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Holden H, Venkatesh S, Budrow C, Nezaria S, Coyle M, Centner A, Lipari N, McManus G, Bishop C. The effects of L-DOPA on gait abnormalities in a unilateral 6-OHDA rat model of Parkinson's disease. Physiol Behav 2024; 281:114563. [PMID: 38723388 DOI: 10.1016/j.physbeh.2024.114563] [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: 02/15/2024] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/27/2024]
Abstract
Parkinson's Disease (PD) is a neurodegenerative movement disorder characterized by dopamine (DA) cell loss in the substantia nigra pars compacta (SNc). As PD progresses, patients display disruptions in gait such as changes in posture, bradykinesia, and shortened stride. DA replacement via L-DOPA alleviates many PD symptoms, though its effects on gait are not well demonstrated. This study aimed to assess the relationship between DA lesion, gait, and deficit-induced reversal with L-DOPA. To do so, Sprague-Dawley rats (N = 25, 14 males, 11 females) received unilateral medial forebrain bundle (MFB) DA lesions with 6-hydroxydopamine (6-OHDA). An automated gait analysis system assessed spatiotemporal gait parameters pre- and post-lesion, and after various doses of L-DOPA (0, 3, or 6 mg/kg; s.c.). The forepaw adjusting steps (FAS) test was implemented to evaluate lesion efficacy while the abnormal involuntary movements (AIMs) scale monitored the emergence of L-DOPA-induced dyskinesia (LID). High performance liquid chromatography (HPLC) assessed changes in brain monoamines on account of lesion and treatment. Results revealed lesion-induced impairments in gait, inclusive of max-contact area and step-sequence alterations that were not reversible with L-DOPA. However, the emergence of AIMs were observed at higher doses. Post-mortem, 6-OHDA lesions induced a loss of striatal DA and norepinephrine (NE), while prefrontal cortex (PFC) displayed noticeable reduction in NE but not DA. Our findings indicate that hemiparkinsonian rats display measurable gait disturbances similar to PD patients that are not rescued by DA replacement. Furthermore, non-DA mechanisms such as attention-related NE in PFC may contribute to altered gait and may constitute a novel target for its treatment.
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Affiliation(s)
- Hannah Holden
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Shruti Venkatesh
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Carla Budrow
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Sareen Nezaria
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Michael Coyle
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Ashley Centner
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Natalie Lipari
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Grace McManus
- Department of Psychology, Binghamton University, Binghamton, NY, USA
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George P, Roushdy T, Fathy M, Hamid E, Ibrahim YA, El-Belkimy M, Abdulghani MO, Shalash A. The clinical and neuroimaging differences between vascular parkinsonism and Parkinson's disease: a case-control study. BMC Neurol 2024; 24:56. [PMID: 38321372 PMCID: PMC10845551 DOI: 10.1186/s12883-024-03556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) and vascular parkinsonism (VaP) have highly overlapping phenotypes, and different prognosis. This study comprehensively investigated the clinical, brain MRI and transcranial sonography differences between VaP and PD. METHODS Forty-eight patients with PD, 27 patients with VaP, and 29 healthy controls were compared. All patients were assessed using the MDS-UPDRS, Berg Balance Scale (BBS), Ten-Meter Walking Test (10-MWT), Time Up and Go Test, and Non-Motor Symptoms Scale. Beck Depression Inventory, PD questionnaire- 39, international urine incontinence scale, cognitive assessment scales, MRI brain and transcranial colour-coded doppler. The study was registered on clinical-Trial.gov (NCT04308135) on 03/12/2020. RESULTS VaP patients showed significantly older age of onset, shorter disease duration, lower drug doses and levodopa responsiveness, higher On and Off axial scores, On and Off BBS, higher On scores for PIGD, rigidity, bradykinesia and total motor MDS-UPDRS, lower On and Off tremor, lower-half predominance, lower asymmetrical presentation and symmetric index than PD patients. VaP patients had worse non-motor symptoms Scale (NMSS) than controls except for perceptual problems/hallucinations but better symptoms than PD patients except for urinary dysfunction. Quality of life (QoL) was impaired in VaP patients and was correlated with motor function and NMSs. The VaP group had significantly higher white matter lesions and brain atrophy, with lower hyperechogenicity of the substantia nigra and more impaired cerebral vascular resistance and vasoreactivity than the PD group. CONCLUSIONS VaP has a characteristic motor and non-motor profile, with impaired QoL, white matter, and transcranial sonography abnormalities that differentiate it from PD. Further studies are warranted to explore the role of vascular lesions in the pathogenesis of VaP. TRIAL REGISTRATION The registered identifier NCT04308135 on clinical-Trial.gov. Registered on 03/12/2020.
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Affiliation(s)
- Peter George
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer Roushdy
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mai Fathy
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman Hamid
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Mahmoud El-Belkimy
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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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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Virmani T, Landes RD, Pillai L, Glover A, Larson-Prior L, Prior F, Factor SA. Gait Declines Differentially in, and Improves Prediction of, People with Parkinson's Disease Converting to a Freezing of Gait Phenotype. JOURNAL OF PARKINSON'S DISEASE 2023; 13:961-973. [PMID: 37522218 PMCID: PMC10578275 DOI: 10.3233/jpd-230020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is a debilitating, variably expressed motor symptom in people with Parkinson's disease (PwPD) with limited treatments. OBJECTIVE To determine if the rate of progression in spatiotemporal gait parameters in people converting from a noFOG to a FOG phenotype (FOGConv) was faster than non-convertors, and determine if gait parameters can help predict this conversion. METHODS PwPD were objectively monitored longitudinally, approximately every 6 months. Non-motor assessments were performed at the initial visit. Steady-state gait in the levodopa ON-state was collected using a gait mat (Protokinetics) at each visit. The rate of progression in 8 spatiotemporal gait parameters was calculated. FOG convertors (FOGConv) were classified if they did not have FOG at initial visit and developed FOG at a subsequent visit. RESULTS Thirty freezers (FOG) and 30 non-freezers were monitored an average of 3.5 years, with 10 non-freezers developing FOG (FOGConv). FOGConv and FOG had faster decline in mean stride-length, swing-phase-percent, and increase in mean total-double-support percent, coefficient of variability (CV) foot-strike-length and CV swing-phase-percent than the remaining non-freezers (noFOG). On univariate modeling, progression rates of mean stride-length, stride-velocity, swing-phase-percent, total-double-support-percent and of CV swing-phase-percent had high discriminative power (AUC > 0.83) for classification of the FOGConv and noFOG groups. CONCLUSION FOGConv had a faster temporal decline in objectively quantified gait than noFOG, and progression rates of spatiotemporal gait parameters were more predictive of FOG phenotype conversion than initial (static) parameters Objectively monitoring gait in disease prediction models may help define FOG prone groups for testing putative treatments.
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Affiliation(s)
- Tuhin Virmani
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Reid D. Landes
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lakshmi Pillai
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aliyah Glover
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Linda Larson-Prior
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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Steinbach MJ, Campbell RW, DeVore BB, Harrison DW. Laterality in Parkinson's disease: A neuropsychological review. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:126-140. [PMID: 33844619 DOI: 10.1080/23279095.2021.1907392] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Laterality of motor symptom onset in Parkinson's disease is both well-known and under-appreciated. Treatment of disorders that have asymmetric pathological features, such as stroke and epilepsy, demonstrate the importance of incorporating hemispheric lateralization and specialization into therapy and care planning. These practices could theoretically extend to Parkinson's disease, providing increased diagnostic accuracy and improved treatment outcomes. Additionally, while motor symptoms have generally received the majority of attention, non-motor features (e.g., autonomic dysfunction) also decrease quality of life and are influenced by asymmetrical neurodegeneration. Due to the laterality of cognitive and behavioral processes in the two brain hemispheres, analysis of hemibody side of onset can potentially give insight into expected symptom profile of the patient and allow for increased predictive accuracy of disease progression and outcome, thus opening the door to personalized and improved therapy in treating Parkinson's disease patients. This review discusses motor and non-motor symptoms (namely autonomic, sensory, emotional, and cognitive dysfunction) of Parkinson's disease in respect to hemispheric lateralization from a theoretical perspective in hopes of providing a framework for future research and personalized treatment.
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Kazemi D, Hajishah H, Chadeganipour AS. Association of Total Bilirubin with Motor Signs in Early Parkinson's Disease in LRRK2 Variant Carriers. J Mol Neurosci 2022; 72:2338-2344. [PMID: 36125733 DOI: 10.1007/s12031-022-02067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/13/2022] [Indexed: 12/13/2022]
Abstract
Oxidative stress is considered a possible mechanism in Parkinson's disease (PD) progression. Bilirubin has been recognized as a powerful antioxidant that increases due to heme-oxygenase activity. We aimed to investigate the association of total bilirubin (TB) with motor signs and asymmetry in different stages of early PD. A case-control study was performed to investigate the differences in TB levels in PD patients and healthy controls (HC) both carrying LRRK2 variants. We compared TB levels in HC and Hoehn and Yahr (HY) I and II cohorts separately, followed by multiple linear regression analysis to evaluate the association between TB and motor dysfunction in each stage. We used Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (UPDRS) part III scores and asymmetry scores to address motor disability. Asymmetry scores were calculated from the corresponding UPDRS III tasks. TB was significantly increased in HY II compared to HC (P < 0.001). Positive correlations with TB were found for UPDRS III total score (ρ = 0.303, P = 0.034) and asymmetry score (ρ = 0.418, P = 0.003) in HY I. Multiple linear regression found a significant relationship between TB and asymmetry scores in HY I (R2 = 0.261, P = 0.037), but no relationship was achieved with UPDRS III total scores. Increased TB serves as an important diagnostic marker in earlier stages of PD. A significant relationship was found between TB and motor asymmetry in HY I patients. According to our findings, bilirubin mainly exhibits its protective effects in HY I population.
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Affiliation(s)
- Danial Kazemi
- Faculty of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Street, Isfahan, Iran.
| | - Hamed Hajishah
- Student Research Committee, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
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da Conceição NR, de Souza CR, Júlia ÁDO, de Lima-Pardini AC, Silva-Batista C, Teixeira LA, Coelho DB. Between-leg asymmetry in automatic postural responses to stance perturbations in people with Parkinson's disease. Gait Posture 2022; 97:40-42. [PMID: 35872481 DOI: 10.1016/j.gaitpost.2022.07.232] [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: 12/20/2021] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND People with Parkinson's disease (PwPD) showed impairments of balance control which can be aggravated by the presence of higher interlateral postural asymmetry caused by a distinct dopaminergic loss in the substantia nigra between cerebral hemispheres. RESEARCH QUESTION We evaluate asymmetries between the more and the less affected leg in PwPD in responses to unanticipated stance perturbations. METHODS Sixteen 16 PwPD participated in the experiment that consisted of recovering a stable upright stance, keeping the feet in place, in response to a perturbation caused by a sudden release of a load equivalent to 7 % of the participant's body mass. Anterior displacement and velocity of the center of pressure (CoP), the latency of gastrocnemius medialis muscle (GM) activation onset, rate of GM activation, and normalized magnitude of muscular activation were analyzed. RESULTS Analysis revealed significantly rate (p = 0.04) and magnitude (p = 0.02) higher activation of GM in the less affected limb. No significant effects of the leg were found for GM activation latency or CoP-related variables. SIGNIFICANCE There is a higher contribution of the less affected leg in automatic postural responses in PwPD.
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Affiliation(s)
- Núbia Ribeiro da Conceição
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Caroline Ribeiro de Souza
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Ávila de Oliveira Júlia
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | - Carla Silva-Batista
- Exercise Neuroscience Research Group, School of Arts, Sciences, and Humanities, University of São Paulo, São Paulo, Brazil
| | - Luis Augusto Teixeira
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Daniel Boari Coelho
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil; Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, São Paulo, Brazil.
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Bosch TJ, Kammermeier S, Groth C, Leedom M, Hanson EK, Berg-Poppe P, Singh A. Cortical and Cerebellar Oscillatory Responses to Postural Instability in Parkinson's Disease. Front Neurol 2021; 12:752271. [PMID: 34803888 PMCID: PMC8599431 DOI: 10.3389/fneur.2021.752271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Posture and balance dysfunctions critically impair activities of daily living of patients with progressing Parkinson's disease (PD). However, the neural mechanisms underlying postural instability in PD are poorly understood, and specific therapies are lacking. Previous electrophysiological studies have shown distinct cortical oscillations with a significant contribution of the cerebellum during postural control tasks in healthy individuals. Methods: We investigated cortical and mid-cerebellar oscillatory activity via electroencephalography (EEG) during a postural control task in 10 PD patients with postural instability (PDPI+), 11 PD patients without postural instability (PDPI–), and 15 age-matched healthy control participants. Relative spectral power was analyzed in the theta (4–7 Hz) and beta (13–30 Hz) frequency bands. Results: Time-dependent postural measurements computed by accelerometer signals showed poor performance in PDPI+ participants. EEG results revealed that theta power was profoundly lower in mid-frontal and mid-cerebellar regions during the postural control task in PDPI+, compared to PDPI– and control participants. In addition, theta power was correlated with postural control performance in PD subjects. No significant changes in beta power were observed. Additionally, oscillatory changes during the postural control task differed from the resting state. Conclusion: This study underlines the involvement of mid-frontal and mid-cerebellar regions in postural stability during a balance task and emphasizes the important role of theta oscillations therein for postural control in PD.
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Affiliation(s)
- Taylor J Bosch
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD, United States.,Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD, United States
| | | | - Christopher Groth
- Department of Neurology, University of Iowa, Iowa City, IA, United States
| | - Matt Leedom
- Avera Therapy, Sioux Falls, SD, United States
| | - Elizabeth K Hanson
- Department of Communication Sciences and Disorders, University of South Dakota, Vermillion, SD, United States
| | - Patti Berg-Poppe
- Department of Physical Therapy, University of South Dakota, Vermillion, SD, United States
| | - Arun Singh
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD, United States.,Center for Brain and Behavior Research, University of South Dakota, Vermillion, SD, United States
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Taximaimaiti R, Wang XP. Comparing the Clinical and Neuropsychological Characteristics of Parkinson's Disease With and Without Freezing of Gait. Front Neurosci 2021; 15:660340. [PMID: 33986641 PMCID: PMC8110824 DOI: 10.3389/fnins.2021.660340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Freezing of gait (FOG) is one of the most common walking problems in Parkinson’s disease (PD). Impaired cognitive function is believed to play an important role in developing and aggravating FOG in PD. But some evidence suggests that motor function discrepancy may affect testing results. Therefore, we think it is necessary for PD-FOG(+) and PD-FOG(−) patients to complete neuropsychological tests under similar motor conditions. Methods This study recruited 44 idiopathic PD patients [PD-FOG(+) n = 22, PD-FOG(−) n = 22] and 20 age-matched healthy controls (HC). PD-FOG(+) and PD-FOG(−) patients were matched for age, year of education, and Hoehn and Yahr score (H&Y). All participants underwent a comprehensive battery of neuropsychological assessment, and demographical and clinical information was also collected. Results PD patients showed poorer cognitive function, higher risks of depression and anxiety, and more neuropsychiatric symptoms compared with HC. When controlling for age, years of education, and H&Y, there were no statistical differences in cognitive function between PD-FOG(+) and PD-FOG(−) patients. But PD-FOG(+) patients had worse motor and non-motor symptoms than PD-FOG(−) patients. PD patients whose motor symptoms initiated with rigidity and initiated unilaterally were more likely to experience FOG. Conclusion Traditional neuropsychological testing may not be sensitive enough to detect cognitive impairment in PD. Motor symptoms initiated with rigidity and initiated unilaterally might be an important predictor of FOG.
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Affiliation(s)
- Reyisha Taximaimaiti
- Department of Neurology, Shanghai TongRen Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Ping Wang
- Department of Neurology, Shanghai TongRen Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Schaefer LV, Löffler N, Klein J, Bittmann FN. Mechanomyography and acceleration show interlimb asymmetries in Parkinson patients without tremor compared to controls during a unilateral motor task. Sci Rep 2021; 11:2631. [PMID: 33514788 PMCID: PMC7846755 DOI: 10.1038/s41598-021-81672-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022] Open
Abstract
The mechanical muscular oscillations are rarely the objective of investigations regarding the identification of a biomarker for Parkinson's disease (PD). Therefore, the aim of this study was to investigate whether or not this specific motor output differs between PD patients and controls. The novelty is that patients without tremor are investigated performing a unilateral isometric motor task. The force of armflexors and the forearm acceleration (ACC) were recorded as well as the mechanomyography of the biceps brachii (MMGbi), brachioradialis (MMGbra) and pectoralis major (MMGpect) muscles using a piezoelectric-sensor-based system during a unilateral motor task at 70% of the MVIC. The frequency, a power-frequency-ratio, the amplitude variation, the slope of amplitudes and their interlimb asymmetries were analysed. The results indicate that the oscillatory behavior of muscular output in PD without tremor deviates from controls in some parameters: Significant differences appeared for the power-frequency-ratio (p = 0.001, r = 0.43) and for the amplitude variation (p = 0.003, r = 0.34) of MMGpect. The interlimb asymmetries differed significantly concerning the power-frequency-ratio of MMGbi (p = 0.013, r = 0.42) and MMGbra (p = 0.048, r = 0.39) as well as regarding the mean frequency (p = 0.004, r = 0.48) and amplitude variation of MMGpect (p = 0.033, r = 0.37). The mean (M) and variation coefficient (CV) of slope of ACC differed significantly (M: p = 0.022, r = 0.33; CV: p = 0.004, r = 0.43). All other parameters showed no significant differences between PD and controls. It remains open, if this altered mechanical muscular output is reproducible and specific for PD.
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Affiliation(s)
- Laura V Schaefer
- Division Regulative Physiology and Prevention, Department Sports and Health Sciences, University of Potsdam, Karl-Liebknecht-Str. 24-25, house 24, 14476, Potsdam, Golm, Germany.
| | - Nils Löffler
- Division Regulative Physiology and Prevention, Department Sports and Health Sciences, University of Potsdam, Karl-Liebknecht-Str. 24-25, house 24, 14476, Potsdam, Golm, Germany
| | - Julia Klein
- Division Regulative Physiology and Prevention, Department Sports and Health Sciences, University of Potsdam, Karl-Liebknecht-Str. 24-25, house 24, 14476, Potsdam, Golm, Germany
| | - Frank N Bittmann
- Division Regulative Physiology and Prevention, Department Sports and Health Sciences, University of Potsdam, Karl-Liebknecht-Str. 24-25, house 24, 14476, Potsdam, Golm, Germany
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11
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Chambers NE, Coyle M, Sergio J, Lanza K, Saito C, Topping B, Clark SD, Bishop C. Effects of pedunculopontine nucleus cholinergic lesion on gait and dyskinesia in hemiparkinsonian rats. Eur J Neurosci 2021; 53:2835-2847. [PMID: 33426708 DOI: 10.1111/ejn.15106] [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: 10/22/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
Pedunculopontine nucleus (PPN) cholinergic neurons are implicated in freezing of gait in Parkinson's disease (PD) and motor stereotypy in normal animals, but the causal role of these neurons on specific gait parameters and treatment-induced dyskinesia remains speculative. Therefore, we examined whether selective cholinergic lesion of the rostral PPN affects PD motor and gait deficits, L-DOPA-induced dyskinesia and motor improvement, and DA-agonist-induced dyskinesia. Sprague-Dawley rats were assigned to one unilaterally lesioned group: Sham lesion, PPN cholinergic lesion with diphtheria urotensin II fusion toxin, medial forebrain bundle dopamine lesion with 6-hydroxydopamine, or dual acetylcholine and dopamine lesion. We used gait analysis and forepaw adjusting steps to examine PD gait and motor deficits. Forepaw adjusting steps were also used to assess motor improvement with L-DOPA treatment. The abnormal involuntary movements scale measured L-DOPA and dopamine D1- and D2-receptor agonist-induced dyskinesia. Lesions, verified via tyrosine hydroxylase and choline acetyltransferase immunohistochemistry reduced an average of 95% of nigral dopamine neurons and 80% of PPN cholinergic neurons, respectively. Rats receiving acetylcholine and dual lesion demonstrated enhanced freezing, and acetylcholine lesioned rats exhibited increased print area and stand index. Dopamine and dual lesion produced similar forepaw adjusting steps task on and off L-DOPA. Relative to DA lesioned rats, dual lesioned rats displayed reduced L-DOPA and DA agonist-induced dyskinesia at specific time points. Our results indicate that PPN cholinergic neurons affect gait parameters related to postural stability. Therefore, therapeutically targeting PPN cholinergic neurons could reduce intractable postural instability in PD without affecting motor benefits or side effects of L-DOPA treatment.
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Affiliation(s)
- Nicole E Chambers
- Department of Psychology, Behavioral Neuroscience Program, Binghamton University, Binghamton, NY, USA
| | - Michael Coyle
- Department of Psychology, Behavioral Neuroscience Program, Binghamton University, Binghamton, NY, USA
| | - Jordan Sergio
- Department of Psychology, Behavioral Neuroscience Program, Binghamton University, Binghamton, NY, USA
| | - Kathryn Lanza
- Department of Psychology, Behavioral Neuroscience Program, Binghamton University, Binghamton, NY, USA
| | - Carolyn Saito
- Department of Psychology, Behavioral Neuroscience Program, Binghamton University, Binghamton, NY, USA
| | - Brent Topping
- Department of Psychology, Behavioral Neuroscience Program, Binghamton University, Binghamton, NY, USA
| | - Stewart D Clark
- Department of Pharmacology and Toxicology, Jacobs School of Medicine & Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Christopher Bishop
- Department of Psychology, Behavioral Neuroscience Program, Binghamton University, Binghamton, NY, USA
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12
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Effect of Parkinson's disease and two therapeutic interventions on muscle activity during walking: a systematic review. NPJ PARKINSONS DISEASE 2020; 6:22. [PMID: 32964107 PMCID: PMC7481232 DOI: 10.1038/s41531-020-00119-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Abstract
Gait deficits are a common feature of Parkinson’s disease (PD) and predictors of future motor and cognitive impairment. Understanding how muscle activity contributes to gait impairment and effects of therapeutic interventions on motor behaviour is crucial for identifying potential biomarkers and developing rehabilitation strategies. This article reviews sixteen studies that investigate the electromyographic (EMG) activity of lower limb muscles in people with PD during walking and reports on their quality. The weight of evidence establishing differences in motor activity between people with PD and healthy older adults (HOAs) is considered. Additionally, the effect of dopaminergic medication and deep brain stimulation (DBS) on modifying motor activity is assessed. Results indicated greater proximal and decreased distal activity of lower limb muscles during walking in individuals with PD compared to HOA. Dopaminergic medication was associated with increased distal lower limb muscle activity whereas subthalamic nucleus DBS increased activity of both proximal and distal lower limb muscles. Tibialis anterior was impacted most by the interventions. Quality of the studies was not strong, with a median score of 61%. Most studies investigated only distal muscles, involved small sample sizes, extracted limited EMG features and lacked rigorous signal processing. Few studies related changes in motor activity with functional gait measures. Understanding mechanisms underpinning gait impairment in PD is essential for development of personalised rehabilitative interventions. Recommendations for future studies include greater participant numbers, recording more functionally diverse muscles, applying multi-muscle analyses, and relating EMG to functional gait measures.
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13
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Schut IM, Pasma JH, Roelofs JMB, Weerdesteyn V, van der Kooij H, Schouten AC. Estimating ankle torque and dynamics of the stabilizing mechanism: No need for horizontal ground reaction forces. J Biomech 2020; 106:109813. [PMID: 32517986 DOI: 10.1016/j.jbiomech.2020.109813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/18/2020] [Accepted: 04/20/2020] [Indexed: 11/17/2022]
Abstract
Changes in human balance control can objectively be assessed using system identification techniques in combination with support surface translations. However, large, expensive and complex motion platforms are required, which are not suitable for the clinic. A treadmill could be a simple alternative to apply support surface translations. In this paper we first validated the estimation of the joint stiffness of an inverted pendulum using system identification methods in combination with support surface translations, by comparison with the joint stiffness calculated using a linear regression method. Second, we used the system identification method to investigate the effect of horizontal ground reaction forces on the estimation of the ankle torque and the dynamics of the stabilizing mechanism of 12 healthy participants. Ankle torque and resulting frequency response functions, which describes the dynamics of the stabilizing mechanism, were calculated by both including and excluding horizontal ground reaction forces. Results showed that the joint stiffness of an inverted pendulum estimated using system identification is comparable to the joint stiffness estimated by a regression method. Secondly, within the induced body sway angles, the ankle torque and frequency response function of the joint dynamics calculated by both including and excluding horizontal ground reaction forces are similar. Therefore, the horizontal ground reaction forces play a minor role in calculating the ankle torque and frequency response function of the dynamics of the stabilizing mechanism and can thus be omitted.
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Affiliation(s)
- I M Schut
- Biomechanical Engineering Department at the Delft University of Technology, Delft 2628 CD, Netherlands.
| | - J H Pasma
- Biomechanical Engineering Department at the Delft University of Technology, Delft 2628 CD, Netherlands; Department of Orthopaedic Surgery at the Haga Hospital, The Hague 2545 AA, Netherlands
| | - J M B Roelofs
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - V Weerdesteyn
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands; Sint Maartenskliniek Research, Develeopment and Education, Nijmegen, Netherlands
| | - H van der Kooij
- Biomechanical Engineering Department at the Delft University of Technology, Delft 2628 CD, Netherlands; Biomechanical Engineering Department at the University of Twente, Enschede 7522 LW, Netherlands
| | - A C Schouten
- Biomechanical Engineering Department at the Delft University of Technology, Delft 2628 CD, Netherlands; Biomechanical Engineering Department at the University of Twente, Enschede 7522 LW, Netherlands
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14
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Human Balance in Response to Continuous, Predictable Translations of the Support Base: Integration of Sensory Information, Adaptation to Perturbations, and the Effect of Age, Neuropathy and Parkinson’s Disease. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9245310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This short narrative review article moves from early papers that described the behaviour of healthy subjects balancing on a motorized platform continuously translating in the antero-posterior direction. Research from the laboratories of two of the authors and related investigations on dynamic balancing behaviour are briefly summarized. More recent findings challenging time-honoured views are considered, such as the statement that vision plays a head-in-space stabilizing role. The time interval to integrate vision or its withdrawal in the balancing pattern is mentioned as well. Similarities and differences between ageing subjects and patients with peripheral or central disorders are concisely reported. The muscle activities recorded during the translation cycles suggest that vision and amplitude changes of the anticipatory postural activities play a predominant role in controlling dynamic balance during prolonged administration of the predictable perturbation. The potential of this paradigm for rehabilitation of balance problems is discussed.
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15
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Schut IM, Pasma JH, Veij Mestdagh JCD, Kooij HVD, Schouten AC. Effect of Amplitude and Number of Repetitions of the Perturbation on System Identification of Human Balance Control During Stance. IEEE Trans Neural Syst Rehabil Eng 2019; 27:2336-2343. [PMID: 31545739 DOI: 10.1109/tnsre.2019.2943206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To unravel the underlying mechanisms of human balance control, system identification techniques are applied in combination with dedicated perturbations, like support surface translations. However, it remains unclear what the optimal amplitude and number of repetitions of the perturbation signal are. In this study we investigated the effect of the amplitude and number of repetitions on the identification of the neuromuscular controller (NMC). Healthy participants were asked to stand on a treadmill while small continuous support surface translations were applied in the form of a periodic multisine signal. The perturbation amplitude varied over seven conditions between 0.02 and 0.20 m peak-to-peak (ptp), where 6.5 repetitions of the multisine signal were applied for each amplitude, resulting in a trial length of 130 sec. For one of the conditions, 24 repetitions were recorded. The recorded external perturbation torque, body sway and ankle torque were used to calculate both the relative variability of the frequency response function (FRF) of the NMC, i.e., a measure for precision, depending on the noise-to-signal ratio (NSR) and the nonlinear distortions. Results showed that the perturbation amplitude should be minimally 0.05 m ptp, but higher perturbation amplitudes are preferred since they resulted in a higher precision, due to a lower noise-to-signal ratio (NSR). There is, however, no need to further increase the perturbation amplitude than 0.14 m ptp. Increasing the number of repetitions improves the precision, but the number of repetitions minimally required, depends on the perturbation amplitude and the preferred precision. Nonlinear contributions are low and, for the ankle torque, constant over perturbation amplitude.
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16
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Broom L, Worley A, Gao F, Hernandez LD, Ashton CE, Shih LC, VanderHorst VG. Translational methods to detect asymmetries in temporal and spatial walking metrics in parkinsonian mouse models and human subjects with Parkinson's disease. Sci Rep 2019; 9:2437. [PMID: 30792396 PMCID: PMC6385183 DOI: 10.1038/s41598-019-38623-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/21/2018] [Indexed: 12/31/2022] Open
Abstract
Clinical signs in Parkinson's disease (PD), including parkinsonian gait, are often asymmetric, but mechanisms underlying gait asymmetries in PD remain poorly understood. A translational toolkit, a set of standardized measures to capture gait asymmetries in relevant mouse models and patients, would greatly facilitate research efforts. We validated approaches to quantify asymmetries in placement and timing of limbs in mouse models of parkinsonism and human PD subjects at speeds that are relevant for human walking. In mice, we applied regression analysis to compare left and right gait metrics within a condition. To compare alternation ratios of left and right limbs before and after induction of parkinsonism, we used circular statistics. Both approaches revealed asymmetries in hind- and forelimb step length in a unilateral PD model, but not in bilateral or control models. In human subjects, a similar regression approach showed a step length asymmetry in the PD but not control group. Sub-analysis of cohorts with predominant postural instability-gait impairment and with predominant tremor revealed asymmetries for step length in both cohorts and for swing time only in the former cohort. This translational approach captures asymmetries of gait in mice and patients. Application revealed striking differences between models, and that spatial and temporal asymmetries may occur independently. This approach will be useful to investigate circuit mechanisms underlying the heterogeneity between models.
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Affiliation(s)
- Lauren Broom
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Audrey Worley
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Fay Gao
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Laura D Hernandez
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Christine E Ashton
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Ludy C Shih
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Veronique G VanderHorst
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center and Harvard Medical School, 3 Blackfan Circle, Boston, MA, 02115, USA.
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17
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Barbieri FA, Carpenter M, Beretta VS, Orcioli-Silva D, Simieli L, Vitório R, Gobbi LTB. Postural control, falls and Parkinson’s disease: Are fallers more asymmetric than non-fallers? Hum Mov Sci 2019; 63:129-137. [DOI: 10.1016/j.humov.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 10/10/2018] [Accepted: 10/17/2018] [Indexed: 10/27/2022]
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18
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Beretta VS, Vitório R, Santos PCRD, Orcioli-Silva D, Gobbi LTB. Postural control after unexpected external perturbation: Effects of Parkinson's disease subtype. Hum Mov Sci 2019; 64:12-18. [PMID: 30639706 DOI: 10.1016/j.humov.2019.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/20/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
Different clinical subtypes of Parkinson's disease (PD) have long been recognized. Recent studies have focused on two PD subtypes: Postural Instability and Gait Difficulty (PIGD) and Tremor Dominant (TD). PIGD patients have greater difficulties in postural control in relation to TD. However, knowledge about the differences in reactive adjustment mechanisms following a perturbation in TD and PIGD is limited. This study aimed to compare reactive postural adjustments under unexpected external perturbation in TD, PIGD, and control group (CG) subjects. Forty-five individuals (15 TD, 15 PIGD, and 15 CG) participated in this study. Postural perturbation was applied by the posterior displacement of the support surface in an unexpected condition. The velocity (15 cm/s) and displacement (5 cm/s) of perturbation were the same for all participants. Center of pressure (CoP) and center of mass (CoM) were analyzed for two reactive windows after the perturbation (0-200 ms and 200-700 ms). The Bonferroni post hoc test indicated a higher range of CoP in the PIGD when compared to the CG (p = 0.021). The PIGD demonstrated greater time to recover the stable posture compared to the TD (p = 0.017) and CG (p = 0.003). Furthermore, the TD showed higher AP-acceleration peak of CoM when compared to the PIGD (p = 0.048) and CG (p = 0.013), and greater AP-acceleration range of CoM in relation to the CG (p = 0.022). These findings suggest that PD patients present worse reactive postural control after perturbation compared to healthy older individuals. CoP and CoM parameters are sensitive to understand and detect the differences in reactive postural mechanisms in PD subtypes.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-Graduation Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Rodrigo Vitório
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-Graduation Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Paulo Cezar Rocha Dos Santos
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-Graduation Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-Graduation Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-Graduation Program in Movement Sciences, São Paulo State University - UNESP, Brazil.
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19
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Neves MA, Bouça-Machado R, Guerreiro D, Caniça V, Ferreira JJ. Risk of drowning in people with Parkinson's disease. Mov Disord 2018; 33:1507-1508. [DOI: 10.1002/mds.27473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/23/2018] [Accepted: 06/01/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Raquel Bouça-Machado
- Instituto de Medicina Molecular; Lisbon Portugal
- Campus Neurológico Sénior (CNS); Torres Vedras Portugal
| | | | | | - Joaquim J. Ferreira
- Instituto de Medicina Molecular; Lisbon Portugal
- Campus Neurológico Sénior (CNS); Torres Vedras Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine; University of Lisbon; Lisbon Portugal
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20
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Ospina BM, Chaparro JAV, Paredes JDA, Pino YJC, Navarro A, Orozco JL. Objective Arm Swing Analysis in Early-Stage Parkinson's Disease Using an RGB-D Camera (Kinect®). JOURNAL OF PARKINSONS DISEASE 2018; 8:563-570. [PMID: 30149466 PMCID: PMC6218143 DOI: 10.3233/jpd-181401] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Arm swing changes are common even in the early stages of Parkinson's disease (PD). We hypothesized that arm swing changes decrease with age and can be detected using a low-cost, RGB-D depth-sensing camera. OBJECTIVE This study aimed to assess the differences in arm swing between PD patients and healthy participants and to investigate the possible effects of aging on these differences. METHODS Twenty-five PD patients (aged 45-87 years) and 25 age-matched, healthy subjects (aged 46-88 years) were included. Clinical variables were evaluated using a descriptive analysis. No spatiotemporal variables were normally distributed; therefore, we used a Mann-Whitney U test to compare the continuous variables between groups and to perform age-stratified analysis. A receiver operating characteristic analysis was generated to evaluate the discrimination activity of arm swing asymmetry (ASA). RESULTS The PD group showed significant reductions in arm swing magnitude (left, p = 0.002; right, p = 0.006) and arm swing speed (left, p = 0.002; right, p = 0.004) and significantly greater ASA (p < 0.001). The age-stratified analysis showed significant differences in ASA in the 40-59-year group (p = 0.001) and bilateral arm swing magnitude in the 60-66-year group. No differences were found in those aged >67 years. CONCLUSIONS The camera detected differences in ASA, arm swing speed, and arm swing magnitude between PD patients and healthy individuals. Analysis of arm swing variables should be stratified by age, and the validity of the analysis may be questionable in patients aged >67 years.
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Affiliation(s)
- Beatriz Muñoz Ospina
- Fundación Valle del Lili, Departamento de Neurología, Cali, Colombia.,i2t Research Group, Universidad Icesi, Cali, Colombia.,Centro de investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
| | - Jaime Andrés Valderrama Chaparro
- Fundación Valle del Lili, Departamento de Neurología, Cali, Colombia.,Centro de investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
| | | | | | | | - Jorge Luis Orozco
- Fundación Valle del Lili, Departamento de Neurología, Cali, Colombia.,i2t Research Group, Universidad Icesi, Cali, Colombia.,Centro de investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
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21
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Bekkers EMJ, Dijkstra BW, Heremans E, Verschueren SMP, Bloem BR, Nieuwboer A. Balancing between the two: Are freezing of gait and postural instability in Parkinson's disease connected? Neurosci Biobehav Rev 2018; 94:113-125. [PMID: 30125601 DOI: 10.1016/j.neubiorev.2018.08.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 08/15/2018] [Indexed: 01/11/2023]
Abstract
Postural instability and freezing of gait (FoG) are key features of Parkinson's disease (PD) closely related to falls. Growing evidence suggests that co-existing postural deficits could influence the occurrence and severity of FoG. To date, the exact nature of this interrelationship remains largely unknown. We analyzed the complex interaction between postural instability and gait disturbance by comparing the findings available in the posturographic literature between patients with and without FoG. Results showed that FoG and postural instability are intertwined, can influence each other behaviorally and may coincide neurologically. The most common FoG-related postural deficits included weight-shifting impairments, and inadequate scaling and timing of postural responses most apparent at forthcoming postural changes under time constraints. Most likely, a negative cycle of combined and more severe postural deficits in people with FoG will enhance postural stability breakdown. As such, the wide brain network deficiencies involved in FoG may also concurrently influence postural stability. Future work needs to examine whether training interventions targeting both symptoms will have extra clinical benefits on fall frequency.
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Affiliation(s)
- E M J Bekkers
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium; Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Parkinson Center Nijmegen (ParC), Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands.
| | - B W Dijkstra
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium.
| | - E Heremans
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium.
| | - S M P Verschueren
- Research Group for Musculoskeletal Research, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium.
| | - B R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Parkinson Center Nijmegen (ParC), Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands.
| | - A Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001, Leuven, Belgium.
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22
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Cai J, Lee S, Ba F, Garg S, Kim LJ, Liu A, Kim D, Wang ZJ, McKeown MJ. Galvanic Vestibular Stimulation (GVS) Augments Deficient Pedunculopontine Nucleus (PPN) Connectivity in Mild Parkinson's Disease: fMRI Effects of Different Stimuli. Front Neurosci 2018. [PMID: 29541016 PMCID: PMC5835530 DOI: 10.3389/fnins.2018.00101] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Falls and balance difficulties remain a major source of morbidity in Parkinson's Disease (PD) and are stubbornly resistant to therapeutic interventions. The mechanisms of gait impairment in PD are incompletely understood but may involve changes in the Pedunculopontine Nucleus (PPN) and its associated connections. We utilized fMRI to explore the modulation of PPN connectivity by Galvanic Vestibular Stimulation (GVS) in healthy controls (n = 12) and PD subjects even without overt evidence of Freezing of Gait (FOG) while on medication (n = 23). We also investigated if the type of GVS stimuli (i.e., sinusoidal or stochastic) differentially affected connectivity. Approximate PPN regions were manually drawn on T1 weighted images and 58 other cortical and subcortical Regions of Interest (ROI) were obtained by automatic segmentation. All analyses were done in the native subject's space without spatial transformation to a common template. We first used Partial Least Squares (PLS) on a subject-by-subject basis to determine ROIs across subjects that covaried significantly with the voxels within the PPN ROI. We then performed functional connectivity analysis on the PPN-ROI connections. In control subjects, GVS did not have a significant effect on PPN connectivity. In PD subjects, baseline overall magnitude of PPN connectivity was negatively correlated with UPDRS scores (p < 0.05). Both noisy and sinusoidal GVS increased the overall magnitude of PPN connectivity (p = 6 × 10−5, 3 × 10−4, respectively) in PD, and increased connectivity with the left inferior parietal region, but had opposite effects on amygdala connectivity. Noisy stimuli selectively decreased connectivity with basal ganglia and cerebellar regions. Our results suggest that GVS can enhance deficient PPN connectivity seen in PD in a stimulus-dependent manner. This may provide a mechanism through which GVS assists balance in PD, and may provide a biomarker to develop individualized stimulus parameters.
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Affiliation(s)
- Jiayue Cai
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Soojin Lee
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada.,Pacific Parkinson's Research Centre, Vancouver, BC, Canada
| | - Fang Ba
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Saurabh Garg
- Pacific Parkinson's Research Centre, Vancouver, BC, Canada
| | - Laura J Kim
- Pacific Parkinson's Research Centre, Vancouver, BC, Canada
| | - Aiping Liu
- Pacific Parkinson's Research Centre, Vancouver, BC, Canada.,School of Electronics and Applied Physics, Hefei University of Technology, Hefei, China
| | - Diana Kim
- Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Z Jane Wang
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Martin J McKeown
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada.,Pacific Parkinson's Research Centre, Vancouver, BC, Canada.,Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
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23
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Pasma JH, van Kordelaar J, de Kam D, Weerdesteyn V, Schouten AC, van der Kooij H. Assessment of the underlying systems involved in standing balance: the additional value of electromyography in system identification and parameter estimation. J Neuroeng Rehabil 2017; 14:97. [PMID: 28915821 PMCID: PMC5603100 DOI: 10.1186/s12984-017-0299-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/30/2017] [Indexed: 11/29/2022] Open
Abstract
Background Closed loop system identification (CLSIT) is a method to disentangle the contribution of underlying systems in standing balance. We investigated whether taking into account lower leg muscle activation in CLSIT could improve the reliability and accuracy of estimated parameters identifying the underlying systems. Methods Standing balance behaviour of 20 healthy young participants was measured using continuous rotations of the support surface (SS). The dynamic balance behaviour obtained with CLSIT was expressed by sensitivity functions of the ankle torque, body sway and muscle activation of the lower legs to the SS rotation. Balance control models, 1) without activation dynamics, 2) with activation dynamics and 3) with activation dynamics and acceleration feedback, were fitted on the data of all possible combinations of the 3 sensitivity functions. The reliability of the estimated model parameters was represented by the mean relative standard errors of the mean (mSEM) of the estimated parameters, expressed for the basic parameters, the activation dynamics parameters and the acceleration feedback parameter. To investigate the accuracy, a model validation study was performed using simulated data obtained with a comprehensive balance control model. The accuracy of the estimated model parameters was described by the mean relative difference (mDIFF) between the estimated parameters and original parameters. Results The experimental data showed a low mSEM of the basic parameters, activation dynamics parameters and acceleration feedback parameter by adding muscle activation in combination with activation dynamics and acceleration feedback to the fitted model. From the simulated data, the mDIFF of the basic parameters varied from 22.2–22.4% when estimated using the torque and body sway sensitivity functions. Adding the activation dynamics, acceleration feedback and muscle activation improved mDIFF to 13.1–15.1%. Conclusions Adding the muscle activation in combination with the activation dynamics and acceleration feedback to CLSIT improves the accuracy and reliability of the estimated parameters and gives the possibility to separate the neural time delay, electromechanical delay and the intrinsic and reflexive dynamics. To diagnose impaired balance more specifically, it is recommended to add electromyography (EMG) to body sway (with or without torque) measurements in the assessment of the underlying systems. Electronic supplementary material The online version of this article (10.1186/s12984-017-0299-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J H Pasma
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.
| | - J van Kordelaar
- Department of Biomechanical Engineering, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, The Netherlands
| | - D de Kam
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - V Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Sint Maartenskliniek Research, Nijmegen, The Netherlands
| | - A C Schouten
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.,Department of Biomechanical Engineering, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, The Netherlands
| | - H van der Kooij
- Department of Biomechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.,Department of Biomechanical Engineering, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, The Netherlands
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24
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Bekkers EMJ, Dijkstra BW, Dockx K, Heremans E, Verschueren SMP, Nieuwboer A. Clinical balance scales indicate worse postural control in people with Parkinson's disease who exhibit freezing of gait compared to those who do not: A meta-analysis. Gait Posture 2017; 56:134-140. [PMID: 28544951 DOI: 10.1016/j.gaitpost.2017.05.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/03/2017] [Accepted: 05/09/2017] [Indexed: 02/02/2023]
Abstract
Postural instability and freezing of gait (FOG) are key features of Parkinson's disease (PD) that are closely related to falls. Uncovering the postural control differences between individuals with and without FOG contributes to our understanding of the relationship between these phenomena. The objective of this meta-analysis was to investigate whether postural control deficits, as detected by clinical balance scales, were more apparent in FOG+ compared to FOG-. Furthermore, we aimed to identify whether different scales were equally sensitive to detect postural control deficits and whether medication affected postural control differentially in each subgroup. Relevant articles were identified via five electronic databases. We performed a meta-analysis on nine studies which reported clinical balance scale scores in 249 freezers and 321 non-freezers. Methodological analysis showed that in 5/9 studies disease duration differed between subgroups. Despite this drawback, postural control was found to be significantly worse in FOG+ compared to FOG-. All included clinical balance scales were found to be sufficiently sensitive to detect the postural control differences. Levodopa did not differentially affect postural control (p=0.21), as in both medication states FOG+ had worse postural stability than FOG-. However, this finding warrants a cautious interpretation given the limitations of the studies included. From subscore analysis, we found that reactive and dynamic postural control were the most affected postural control systems in FOG+. We conclude that our findings provide important evidence for pronounced postural instability in individuals with FOG, which can be easily picked up with clinical evaluation tools. Posturographic measures in well-matched subgroups are needed to highlight the exact nature of these deficits.
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Affiliation(s)
- Esther M J Bekkers
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium.
| | - Bauke W Dijkstra
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Kim Dockx
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Elke Heremans
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Sabine M P Verschueren
- Research Group for Musculoskeletal Research, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
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Falaki A, Huang X, Lewis MM, Latash ML. Motor equivalence and structure of variance: multi-muscle postural synergies in Parkinson's disease. Exp Brain Res 2017; 235:2243-2258. [PMID: 28455740 PMCID: PMC5507367 DOI: 10.1007/s00221-017-4971-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/25/2017] [Indexed: 01/06/2023]
Abstract
We explored posture-stabilizing multi-muscle synergies with two methods of analysis of multi-element, abundant systems: (1) Analysis of inter-cycle variance; and (2) Analysis of motor equivalence, both quantified within the framework of the uncontrolled manifold (UCM) hypothesis. Data collected in two earlier studies of patients with Parkinson's disease (PD) were re-analyzed. One study compared synergies in the space of muscle modes (muscle groups with parallel scaling of activation) during tasks performed by early-stage PD patients and controls. The other study explored the effects of dopaminergic medication on multi-muscle-mode synergies. Inter-cycle variance and absolute magnitude of the center of pressure displacement across consecutive cycles were quantified during voluntary whole-body sway within the UCM and orthogonal to the UCM space. The patients showed smaller indices of variance within the UCM and motor equivalence compared to controls. The indices were also smaller in the off-drug compared to on-drug condition. There were strong across-subject correlations between the inter-cycle variance within/orthogonal to the UCM and motor equivalent/non-motor equivalent displacements. This study has shown that, at least for cyclical tasks, analysis of variance and analysis of motor equivalence lead to metrics of stability that correlate with each other and show similar effects of disease and medication. These results show, for the first time, intimate links between indices of variance and motor equivalence. They suggest that analysis of motor equivalence, which requires only a handful of trials, could be used broadly in the field of motor disorders to analyze problems with action stability.
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Affiliation(s)
- Ali Falaki
- Department of Kinesiology, The Pennsylvania State University, Rec.Hall-268N, University Park, PA, 16802, USA
| | - Xuemei Huang
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
- Department of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
- Department of Radiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
- Department of Neurosurgery, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Mechelle M Lewis
- Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
- Department of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
| | - Mark L Latash
- Department of Kinesiology, The Pennsylvania State University, Rec.Hall-268N, University Park, PA, 16802, USA.
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Variability of Anticipatory Postural Adjustments During Gait Initiation in Individuals With Parkinson Disease. J Neurol Phys Ther 2016; 40:40-6. [PMID: 26630325 DOI: 10.1097/npt.0000000000000112] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE In people with Parkinson disease (PD), difficulties with initiating stepping may be related to impairments of anticipatory postural adjustments (APAs). Increased variability in step length and step time has been observed in gait initiation in individuals with PD. In this study, we investigated whether the ability to generate consistent APAs during gait initiation is compromised in these individuals. METHODS Fifteen subjects with PD and 8 healthy control subjects were instructed to take rapid forward steps after a verbal cue. The changes in vertical force and ankle marker position were recorded via force platforms and a 3-dimensional motion capture system, respectively. Means, standard deviations, and coefficients of variation of both timing and magnitude of vertical force, as well as stepping variables, were calculated. RESULTS During the postural phase of gait initiation the interval was longer and the force modulation was smaller in subjects with PD. Both the variability of timing and force modulation were larger in subjects with PD. Individuals with PD also had a longer time to complete the first step, but no significant differences were found for the variability of step time, length, and speed between groups. DISCUSSION AND CONCLUSIONS The increased variability of APAs during gait initiation in subjects with PD could affect posture-locomotion coupling, and lead to start hesitation, and even falls. Future studies are needed to investigate the effect of rehabilitation interventions on the variability of APAs during gait initiation in individuals with PD.Video abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A119).
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Schlenstedt C, Muthuraman M, Witt K, Weisser B, Fasano A, Deuschl G. Postural control and freezing of gait in Parkinson's disease. Parkinsonism Relat Disord 2016; 24:107-12. [DOI: 10.1016/j.parkreldis.2015.12.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/30/2015] [Accepted: 12/15/2015] [Indexed: 11/26/2022]
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Falaki A, Huang X, Lewis MM, Latash ML. Impaired synergic control of posture in Parkinson's patients without postural instability. Gait Posture 2016; 44:209-15. [PMID: 27004660 PMCID: PMC4806225 DOI: 10.1016/j.gaitpost.2015.12.035] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 11/03/2015] [Accepted: 12/16/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postural instability is one of most disabling motor symptoms in Parkinson's disease. Indices of multi-muscle synergies are new measurements of movement and postural stability. OBJECTIVES Multi-muscle synergies stabilizing vertical posture were studied in Parkinson's disease patients without clinical symptoms of postural instability (Hoehn-Yahr ≤ II) and age-matched controls. We tested the hypothesis that both synergy indices during quiet standing and synergy adjustments to self-triggered postural perturbations would be reduced in patients. METHODS Eleven Parkinson's disease patients and 11 controls performed whole-body tasks while standing. Surface electromyography was used to quantify synergy indices stabilizing center of pressure shifts in the anterior-posterior direction during a load-release task. RESULTS Parkinson's disease patients showed a significantly lower percentage of variance in the muscle activation space accounted for by the first four principal components, significantly reduced synergy indices during steady state, and significantly reduced anticipatory synergy adjustments (a drop in the synergy index prior to the self-triggered unloading). CONCLUSIONS The study demonstrates for the first time that impaired synergic control in Parkinson's disease can be quantified in postural tasks, even in patients without clinical manifestations of postural instability. Synergy measurements may provide a biomarker sensitive for early problems with postural stability in Parkinson's disease.
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Affiliation(s)
- Ali Falaki
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA
| | - Xuemei Huang
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA; Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA; Department of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA; Department of Radiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA; Department of Neurosurgery, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Mechelle M Lewis
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA; Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA; Department of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Mark L Latash
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA.
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Boonstra TA, van Kordelaar J, Engelhart D, van Vugt JPP, van der Kooij H. Asymmetries in reactive and anticipatory balance control are of similar magnitude in Parkinson's disease patients. Gait Posture 2016; 43:108-13. [PMID: 26475760 DOI: 10.1016/j.gaitpost.2015.08.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 07/21/2015] [Accepted: 08/31/2015] [Indexed: 02/02/2023]
Abstract
Many Parkinson's disease (PD) patients show asymmetries in balance control during quiet stance and in response to perturbations (i.e., reactive balance control) in the sagittal plane. In addition, PD patients show a reduced ability to anticipate to self-induced disturbances, but it is not clear whether these anticipatory responses can be asymmetric too. Furthermore, it is not known how reactive balance control and anticipatory balance control are related in PD patients. Therefore, we investigated whether reactive and anticipatory balance control are asymmetric to the same extent in PD patients. 14 PD patients and 10 controls participated. Reactive balance control (RBC) was investigated by applying external platform and force perturbations and relating the response of the left and right ankle torque to the body sway angle at the excited frequencies. Anticipatory postural adjustments (APAs) were investigated by determining the increase in the left and right ankle torque just before the subjects released a force exerted with the hands against a force sensor. The symmetry ratio between the contribution of the left and right ankle was used to express the asymmetry in reactive and anticipatory balance control; the correlation between the two ratio's was investigated with Spearman's rank correlation coefficients. PD patients were more asymmetric in anticipatory (p=0.026) and reactive balance control (p=0.004) compared to controls and the symmetry ratios were significantly related (ρ=0.74; p=0.003) in PD patients. These findings suggest that asymmetric reactive balance control during bipedal stance may share a common pathophysiology with asymmetries in the anticipation of voluntary perturbations during, for instance, gait initiation.
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Affiliation(s)
- Tjitske A Boonstra
- Laboratory of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
| | - Joost van Kordelaar
- Laboratory of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Denise Engelhart
- Laboratory of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | | | - Herman van der Kooij
- Laboratory of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Barbieri FA, Polastri PF, Baptista AM, Lirani-Silva E, Simieli L, Orcioli-Silva D, Beretta VS, Gobbi LTB. Effects of disease severity and medication state on postural control asymmetry during challenging postural tasks in individuals with Parkinson's disease. Hum Mov Sci 2015; 46:96-103. [PMID: 26741255 DOI: 10.1016/j.humov.2015.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 12/01/2015] [Accepted: 12/17/2015] [Indexed: 11/19/2022]
Abstract
The aim of this study was to investigate the effects of disease severity and medication state on postural control asymmetry during challenging tasks in individuals with Parkinson's disease (PD). Nineteen people with PD and 11 neurologically healthy individuals performed three standing task conditions: bipedal standing, tandem and unipedal adapted standing; the individuals with PD performed the tasks in ON and OFF medication state. The participants with PD were distributed into 2 groups according to disease severity: unilateral group (n=8) and bilateral group (n=11). The two PD groups performed the evaluations both under and without the medication. Two force plates were used to analyze the posture. The symmetric index was calculated for various of center of pressure. ANOVA one-way (groups) and two-way (PD groups×medication), with repeated measures for medication, were calculated. For main effects of group, the bilateral group was more asymmetric than CG. For main effects of medication, only unipedal adapted standing presented effects of PD medication. There was PD groups×medication interaction. Under the effects of medication, the unilateral group presented lower asymmetry of RMS in anterior-posterior direction and area than the bilateral group in unipedal adapted standing. In addition, the unilateral group presented lower asymmetry of mean velocity, RMS in anterior-posterior direction and area in unipedal standing and area in tandem adapted standing after a medication dose. Postural control asymmetry during challenging postural tasks was dependent on disease severity and medication state in people with PD. The bilateral group presented higher postural control asymmetry than the control and unilateral groups in challenging postural tasks. Finally, the medication dose was able to reduce postural control asymmetry in the unilateral group during challenging postural tasks.
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Affiliation(s)
- Fabio A Barbieri
- Univ Estadual Paulista - Campus Rio Claro, Posture and Gait Studies Laboratory, Av. 24-A, 1515, Rio Claro, SP CEP: 13506-900, Brazil; Univ Estadual Paulista - Campus Bauru, Laboratory of Human Movement Research, Laboratory of Information, Vision and Action, Av. Eng. Luiz Edmundo Carrijo Coube, 14-01, Bauru, SP CEP: 17033-360, Brazil.
| | - Paula F Polastri
- Univ Estadual Paulista - Campus Bauru, Laboratory of Human Movement Research, Laboratory of Information, Vision and Action, Av. Eng. Luiz Edmundo Carrijo Coube, 14-01, Bauru, SP CEP: 17033-360, Brazil
| | - André M Baptista
- Univ Estadual Paulista - Campus Rio Claro, Posture and Gait Studies Laboratory, Av. 24-A, 1515, Rio Claro, SP CEP: 13506-900, Brazil; Univ Estadual Paulista - Campus Bauru, Laboratory of Human Movement Research, Laboratory of Information, Vision and Action, Av. Eng. Luiz Edmundo Carrijo Coube, 14-01, Bauru, SP CEP: 17033-360, Brazil
| | - Ellen Lirani-Silva
- Univ Estadual Paulista - Campus Rio Claro, Posture and Gait Studies Laboratory, Av. 24-A, 1515, Rio Claro, SP CEP: 13506-900, Brazil
| | - Lucas Simieli
- Univ Estadual Paulista - Campus Rio Claro, Posture and Gait Studies Laboratory, Av. 24-A, 1515, Rio Claro, SP CEP: 13506-900, Brazil
| | - Diego Orcioli-Silva
- Univ Estadual Paulista - Campus Rio Claro, Posture and Gait Studies Laboratory, Av. 24-A, 1515, Rio Claro, SP CEP: 13506-900, Brazil
| | - Victor S Beretta
- Univ Estadual Paulista - Campus Rio Claro, Posture and Gait Studies Laboratory, Av. 24-A, 1515, Rio Claro, SP CEP: 13506-900, Brazil
| | - Lilian T B Gobbi
- Univ Estadual Paulista - Campus Rio Claro, Posture and Gait Studies Laboratory, Av. 24-A, 1515, Rio Claro, SP CEP: 13506-900, Brazil
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Balance Dysfunction in Parkinson's Disease: The Role of Posturography in Developing a Rehabilitation Program. PARKINSONS DISEASE 2015; 2015:520128. [PMID: 26504611 PMCID: PMC4609480 DOI: 10.1155/2015/520128] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/20/2015] [Accepted: 04/23/2015] [Indexed: 11/22/2022]
Abstract
Balance dysfunction (BD) in Parkinson's disease (PD) is a disabling symptom, difficult to treat and predisposing to falls. The dopaminergic drugs or deep brain stimulation does not always provide significant improvements of BD and rehabilitative approaches have also failed to restore this condition. In this study, we investigated the suitability of quantitative posturographic indicators to early identify patients that could develop disabling BD. Parkinsonian patients not complaining of a subjective BD and controls were tested using a posturographic platform (PP) with open eyes (OE) and performing a simple cognitive task [counting (OEC)]. We found that patients show higher values of total standard deviation (SD) of body sway and along the medio-lateral (ML) axis during OE condition. Furthermore, total and ML SD of body sway during OE condition and total SD of body sway with OEC were higher than controls also in a subgroup of patients with normal Berg Balance Scale. We conclude that BD in Parkinsonian patients can be discovered before its appearance using a PP and that these data may allow developing specific rehabilitative treatment to prevent or delay their onset.
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Beretta VS, Gobbi LTB, Lirani-Silva E, Simieli L, Orcioli-Silva D, Barbieri FA. Challenging Postural Tasks Increase Asymmetry in Patients with Parkinson's Disease. PLoS One 2015; 10:e0137722. [PMID: 26367032 PMCID: PMC4569579 DOI: 10.1371/journal.pone.0137722] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 08/20/2015] [Indexed: 11/19/2022] Open
Abstract
The unilateral predominance of Parkinson’s disease (PD) symptoms suggests that balance control could be asymmetrical during static tasks. Although studies have shown that balance control asymmetries exist in patients with PD, these analyses were performed using only simple bipedal standing tasks. Challenging postural tasks, such as unipedal or tandem standing, could exacerbate balance control asymmetries. To address this, we studied the impact of challenging standing tasks on postural control asymmetry in patients with PD. Twenty patients with PD and twenty neurologically healthy individuals (control group) participated in this study. Participants performed three 30s trials for each postural task: bipedal, tandem adapted and unipedal standing. The center of pressure parameter was calculated for both limbs in each of these conditions, and the asymmetry between limbs was assessed using the symmetric index. A significant effect of condition was observed, with unipedal standing and tandem standing showing greater asymmetry than bipedal standing for the mediolateral root mean square (RMS) and area of sway parameters, respectively. In addition, a group*condition interaction indicated that, only for patients with PD, the unipedal condition showed greater asymmetry in the mediolateral RMS and area of sway than the bipedal condition and the tandem condition showed greater asymmetry in the area of sway than the bipedal condition. Patients with PD exhibited greater asymmetry while performing tasks requiring postural control when compared to neurologically healthy individuals, especially for challenging tasks such as tandem and unipedal standing.
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Affiliation(s)
- Victor Spiandor Beretta
- Univ Estadual Paulista, UNESP, Posture and Gait Studies Laboratory, Department of Physical Education, Bioscience Institute, Rio Claro, São Paulo, Brazil
| | - Lilian Teresa Bucken Gobbi
- Univ Estadual Paulista, UNESP, Posture and Gait Studies Laboratory, Department of Physical Education, Bioscience Institute, Rio Claro, São Paulo, Brazil
| | - Ellen Lirani-Silva
- Univ Estadual Paulista, UNESP, Posture and Gait Studies Laboratory, Department of Physical Education, Bioscience Institute, Rio Claro, São Paulo, Brazil
| | - Lucas Simieli
- Univ Estadual Paulista, UNESP, Posture and Gait Studies Laboratory, Department of Physical Education, Bioscience Institute, Rio Claro, São Paulo, Brazil
| | - Diego Orcioli-Silva
- Univ Estadual Paulista, UNESP, Posture and Gait Studies Laboratory, Department of Physical Education, Bioscience Institute, Rio Claro, São Paulo, Brazil
| | - Fabio Augusto Barbieri
- Univ Estadual Paulista, UNESP, Posture and Gait Studies Laboratory, Department of Physical Education, Bioscience Institute, Rio Claro, São Paulo, Brazil
- Univ Estadual Paulista, UNESP, Laboratory of Information, Vision and Action, Department of Physical Education, Faculty of Science, Bauru, São Paulo, Brazil
- * E-mail:
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Boonstra TA, Schouten AC, van Vugt JPP, Bloem BR, van der Kooij H. Parkinson's disease patients compensate for balance control asymmetry. J Neurophysiol 2014; 112:3227-39. [DOI: 10.1152/jn.00813.2013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In Parkinson's disease (PD) subtle balance abnormalities can already be detected in early-stage patients. One feature of impaired balance control in PD is asymmetry: one leg produces more corrective joint torque than the other. We hypothesize that in mild to moderately affected PD patients, the least impaired leg compensates for the more impaired leg. Twenty PD patients and eleven healthy matched control subjects participated. Clinical asymmetry was determined by the difference between the left and right body side scores on the Unified Parkinson's Disease Rating Scale. Balance was perturbed with two independent continuous multisine perturbations in the forward-backward direction. Subsequently, we applied closed-loop system identification, which determined the spectral estimate of the stabilizing mechanisms, for each leg. Balance control behavior was similar in PD patients and control subjects at the ankle, but at the hip stiffness was increased. Control subjects exhibited symmetric balance control, but in PD patients the balance contribution of the leg of the clinically least affected body side was higher whereas the leg of the clinically most affected body side contributed less. The ratio between the legs helped to preserve a normal motor output at the ankle. Our results suggest that PD patients compensate for balance control asymmetries by increasing the relative contribution of the leg of their least affected body side. This compensation appears to be successful at the ankle but is accompanied by an increased stiffness at the hip. We discuss the possible implications of these findings for postural stability and fall risk in PD patients.
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Affiliation(s)
- T. A. Boonstra
- Department of Biomechanical Engineering, University of Twente, MIRA Institute for Biomechanical Technology and Technical Medicine, Enschede, The Netherlands
| | - A. C. Schouten
- Department of Biomechanical Engineering, University of Twente, MIRA Institute for Biomechanical Technology and Technical Medicine, Enschede, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - J. P. P. van Vugt
- Department of Neurology, Medical Spectrum Twente, Enschede, The Netherlands; and
| | - B. R. Bloem
- Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| | - H. van der Kooij
- Department of Biomechanical Engineering, University of Twente, MIRA Institute for Biomechanical Technology and Technical Medicine, Enschede, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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