize the importance of aerobic exercise for improving autonomic modulation among individuals with PD.
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Affiliation(s)
- Mileide Cristina Stoco-Oliveira
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Heloisa Balotari Valente
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Laís Manata Vanzella
- University Health Network, Toronto Rehabilitation Institute, East York ON, Canada
| | - Larissa Borba André
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Mariana Viana Rodrigues
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Franciele Marques Vanderlei
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Augusto Cesinando de Carvalho
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Luiz Carlos Marques Vanderlei
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
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21
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The Feasibility of Using the Virtual Time-to-Contact Measure of Postural Stability to Examine Postural Recovery in People With Diabetes Mellitus. Motor Control 2022; 26:181-193. [PMID: 35016156 DOI: 10.1123/mc.2021-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 11/18/2022]
Abstract
This study aimed to examine the feasibility of using time-to-contact measures during the perturbation protocol in people with diabetes mellitus. Three-dimension motion capture and force data were collected during 0.5-s perturbations in four directions (forward, backward, right, and left) and at two accelerations (20 and 40 cm/s2) to compute the time-to-contact. Time-to-contact analysis was divided into three phases: perturbation, initial recovery, and final recovery. The statistical analysis showed the main effects of Direction and Phase (p < .01) as well as a Direction by Phase interaction (p < .01). Backward perturbation with lower acceleration and backward/forward perturbation with higher acceleration had deleterious effects on postural stability in people with diabetes mellitus.
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Staying UpRight in Parkinson's disease: A pilot study of a novel wearable postural intervention. Gait Posture 2022; 91:86-93. [PMID: 34656009 DOI: 10.1016/j.gaitpost.2021.09.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This interventional pilot study aimed to 1) examine whether a novel wearable vibro-tactile feedback device ('UpRight Go') is effective and feasible to improve postural alignment in Parkinson's disease (PD); 2) explore relationships between postural alignment and attention in PD; 3) explore effect of vibro-tactile device on balance and gait; and 4) gain initial feedback on the use of the vibro-tactile device in the laboratory and at home. METHODS 25 people with PD sat, stood and walked for two-minutes without and with the UpRight device attached to their upper backs to provide feedback on postural alignment in the laboratory. A sub-group (n = 12) wore the UpRight device at home for 60 min. per day for 7-days of postural feedback. Subjective feedback on use of the device was obtained in the laboratory and at the end of the 7-day period. The primary outcome for this study was posture measured by verticality of inertial measurement units (IMUs) at the neck, trunk and low back, which was done with and without the UpRight device. Secondary outcomes included clinical measures of posture, subjective feedback on the device, computerized attention measures, gait and balance. RESULTS Neck postural alignment in PD was significantly improved (reduced neck flexion) with the UpRight during sitting and standing in both clinical measures (p = 0.005) and IMU outcomes (p = 0.046), but trunk and low back posture did not change. There was no change in postural alignment during walking with the UpRight. Postural alignment response was related to attentional capabilities. Many subjects (68 %) reported that they felt a benefit from the UpRight and most participants reported that the device was acceptable (Lab use; 72 %, Home use; 75 %). CONCLUSION The UpRight Go feedback device may improve neck/upper-back posture in PD during sitting and standing, but not during walking. Postural alignment response to the device may depend on attentional mechanisms.
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Amiaz R, Kimel Naor S, Caspi A, Czerniak E, Noy S, Pelc T, Mintz M, Plotnik M. Responses to balance challenges in persons with panic disorder: A pilot study of computerized static and dynamic balance measurements. Brain Behav 2022; 12:e2411. [PMID: 34843172 PMCID: PMC8785611 DOI: 10.1002/brb3.2411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 08/22/2021] [Accepted: 09/05/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Several studies have shown an association between panic disorder (PD) and reduced balance abilities, mainly based on functional balance scales. This pilot study aims to demonstrate the feasibility of studying balance abilities of persons with PD (PwPD) using computerized static and, for the first time, dynamic balance measurements in order to characterize balance control strategies employed by PwPD. METHODS Twelve PwPD and 11 healthy controls were recruited. PD diagnosis was confirmed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), and the severity of symptoms was evaluated using the Hamilton Anxiety Scale (HAM-A), PD Severity Scales (PDSS), and Panic and Agoraphobia Scale (PAS). Balance was clinically assessed using the Activities-Specific Balance Confidence (ABC) scale and physically by the Mini-Balance Evaluation Systems Test (Mini-BESTest). Dizziness was evaluated using the Dizziness Handicap Inventory (DHI) scale. Postural control was evaluated statically by measuring body sway and dynamically by measuring body responses to rapid unexpected physical perturbations. RESULTS PwPD had higher scores on the HAM-A (17.6 ± 10.3 vs. 3.0 ± 2.9; p < .001), PDSS (11.3 ± 5.1 vs. 0; p < .001), and PAS (20.3 ± 8.7 vs. 0; p < .001) questionnaires and lower scores on the balance scales compared to the controls (ABC scale: 156.2 ± 5.9 vs. 160 ± 0.0, p = .016; Mini-BESTest: 29.4 ± 2.1 vs. 31.4 ± 0.9, p = .014; DHI: 5.3 ± 4.4 vs. 0.09 ± 0.3, p < .001). In the static balance tests, PwPD showed a not-significantly smaller ellipse area of center of pressure trajectory (p = .36) and higher body sway velocity (p = .46), whereas in the dynamic balance tests, PwPD had shorter recovery time from physical perturbations in comparison to controls (2.1 ± 1.2s vs. 1.6 ± 0.9 s, p = .018). CONCLUSION The computerized balance tests results point to an adoption of a ''postural rigidity'' strategy by the PwPD, that is, reduced dynamic adaptations in the face of postural challenges. This may reflect a nonsecure compensatory behavior. Further research is needed to delineate this strategy.
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Affiliation(s)
- Revital Amiaz
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Kimel Naor
- The Center of Advanced Technologies in Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Asaf Caspi
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Czerniak
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Noy
- Psychiatry Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tatiana Pelc
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Matti Mintz
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Meir Plotnik
- The Center of Advanced Technologies in Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Araújo-Silva F, Santinelli FB, Felipe I Imaizumi L, Silveira APB, Vieira LHP, Alcock L, Barbieri FA. Temporal dynamics of cortical activity and postural control in response to the first levodopa dose of the day in people with Parkinson's disease. Brain Res 2021; 1775:147727. [PMID: 34788638 DOI: 10.1016/j.brainres.2021.147727] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Our understanding of how balance control responds to levodopa over the course of a single day in people with Parkinson's disease (PD) is limited with the majority of studies focused on isolated comparisons of ON vs. OFF levodopa medication. OBJECTIVE To evaluate the temporal dynamics of postural control following the first levodopa dose of the day during a challenging standing task in a group of people with PD. METHODS Changes in postural control were evaluated by monitoring cortical activity (covering frontal, motor, parietal and occipital areas), body sway parameters (force platform), and lower limb muscle activity (tibialis anterior and gastrocnemius medialis) in 15 individuals with PD during a semi-tandem standing task. Participants were assessed during two 60 second trials every 30 minutes (ON-30 ON-60 etc.) for 3 hours after the first matinal dose (ON-180). RESULTS Compared to when tested OFF-medication, cortical activity was increased across all four regions from ON-60 to ON-120 with early increases in alpha and beta band activity observed at ON-30. Levodopa was associated with increased gastrocnemius medialis activity (ON-30 to ON-120) and ankle co-contraction (ON-60 to ON-120). Changes in body sway outcomes (particularly in the anterior-posterior direction) were evident from ON-60 to ON-120. CONCLUSIONS Our results reveal a 60-minute window within which postural control outcomes may be obtained that are different compared to OFF-state and remain stable (from 60-minutes to 120-minutes after levodopa intake). Identifying a window of opportunity for measurement when individuals are optimally medicated is important for observations in a clinical and research setting.
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Affiliation(s)
- Fabiana Araújo-Silva
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Felipe B Santinelli
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Luis Felipe I Imaizumi
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Aline P B Silveira
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Luiz H P Vieira
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne, UK
| | - Fabio A Barbieri
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil.
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Eldeeb HM, Abdelraheem HS. Functional gait assessment in early and advanced Parkinson’s disease. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00399-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Postural instability and balance problems in patients with Parkinson’s disease (PD) can seriously affect the quality of life and lead to falls with a subsequent increase in the morbidity and mortality. Early identification of gait dysfunction in early stages of PD establishes an effective therapy, prevention of the falls and reducing health care costs. This work aimed to detect gait disorders in patients with PD using the functional gait assessment (FGA) scale and to correlate it with the disease severity in Egyptian PD patients. This is a case–control study in which 40 patients with PD were recruited from the Involuntary Movement Clinic at Alexandria University El-Hadara Hspoital; 20 patients had early stages of PD (Hoehn Yahr stages 1 and 2) and 20 patients had advanced PD (Hoehn Yahr stages 3 and 4). Another 20 subjects were recruited as controls. All recruited subjects underwent gait assessment using FGA scale.
Results
Gait analysis using FGA showed significant differences (P < 0.001) between the recruited PD patients and the control group. Upon comparing the early and advanced PD patients’ groups, certain items in the FGA (gait with pivot turn, step over obstacle, gait with eyes closed and backward gait) together with time consumed for 6-m walk with eyes open and close showed significant statistical differences between early and advanced PD patients. The patients’ duration of illness with PD was reversely correlated with the total FGA score.
Conclusion
The FGA scale was strongly influenced by the duration of PD among the Egyptian patients and can potentially detect early stages of PD.
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Hallett M, DelRosso LM, Elble R, Ferri R, Horak FB, Lehericy S, Mancini M, Matsuhashi M, Matsumoto R, Muthuraman M, Raethjen J, Shibasaki H. Evaluation of movement and brain activity. Clin Neurophysiol 2021; 132:2608-2638. [PMID: 34488012 PMCID: PMC8478902 DOI: 10.1016/j.clinph.2021.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/07/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
Clinical neurophysiology studies can contribute important information about the physiology of human movement and the pathophysiology and diagnosis of different movement disorders. Some techniques can be accomplished in a routine clinical neurophysiology laboratory and others require some special equipment. This review, initiating a series of articles on this topic, focuses on the methods and techniques. The methods reviewed include EMG, EEG, MEG, evoked potentials, coherence, accelerometry, posturography (balance), gait, and sleep studies. Functional MRI (fMRI) is also reviewed as a physiological method that can be used independently or together with other methods. A few applications to patients with movement disorders are discussed as examples, but the detailed applications will be the subject of other articles.
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Affiliation(s)
- Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA.
| | | | - Rodger Elble
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | | | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Stephan Lehericy
- Paris Brain Institute (ICM), Centre de NeuroImagerie de Recherche (CENIR), Team "Movement, Investigations and Therapeutics" (MOV'IT), INSERM U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Masao Matsuhashi
- Department of Epilepsy, Movement Disorders and Physiology, Kyoto University Graduate, School of Medicine, Japan
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, Japan
| | - Muthuraman Muthuraman
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing unit, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jan Raethjen
- Neurology Outpatient Clinic, Preusserstr. 1-9, 24105 Kiel, Germany
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Monaghan AS, Finley JM, Mehta SH, Peterson DS. Assessing the impact of dual-task reactive step practice in people with Parkinson's disease: A feasibility study. Hum Mov Sci 2021; 80:102876. [PMID: 34534945 DOI: 10.1016/j.humov.2021.102876] [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: 11/20/2020] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022]
Abstract
Reactive stepping is impaired in people with Parkinson's Disease (PD) but can be improved with training. However, it is unclear if reactive steps can be improved when performing a concurrent cognitive task, a common and fall-relevant circumstance. We assessed the feasibility and preliminary effectiveness of dual-task reactive step training. Specifically, we measured whether stepping and cognitive reaction time are improved after one day of dual-task reactive step practice and if improvements are retained 24 h later. Sixteen people with PD and 13 age-matched healthy controls (HC) underwent repeated from-stance support surface perturbations that elicited a reactive step while performing an auditory Stroop task. Participants returned the following day to reassess dual-task reactive stepping performance. Cognitive, neuromuscular, and stepping outcomes were calculated. Increased step lengths were observed for both groups after practice (p < 0.001). Cognitive reaction times also improved through practice; however, this was more pronounced in the HC group (group by time interaction- p < 0.001). No changes were observed for step latency, margin of stability, or EMG onset through practice. Step length and cognitive reaction time improvements were retained 24 h after practice in both groups (step length: p < 0.001; cognitive reaction time: p = 0.05). This study provides preliminary evidence for the effectiveness of dual-task reactive step training to improve step length in people with PD. The improvements in step length without compromising cognitive reaction times suggest that participants improved reactive stepping without a robust attention shift toward the postural task. Future research is necessary to determine optimal training protocols and determine if such training protocols impact falls in PD patients.
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Affiliation(s)
- Andrew S Monaghan
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - James M Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | | | - Daniel S Peterson
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA; Phoenix VA Health Care Center, Phoenix, AZ, USA.
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Zampogna A, Mileti I, Martelli F, Paoloni M, Del Prete Z, Palermo E, Suppa A. Early balance impairment in Parkinson's Disease: Evidence from Robot-assisted axial rotations. Clin Neurophysiol 2021; 132:2422-2430. [PMID: 34454269 DOI: 10.1016/j.clinph.2021.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/27/2021] [Accepted: 06/06/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Early postural instability (PI) is a red flag for the diagnosis of Parkinson's disease (PD). Several patients, however, fall within the first three years of disease, particularly when turning. We investigated whether PD patients, without clinically overt PI, manifest abnormal reactive postural responses to ecological perturbations resembling turning. METHODS Fifteen healthy subjects and 20 patients without clinically overt PI, under and not under L-Dopa, underwent dynamic posturography during axial rotations around the longitudinal axis, provided by a robotic mechatronic platform. We measured reactive postural responses, including body displacement and reciprocal movements of the head, trunk, and pelvis, by using a network of three wearable inertial sensors. RESULTS Patients showed higher body displacement of the head, trunk and pelvis, and lower joint movements at the lumbo-sacral junction than controls. Conversely, movements at the cranio-cervical junction were normal in PD. L-Dopa left reactive postural responses unchanged. CONCLUSIONS Patients with PD without clinically overt PI manifest abnormal reactive postural responses to axial rotations, unresponsive to L-Dopa. The biomechanical model resulting from our experimental approach supports novel pathophysiological hypotheses of abnormal axial rotations in PD. SIGNIFICANCE PD patients without clinically overt PI present subclinical balance impairment during axial rotations, unresponsive to L-Dopa.
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Affiliation(s)
- Alessandro Zampogna
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Ilaria Mileti
- Mechanical Measurements and Microelectronics (M3Lab) Lab, Engineering Department, University Niccolò Cusano, 00166 Rome, Italy
| | - Francesca Martelli
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, 00184 Rome, Italy
| | - Marco Paoloni
- Department of Physical Medicine and Rehabilitation, Sapienza University of Rome, 00161 Rome, Italy
| | - Zaccaria Del Prete
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, 00184 Rome, Italy
| | - Eduardo Palermo
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, 00184 Rome, Italy
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; IRCCS Neuromed, 86077 Pozzilli, IS, Italy.
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Papa EV, Patterson RM, Bugnariu N. "Going Backward": Effects of age and fatigue on posterior-directed falls in Parkinson disease. NeuroRehabilitation 2021; 49:151-159. [PMID: 34180424 DOI: 10.3233/nre-210040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nearly half of persons with Parkinson disease (PD) report fatigue as a factor in their fall history. However, it is unknown whether these self-reported falls are caused by a sensation of fatigue or performance fatigue. OBJECTIVE We sought to investigate the influences of performance fatigue and age on postural control in persons with PD. METHODS Individuals with PD (n = 14) underwent postural control assessments before (T0) and immediately after (T1) fatiguing exercise. Biomechanical data were gathered on participants completing a treadmill-induced, posterior-directed fall. Performance fatigue was produced using lower extremity resistance exercise on an isokinetic ergometer. Repeated measures ANCOVAs were used with age as a covariate to determine the effects of performance fatigue on biomechanical variables. RESULTS After adjustment for age, there was a statistically significant difference in peak center of pressure (COP) latency during the support phase of recovery. Pairwise comparisons demonstrated a decrease in peak ankle displacement from T0 to T1. Age was also found to be significantly related to reaction time and peak knee displacement while participants were fatigued. CONCLUSIONS The decreased peak COP latency, along with decreased ankle angular displacement, suggest that persons with PD adopt a stiffening strategy in response to backward directed falls. Postural stiffening is not uncommon in persons with PD and could be a risk factor for falls. Older individuals with PD demonstrate slower mobility scores and decreased reaction times in the setting of fatigue, suggesting a combined effect of the aging and fatigue processes.
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Affiliation(s)
- Evan V Papa
- School of Rehabilitation and Communication Sciences, Idaho State University, Meridian, ID, USA
| | - Rita M Patterson
- University of North Texas Health Science Center, Fort Worth, TX, USA
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Abnormal center of mass feedback responses during balance: A potential biomarker of falls in Parkinson's disease. PLoS One 2021; 16:e0252119. [PMID: 34043678 PMCID: PMC8158870 DOI: 10.1371/journal.pone.0252119] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/10/2021] [Indexed: 02/01/2023] Open
Abstract
Although Parkinson disease (PD) causes profound balance impairments, we know very little about how PD impacts the sensorimotor networks we rely on for automatically maintaining balance control. In young healthy people and animals, muscles are activated in a precise temporal and spatial organization when the center of body mass (CoM) is unexpectedly moved that is largely automatic and determined by feedback of CoM motion. Here, we show that PD alters the sensitivity of the sensorimotor feedback transformation. Importantly, sensorimotor feedback transformations for balance in PD remain temporally precise, but become spatially diffuse by recruiting additional muscle activity in antagonist muscles during balance responses. The abnormal antagonist muscle activity remains precisely time-locked to sensorimotor feedback signals encoding undesirable motion of the body in space. Further, among people with PD, the sensitivity of abnormal antagonist muscle activity to CoM motion varies directly with the number of recent falls. Our work shows that in people with PD, sensorimotor feedback transformations for balance are intact but disinhibited in antagonist muscles, likely contributing to balance deficits and falls.
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Bliss RR, Church FC. Golf as a Physical Activity to Potentially Reduce the Risk of Falls in Older Adults with Parkinson's Disease. Sports (Basel) 2021; 9:sports9060072. [PMID: 34070988 PMCID: PMC8224548 DOI: 10.3390/sports9060072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 12/11/2022] Open
Abstract
Advanced age is associated with an increased risk for falls in aging adults. Older adults are also more likely to be diagnosed with Parkinson’s disease (PD), with advanced age as the most significant risk factor. PD is a neurodegenerative disorder with four Cardinal motor symptoms: rigidity, bradykinesia, postural instability, and tremor. Thus, people (person)-with-Parkinson’s disease (PwP) have an even greater risk of falling than non-disorder age-matched peers. Exercise is an activity requiring physical effort, typically carried out to sustain or improve overall health and fitness, and it lowers the risk of falls in the general population. The sport of golf provides a low-impact all-around workout promoting a range of motion, activation of muscles in the upper and lower body, flexibility, and balance. Swinging a golf club offers a unique combination of high amplitude axial rotation, strengthening postural musculature, coordination, and stabilization, demonstrating the potential to impact PD symptoms positively. Golf may be a novel exercise treatment regimen for PD to use in conjunction with traditional medical therapy. We completed a literature review to determine the relationship between the game of golf, PD, and the risk of falls. We concluded that regularly playing golf can lower the risk for falls in community ambulating older adults with PD and demonstrates the potential to improve quality of life for PwP.
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Affiliation(s)
| | - Frank C. Church
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
- Correspondence:
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Roberts BWR, Atkinson DA, Manson GA, Markley R, Kaldis T, Britz GW, Horner PJ, Vette AH, Sayenko DG. Transcutaneous spinal cord stimulation improves postural stability in individuals with multiple sclerosis. Mult Scler Relat Disord 2021; 52:103009. [PMID: 34023772 DOI: 10.1016/j.msard.2021.103009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/09/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Widespread demyelination in the central nervous system can lead to progressive sensorimotor impairments following multiple sclerosis, with compromised postural stability during standing being a common consequence. As such, clinical strategies are needed to improve postural stability following multiple sclerosis. The objective of this study was therefore to investigate the effect of non-invasive transcutaneous spinal stimulation on postural stability during upright standing in individuals with multiple sclerosis. METHODS Center of pressure displacement and electromyograms from the soleus and tibialis anterior were recorded in seven individuals with multiple sclerosis during standing without and with transcutaneous spinal stimulation. Center of pressure and muscle activity measures were calculated and compared between no stimulation and transcutaneous spinal stimulation conditions. The relationship between the center of pressure displacement and electromyograms was quantified using cross-correlation analysis. RESULTS For transcutaneous spinal stimulation, postural stability was significantly improved during standing with eyes closed: the time- and frequency-domain measures obtained from the anterior-posterior center of pressure fluctuation decreased and increased, respectively, and the tibialis anterior activity was lower compared to no stimulation. Conversely, no differences were found between no stimulation and transcutaneous spinal stimulation when standing with eyes open. CONCLUSION Following multiple sclerosis, transcutaneous spinal stimulation improved postural stability during standing with eyes closed, presumably by catalyzing proprioceptive function. Future work should confirm underlying mechanisms and explore the clinical value of transcutaneous spinal stimulation for individuals with multiple sclerosis.
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Affiliation(s)
- Brad W R Roberts
- Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, Alberta, T6G 1H9, Canada.
| | - Darryn A Atkinson
- College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, 5401 La Crosse Avenue, Austin, TX, 78739, United States.
| | - Gerome A Manson
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX, 77030, United States.
| | - Rachel Markley
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX, 77030, United States.
| | - Teresa Kaldis
- Department of Physical Medicine and Rehabilitation, Center for Neuroregeneration, Houston Methodist Research Institute, 6560 Fannin Street, Houston, TX, 77030, United States.
| | - Gavin W Britz
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX, 77030, United States.
| | - Philip J Horner
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX, 77030, United States.
| | - Albert H Vette
- Department of Mechanical Engineering, University of Alberta, 9211 116 Street NW, Edmonton, Alberta, T6G 1H9, Canada; Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 111 Avenue NW, Edmonton, Alberta, T5G 0B7, Canada; Neuroscience and Mental Health Institute, University of Alberta, 87 Avenue & 112 Street, Edmonton, Alberta, T6G 2E1, Canada.
| | - Dimitry G Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, 6550 Fannin Street, Houston, TX, 77030, United States.
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Beretta VS, Carpenter MG, Barbieri FA, Santos PCR, Orcioli-Silva D, Pereira MP, Gobbi LTB. Does the impaired postural control in Parkinson's disease affect the habituation to non-sequential external perturbation trials? Clin Biomech (Bristol, Avon) 2021; 85:105363. [PMID: 33932865 DOI: 10.1016/j.clinbiomech.2021.105363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND How people with Parkinson's disease habituate their postural response to unpredictable translation perturbation is not totally understood. We compared the capacity to change the postural responses after unexpected external perturbation and investigated the habituation plateaus of postural responses to non-sequential perturbation trials in people with Parkinson's disease and healthy older adults. METHODS In people with Parkinson's disease (n = 37) and older adults (n = 20), sudden posterior support-surface translational were applied in 7 out of 17 randomized trials to ensure perturbation unpredictability. Electromyography and center of pressure parameters of postural response were analyzed by ANOVAs (Group vs. Trials). Two simple planned contrasts were performed to determine at which trial the responses first significantly habituate, and by which trials the habituation plateaus. FINDINGS Older adults demonstrated a first response change in trial 5 and habituation plateaus after trial 4, while for people with Parkinson's disease, the first change occurred in trial 2 and habituation plateau after trial 5 observed by center of pressure range. People with Parkinson's disease demonstrated a greater center of pressure range in trial 1 compared to older adults. Independent of trial, people with Parkinson's disease vs. older adults demonstrated a greater ankle muscle co-activation and recovery time. INTERPRETATION Despite the greater center of pressure range in the first trial, people with Parkinson's disease can habituate to unpredictable perturbations. This is reflected by little, to no difference in the time-course of adaptation for all but 2 parameters that showed only marginal differences between people with Parkinson's disease and older adults.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Mark Gregory Carpenter
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabio Augusto Barbieri
- São Paulo State University (Unesp), School of Sciences, Graduate Program in Movement Sciences, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Paulo Cezar Rocha Santos
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Marcelo Pinto Pereira
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
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Genoves GG, Cruz CF, Doná F, Andrade TAM, Ferraz HB, Barela JA. Detection of passive movement in lower limb joints is impaired in individuals with Parkinson's disease. Neurophysiol Clin 2021; 51:279-285. [PMID: 33934993 DOI: 10.1016/j.neucli.2021.03.005] [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: 12/08/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Sensory information is crucial when performing daily activities, and Parkinson's disease may diminish sensitivity to sensory cues. This study aimed to examine the detection threshold of passive motion of knee and ankle joints in individuals with Parkinson's disease. METHODS Eighteen individuals in the early stages of idiopathic Parkinson's disease (age: 62.7 ± 7.3 years) and 18 healthy matched controls (age: 62.5 ± 7.1 years) first performed a simple reaction time test. Participants were asked to perform ten trials, during which they had to watch a square on a screen and press a button as quickly as possible when the square lit up. Thereafter, the participants were tested for their detection threshold of passive motion of their lower limb joints. Participants were seated in a specially designed chair and their knee or ankle joint was passively moved at a velocity of 0.5º/s. Participants kept their eyes closed and were instructed to press a button as quickly as possible when any joint motion was detected. RESULTS Individuals with Parkinson's disease needed more time to perform the reaction time test than did the control participants. Individuals with Parkinson's disease also needed larger angular displacement, even when reaction time was used as a covariate measure, to detect any passive motion, in both knee (0.70º ± 0.20º) and ankle (1.03º ± 0.23º) joints than did the control participants [(0.57º ± 0.20º) and (0.84º ± 0.27º), respectively]. CONCLUSION Impaired joint proprioception can be observed in the early stages of Parkinson's disease, which may compromise the use of proprioception cues from lower limbs.
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Affiliation(s)
- Giovanna Gracioli Genoves
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - Caio Ferraz Cruz
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil
| | - Flávia Doná
- Federal University of São Paulo, São Paulo, SP, Brazil
| | | | | | - José Angelo Barela
- Institute of Biosciences, São Paulo State University, Rio Claro, SP, Brazil.
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Quantitative Analysis of Postural Instability in Patients with Parkinson's Disease. PARKINSONS DISEASE 2021; 2021:5681870. [PMID: 33936583 PMCID: PMC8060093 DOI: 10.1155/2021/5681870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022]
Abstract
Introduction Postural instability is commonly observed in Parkinson's disease, leading to an increasing risk of falling and worsening as the disease progresses. We found that limit of stability can be applied to reflect the dynamic evolution of postural instability in patients with Parkinson's disease. Methods Forty-three patients (9 of Hoehn and Yahr stage I, 12 of stage II, 14 of stage III, and 8 of stage IV) met the criteria for the diagnosis of idiopathic Parkinson's disease and could stand independently for at least 10 minutes. Twelve healthy controls with no sign of parkinsonism were also recruited. Postural instability was assessed by posturography in different directions (forward, backward, right, left, forward-right, forward-left, backward-right, and backward-left). This study trial was registered with the Chinese Clinical Trial Registry (no. ChiCTR1900022715). Results All participants were able to complete the limit of stability tasks without any complications. Patients in stages II to IV exhibited smaller end point excursion and slower time to complete than controls, suggesting an impaired limit of stability. The patients in stage II exhibited a remarkable decline in most directions compared to controls, except for right and left, and forward and backward decline occurred the earliest. For patients in stage III, right was the only direction with no significant difference from controls. In stage IV patients, the limit of stability declined significantly in all directions (p < 0.05). Conclusions The postural abnormalities of Parkinson's disease can occur at early stages, and the pattern of decline is more severe in the forward-backward direction. This trial is registered with ChiCTR1900022715.
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Siragy T, Hill A, Nantel J. Recovery of dynamic stability during slips unaffected by arm swing in people with Parkinson's Disease. PLoS One 2021; 16:e0249303. [PMID: 33822806 PMCID: PMC8023478 DOI: 10.1371/journal.pone.0249303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/15/2021] [Indexed: 11/18/2022] Open
Abstract
The arm elevation strategy assists in recovering stability during slips in healthy young and elderly individuals. However, in people with Parkinson's Disease, one of the main motor symptoms affecting the upper limbs is reduced arm swing which intensifies throughout the course of the disease before becoming absent. This holds direct implications for these individuals when encountering slips as the arm elevation strategy is an integral component in the interlimb slip response to restore stability. Arm swing's effect in recovering from slips in people with Parkinson's Disease though remains unexamined. Twenty people with Parkinson's Disease (63.78 ± 8.97 years) walked with restricted and unrestricted arm swing conditions on a dual-belt treadmill where slips were induced on the least and most affected sides. Data were collected on the CAREN Extended System (Motek Medical, Amsterdam, NL). The Margin of Stability, linear and angular trunk velocities, as well as step length, time, and width were calculated. Data were examined during the slipped step and recovery step. The restricted arm swing condition, compared to unrestricted, caused a faster step time during the slipped step. Compared to the most affected leg, the least affected had a wider step width during the slipped step. During the recovery step, the least affected leg had a larger anteroposterior Margin of Stability and longer step time than the most affected. No differences between our arm swing conditions suggests that the normal arm swing in our participants was not more effective at restoring stability after an induced slip compared to when their arm motion was restricted. This may be due to the arm elevation strategy being ineffective in counteracting the slip's backward destabilization in these individuals. Differences between the legs revealed that our participants were asymmetrically impaired in their slip recovery response.
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Affiliation(s)
- Tarique Siragy
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Allen Hill
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Julie Nantel
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- * E-mail:
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Stoco-Oliveira MC, Ricci-Vitor AL, Vanzella LM, Valente HB, Silva VEDS, André LB, Carvalho ACD, Garner DM, Vanderlei LCM. Parkinson's disease effect on autonomic modulation: an analysis using geometric indices. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:114-121. [PMID: 33759977 DOI: 10.1590/0004-282x-anp-2020-0088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/25/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Parkinson's disease (PD) produces autonomic changes, indicating lower parasympathetic modulation and global variability, but these changes need further studying regarding geometric methods. OBJECTIVE To investigate the autonomic modulation in individuals with PD using heart rate variability (HRV) indices obtained through geometric methods. METHODS This is a cross-sectional study that assessed 50 individuals, split into two groups: PD group (PDG; n=26; 75.36±5.21 years) and control group (CG; n=24; 75.36±5.21 years). We evaluated the autonomic modulation by measuring the heart rate beat-to-beat for 30 min with the individual in supine rest using a heart rate monitor and assessed geometric indices (RRtri, TINN, SD1, SD2, SD1/SD2 ratio, and qualitative analysis of the Poincaré plot). RESULTS Significant reductions were found in RRtri, TINN, SD1, and SD2 indices among PDG compared to CG. Regarding the SD1/SD2 ratio, no significant changes were detected between the groups. The Poincaré plot demonstrated that individuals with PD had lower beat-to-beat dispersion in RR intervals, in addition to greater long-term dispersion of RR intervals compared to CG. CONCLUSIONS The results suggest a reduction in the parasympathetic autonomic modulation and global variability in individuals with PD compared to controls, regardless of sex, age, and body mass index.
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Affiliation(s)
- Mileide Cristina Stoco-Oliveira
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente, São Paulo, Brazil
| | - Ana Laura Ricci-Vitor
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente, São Paulo, Brazil
| | - Laís Manata Vanzella
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente, São Paulo, Brazil
| | - Heloisa Balotari Valente
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente, São Paulo, Brazil
| | - Vitor Eduardo Dos Santos Silva
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente, São Paulo, Brazil
| | - Larissa Borba André
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente, São Paulo, Brazil
| | - Augusto Cesinando de Carvalho
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente, São Paulo, Brazil
| | - David Matthew Garner
- Oxford Brookes University, Faculty of Health and Life Sciences, Department of Biological and Medical Sciences, Oxford, United Kingdom
| | - Luiz Carlos Marques Vanderlei
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente, São Paulo, Brazil
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Mahmoudzadeh A, Nakhostin Ansari N, Naghdi S, Ghasemi E, Motamedzadeh O, Shaw BS, Shaw I. Role of Spasticity Severity in the Balance of Post-stroke Patients. Front Hum Neurosci 2021; 15:783093. [PMID: 34975436 PMCID: PMC8715739 DOI: 10.3389/fnhum.2021.783093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/24/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Lower limb spasticity after stroke is common that can affect the balance, increase the risk of falling, and reduces the quality of life. Objective: First, evaluate the effects of spasticity severity of ankle plantar flexors on balance of patients after stroke. Second, to determine the relationship between the spasticity severity with ankle proprioception, passive ankle dorsiflexion range of motion (ROM), and balance confidence. Methods: Twenty-eight patients with stroke based on the Modified Modified Ashworth Scale (MMAS) were divided into two groups: High Spasticity Group (HSG) (MMAS > 2) (n = 14) or a Low Spasticity Group (LSG) (MMAS ≤ 2) (n = 14). The MMAS scores, Activities-Specific Balance Confidence Questionnaire, postural sway of both affected and non-affected limbs under the eyes open and eyes closed conditions, timed up and go (TUG) test, passive ankle dorsiflexion ROM, and ankle joint proprioception were measured. Results: The ankle joint proprioception was significantly better in the LSG compared to the HSG (p = 0.01). No significant differences were found between the LSG and HSG on all other outcome measures. There were no significant relationships between the spasticity severity and passive ankle dorsiflexion ROM, and balance confidence. Conclusion: The severity of ankle plantar flexor spasticity had no effects on balance of patients with stroke. However, the ankle joint proprioception was better in patients with low spasticity. Our findings suggest that the balance is affected regardless of the severity of the ankle plantar flexor spasticity in this group of participants with stroke.
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Affiliation(s)
- Ashraf Mahmoudzadeh
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- *Correspondence: Ashraf Mahmoudzadeh,
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Ghasemi
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Motamedzadeh
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Brandon S. Shaw
- Department of Human Movement Science, University of Zululand, Kwazulu-Natal, South Africa
| | - Ina Shaw
- Department of Human Movement Science, University of Zululand, Kwazulu-Natal, South Africa
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Tsai YY, Chang GC, Hwang IS. Changes in postural strategy of the lower limb under mechanical knee constraint on an unsteady stance surface. PLoS One 2020; 15:e0242790. [PMID: 33253285 PMCID: PMC7703948 DOI: 10.1371/journal.pone.0242790] [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: 05/25/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022] Open
Abstract
Joint constraint could limit the available degrees of freedom in a kinematic chain for maintaining postural stability. This study investigated adaptive changes in postural synergy due to bracing of bilateral knee joints, usually thought to have a trifling impact on upright stance. Twenty-four young adults were requested to maintain balance on a stabilometer plate as steadily as possible while wearing a pair of knee orthoses, either unlocked (the non-constraint (NC) condition) or locked to restrict knee motion (the knee constraint (KC) condition). Knee constraint led to a significant increase in the regularity of the stabilometer angular velocity. More than 95% of the variance properties of the joint angular velocities in the lower limb were explained by the first and second principal components (PC1 and PC2), which represented the ankle strategy and the combined knee and hip strategy, respectively. In addition to the increase trend in PC1 regularity, knee constraint enhanced the mutual information of the stabilometer angular velocity and PC1 (MISTBV-PC1) but reduced the mutual information of the stabilometer angular velocity and PC2 (MISTBV-PC2). The MISTBV-PC1 was also positively correlated to stance steadiness on the stabilometer in the KC condition. In summary, in the knee constraint condition, postural synergy on the stabilometer was reorganized to increase reliance on ankle strategies to maintain equilibrium. In particular, a stable stabilometer stance under knee constraint is associated with a high level of coherent ankle–stabilometer interaction.
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Affiliation(s)
- Yi-Ying Tsai
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Gwo-Ching Chang
- Department of information Engineering, I-Shou University, Kaohsiung City, Taiwan
| | - Ing-Shiou Hwang
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- * E-mail:
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Peterson DS, Barajas JS, Denney L, Mehta SH. Backward Protective Stepping During Dual-Task Scenarios in People With Parkinson's Disease: A Pilot Study. Neurorehabil Neural Repair 2020; 34:702-710. [PMID: 32633614 DOI: 10.1177/1545968320935814] [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] [Indexed: 12/27/2022]
Abstract
Introduction. Reactive movements in response to a loss of balance are altered in people with Parkinson's disease (PD) and are critical for fall prevention. Further, falls are more common while attention is divided. Although divided attention has been shown to impact postural responses in healthy older adults, the impact of dividing attention on reactive balance, and the natural prioritization across postural and cognitive tasks in people with PD is largely unknown. Objectives. To characterize (1) the impact of a secondary cognitive task on reactive postural control and (2) the prioritization across stepping and cognitive tasks in people with PD. Methods. Sixteen people with PD and 14 age-matched controls underwent step-inducing, support-surface perturbations from stance, with and without an auditory Stroop secondary cognitive task. Cognitive, neuromuscular, and protective stepping performance were calculated for single and dual task scenarios. Results. In PD and control participants, cognitive reaction times (P = .001) and muscle onset latency (P = .007), but not protective step outcomes (P > .12 for all) were worse during dual tasking compared with single-task scenarios. Both PD and control groups prioritized the protective stepping task over the cognitive task. Overall, people with PD exhibited worse first-step margin of stability (a measure of protective step performance) than controls (P = .044). Conclusion. This study provides preliminary evidence that people with PD, like age-matched controls, exhibit cognitive and neuromuscular, but not protective step, dual-task interference. The lack of dual-task interference on step performance indicates a postural prioritization for PD and healthy older adults during dual-task protective stepping.
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Affiliation(s)
- Daniel S Peterson
- Arizona State University, Phoenix, AZ, USA.,Phoenix VA Health Care Center, Phoenix, AZ, USA
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The Effects of Task Prioritization on Dual-Tasking Postural Control in Patients With Parkinson Disease Who Have Different Postural Impairments. Arch Phys Med Rehabil 2020; 101:1212-1219. [DOI: 10.1016/j.apmr.2020.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/12/2020] [Accepted: 02/24/2020] [Indexed: 11/19/2022]
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Lemus D, Berry A, Jabeen S, Jayaraman C, Hohl K, van der Helm FCT, Jayaraman A, Vallery H. Controller synthesis and clinical exploration of wearable gyroscopic actuators to support human balance. Sci Rep 2020; 10:10412. [PMID: 32591577 PMCID: PMC7320159 DOI: 10.1038/s41598-020-66760-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 05/11/2020] [Indexed: 12/02/2022] Open
Abstract
Gyroscopic actuators are appealing for wearable applications due to their ability to provide overground balance support without obstructing the legs. Multiple wearable robots using this actuation principle have been proposed, but none has yet been evaluated with humans. Here we use the GyBAR, a backpack-like prototype portable robot, to investigate the hypothesis that the balance of both healthy and chronic stroke subjects can be augmented through moments applied to the upper body. We quantified balance performance in terms of each participant's ability to walk or remain standing on a narrow support surface oriented to challenge stability in either the frontal or the sagittal plane. By comparing candidate balance controllers, it was found that effective assistance did not require regulation to a reference posture. A rotational viscous field increased the distance healthy participants could walk along a 30mm-wide beam by a factor of 2.0, compared to when the GyBAR was worn but inactive. The same controller enabled individuals with chronic stroke to remain standing for a factor of 2.5 longer on a narrow block. Due to its wearability and versatility of control, the GyBAR could enable new therapy interventions for training and rehabilitation.
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Affiliation(s)
- Daniel Lemus
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Andrew Berry
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Saher Jabeen
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Chandrasekaran Jayaraman
- Max Näder Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Kristen Hohl
- Max Näder Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Frans C T van der Helm
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Heike Vallery
- Department of Biomechanical Engineering, Delft University of Technology, Delft, 2628 CD, The Netherlands.
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Berardi A, Galeoto G, Valente D, Conte A, Fabbrini G, Tofani M. Validity and reliability of the 12-item Berg Balance Scale in an Italian population with Parkinson's disease: A cross sectional study. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:419-423. [PMID: 32520233 DOI: 10.1590/0004-282x20200030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/26/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Berg Balance Scale is widely used to measure balance ability in clinical practice. Recently, the original version was redefined from 14 into 12 items. Its psychometric properties were investigated for different populations. However, for Parkinson disease the new version has not been validated yet. OBJECTIVE The purpose of the present study was to evaluate psychometric properties of the 12-item Berg Balance Scale (BBS-12) in a population with Parkinson disease. METHODS Internal consistency was evaluated with Cronbach's alpha coefficient, whereas reliability was assessed with the intraclass correlation coefficient. For validity analysis, the Pearson correlation coefficient of the BBS-12 was evaluated with the Tinetti Scale and the Physical Activity Scale for the Elderly. RESULTS The BBS-12 was applied to 50 individuals with a mean age of 65.6 years (SD 11.8). The internal consistency showed a good value (Cronbach's alpha 0.886) and reproducibility reveled very high performances for both inter-rater and intra-rater reliabilities (ICC 0.987 and 0.986, respectively). The validity study demonstrated good linear correlation with the Tinetti Scale (p<0.01) and with the Sport and Home Subscales of the Physical Activity Scale for the Elderly (p<0.01). CONCLUSIONS The present findings revealed the BBS-12 as a reliable and valid assessment tool to measure balance ability in Parkinson disease. Italian health professionals can now use it with more confidence.
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Affiliation(s)
| | - Giovanni Galeoto
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Rome, LZ, Italy
| | - Donatella Valente
- Dipartimento di Neuroscienze Umane, Sapienza Università di Roma, Rome, LZ, Italy
| | - Antonella Conte
- Dipartimento di Neuroscienze Umane, Sapienza Università di Roma, Rome, LZ, Italy
| | - Giovanni Fabbrini
- Dipartimento di Neuroscienze Umane, Sapienza Università di Roma, Rome, LZ, Italy
| | - Marco Tofani
- Ospedale Pediatrico Bambino Gesù, Dipartimento di Neuroscienze e Neuroriabilitazione, Unità di Neuroriabilitazione, Fiumicino, RM, Italy
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Spagnolo F, Rini AM, Guida P, Longobardi S, Battista P, Passarella B. The Choice of Leg During Pull Test in Parkinson's Disease: Not Mere Chance. Front Neurol 2020; 11:302. [PMID: 32477234 PMCID: PMC7238876 DOI: 10.3389/fneur.2020.00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/30/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Parkinson's disease (PD) starts asymmetrically and it maintains a certain degree of asymmetry throughout its course. Once functional disability proceeds, people with PD can change their dominant hand due to the increased disease severity. This is particularly true for hand dominance, while no studies have been performed so far exploring the behavioral changes of lower limb utilization in PD according to the lateralized symptom dominance. In the current study, we aim to track the foot preference of participants with PD to respond to the Pull Test. Methods: Forty-one subjects suffering from PD, with a H&Y scale ≤ 2, were recruited. A motor evaluation was performed, including the motor part of the MDS-UPDRS, its axial and lateralized scores (for more and less affected side), two Timed Tests, namely Time to Walk a standard distance (TW, in seconds) and Time Up and Go Test (TUG, in seconds), and the Pull Test. The preferred foot (right or left) involved in the step backward was recorded. Thirty-seven healthy controls underwent a motor assessment which included the Pull Test and the Timed Tests. Both participants with PD and controls were right-handed. To evaluate the relationship between the response to Pull-Test and PD-symptoms, subjects with PD were further divided into two groups: (1) Right more affected side (Right-MAS), and (2) Left more affected side (Left-MAS). Results: Both groups of subjects with PD (Right-MAS and Left-MAS) during the Pull Test shifted significantly their leg use preference toward the opposite side than the more affected side: Right-MAS used preferentially their left leg (71%) and vice versa (p < 0.001). The limb preference shift was especially true for Left-MAS group that almost invariably used their right, dominant leg to respond to the Pull Test (95%). Similar results were obtained comparing people with PD and Controls. Conclusions: This study shows that the limb used to respond to the Pull Test generally predicts the contralateral side of worse PD involvement. As the disease takes place, it prevails over hemispheric dominance: right-handed subjects with left side PD-onset and worse lateralization tend to be hyper-right-dominant, while right-handed subjects with right side PD-onset and worse impairment tend to behave as left-handers. Lateralization of symptoms in PD is still a mysterious phenomenon; more studies are needed to better understand this association and to optimize tailored rehabilitation programs for people with PD.
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Affiliation(s)
| | | | - Pietro Guida
- Scientific Clinical Institute Maugeri SPA SB, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Sara Longobardi
- Neurological Department, Antonio Perrino's Hospital, Brindisi, Italy
| | - Petronilla Battista
- Scientific Clinical Institute Maugeri SPA SB, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Bruno Passarella
- Neurological Department, Antonio Perrino's Hospital, Brindisi, Italy
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Elangovan N, Cheung C, Mahnan A, Wyman JF, Tuite P, Konczak J. Hatha yoga training improves standing balance but not gait in Parkinson's disease. SPORTS MEDICINE AND HEALTH SCIENCE 2020; 2:80-88. [PMID: 35784178 PMCID: PMC9219298 DOI: 10.1016/j.smhs.2020.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 12/01/2022] Open
Abstract
Background and purpose Complementary therapies, such as yoga, have been proposed to address gait and balance problems in Parkinson's disease (PD). However, the effects of yoga on gait and static balance have not been studied systematically in people with PD (PWP). Here we evaluated the effects of a 12-week long Hatha yoga intervention on biomechanical parameters of gait and posture in PWP. Methods We employed a pilot randomized controlled trial design with two groups of mild-to-moderate PWP (immediate treatment, waitlist control; N = 10 each; Mean Hoehn and Yahr score = 2 for each group). Baseline Unified Parkinson's Disease Rating Scale (UPDRS) motor scores, and gait and postural kinematics including postural sway path length, cadence, walking speed, and turning time were obtained. The immediate treatment group received a 60-min Hatha yoga training twice a week for 12 weeks, while the waitlisted control group received no training. After 12 weeks, gait and postural kinematics were assessed (post-test for treatment group and second-baseline for waitlist group). Then, the waitlist group received the same yoga training and was evaluated post-training. Results After Hatha yoga training, UPDRS motor scores improved with an 8-point mean decrease which is considered as a moderate clinically important change for mild-moderate PD. Sway path length during stance decreased significantly (mean reduction: -34.4%). No significant between-group differences or improvements in gait kinematics were observed. Conclusion This study showed that a 12-week Hatha yoga training can improve static balance in PWP. We found no evidence that it systematically improves gait performance in PWP.
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Affiliation(s)
- Naveen Elangovan
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
- Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, USA
- Corresponding author. Human Sensorimotor Control Laboratory School of Kinesiology, University of Minnesota, 1900 University Ave. SE, Minneapolis, MN, 55455, USA.
| | - Corjena Cheung
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
- Department of Health, Hong Kong Adventist College, Hong Kong, China
| | - Arash Mahnan
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Jean F. Wyman
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Paul Tuite
- Department of Neurology, University of Minnesota Health, Minneapolis, MN, USA
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
- Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, USA
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46
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Rahmati Z, Behzadipour S, Schouten AC, Taghizadeh G, Firoozbakhsh K. Postural control learning dynamics in Parkinson's disease: early improvement with plateau in stability, and continuous progression in flexibility and mobility. Biomed Eng Online 2020; 19:29. [PMID: 32393271 PMCID: PMC7216342 DOI: 10.1186/s12938-020-00776-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/28/2020] [Indexed: 12/17/2022] Open
Abstract
Background Balance training improves postural control in Parkinson’s disease (PD). However, a systematic approach for the development of individualized, optimal training programs is still lacking, as the learning dynamics of the postural control in PD, over a training program, are poorly understood. Objectives We investigated the learning dynamics of the postural control in PD, during a balance-training program, in terms of the clinical, posturographic, and novel model-based measures. Methods Twenty patients with PD participated in a balance-training program, 3 days a week, for 6 weeks. Clinical tests assessed functional balance and mobility pre-training, mid-training, and post-training. Center-of-pressure (COP) was recorded at four time-points during the training (pre-, week 2, week 4, and post-training). COP was used to calculate the sway measures and to identify the parameters of a patient-specific postural control model, at each time-point. The posturographic and model-based measures constituted the two sets of stability- and flexibility-related measures. Results Mobility- and flexibility-related measures showed a continuous improvement during the balance-training program. In particular, mobility improved at mid-training and continued to improve to the end of the training, whereas flexibility-related measures reached significance only at the end. The progression in the balance- and stability-related measures was characterized by early improvements over the first 3 to 4 weeks of training, and reached a plateau for the rest of the training. Conclusions The progression in balance and postural stability is achieved earlier and susceptible to plateau out, while mobility and flexibility continue to improve during the balance training.
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Affiliation(s)
- Zahra Rahmati
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.,Djawad Movafaghian Research Center in Neurorehab Technologies, Sharif University of Technology, Tehran, Iran
| | - Saeed Behzadipour
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran. .,Djawad Movafaghian Research Center in Neurorehab Technologies, Sharif University of Technology, Tehran, Iran.
| | - Alfred C Schouten
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Cabrera-Martos I, Jiménez-Martín AT, López-López L, Rodríguez-Torres J, Ortiz-Rubio A, Valenza MC. Effects of a core stabilization training program on balance ability in persons with Parkinson's disease: a randomized controlled trial. Clin Rehabil 2020; 34:764-772. [PMID: 32349543 DOI: 10.1177/0269215520918631] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the effects of an eight-week core stability program on balance ability in persons with Parkinson's disease. DESIGN Randomized controlled trial. SETTING A local Parkinson's association. SUBJECTS A total of 44 participants with a clinical diagnosis of Parkinson's disease were randomly assigned to an experimental (n = 22) or control group (n = 22). INTERVENTION The experimental group received 24 sessions of core training, while the control group received an intervention including active joint mobilization, muscle stretching, and motor coordination exercises. MAIN MEASURES The primary outcome measure was dynamic balance evaluated using the Mini-Balance Evaluation Systems Test. Secondary outcomes included the balance confidence assessed with the Activities-specific Balance Confidence Scale and standing balance assessed by the maximal excursion of center of pressure during the Modified Clinical Test of Sensory Interaction on Balance and the Limits of Stability test. RESULTS After treatment, a significant between-group improvement in dynamic balance was observed in the experimental group compared to the control group (change, 2.75 ± 1.80 vs 0.38 ± 2.15, P = 0.002). The experimental group also showed a significant improvement in confidence (change, 16.48 ± 16.21 vs 3.05 ± 13.53, P = 0.047) and maximal excursion of center of pressure in forward (change, 0.86 ± 1.89 cm vs 0.17 ± 0.26 cm, P = 0.048), left (change, 0.88 ± 2.63 cm vs 0.07 ± 0.48 cm, P = 0.010), and right (change, 1.63 ± 2.82 cm vs 0.05 ± 0.17 cm, P = 0.046) directions of limits of stability compared to the control group. CONCLUSION A program based on core stability in comparison with non-specific exercise benefits dynamic balance and confidence and increases center of mass excursion in patients with Parkinson's disease.
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Affiliation(s)
- Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | - Laura López-López
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Janet Rodríguez-Torres
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortiz-Rubio
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Colebatch JG, Govender S. Axial perturbations evoke increased postural reflexes in Parkinson's disease with postural instability. Clin Neurophysiol 2020; 131:928-935. [PMID: 32078922 DOI: 10.1016/j.clinph.2020.01.006] [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: 10/01/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To measure axially-evoked postural reflexes in 11 Parkinson's disease (PD) subjects, both stable and unstable, and to compare these with 13 age-matched controls. METHODS We measured the short-latency electromyography (EMG) reflex effects of brief impulsive displacements applied to the upper sternum or C7 for tibialis anterior (TA) and soleus. Our subjects were studied standing normally and when leaning both forwards and backwards. RESULTS The initial mechanical effects of the stimuli were similar but the reflex responses for the unstable PD group were increased, even after allowing for the increased levels of tonic activation. For TA, unstable PD subjects had significantly larger responses than the stable PD group whose responses were in turn significantly larger than controls. For soleus, unstable PD subjects had significantly greater responses than controls. CONCLUSIONS These findings are consistent with previous evidence that exaggerated postural responses are characteristic of unstable PD subjects. SIGNIFICANCE Increased postural reflexes are characteristic of unstable PD subjects and may contribute to the instability seen for these patients in response to larger perturbations.
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Affiliation(s)
- James G Colebatch
- Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, NSW 2031, Australia.
| | - Sendhil Govender
- Prince of Wales Clinical School and Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, NSW 2031, Australia
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Marchesi G, Casadio M, Ballardini G, Luca AD, Squeri V, Vallone F, Giorgini C, Crea P, Pilotto A, Sanfilippo C, Saglia J, Canessa A. Robot-based assessment of sitting and standing balance: preliminary results in Parkinson's disease. IEEE Int Conf Rehabil Robot 2020; 2019:570-576. [PMID: 31374691 DOI: 10.1109/icorr.2019.8779387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Postural responses to unstable conditions or perturbations are important predictors of the risk of falling and can reveal balance deficits in people with neurological disorders, such as Parkinson's Disease (PD). However, there is a lack of evidences related to devices and protocols providing a comprehensive and quantitative evaluation of postural responses in different stability conditions. We tested ten people with PD and ten controls on a robotic platform capable to provide different mechanical interactions and to measure the center of pressure displacement, while trunk acceleration was recorded with a sensor placed on the sternum. We evaluated performance while maintaining upright posture in unperturbed, perturbed, and unstable conditions. The latter was tested while standing and sitting. We measured whether the proposed exercises and metrics could highlight differences in postural control. Participants with PD had worse performance metrics when standing under unperturbed or unstable conditions, and when sitting on the unstable platform. PD subjects in response to a forward perturbation showed bigger trunk oscillations coupled with a sharper increase of the CoP backward displacement. These responses could be due to higher stiffness of lower limb which leads to postural instability. The exercises and the proposed metrics highlighted differences in postural control, hence they can be used in clinical environment for the assessment and progression of postural impairments.
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Oliveira Lira JL, Ugrinowitsch C, Fecchio R, Coelho DB, Moreira‐Neto A, Germano R, Lima Miliatto AC, Santos Vieira Yano BC, Silva‐Batista C. Minimal Detectable Change for Balance Using the Biodex Balance System in Patients with Parkinson Disease. PM R 2019; 12:281-287. [DOI: 10.1002/pmrj.12216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/30/2019] [Indexed: 01/21/2023]
Affiliation(s)
| | - Carlos Ugrinowitsch
- Laboratory of Adaptations to Strength Training, School of Physical Education and SportUniversity of São Paulo at São Paulo São Paulo Brazil
| | - Rafael Fecchio
- Exercise Hemodynamic Laboratory, School of Physical Education and SportUniversity of São Paulo São Paulo Brazil
| | - Daniel Boari Coelho
- Biomedical EngineeringFederal University of ABC São Bernardo do Campo Brazil
| | - Acácio Moreira‐Neto
- Exercise Neuroscience Research Group, School of Arts, Sciences and HumanitiesUniversity of São Paulo São Paulo Brazil
| | - Renan Germano
- Laboratory of Adaptations to Strength Training, School of Physical Education and SportUniversity of São Paulo at São Paulo São Paulo Brazil
| | - Angelo Corrêa Lima Miliatto
- Exercise Neuroscience Research Group, School of Arts, Sciences and HumanitiesUniversity of São Paulo São Paulo Brazil
| | | | - Carla Silva‐Batista
- Exercise Neuroscience Research Group, School of Arts, Sciences and HumanitiesUniversity of São Paulo São Paulo Brazil
- Laboratory of Adaptations to Strength Training, School of Physical Education and SportUniversity of São Paulo at São Paulo São Paulo Brazil
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