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Deng Y, Tang Z, Yang Z, Chai Q, Lu W, Cai Y, Luo Y, Zhou Y. Comparing the effects of aquatic-based exercise and land-based exercise on balance in older adults: a systematic review and meta-analysis. Eur Rev Aging Phys Act 2024; 21:13. [PMID: 38764039 PMCID: PMC11102618 DOI: 10.1186/s11556-024-00349-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 05/10/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Balance plays a crucial role in the daily activities of older adults. Aquatic-based exercises (AE) are widely conducted as an alternative to land-based exercises (LE). Previous studies have compared AE and LE as effective ways to improve balance and have yielded inconsistent results. Therefore, this review aimed to compare the effects of AE and LE on balance function in older adults. METHODS Electronic databases, including PubMed, Web of Science, Scopus, and Embase, were searched. Randomized controlled trials published from January 2003 to June 2023 were included following predetermined criteria. Data extraction was carried out by two independent reviewers. Data synthesis was conducted using RevMan 5.3 software. The fixed-effect model or random-effect model was chosen based on the results of the heterogeneity test. Meta-analysis for the effect sizes of balance outcomes was calculated as standardized mean difference (SMD) with 95% confidence intervals (CI). The quality of the included studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale. This review was registered at PROSPERO CRD42023429557. RESULTS A total of 29 studies involving 1486 older adults (with an average age of 66.2 years) were included. Meta-analysis results indicated that AE could improve balance ability based on two tests: the Berg balance scale (BBS: SMD = 1.13, 95% CI 0.25 to 2.00, p = 0.01, I2 = 94%) and the 30-s chair stand test (30 CST: SMD = 2.02, 95% CI 0.50 to 3.54, p = 0.009, I2 = 96%). However, there were no significant differences between the AE group and the LE group in terms of the 6-min walking test (6 MWT: SMD = 0.13, 95% CI -0.16 to 0.43, p = 0.38, I2 = 62%) and time up to go test (TUGT: SMD = 0.44, 95% CI -0.44 to 0.91, p = 0.07, I2 = 85%). Older adults with different health conditions have different gains in different balance measurements after AE intervention and LE intervention. CONCLUSIONS Although this was influenced by participant health status, transfer effects, sample size, and other factors, AE offers better benefits than LE for improving balance function in older adults.
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Affiliation(s)
- Ying Deng
- Sichuan University, West China Hospital, Chengdu, 610041, Sichuan, China
| | - Zheng Tang
- Sichuan University, West China Hospital, Chengdu, 610041, Sichuan, China
| | - Zhengting Yang
- Sichuan University, West China Hospital, Chengdu, 610041, Sichuan, China
| | - Qi Chai
- Sichuan University, West China Hospital, Chengdu, 610041, Sichuan, China
| | - Wenting Lu
- Sichuan University, West China Hospital, Chengdu, 610041, Sichuan, China
| | - Yunshi Cai
- Sichuan University, West China Hospital, Chengdu, 610041, Sichuan, China
| | - Yiting Luo
- Sichuan University, West China Hospital, Chengdu, 610041, Sichuan, China
| | - Yongzhao Zhou
- Sichuan University, West China Hospital, Chengdu, 610041, Sichuan, China.
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Schönberg NKT, Poppel J, Howell D, Wagner J, Höfinger M, Fabri N, Bonke EM, Rojczyk P, Hösl M, Kiwull L, Schröder SA, Blaschek A, Vill K, Koerte IK, Huppert D, Heinen F, Bonfert MV. Instrumented Balance Error Scoring System in Children and Adolescents-A Cross Sectional Study. Diagnostics (Basel) 2024; 14:513. [PMID: 38472985 DOI: 10.3390/diagnostics14050513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/14/2024] Open
Abstract
Background: The Balance Error Scoring System (BESS) is a commonly used method for clinically evaluating balance after traumatic brain injury. The utilization of force plates, characterized by their cost-effectiveness and portability, facilitates the integration of instrumentation into the BESS protocol. Despite the enhanced precision associated with instrumented measures, there remains a need to determine the clinical significance and feasibility of such measures within pediatric cohorts. Objective: To report a comprehensive set of posturographic measures obtained during instrumented BESS and to examine the concurrent validity, reliability, and feasibility of instrumented BESS in the pediatric point of care setting. Methods: Thirty-seven participants (18 female; aged 13.32 ± 3.31 years) performed BESS while standing on a force plate to simultaneously compute stabilometric measures (instrumented BESS). Ellipse area (EA), path length (PL), and sway velocity (VM) were obtained for each of the six BESS positions and compared with the respective BESS scores. Additionally, the effects of sex and age were explored. A second BESS repetition was performed to evaluate the test-retest reliability. Feedback questionnaires were handed out after testing to evaluate the feasibility of the proposed protocol. Results: The BESS total score was 20.81 ± 6.28. While there was no statistically significant age or sex dependency in the BESS results, instrumented posturography demonstrated an age dependency in EA, VM, and PL. The one-leg stance on a soft surface resulted in the highest BESS score (8.38 ± 1.76), EA (218.78 cm2 ± 168.65), PL (4386.91 mm ± 1859.00), and VM (21.93 mm/s ± 9.29). The Spearman's coefficient displayed moderate to high correlations between the EA (rs = 0.429-0.770, p = 0.001-0.009), PL (rs = 0.451-0.809, p = 0.001-0.006), and VM (rs = 0.451-0.809, p = 0.001-0.006) when compared with the BESS scores for all testing positions, except for the one-leg stance on a soft surface. The BESS total score significantly correlated during the first and second repetition (rs = 0.734, p ≤ 0.001), as did errors during the different testing positions (rs = 0.489-0.799, p ≤ 0.001-0.002), except during the two-legged stance on a soft surface. VM and PL correlated significantly in all testing positions (rs = 0.465-0.675, p ≤ 0.001-0.004; (rs = 0.465-0.675, p ≤ 0.001-0.004), as did EA for all positions except for the two-legged stance on a soft surface (rs = 0.392-0.581, p ≤ 0.001-0.016). A total of 92% of participants stated that the instructions for the testing procedure were very well-explained, while 78% of participants enjoyed the balance testing, and 61% of participants could not decide whether the testing was easy or hard to perform. Conclusions: Instrumented posturography may complement clinical assessment in investigating postural control in children and adolescents. While the BESS score only allows for the consideration of a total score approximating postural control, instrumented posturography offers several parameters representing the responsiveness and magnitude of body sway as well as a more differentiated analysis of movement trajectory. Concise instrumented posturography protocols should be developed to augment neuropediatric assessments in cases where a deficiency in postural control is suspected, potentially stemming from disruptions in the processing of visual, proprioceptive, and/or vestibular information.
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Affiliation(s)
- Nils K T Schönberg
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Julius Poppel
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - David Howell
- Department of Orthopedics, University of Colorado School of Medicine, Colorado Children's Hospital, Sports Medicine Center, Aurora, CO 80045, USA
| | - Johanna Wagner
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Michael Höfinger
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Nicole Fabri
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Elena M Bonke
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Philine Rojczyk
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Matthias Hösl
- Gait and Motion Analysis Laboratory, Schoen Clinic Vogtareuth, 83569 Vogtareuth, Germany
| | - Lorenz Kiwull
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Clinic for Child Neurology and Social Pediatrics, Kinderzentrum Maulbronn gGmbH, 75433 Maulbronn, Germany
| | - Sebastian A Schröder
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Clinic for Child Neurology and Social Pediatrics, Kinderzentrum Maulbronn gGmbH, 75433 Maulbronn, Germany
| | - Astrid Blaschek
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Katharina Vill
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Michaela V Bonfert
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
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Hong JP, Kwon H, Park E, Lee SU, Lee CN, Kim BJ, Kim JS, Park KW. The semicircular canal function is preserved with little impact on falls in patients with mild Parkinson's disease. Parkinsonism Relat Disord 2024; 118:105933. [PMID: 38007917 DOI: 10.1016/j.parkreldis.2023.105933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Postural instability is a cardinal symptom of Parkinson's disease (PD), which suggests the vestibular system may be affected in PD. This study aimed to determine whether vestibular dysfunction is associated with the risk of falls in PD. METHODS We prospectively recruited patients with de-novo PD at a tertiary medical center between December 2019 and March 2023. During initial assessment, each patient was queried about falls within the preceding year. All patients underwent evaluation of video head-impulse tests (video-HITs), motion analysis, mini-mental state examination (MMSE), and Montreal Cognitive Assessment (MOCA). We determined whether head impulse gain of the vestibulo-ocular reflex (VOR) was associated with clinical severity of PD or risk of falls. RESULTS Overall, 133 patients (mean age ± SD = 68 ± 10, 59 men) were recruited. The median Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor part (MDS-UPDRS-III) was 23 (interquartile range = 16-31), and 81 patients (61 %) scored 2 or less on the Hoehn and Yahr scale. Fallers were older (p = 0.001), had longer disease duration (p = 0.001), slower gait velocity (p = 0.009), higher MDS-UPDRS-III (p < 0.001) and H&Y scale (p < 0.001), lower MMSE (p = 0.018) and MOCA scores (p = 0.001) than non-fallers. Multiple logistic regression showed that MDS-UPDRS-III had a positive association with falling (p = 0.004). Falling was not associated with VOR gain (p = 0.405). The VOR gain for each semicircular canal showed no correlation with the MDS-UPDRS-III or disease duration. CONCLUSIONS The semicircular canal function, as determined by video-HITs, is relatively spared and has little effect on the risk of falls in patients with mild-to-moderate PD.
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Affiliation(s)
- Jun-Pyo Hong
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
| | - Hanim Kwon
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Euyhyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea; Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea; Neurotology and Neuro-ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea.
| | - Chan-Nyoung Lee
- Department of Neurology, Korea University Medical Center, Seoul, South Korea.
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Seoul, South Korea; BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea; Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kun-Woo Park
- Department of Neurology, Korea University Medical Center, Seoul, South Korea
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Bao W, Tan Y, Yang Y, Chen K, Liu J. Correlation of balance posturographic parameters during quiet standing with the berg balance scale in patients with parkinson's disease. BMC Neurol 2023; 23:362. [PMID: 37803250 PMCID: PMC10557353 DOI: 10.1186/s12883-023-03386-1] [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: 04/25/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is often clinically associated with posture instability and more easily falling. The Berg balance scale is a clinical indicator commonly used to subjectively evaluate a patient's balance ability. Meanwhile, computerized force platforms have been used in research on postural control. The various parameters obtained from posturography are interpreted to assess balance ability. The present study aims to explore the correlations between posturographic variables and the BBS, and furthermore to efficiently evaluate postural instability and fall risk of early and moderate PD patients. METHODS A total of 46 PD patients were involved in the experiment. Patients were asked to perform BBS tests and force platform tests under eye open (EO) and eye closed (EC) conditions. The recorded COP signal was analyzed with the time domain statistical method, the frequency domain method of Power Spectral Density (PSD), and structural methods of Stabilogram Diffusion Analysis (SDA), Sway Density Plot (SDP) to retrieve different posturographic variables. The correlation between posturographic variables under EO and EC conditions with BBS was compared statistically. The significantly correlated posturographic parameters were then applied to analyze posturographic differences between different groups: faller vs. non-faller (patients with/without a history of falls in the past 12 months). RESULTS Among the different posturographic parameters, the prediction ellipse area, the slope of the regression line at a high-frequency band of PSD in the medial-lateral (ML) direction, the crossover point of the regression lines of SDA in the anterior-posterior (AP) direction, and the distance between successive peaks of SDP had significant correlations with BBS. These selected BBS-related parameters also showed significant differences between faller and non-faller. The selected posturographic parameters can be used as effective indicators to evaluate the balance ability of Parkinson's disease patients.
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Affiliation(s)
- Wei Bao
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China
| | - Yuyan Tan
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ying Yang
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China
| | - Kai Chen
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China.
| | - Jun Liu
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
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Wodarski P, Jurkojć J, Michalska J, Kamieniarz A, Juras G, Gzik M. Balance assessment in selected stages of Parkinson's disease using trend change analysis. J Neuroeng Rehabil 2023; 20:99. [PMID: 37528430 PMCID: PMC10394805 DOI: 10.1186/s12984-023-01229-1] [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: 02/21/2023] [Accepted: 07/28/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Balance disorders in patients diagnosed with Parkinson's disease (PD) are associated with a change in balance-keeping strategy and reflex disorders which regulate the maintenance of vertical body posture. Center of foot pressure (COP) displacement signals were analyzed during quiet standing experiments to define such changes. The research aimed to apply stock exchange indices based on the trend change analyses to the assessment of a level of the Parkinson disease progression on the grounds of the analysis of the COP signals. METHODS 30 patients in two stages of PD, 40 elderly participants, and 20 individuals at a young age were studied. Each person was subjected to 3 measurements with open and closed eyes. A technical analysis of the COP displacement signal was performed, and the following quantities were determined: indices related to the number of trend changes (TCI), indices defining a mean time (TCI_dT), and mean displacement (TCI_dS) and mean velocity (TCI_dV) between such changes. RESULTS The results indicate a higher TCI value for PD than for aged-matched control group (p < 0.05). In the case of PD patients, there was also an increase in the TCI_dS value by 2-5 mm, which mainly contributed to the increase in TCI_dV. Statistically significant differences for the TCI_dT values occurred between all groups in which differences in the average COP velocity were noted. CONCLUSIONS The TCI and TCI_dV results obtained for the healthy participants enabled the development of indices supporting PD diagnostics. The causes of the TCI_dV changes in patients were determined, i.e., whether they resulted from an increase in the TCI_dT or TCI_dS between the moments of trend changes indicated by the developed algorithm. The developed methodology provides new information on the impact of PD on the strategy of maintaining balance, which was impossible to obtain using currently used analyses. Trial registration The conducted research is an observational study and does not include a health care intervention. Participants gave their consent to participate in the research and the procedure was approved by the Institutional Bioethics Committee.
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Affiliation(s)
- Piotr Wodarski
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
| | - Jacek Jurkojć
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
| | - Justyna Michalska
- Department of Human Motor Behavior, Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland
| | - Anna Kamieniarz
- Department of Human Motor Behavior, Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland
| | - Grzegorz Juras
- Department of Human Motor Behavior, Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland
| | - Marek Gzik
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
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Charalambous D, Lutonsky C, Keider S, Tichy A, Bockstahler B. Vertical ground reaction forces, paw pressure distribution, and center of pressure during heelwork in working dogs competing in obedience. Front Vet Sci 2023; 10:1106170. [PMID: 36846253 PMCID: PMC9950403 DOI: 10.3389/fvets.2023.1106170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
Heelwork walking is a command that competitive obedience and working dogs are trained to perform. Unlike other canine sports, the research for competitive obedience sport is limited and no research regarding biomechanical gait adaptions during heelwork walking has been published. The aim of the study was to investigate the changes in vertical ground reaction forces, paw pressure distribution (PPD), and center of pressure (COP) of Belgian Malinois during heelwork walking. Ten healthy Belgian Malinois were included in the study. The dogs walked first without heeling (normal walk) and then while heeling on a pressure platform. The comparison between normal and heelwork walking was performed using mixed-effects models. Post-hoc analyses were performed using Sidak's alpha correction procedure. During heelwork walking, a significant decrease in the vertical impulse and stance phase duration (SPD) and a significant increase in the craniocaudal index and speed of COP was observed in the forelimbs compared to normal walking. At the hindlimbs, a significant increase in vertical impulse and SPD was observed during heelwork walking. Regarding PPD, a significant decrease of vertical impulse was observed at the cranial quadrants of the right forelimb and craniolateral quadrant of the left forelimb during heelwork. The area was significantly decreased at the craniolateral quadrant of the left forelimb and the time for the peak vertical force was prolonged significantly at the caudal quadrants of the right forelimb during heelwork walking. The vertical impulse was significantly increased in all quadrants of the hindlimbs except the craniolateral quadrant of the left hindlimb. The effect of these changes on the musculoskeletal system of working dogs should be investigated in further studies, using electromyography and kinematic analysis.
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Affiliation(s)
- Danae Charalambous
- Department of Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, Section of Physical Therapy, University of Veterinary Medicine, Vienna, Austria,*Correspondence: Danae Charalambous ✉
| | - Christiane Lutonsky
- Department of Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, Section of Physical Therapy, University of Veterinary Medicine, Vienna, Austria
| | - Stefan Keider
- Department of Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, Section of Physical Therapy, University of Veterinary Medicine, Vienna, Austria
| | - Alexander Tichy
- Department of Biomedical Sciences, Platform of Bioinformatics and Biostatistics, University of Veterinary Medicine, Vienna, Austria
| | - Barbara Bockstahler
- Department of Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, Section of Physical Therapy, University of Veterinary Medicine, Vienna, Austria
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Wang Y, Hu Z, Chen K, Yang Y. Automatic characterization of stroke patients' posturography based on probability density analysis. Biomed Eng Online 2023; 22:8. [PMID: 36739411 PMCID: PMC9899377 DOI: 10.1186/s12938-023-01069-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/16/2023] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The probability density analysis was applied to automatically characterize the center of pressure (COP) data for evaluation of the stroke patients' balance ability. METHODS The real-time COP coordinates of 38 stroke patients with eyes open and closed during quiet standing were obtained, respectively, from a precision force platform. The COP data were analyzed and characterized by the commonly used parameters: total sway length (SL), sway radius (SR), envelope sway area (EA), and the probability density analysis based parameters: projection area (PA), skewness (SK) and kurtosis (KT), and their statistical correlations were analyzed. The differences of both conventional parameters and probability density parameters under the conditions of eyes open (EO) and eyes closed (EC) were compared. RESULTS The PA from probability density analysis is strongly correlated with SL and SR. Both the traditional parameters and probability density parameters in the EC state are significantly different from those in the EO state. The obtained various statokinesigrams were calculated and categorized into typical sway types through probability density function for clinical evaluation of the balance ability of stroke patients. CONCLUSIONS The probability density analysis of COP data can be used to characterize the posturography for evaluation of the balance ability of stroke patients.
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Affiliation(s)
- Ying Wang
- grid.411963.80000 0000 9804 6672School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018 Zhejiang China
| | - Zhen Hu
- grid.16821.3c0000 0004 0368 8293Department of Neurology, Ruijin Hospital Luwan Branch Affiliated to Shanghai Jiao Tong University, Shanghai, 200000 China
| | - Kai Chen
- grid.411963.80000 0000 9804 6672School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018 Zhejiang China
| | - Ying Yang
- grid.411963.80000 0000 9804 6672School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018 Zhejiang China
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Kelemen A, Halász L, Muthuraman M, Erőss L, Barsi P, Zádori D, Laczó B, Kis D, Klivényi P, Fekete G, Bognár L, Bereczki D, Tamás G. Clinical parameters predict the effect of bilateral subthalamic stimulation on dynamic balance parameters during gait in Parkinson's disease. Front Neurol 2022; 13:917187. [PMID: 36226087 PMCID: PMC9549153 DOI: 10.3389/fneur.2022.917187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
We investigated the effect of deep brain stimulation on dynamic balance during gait in Parkinson's disease with motion sensor measurements and predicted their values from disease-related factors. We recruited twenty patients with Parkinson's disease treated with bilateral subthalamic stimulation for at least 12 months and 24 healthy controls. Six monitors with three-dimensional gyroscopes and accelerometers were placed on the chest, the lumbar region, the two wrists, and the shins. Patients performed the instrumented Timed Up and Go test in stimulation OFF, stimulation ON, and right- and left-sided stimulation ON conditions. Gait parameters and dynamic balance parameters such as double support, peak turn velocity, and the trunk's range of motion and velocity in three dimensions were analyzed. Age, disease duration, the time elapsed after implantation, the Hoehn-Yahr stage before and after the operation, the levodopa, and stimulation responsiveness were reported. We individually calculated the distance values of stimulation locations from the subthalamic motor center in three dimensions. Sway values of static balance were collected. We compared the gait parameters in the OFF and stimulation ON states and controls. With cluster analysis and a machine-learning-based multiple regression method, we explored the predictive clinical factors for each dynamic balance parameter (with age as a confounder). The arm movements improved the most among gait parameters due to stimulation and the horizontal and sagittal trunk movements. Double support did not change after switching on the stimulation on the group level and did not differ from control values. Individual changes in double support and horizontal range of trunk motion due to stimulation could be predicted from the most disease-related factors and the severity of the disease; the latter also from the stimulation-related changes in the static balance parameters. Physiotherapy should focus on double support and horizontal trunk movements when treating patients with subthalamic deep brain stimulation.
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Affiliation(s)
- Andrea Kelemen
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - László Halász
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Muthuraman Muthuraman
- Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Loránd Erőss
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Péter Barsi
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Dénes Zádori
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Bence Laczó
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Dávid Kis
- Department of Neurosurgery, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Gábor Fekete
- Department of Neurosurgery, University of Debrecen, Debrecen, Hungary
| | - László Bognár
- Department of Neurosurgery, University of Debrecen, Debrecen, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Gertrúd Tamás
- Department of Neurology, Semmelweis University, Budapest, Hungary
- *Correspondence: Gertrúd Tamás
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9
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Kelemen A, Halász L, Erőss L, Rudas G, Muthuraman M, Zádori D, Laczó B, Kis D, Klivényi P, Fekete G, Bognár L, Bereczki D, Tamás G. Factors affecting postural instability after more than one-year bilateral subthalamic stimulation in Parkinson's disease: A cross-sectional study. PLoS One 2022; 17:e0264114. [PMID: 35196348 PMCID: PMC8865658 DOI: 10.1371/journal.pone.0264114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 02/03/2022] [Indexed: 01/16/2023] Open
Abstract
Background Balance impairment in Parkinson’s disease is multifactorial and its changes due to subthalamic stimulation vary in different studies. Objective We aimed to analyze the combination of predictive clinical factors of balance impairment in patients with Parkinson’s disease treated with bilateral subthalamic stimulation for at least one year. Methods We recruited 24 patients with Parkinson’s disease treated with bilateral subthalamic stimulation and 24 healthy controls. They wore an Opal monitor (APDM Inc.) consisting of three-dimensional gyroscopes and accelerometers in the lumbar region. We investigated four stimulation conditions (bilateral stimulation OFF, bilateral stimulation ON, and unilateral right- and left-sided stimulation ON) with four tests: stance on a plain ground with eyes open and closed, stance on a foam platform with eyes open and closed. Age, disease duration, the time elapsed after implantation, levodopa, and stimulation responsiveness were analyzed. The distance of stimulation location from the subthalamic motor center was calculated individually in each plane of the three dimensions. We analyzed the sway values in the four stimulation conditions in the patient group and compared them with the control values. We explored factor combinations (with age as confounder) in the patient group predictive for imbalance with cluster analysis and a machine‐learning‐based multiple regression method. Results Sway combined from the four tasks did not differ in the patients and controls on a group level. The combination of the disease duration, the preoperative levodopa responsiveness, and the stimulation responsiveness predicted individual stimulation-induced static imbalance. The more affected patients had more severe motor symptoms; primarily, the proprioceptive followed by visual sensory feedback loss provoked imbalance in them when switching on the stimulation. Conclusions The duration of the disease, the severity of motor symptoms, the levodopa responsiveness, and additional sensory deficits should be carefully considered during preoperative evaluation to predict subthalamic stimulation-induced imbalance in Parkinson’s disease.
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Affiliation(s)
- Andrea Kelemen
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - László Halász
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Loránd Erőss
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Gábor Rudas
- MR Research Centre, Semmelweis University, Budapest, Hungary
| | - Muthuraman Muthuraman
- Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Dénes Zádori
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Bence Laczó
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Dávid Kis
- Department of Neurosurgery, University of Szeged, Szeged, Hungary
| | - Péter Klivényi
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Gábor Fekete
- Department of Neurosurgery, University of Debrecen, Debrecen, Hungary
| | - László Bognár
- Department of Neurosurgery, University of Debrecen, Debrecen, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Gertrúd Tamás
- Department of Neurology, Semmelweis University, Budapest, Hungary
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Ali F, Loushin SR, Botha H, Josephs KA, Whitwell JL, Kaufman K. Laboratory based assessment of gait and balance impairment in patients with progressive supranuclear palsy. J Neurol Sci 2021; 429:118054. [PMID: 34461552 PMCID: PMC8489851 DOI: 10.1016/j.jns.2021.118054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/27/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gait and balance abnormalities are a significant source of morbidity and mortality in progressive supranuclear palsy (PSP). Gait impairment in PSP is primarily assessed clinically on exam or with the use of rating scales. Three dimensional video based gait and balance analysis performed in a laboratory setting is a highly accurate method of motion analysis (Wren et al., 2020), however limited data is available in patients with PSP. RESEARCH QUESTION In this study we assess the objective features of postural control, kinematics, kinetic and temporal-spatial gait metrics in PSP, using three-dimensional video motion analysis in a laboratory setting compared to normal controls. METHODS Three-dimensional motion was captured using a 10-camera motion capture system, 41 body markers and ground embedded force plates in 16 patients with PSP patients and compared to motorically normal controls. RESULTS Spatiotemporal, kinematic, and kinetic gait measures effectively differentiated patients with PSP from controls. Patients had slower gait velocity, lower cadence, increased double support time and abnormal antero-posterior sway. Joint kinematics and kinetics were reduced and showed less variation among patients with PSP compared to controls which is suggestive of bradykinesia. Objective gait measures of abnormality correlated with clinical disease severity. Postural sway metrics distinguished PSP from controls and captured gait imbalance. SIGNIFICANCE Objective measures of gait and balance abnormalities in patients with PSP provide an outcome measure that can be potentially used for early disease detection, in clinical trials and to validate portable motion capture devices in the future.
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Affiliation(s)
- Farwa Ali
- Department of Neurology, Rochester, MN, United States of America.
| | - Stacy R Loushin
- Department of Orthopedic Surgery, Rochester, MN, United States of America
| | - Hugo Botha
- Department of Neurology, Rochester, MN, United States of America
| | - Keith A Josephs
- Department of Neurology, Rochester, MN, United States of America
| | - Jennifer L Whitwell
- Department of Radiology, Mayo Clinic Rochester, Rochester, MN, United States of America
| | - Kenton Kaufman
- Department of Orthopedic Surgery, Rochester, MN, United States of America
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11
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Chen J, Chien HF, Francato DCV, Barbosa AF, Souza CDO, Voos MC, Greve JMD, Barbosa ER. Effects of resistance training on postural control in Parkinson's disease: a randomized controlled trial. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:S0004-282X2021005014102. [PMID: 34231653 PMCID: PMC9394568 DOI: 10.1590/0004-282x-anp-2020-0285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/23/2020] [Accepted: 09/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Postural instability affects Parkinson's disease (PD) patients' postural control right from the early stages of the disease. The benefits of resistance training (RT) for balance and functional capacity have been described in the literature, but few studies have been conducted showing its effects on PD patients' postural control. OBJECTIVE To investigate the effects of a three-month RT intervention on static posturography (SP) measurements and clinical functional balance assessment among PD patients. METHODS Seventy-four patients were randomly assigned to a three-month RT intervention consisting of using weightlifting machines at a gym (gym group) or RT consisting of using free weights and elastic bands (freew group), or to a control group. The participants were evaluated at baseline, three months and six months. We evaluated changes of SP measurements under eyes-open, eyes-closed and dual-task conditions (primary endpoint), along with motor performance and balance effects by means of clinical scales, dynamic posturography and perceptions of quality of life (secondary endpoints). RESULTS There were no significant interactions in SP measurements among the groups. Unified Parkinson Disease Rating Scale (UPDRS-III) motor scores decreased in both RT groups (p<0.05). Better perceived quality of life for the mobility domain was reported in the gym group while functional balance scores improved in the freew group, which were maintained at the six-month follow-up (p<0.05). CONCLUSIONS This study was not able to detect changes in SP measurements following a three-month RT intervention. Both RT groups of PD patients showed improved motor performance, with positive balance effects in the freew group and better perceived quality of life in the gym group.
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Affiliation(s)
- Janini Chen
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil
- Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo SP, Brazil
| | - Hsin Fen Chien
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil
- Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo SP, Brazil
| | - Debora Cristina Valente Francato
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil
- Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil
| | - Alessandra Ferreira Barbosa
- Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil
- Universidade de São Paulo, Departamento de Fisioterapia, Terapia Ocupacional e Fonoaudiologia, São Paulo SP, Brazil
| | - Carolina de Oliveira Souza
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil
- Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil
| | - Mariana Callil Voos
- Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil
- Universidade de São Paulo, Departamento de Fisioterapia, Terapia Ocupacional e Fonoaudiologia, São Paulo SP, Brazil
| | - Julia Maria D'Andréa Greve
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Instituto de Ortopedia e Traumatologia, Laboratório de Estudo do Movimento, São Paulo SP, Brazil
| | - Egberto Reis Barbosa
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil
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12
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Shin KJ, Kang JW, Sung KH, Park SH, Kim SE, Park KM, Ha SY, Kim SE, In Lee B, Park J. Quantitative gait and postural analyses in patients with diabetic polyneuropathy. J Diabetes Complications 2021; 35:107857. [PMID: 33610435 DOI: 10.1016/j.jdiacomp.2021.107857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 01/08/2021] [Accepted: 01/08/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although gait disturbances are relatively common symptoms in diabetic polyneuropathy (DPN), few studies have quantitatively analyzed gait and posture in DPN patients. This study aimed to analyze gait and posture quantitatively in DPN patients and to determine the association between clinical and electrophysiological parameters and gait and posture parameters. METHODS Sixty-four DPN patients were enrolled in this study. DPN was clinically assessed using the Toronto clinical neuropathy score (TCNS). All participants underwent nerve conduction study (NCS), three-dimensional motion analysis, and static posturography. We evaluate the correlation of gait and posture parameters with electrophysiological and clinical parameters. RESULTS Foot height, step length, and stride length among gait parameters were inversely correlated with the TCNS. Anteroposterior range during eyes-closed and mediolateral distance and range during eyes-open and eyes-closed were inversely correlated with the sensory nerve action potential amplitude in the sural nerve. Mediolateral distance during eyes-open and eyes-closed was correlated with the compound muscle action potential amplitude in the peroneal nerve. CONCLUSIONS Gait parameters are associated with clinical parameters, and postural parameters are associated with electrophysiological parameters, particularly sensory NCS. Gait and postural analysis can be a useful tool for assessing the neurological status in DPN patients.
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Affiliation(s)
- Kyong Jin Shin
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Jong Woo Kang
- Department of Orthopaedic Surgery, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
| | - Kwon Hyuk Sung
- Department of Neurology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Sung Ho Park
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Si Eun Kim
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Sam Yeol Ha
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Sung Eun Kim
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Byoung In Lee
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Jinse Park
- Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea.
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Liu B, Zhao G, Jin L, Shi J. Association of Static Posturography With Severity of White Matter Hyperintensities. Front Neurol 2021; 12:579281. [PMID: 33643184 PMCID: PMC7905220 DOI: 10.3389/fneur.2021.579281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Impaired gait and balance are associated with severity of leukoaraiosis. Evaluation of balance is based on neurological examination using Romberg's test with bipedal standing, assessment scale, and posturographic parameters. The goal of this study was to determine the relationship between static equilibrium and grades of white matter hyperintensities (WMHs) using static posturography as a quantitative technical method. Method: One hundred and eighteen (118) patients with lacunar infarct were recruited and assessed on MRI with Fazekas's grading scale into four groups. On admission, age, gender, height, weight, Berg Balance Scale (BBS), mini-mental state examination (MMSE), and static posturography parameters were recorded, and their correlations with WMHs were determined. Results: Age was significantly and positively correlated with severity of WMHs (r = 0.39, p < 0.05). WMH score was negatively correlated with BBS score (r = −0.65, p < 0.05) and MMSE score (r = −0.79, p < 0.05). There was a significant positive correlation between track length anteroposterior (AP, with eyes closed) and severity of WMHs (r = 0.70, p < 0.05). Partial correlation analysis and multiple logistic regression analysis indicated that track length AP with eyes closed, was a predictor for the severity of WMHs (p< 0.05). Conclusion: The severity of WHMs is associated with age, cognitive decline, and impairment in balance. Posturography parameter in track length in AP direction with eyes closed in relation to cognition and balance, may be a potential marker for disease progression in WMHs.
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Affiliation(s)
- Bin Liu
- Department of Geriatrics, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, China
| | - Guifeng Zhao
- Department Key Laboratory of Research and Application of Animal Models for Environmental and Metabolic Diseases, Sheng Jing Hospital of China Medical University, Shenyang, China
| | - Ling Jin
- Department of Geriatrics, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, China
| | - Jingping Shi
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, China
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14
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Ünlüer NÖ, Ateş Y, Balbaba A, Sücüllü Karadağ Y. Investigation of non-motor symptoms, balance, muscle strength, and functional mobility in patients with parkinson's disease. Somatosens Mot Res 2020; 38:20-26. [PMID: 33131377 DOI: 10.1080/08990220.2020.1834377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Although both motor symptoms and non-motor symptoms (NMSs) occur in patients with Parkinson's disease (PD), clinical practice focuses more on motor symptoms. The aim of this study was to examine balance, muscle strength, and mobility in relation with NMSs in patients with PD. The other aim of this study was to investigate the relationship between NMSs and muscle strength, balance, and functional mobility in PD. MATERIALS AND METHODS The study included 24 patients with PD (between Hoehn & Yahr Stage 1 and 3) and 20 healthy individuals of similar age and sex. The participants' balance was assessed with the Biodex Balance System (Biodex Medical Systems, Shirley, NY, USA), muscle strength assessments were conducted with a Biodex® System 4 Dynamometer device, and functional mobility was assessed with the Timed Up and Go test (TUG). The non-motor symptoms scale was used for NMSs. RESULTS We found that lower extremity strength scores were lower and NMSs, balance, and mobility scores were greater in patients with PD in comparison to healthy controls (p < 0.05). The correlation analysis revealed that higher NMSs were related to reduced knee extension strength and cognitive dual task performance. CONCLUSION Although no relationship between NMSs and balance was observed, the relationship between the TUG + cognitive task and muscle strength suggests that NMSs should be carefully evaluated along with the motor symptoms, which deteriorate beginning with the early period.
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Affiliation(s)
- Nezehat Özgül Ünlüer
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Yasemin Ateş
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Ayşe Balbaba
- Department of Physiotherapy and Rehabilitation, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Yeşim Sücüllü Karadağ
- Department of Neurology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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15
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Grant A, Metzger GJ, Van de Moortele PF, Adriany G, Olman C, Zhang L, Koopermeiners J, Eryaman Y, Koeritzer M, Adams ME, Henry TR, Uğurbil K. 10.5 T MRI static field effects on human cognitive, vestibular, and physiological function. Magn Reson Imaging 2020; 73:163-176. [PMID: 32822819 DOI: 10.1016/j.mri.2020.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/21/2020] [Accepted: 08/14/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE To perform a pilot study to quantitatively assess cognitive, vestibular, and physiological function during and after exposure to a magnetic resonance imaging (MRI) system with a static field strength of 10.5 Tesla at multiple time scales. METHODS A total of 29 subjects were exposed to a 10.5 T MRI field and underwent vestibular, cognitive, and physiological testing before, during, and after exposure; for 26 subjects, testing and exposure were repeated within 2-4 weeks of the first visit. Subjects also reported sensory perceptions after each exposure. Comparisons were made between short and long term time points in the study with respect to the parameters measured in the study; short term comparison included pre-vs-isocenter and pre-vs-post (1-24 h), while long term compared pre-exposures 2-4 weeks apart. RESULTS Of the 79 comparisons, 73 parameters were unchanged or had small improvements after magnet exposure. The exceptions to this included lower scores on short term (i.e. same day) executive function testing, greater isocenter spontaneous eye movement during visit 1 (relative to pre-exposure), increased number of abnormalities on videonystagmography visit 2 versus visit 1 and a mix of small increases (short term visit 2) and decreases (short term visit 1) in blood pressure. In addition, more subjects reported metallic taste at 10.5 T in comparison to similar data obtained in previous studies at 7 T and 9.4 T. CONCLUSION Initial results of 10.5 T static field exposure indicate that 1) cognitive performance is not compromised at isocenter, 2) subjects experience increased eye movement at isocenter, and 3) subjects experience small changes in vital signs but no field-induced increase in blood pressure. While small but significant differences were found in some comparisons, none were identified as compromising subject safety. A modified testing protocol informed by these results was devised with the goal of permitting increased enrollment while providing continued monitoring to evaluate field effects.
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Affiliation(s)
- Andrea Grant
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States.
| | - Gregory J Metzger
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | | | - Gregor Adriany
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Cheryl Olman
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States
| | - Lin Zhang
- School of Public Health Biostatistics, University of Minnesota, Minneapolis, MN, United States
| | - Joseph Koopermeiners
- School of Public Health Biostatistics, University of Minnesota, Minneapolis, MN, United States
| | - Yiğitcan Eryaman
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Margaret Koeritzer
- M Health Fairview, Department of Audiology, Minneapolis, MN, United States
| | - Meredith E Adams
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Thomas R Henry
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States; Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Kamil Uğurbil
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
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16
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Kamieniarz A, Michalska J, Marszałek W, Akbaş A, Słomka KJ, Krzak-Kubica A, Rudzińska-Bar M, Juras G. Transitional Locomotor Tasks in People With Mild to Moderate Parkinson's Disease. Front Neurol 2020; 11:405. [PMID: 32499752 PMCID: PMC7242736 DOI: 10.3389/fneur.2020.00405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/17/2020] [Indexed: 12/12/2022] Open
Abstract
Background: People with Parkinson's disease (PD) exhibit deficits in maintaining balance both during quiet standing and during walking, turning, standing up from sitting, and step initiation. Objective: The purpose of this study was to examine balance disorders during a transitional task under different conditions in participants with PD. Methods: The research was conducted on 15 PD-II (mild) and 15 PD-III (moderate) individuals (H&Y II-III stage) and 30 healthy elderly. The transitional task was measured on two force platforms (A and B). The procedure consisted of three phases: (1) quiet standing on platform A, (2) crossing to platform B, and (3) quiet standing on platform B, each until measurements were completed. There were four conditions: crossing without an obstacle, crossing with an obstacle, and walking up and down the step. Results: There were no significant differences between mild PD individuals and healthy elderly during quiet standing before the transitional task and after completing the task. The temporal aspects describing the different transitional tasks were comparable between mild PD and healthy subjects. Moderate PD participants presented a significantly higher COP velocity after the transitional task compared to the healthy older adults (p < 0.05). Additionally, the moderate PD group showed significantly higher values for transit time relative to healthy subjects during the transitional task in all conditions (p < 0.05). Conclusions: Disease severity affects the temporal aspects of different transitional tasks in people with PD. The procedure of completing a transitional task under different conditions allowed differences between moderate and mild PD stages and healthy subjects to be observed.
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Affiliation(s)
- Anna Kamieniarz
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Justyna Michalska
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Wojciech Marszałek
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Anna Akbaş
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Kajetan J. Słomka
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Agnieszka Krzak-Kubica
- Department of Neurology, Medical University of Silesia in Katowice, University Clinical Center, Katowice, Poland
| | - Monika Rudzińska-Bar
- Department of Neurology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Grzegorz Juras
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
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17
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Lazarotto L, Bobbo GZG, Siega J, da Silva AZ, Iucksch DD, Israel VL, Bento PCB. Static and dynamic postural control: Comparison between community old adults and people with Parkinson's disease. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1844. [PMID: 32363670 DOI: 10.1002/pri.1844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 01/16/2020] [Accepted: 03/23/2020] [Indexed: 11/12/2022]
Abstract
AIMS To compare the static and dynamic postural control of people with Parkinson's disease and community old adults. METHODS Thirty-five people were in the Parkinson's disease group (PDG; 12 women, 62.4 ± 11.0 years, 77.9 ± 15.6 kg, 166.5 ± 11.0 cm, 27.9 ± 3.8 kg/m2 , 1.9 ± 0.5 Hoehn & Yahr) and 32 were in the old adults group (OAG; 13 women, 69.5 ± 6.0 years, 74.2 ± 12.3 kg, 165.0 ± 8.3 cm, 27.2 ± 4.0 kg/m2 ). The static balance was measured on a force platform, three 30-s trials in four conditions: feet side-by-side (FSBS) and semi-tandem stance (ST) positioning, eyes open (EO) and eyes closed (EC). The total sway path length (SPL), sway area (SA), anterior-posterior (APSR) and medial-lateral (MLSR) sway range of the centre of pressure were obtained. Dynamic balance was assessed using the timed-up-and-go test (TUG). For comparison between groups and repeated-measures, a mixed-design ANOVA was carried out and the Mann-Whitney U test to compare TUG between groups. The significance level was set at p ≤ .05. RESULTS Between groups, PDG presented higher mean values for SPL, APSR and SA in feet side-by-side eyes open compared to the OAG, for SPL in feet side-by-side eyes closed, for SPL and SA in STEO. For repeated-measures, both groups had higher mean values in the EC condition compared to EO and MLSR compared to APSR. No significant difference was found between groups for TUG. CONCLUSION Balance disorders are found early in people with Parkinson's disease compared to healthy older adults. Thus, Parkinson's disease seems to advance the process of alterations in the postural control system.
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Affiliation(s)
- Leilane Lazarotto
- Center for Motor Behavior Studies Center (CECOM), Ph.D. Program in Physical Education, Federal University of Paraná, Curitiba, Brazil.,Department of Physical Education, Universidade Federal do Parná, Curitiba, Brazil
| | - Giovana Z G Bobbo
- Center for Motor Behavior Studies Center (CECOM), Ph.D. Program in Physical Education, Federal University of Paraná, Curitiba, Brazil.,Department of Physical Education, Universidade Federal do Parná, Curitiba, Brazil
| | - Juliana Siega
- Center for Motor Behavior Studies Center (CECOM), Ph.D. Program in Physical Education, Federal University of Paraná, Curitiba, Brazil
| | - Adriano Z da Silva
- Center for Motor Behavior Studies Center (CECOM), Ph.D. Program in Physical Education, Federal University of Paraná, Curitiba, Brazil
| | - Dielise D Iucksch
- Center for Motor Behavior Studies Center (CECOM), Ph.D. Program in Physical Education, Federal University of Paraná, Curitiba, Brazil
| | - Vera L Israel
- Center for Motor Behavior Studies Center (CECOM), Ph.D. Program in Physical Education, Federal University of Paraná, Curitiba, Brazil
| | - Paulo C B Bento
- Center for Motor Behavior Studies Center (CECOM), Ph.D. Program in Physical Education, Federal University of Paraná, Curitiba, Brazil.,Department of Physical Education, Universidade Federal do Parná, Curitiba, Brazil
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18
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Piano L, Geri T, Testa M. Raising and stabilization phase of the sit-to-stand movement better discriminate healthy elderly adults from young subjects: a pilot cross-sectional study. Arch Physiother 2020; 10:7. [PMID: 32318274 PMCID: PMC7161000 DOI: 10.1186/s40945-020-00078-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background The sit-to-stand (STS) test is usually included in the clinical assessment of balance and its instrumented analysis may support clinicians in objectively assessing the risk of falling. The aim of the present study was to assess if kinetic parameters of STS collected using a force platform, with particular focus on the raising and stabilization phase, could discriminate between young and older adults. Methods Twenty-four adults (age ranging from 18 to 65 years old) and 28 elderly adults (older than 65 years old) performed STS on a force platform. Data on ground reaction forces, sway, displacement and velocity of the center of pressure were gathered during the raising and the stabilization phases. Results elderly subjects showed significant greater global sway (146.97 vs 119.85; p < 0.05) and a higher velocity (vs 40.03 vs 34.35 mm/s; p < 0.05) of execution of STS. Between-group comparisons highlighted a greater postural sway in the raising phase (21.63 vs 13.58; p < 0.001) and a doubled sway during the stabilization phase (12.38 vs 4.98; p < 0.001). Conclusions The analysis of STS performed on a force platform provides further information about the age-specific pattern of STS execution. The stabilization phase of STS seems to be the more challenging for functional independent older adults and should be considered during balance assessment.Further studies are needed to confirm findings and improve generalizability of this study.
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Affiliation(s)
- Leonardo Piano
- Unit of Rehabilitation and Functional Recovery, Casa di Cura "La Residenza", via Roma 1, 12050, Rodello, CN Italy
| | - Tommaso Geri
- 2Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, via Magliotto 2, 17100 Savona, Italy
| | - Marco Testa
- 2Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, via Magliotto 2, 17100 Savona, Italy
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19
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Robotic balance assessment in community-dwelling older people with different grades of impairment of physical performance. Aging Clin Exp Res 2020; 32:491-503. [PMID: 31691151 DOI: 10.1007/s40520-019-01395-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/19/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Impaired physical performance is common in older adults and has been identified as a major risk factor for falls. To date, there are no conclusive data on the impairment of balance parameters in older subjects with different levels of physical performance. AIMS The aim of this study was to investigate the relationship between different grades of physical performance, as assessed by the Short Physical Performance Battery (SPPB), and the multidimensional balance control parameters, as measured by means of a robotic system, in community-dwelling older adults. METHODS This study enrolled subjects aged ≥ 65 years. Balance parameters were assessed by the hunova robot in static and dynamic (unstable and perturbating) conditions, in both standing and seated positions and with the eyes open/closed. RESULTS The study population consisted of 96 subjects (62 females, mean age 77.2 ± 6.5 years). According to their SPPB scores, subjects were separated into poor performers (SPPB < 8, n = 29), intermediate performers (SPPB = 8-9, n = 29) and good performers (SPPB > 9, n = 38). Poor performers displayed significantly worse balance control, showing impaired trunk control in most of the standing and sitting balance tests, especially in dynamic (both with unstable and perturbating platform/seat) conditions. CONCLUSIONS For the first time, multidimensional balance parameters, as detected by the hunova robotic system, were significantly correlated with SPPB functional performances in community-dwelling older subjects. In addition, balance parameters in dynamic conditions proved to be more sensitive in detecting balance impairments than static tests.
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20
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Inojosa H, Schriefer D, Klöditz A, Trentzsch K, Ziemssen T. Balance Testing in Multiple Sclerosis-Improving Neurological Assessment With Static Posturography? Front Neurol 2020; 11:135. [PMID: 32174886 PMCID: PMC7057229 DOI: 10.3389/fneur.2020.00135] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/06/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Balance problems can severely limit the quality of life for people with Multiple Sclerosis (pwMS) already in the early stages of the disease. PwMS are usually assessed with the Expanded Disability Status Scale (EDSS), which includes a Romberg test for assessing balance. As the EDSS assessments are subjective to the examining neurologist, the postural stability of pwMS could be objectively quantified by implementing static posturography to detect balance problems and address preventive medical care. Methods: In this cross-sectional study, we added static posturography to the neurological EDSS examination in pwMS and healthy subjects to determine how this technique could supply additional information during the evaluation of the cerebellar functional system of the neurostatus EDSS as clinical outcome already in early disease stages. Static posturography was performed with subjects standing on a force platform while outcome variables such as delineated area, average speed and average sway were obtained. Unpaired t-test as well as (Welch's) analysis of variance (ANOVA) with pairwise post-hoc comparisons according to Games-Howell were used. Spearman rank correlations were implemented to study associations of balance outcomes with EDSS-associated outcomes. Results: A total of 99 pwMS (mean age: 35.01 years; EDSS median: 2.0, 68.69% females) and 30 healthy subjects (mean age: 34.03 years; 70% females) were enrolled. PwMS had worse performances in the three evaluated balance parameters than the healthy group (all p < 0.001). Even patients without postural instability as documented in the Romberg test score of the EDSS assessment showed significantly worse outcome regarding the delineated area [+1.97 cm2, 95%-CI (0.61-3.34); p = 0.002] vs. healthy controls. Similar results were observed for the comparison between pwMS with normal cerebellar function EDSS-systems and healthy subjects. There were significant correlations with the EDSS, cerebellar function score and Romberg test for the delineated area and average speed (r's ranging from 0.330 to 0.537, p < 0.001). Conclusions: Static posturography can complement neurological assessment of EDSS as an objective and quantitative test, especially for MS patients in early stages of the disease.
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Affiliation(s)
- Hernan Inojosa
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
| | - Dirk Schriefer
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
| | - Antonia Klöditz
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
| | - Katrin Trentzsch
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- MS Center, Center of Clinical Neuroscience, Department of Neurology, Carl Gustav Carus University Hospital, University of Dresden, Dresden, Germany
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21
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Panyakaew P, Anan C, Bhidayasiri R. Posturographic abnormalities in ambulatory atypical parkinsonian disorders: Differentiating characteristics. Parkinsonism Relat Disord 2019; 66:94-99. [PMID: 31337595 DOI: 10.1016/j.parkreldis.2019.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/26/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Postural instability is a common complaint in patients with Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). However, objective evaluation to identify posturographic characteristics to enable clinical differentiation is limited. METHOD Postural sway abnormalities in 35 atypical parkinsonian patients (19 PSP, 16 MSA), 35 matched PD patients, and healthy subjects were assessed under static posturography with eyes-open (EO) and eyes-closed (EC). RESULTS With EO, MSA patients showed a significantly greater mean ML sway than PD patients (p = 0.03), but with EC even more parameters were significantly different, including mean sway in both ML (p = 0.02) and AP directions (p = 0.01), sway area (p = 0.001), and sway path length (p = 0.003). While differences between MSA and PD were seen in both ML and AP directions, significant differences between PD and PSP were limited to greater mean ML sway (p = 0.01) with EO, greater mean (p = 0.002) and maximal AP sway (p = 0.02) amongst PSP patient with EC. Moderate and significant correlation was demonstrated between HY stage and mean AP sway amongst APD patients (r = 0.56, p < 0.01) and in PSP patients (r = 0.62, p < 0.01). CONCLUSION Our study identifies a number of objective sway measures assessed with EC that are potentially useful for clinical differentiation between APDs and PD. In comparison to PD, MSA showed greater sway area and a mean sway distance in both AP and ML directions, while the difference was limited to AP in PSP. Significant correlation between HY stage and sway parameters further supports postural sway as a potential disease progression marker in APDs.
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Affiliation(s)
- Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Chanawat Anan
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand.
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22
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Ahmadi SA, Vivar G, Frei J, Nowoshilow S, Bardins S, Brandt T, Krafczyk S. Towards computerized diagnosis of neurological stance disorders: data mining and machine learning of posturography and sway. J Neurol 2019; 266:108-117. [PMID: 31286203 DOI: 10.1007/s00415-019-09458-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
Abstract
We perform classification, ranking and mapping of body sway parameters from static posturography data of patients using recent machine-learning and data-mining techniques. Body sway is measured in 293 individuals with the clinical diagnoses of acute unilateral vestibulopathy (AVS, n = 49), distal sensory polyneuropathy (PNP, n = 12), anterior lobe cerebellar atrophy (CA, n = 48), downbeat nystagmus syndrome (DN, n = 16), primary orthostatic tremor (OT, n = 25), Parkinson's disease (PD, n = 27), phobic postural vertigo (PPV n = 59) and healthy controls (HC, n = 57). We classify disorders and rank sway features using supervised machine learning. We compute a continuous, human-interpretable 2D map of stance disorders using t-stochastic neighborhood embedding (t-SNE). Classification of eight diagnoses yielded 82.7% accuracy [95% CI (80.9%, 84.5%)]. Five (CA, PPV, AVS, HC, OT) were classified with a mean sensitivity and specificity of 88.4% and 97.1%, while three (PD, PNP, and DN) achieved a mean sensitivity of 53.7%. The most discriminative stance condition was ranked as "standing on foam-rubber, eyes closed". Mapping of sway path features into 2D space revealed clear clusters among CA, PPV, AVS, HC and OT subjects. We confirm previous claims that machine learning can aid in classification of clinical sway patterns measured with static posturography. Given a standardized, long-term acquisition of quantitative patient databases, modern machine learning and data analysis techniques help in visualizing, understanding and utilizing high-dimensional sensor data from clinical routine.
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Affiliation(s)
- Seyed-Ahmad Ahmadi
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany. .,Computer Aided Medical Procedures, Technical University of Munich, 85748, Garching, Germany.
| | - Gerome Vivar
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany.,Computer Aided Medical Procedures, Technical University of Munich, 85748, Garching, Germany
| | - Johann Frei
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany.,Computer Aided Medical Procedures, Technical University of Munich, 85748, Garching, Germany
| | - Sergej Nowoshilow
- IMP Research Institute of Molecular Pathology, Campus-Vienna-Biocenter 1, 1030, Vienna, Austria
| | - Stanislav Bardins
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany
| | - Siegbert Krafczyk
- German Center for Vertigo and Balance Disorders, Ludwig Maximilians Universität, Marchioninistr. 15, 81377, Munich, Germany
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Tollár J, Nagy F, Kovács N, Hortobágyi T. A High-Intensity Multicomponent Agility Intervention Improves Parkinson Patients’ Clinical and Motor Symptoms. Arch Phys Med Rehabil 2018; 99:2478-2484.e1. [DOI: 10.1016/j.apmr.2018.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 02/06/2023]
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24
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Kamieniarz A, Michalska J, Brachman A, Pawłowski M, Słomka KJ, Juras G. A posturographic procedure assessing balance disorders in Parkinson's disease: a systematic review. Clin Interv Aging 2018; 13:2301-2316. [PMID: 30519012 PMCID: PMC6237244 DOI: 10.2147/cia.s180894] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Postural instability is common in Parkinson's disease (PD), often contributing to falls, injuries, and reduced mobility. In the clinical setting, balance disorder is commonly diagnosed using clinical tests and balance scales, but it is suggested that the most sensitive measurement is the force platform. The aim of this systematic review was to summarize the methods and various posturographic procedures used to assess the body balance and gait in PD. A systematic review was conducted of papers published from 2000 to 2017. Databases searched were PubMed and EBSCO. Studies must have involved patients with PD, used force platform or motion analysis system as a measurement tool, and described posturographic procedure. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. A total of 32 studies met the inclusion criteria. The PEDro scores ranged from 5 to 7 points. The analysis of the objective methods assessing balance disorders revealed a large discrepancy in the duration and procedures of measurements. The number of repetitions of each trial fluctuated between 1 and 8, and the duration of a single trial ranged from 10 to 60 seconds. Overall, there are many scales and tests used to assess the balance disorders and disabilities of people with PD. Although in many included studies the authors have used posturography as a method to evaluate the postural instability of PD patients, the results are contradictory. To solve this issue, it is indicated to establish a "gold standard" of procedures of measures of balance.
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Affiliation(s)
- Anna Kamieniarz
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Justyna Michalska
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Anna Brachman
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Michał Pawłowski
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Kajetan J Słomka
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Grzegorz Juras
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
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25
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Terra MB, Da Silva RA, Bueno MEB, Ferraz HB, Smaili SM. Center of pressure-based balance evaluation in individuals with Parkinson's disease: a reliability study. Physiother Theory Pract 2018; 36:826-833. [PMID: 30118638 DOI: 10.1080/09593985.2018.1508261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the test-retest reliability of different balance task outcomes, based on center of pressure (COP) measures in individuals with Parkinson's disease. METHOD In this cross-sectional study, 19 older individuals with idiopathic Parkinson's disease (seven females, 71 ± 7.8 years) performed a set of seven balance tasks on two occasions (a week apart) on an electronic force platform. Each set consisted of: 1) Bipedal; 2) Romberg with open eyes (OE); 3) Romberg with closed eyes (CE); 4) Tandem with OE; 5) Tandem with CE; 6) Tandem with OE using a dual task (DT) condition (simple mathematic operations concomitant with testing); and 7) One-leg stance, with the leg of preference over the force platform, with OE. The test-retest reliability of COP measures was tested using intraclass correlation coefficient (ICC) and Bland-Altman plots. RESULTS The ICC results for the different tasks showed that the most reliable para- meters were derived from a 95% confidence ellipse around the COP and mean velocity, with the most reliable task being the Romberg with CE. Conclusions: We confirmed that balance based on COP measures was reliable in individuals with Parkinson's disease, especially during the Romberg condition with closed eyes.
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Affiliation(s)
- Marcelle Brandão Terra
- Department of Physiotherapy, Universidade Estadual de Londrina (UEL) , Londrina, Paraná, Brazil.,Doctoral and Master Program in Rehabilitation Sciences UEL/UNOPAR , Londrina, PR, Brazil
| | - Rubens A Da Silva
- Département des Sciences de la Santé, Programme de Physiothérapie de l'université McGill Offert en Extension à l'Université du Québec à Chicoutimi (UQAC) , ville du Saguenay, Canada.,Doctoral and Master Program in Rehabilitation Sciences UEL/UNOPAR , Londrina, PR, Brazil
| | - Maria E B Bueno
- Department of Physiotherapy, Universidade Estadual de Londrina (UEL) , Londrina, Paraná, Brazil.,Doctoral and Master Program in Rehabilitation Sciences UEL/UNOPAR , Londrina, PR, Brazil
| | | | - Suhaila M Smaili
- Department of Physiotherapy, Universidade Estadual de Londrina (UEL) , Londrina, Paraná, Brazil.,Doctoral and Master Program in Rehabilitation Sciences UEL/UNOPAR , Londrina, PR, Brazil
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26
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Souza CDO, Voos MC, Barbosa AF, Chen J, Francato DCV, Milosevic M, Popovic M, Fonoff ET, Chien HF, Barbosa ER. Relationship Between Posturography, Clinical Balance and Executive Function in Parkinson´s Disease. J Mot Behav 2018; 51:212-221. [PMID: 29683777 DOI: 10.1080/00222895.2018.1458279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study aimed to evaluate the relationship between posturography, clinical balance, and executive function tests in Parkinson´s disease (PD). Seventy-one people participated in the study. Static posturography evaluated the center of pressure fluctuations in quiet standing and dynamic posturography assessed sit-to-stand, tandem walk, and step over an obstacle. Functional balance was evaluated by Berg Balance Scale, MiniBESTest, and Timed Up and Go test. Executive function was assessed by Trail Making Test (TMT) and semantic verbal fluency test. Step over obstacle measures (percentage of body weight transfer and movement time) were moderately correlated to Timed Up and Go, part B of TMT and semantic verbal fluency (r > 0.40; p < 0.05 in all relationships). Stepping over an obstacle assesses the responses to internal perturbations. Participants with shorter movement times and higher percentage of body weight transfer (higher lift up index) on this task were also faster in Timed Up and Go, part B of TMT, and semantic verbal fluency. All these tasks require executive function (problem solving, sequencing, shifting attention), which is affected by PD and contribute to postural assessment.
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Affiliation(s)
- Carolina de Oliveira Souza
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,b Department of Functional Neurosurgery , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil
| | - Mariana Callil Voos
- c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil.,d Physical Therapy, Occupational Therapy and Speech Therapy Department , University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Alessandra Ferreira Barbosa
- c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil.,d Physical Therapy, Occupational Therapy and Speech Therapy Department , University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Janini Chen
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil
| | - Debora Cristina Valente Francato
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Matija Milosevic
- e Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto , Ontario , Canada.,f Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto , Ontario , Canada
| | - Milos Popovic
- e Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto , Ontario , Canada.,f Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto , Ontario , Canada
| | - Erich Talamoni Fonoff
- b Department of Functional Neurosurgery , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Hsin Fen Chien
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil
| | - Egberto Reis Barbosa
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil
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Shahmohammadi R, Sharifi GR, Melvin JMA, Sadeghi-Demneh E. A comparison between aquatic and land-based physical exercise on postural sway and quality of life in people with Parkinson’s disease: a randomized controlled pilot study. SPORT SCIENCES FOR HEALTH 2017. [DOI: 10.1007/s11332-017-0363-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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28
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Grassi L, Rossi S, Studer V, Vasco G, Motta C, Patanè F, Castelli E, Rossi S, Cappa P. Quantification of postural stability in minimally disabled multiple sclerosis patients by means of dynamic posturography: an observational study. J Neuroeng Rehabil 2017; 14:4. [PMID: 28069073 PMCID: PMC5223530 DOI: 10.1186/s12984-016-0216-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 12/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is a widespread progressive neurologic disease with consequent impairments in daily activities. Disorders of balance are frequent and equilibrium tests are potentially useful to quantify disability and to verify treatment effectiveness. The fair sensitivity of the widely used not-perturbed tests to detect balance disturbances in MS patients have prompted the development of mechatronic systems capable to impose known equilibrium perturbations, in order to challenge the balance control and, consequently, to better assess the level of impairment. We sought to clarify whether the proposed perturbed-test is capable to discriminate healthy subjects from patients with MS, even in mild or in the absence of clinically evident balance disturbances. METHODS We assessed balance performances of 17 adults with MS and 13 age-matched healthy controls (HC) using both perturbed (PT) and not-perturbed (NPT) postural tests by means of a 3 Degree Of Freedom (DOF) rotational mechatronic platform. Participants stood barefoot on the platform in standing position and their center of pressure (CoP) was gathered by using a pressure matrix. Each trial lasted 30 s and was carried out with and without visual stimuli. Several postural indices were computed for each trial. Correlations between postural indices and clinical scales were analyzed. RESULTS No significant differences were found between groups for all indices when subjects performed NPTs. Conversely, significant differences in postural indices between MS and HC emerged during PTs. Additionally, PTs revealed significant differences between patients without any cerebellar impairment (cerebellar EDSS subscore equal to 0) and HC. The discrimination capability of PTs was confirmed by the ROC analysis. No significant change of the selected metrics occurred in HC when NPTs were performed with eyes closed, while indices presented a significant worsening in MS subjects. CONCLUSIONS Not-perturbed tests showed lower sensitivity than perturbed ones in the identification of equilibrium impairments in minimally disabled MS patients. However, not-perturbed tests allow to better evaluate the influence of visual flow disturbances on balance control in MS. In conclusion, our findings proved that the use of the novel tests based on a 3DOF mechatronic device represents an effective tool to investigate early balance disturbances in MS.
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Affiliation(s)
- Lucia Grassi
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
| | - Stefano Rossi
- Department of Economics and Management, Industrial Engineering, University of Tuscia, Viterbo, Italy.
| | - Valeria Studer
- Dipartimento di Medicina dei Sistemi, Tor Vergata University, Rome, Italy
| | - Gessica Vasco
- Department of Neurosciences, Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Caterina Motta
- Dipartimento di Medicina dei Sistemi, Tor Vergata University, Rome, Italy
| | - Fabrizio Patanè
- School of Mechanical Engineering, "Niccolò Cusano" University, Rome, Italy
| | - Enrico Castelli
- Department of Neurosciences, Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Silvia Rossi
- Neuroimmunology and Neuromuscular Diseases Unit, Foundation Neurological Institute Carlo Besta, Milan, Italy
| | - Paolo Cappa
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
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29
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Barbosa AF, Chen J, Freitag F, Valente D, Souza CDO, Voos MC, Chien HF. Gait, posture and cognition in Parkinson's disease. Dement Neuropsychol 2016; 10:280-286. [PMID: 29213470 PMCID: PMC5619266 DOI: 10.1590/s1980-5764-2016dn1004005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Gait disorders and postural instability are the leading causes of falls and
disability in Parkinson's disease (PD). Cognition plays an important role in
postural control and may interfere with gait and posture assessment and
treatment. It is important to recognize gait, posture and balance dysfunctions
by choosing proper assessment tools for PD. Patients at higher risk of falling
must be referred for rehabilitation as early as possible, because
antiparkinsonian drugs and surgery do not improve gait and posture in PD.
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Affiliation(s)
- Alessandra Ferreira Barbosa
- Physical Therapy, Occupational Therapy and Speech Therapy Department, University of São Paulo School of Medicine, São Paulo, SP, Brazil.,ReMove. Rehabilitation of Movement Disorders Research Group
| | - Janini Chen
- Movement Disorders Clinic of Hospital das Clinicas of the Department of Neurology. University of São Paulo School of Medicine, São Paulo, SP, Brazil.,ReMove. Rehabilitation of Movement Disorders Research Group
| | - Fernanda Freitag
- Movement Disorders Clinic of Hospital das Clinicas of the Department of Neurology. University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | - Debora Valente
- Movement Disorders Clinic of Hospital das Clinicas of the Department of Neurology. University of São Paulo School of Medicine, São Paulo, SP, Brazil.,ReMove. Rehabilitation of Movement Disorders Research Group
| | - Carolina de Oliveira Souza
- Movement Disorders Clinic of Hospital das Clinicas of the Department of Neurology. University of São Paulo School of Medicine, São Paulo, SP, Brazil.,ReMove. Rehabilitation of Movement Disorders Research Group
| | - Mariana Callil Voos
- Physical Therapy, Occupational Therapy and Speech Therapy Department, University of São Paulo School of Medicine, São Paulo, SP, Brazil.,ReMove. Rehabilitation of Movement Disorders Research Group
| | - Hsin Fen Chien
- Movement Disorders Clinic of Hospital das Clinicas of the Department of Neurology. University of São Paulo School of Medicine, São Paulo, SP, Brazil.,ReMove. Rehabilitation of Movement Disorders Research Group.,Institute of Orthopedics and Traumatology of Hospital das Clínicas of University of São Paulo School of Medicine, São Paulo, SP, Brazil
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Barbosa AF, Souza CDO, Chen J, Francato DV, Caromano FA, Chien HF, Barbosa ER, Greve JMD, Voos MC. The competition with a concurrent cognitive task affects posturographic measures in patients with Parkinson disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:906-12. [PMID: 26517212 DOI: 10.1590/0004-282x20150153] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 08/12/2015] [Indexed: 11/22/2022]
Abstract
ABSTRACTObjectives To estimate the impact of a sensory-motor- cognitive task on postural balance, in Parkinson disease patients (Hoehn and Yahr 2-3) and to investigate possible relationships between posturography and functional balance clinical scales.Method Parkinson disease patients (n = 40) and healthy controls (n = 27) were evaluated with fluency tests, Berg Balance scale, Mini Best test and static posturography on the conditions eyes open, eyes closed and dual-task (simultaneous balance and fluency tasks).Results Posturographic data showed that Parkinson disease patients performed worse than controls in all evaluations. In general, balance on dual-task was significantly poorer than balance with eyes closed. Posturographic data were weakly correlated to clinical balance scales.Conclusion In clinical practice, Parkinson disease patients are commonly assessed with eyes closed, to sensitize balance. Our study showed that adding a cognitive task is even more effective. Static posturographic data should be carefully overgeneralized to infer functional balance impairments.
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Geroin C, Smania N, Schena F, Dimitrova E, Verzini E, Bombieri F, Nardello F, Tinazzi M, Gandolfi M. Does the Pisa syndrome affect postural control, balance, and gait in patients with Parkinson's disease? An observational cross-sectional study. Parkinsonism Relat Disord 2015; 21:736-41. [PMID: 25940999 DOI: 10.1016/j.parkreldis.2015.04.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/16/2015] [Accepted: 04/19/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION An altered sense of verticality, associated with impaired proprioception and somatosensory integration deficits, has been reported in patients with Parkinson's disease (PD) but it has not been characterized in patients with Pisa syndrome (PS). Therefore, we investigated postural control, balance, and gait disturbances in patients with PD and PS, patients with PD but without PS, and aged-matched normal controls. METHODS This observational cross-sectional study involved patients with PD and PS (n = 10, Hoehn & Yahr score <4), patients with PD but without PS (n = 10), and age-matched healthy controls (n = 10). The primary outcome measure was the velocity of CoP displacement (VEL_MED_AP/ML) assessed by static stabilometry in eyes open (EO) and eyes closed (EC) conditions. The secondary outcomes were other stabilometric parameters, the Sensory Organization Balance Test (SOT), and gait analysis (GA). RESULTS There were no significant differences in demographic and clinical data and Berg Balance Scale scores between the groups. There was a significant main effect in the VEL_MED_AP/ML between the groups and eye conditions (p = .016). A significant main effect was found in the EO (p = .01) and EC (p = .04) conditions. Post-hoc comparisons showed a significant increase in VEL_CoP in both the EO and EC conditions only in the patients with PD and PS. No significant main effects on SOT and GA were found. CONCLUSION Patients with PD and PS had more difficulty achieving good postural alignment with gravity and greater velocity of body sway than the other groups. Rehabilitation programs for patients with PD and PS should include spine alignment and dynamic postural training.
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Affiliation(s)
- Christian Geroin
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurological and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy.
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurological and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy; Neurological Rehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, P.le Scuro 10, 37134 Verona, Italy.
| | - Federico Schena
- School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Via Casorati 43, 37137 Verona, Italy.
| | - Eleonora Dimitrova
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurological and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy.
| | - Elisabetta Verzini
- School of Specialization in Physical Medicine and Rehabilitation, Department of Neurological and Movement Sciences, University of Verona, Italy.
| | - Federica Bombieri
- School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Via Casorati 43, 37137 Verona, Italy.
| | - Francesca Nardello
- School of Sport and Exercise Sciences, Department of Neurological and Movement Sciences, University of Verona, Via Casorati 43, 37137 Verona, Italy.
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, Department of Neurological and Movement Sciences, University of Verona, P.le Scuro 10, 37134 Verona, Italy.
| | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), Department of Neurological and Movement Sciences, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy.
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Panyakaew P, Anan C, Bhidayasiri R. Visual deprivation elicits subclinical postural inflexibilities in early Parkinson's disease. J Neurol Sci 2015; 349:214-9. [PMID: 25656100 DOI: 10.1016/j.jns.2015.01.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Postural instability is often experienced in the late stages of PD and is a marker of disease progression. Little information is available on the role of visual inputs as an adaptive strategy to compensate for postural instability in PD. The purpose of this study was to determine visual dependency for postural control in early PD. METHODS Thirty early PD subjects without postural complaints and 30 matched controls were evaluated for subtle postural instability using static posturography under eyes opened and eyes closed conditions. RESULTS No significant differences between groups were observed under eyes opened condition. In eyes closed condition, there was significantly greater mean sway in the mediolateral direction (p=0.01), mean sway velocity (p=0.03), lateral sway velocity (p=0.04), and sway area (p=0.04) in PD than in the control subjects. 95% confidence ellipse of mean sway was largest in PD patients with eyes closed. A strong and significant correlation was observed between disease duration and mean mediolateral sway, sway area, mean sway and lateral sway velocity, and a moderate correlation was shown between Hoehn & Yahr stage and mean mediolateral sway, and sway area. CONCLUSION Our findings suggest that visual dependency exists in early PD and visual deprivation task can help identify subclinical postural instability.
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Affiliation(s)
- Pattamon Panyakaew
- Chulalongkorn Center of Excellence on Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Chanawat Anan
- Chulalongkorn Center of Excellence on Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence on Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles 90095, USA.
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Bekkers EMJ, Dockx K, Heremans E, Vercruysse S, Verschueren SMP, Mirelman A, Nieuwboer A. The contribution of proprioceptive information to postural control in elderly and patients with Parkinson's disease with a history of falls. Front Hum Neurosci 2014; 8:939. [PMID: 25505395 PMCID: PMC4241823 DOI: 10.3389/fnhum.2014.00939] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 11/04/2014] [Indexed: 11/30/2022] Open
Abstract
Proprioceptive deficits negatively affect postural control but their precise contribution to postural instability in Parkinson’s disease (PD) is unclear. We investigated if proprioceptive manipulations differentially affect balance, measured by force plates, during quiet standing in 13 PD patients and 13 age-matched controls with a history of falls. Perceived limits of stability (LoS) were derived from the differences between maximal center of pressure (CoP) displacement in anterior–posterior (AP) and medio-lateral (ML) direction during a maximal leaning task. Task conditions comprised standing with eyes open (EO) and eyes closed (EC): (1) on a stable surface; (2) an unstable surface; and (3) with Achilles tendon vibration. CoP displacements were calculated as a percentage of their respective LoS. Perceived LoS did not differ between groups. PD patients showed greater ML CoP displacement than elderly fallers (EF) across all conditions (p = 0.043) and tended to have higher postural sway in relation to the LoS (p = 0.050). Both groups performed worse on an unstable surface and during tendon vibration compared to standing on a stable surface with EO and even more so with EC. Both PD and EF had more AP sway in all conditions with EC compared to EO (p < 0.001) and showed increased CoP displacements when relying on proprioception only compared to standing with normal sensory input. This implies a similar role of the proprioceptive system in postural control in fallers with and without PD. PD fallers showed higher ML sway after sensory manipulations, as a result of which these values approached their perceived LoS more closely than in EF. We conclude that despite a similar fall history, PD patients showed more ML instability than EF, irrespective of sensory manipulation, but had a similar reliance on ankle proprioception. Hence, we recommend that rehabilitation and fall prevention for PD should focus on motor rather than on sensory aspects.
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Affiliation(s)
- Esther M J Bekkers
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven , Leuven , Belgium
| | - Kim Dockx
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven , Leuven , Belgium
| | - Elke Heremans
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven , Leuven , Belgium
| | - Sarah Vercruysse
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven , Leuven , Belgium
| | - Sabine M P Verschueren
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven , Leuven , Belgium
| | - Anat Mirelman
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center , Tel-Aviv , Israel
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven , Leuven , Belgium
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Toosizadeh N, Lei H, Schwenk M, Sherman SJ, Sternberg E, Mohler J, Najafi B. Does integrative medicine enhance balance in aging adults? Proof of concept for the benefit of electroacupuncture therapy in Parkinson's disease. Gerontology 2014; 61:3-14. [PMID: 25341431 DOI: 10.1159/000363442] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Postural balance and potentially fall risk increases among older adults living with neurological diseases, especially Parkinson's disease (PD). Since conventional therapies such as levodopa or deep brain stimulation may fail to alleviate or may even worsen balance, interest is growing in evaluating alternative PD therapies. OBJECTIVE The purpose of the current study was to assess improvement in postural balance in PD patients following electroacupuncture (EA) as an alternative therapy. METHODS 15 aging adults (71.2 ± 6.3 years) with idiopathic PD and 44 healthy age-matched participants (74.6 ± 6.5 years) were recruited. The PD participants were randomly assigned (at a ratio of 2:1) to an intervention (n = 10) or to a control group (n = 5). The intervention group received a 30-min EA treatment on a weekly basis for 3 weeks, while the control group received a sham treatment. Outcomes were assessed at baseline and after the final therapy. Measurements included balance assessment, specifically the ratio of medial-lateral (ML) center-of-gravity (COG) sway to anterior-posterior (AP) sway (COGML/AP) and ankle/hip sway during eyes-open, eyes-closed, and eyes-open dual-task trials, the Unified Parkinson's Disease Rating Scale (UPDRS), as well as quality of life, concerns for fall, and pain questionnaires. RESULTS No difference was observed for the assessed parameters between the intervention and the control group at baseline. After treatment, an improvement in balance performance was observed in the intervention group. Compared with the healthy population, PD patients prior to treatment had larger COGML/AP sway with more dependency on upper-body movements for maintaining balance. Following EA therapy, COGML/AP sway was reduced by 31% and ankle/hip sway increased by 46% in the different conditions (p = 0.02 for the dual-task condition). The clinical rating revealed an overall improvement (p < 0.01) in mentation, behavior, and mood (UPDRS part I, 49%), activities of daily living (UPDRS part II, 46%), and motor examination (UPDRS part III, 40%). There was a significant reduction (p < 0.02) in the specific items regarding UPDRS fall status (67%) and rigidity (48%). Changes were small and nonsignificant in the controls (p > 0.29). CONCLUSIONS This pilot study demonstrates improvement in rigidity and balance following EA. These preliminary results suggest EA could be a promising alternative treatment for balance disturbance in PD.
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Affiliation(s)
- Nima Toosizadeh
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP) and Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona, Tucson, Ariz., USA
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Assessment of Postural Balance Among Individuals with Parkinson Disease with and Without Effects from Dopaminergic Medications. Am J Phys Med Rehabil 2014; 93:365-71. [DOI: 10.1097/phm.0b013e3182a92aa9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Park JW, Jung M, Kweon M. The Mediolateral CoP Parameters can Differentiate the Fallers among the Community-dwelling Elderly Population. J Phys Ther Sci 2014; 26:381-4. [PMID: 24707088 PMCID: PMC3976007 DOI: 10.1589/jpts.26.381] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/02/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Age-related mediolateral (ML) instability of static postural control in the
elderly has been well studied. Recent studies have provided evidence that ML center of
pressure (CoP) parameters during dynamic postural control are more sensitive for
differentiation of the fallers in the elderly. However, very limited studies have been
done in which ML stability differences between fallers and non-fallers were investigated.
The purpose of this study was to investigate the differences in ML CoP parameters between
elderly fallers and elderly non-fallers during dynamic postural control. [Subjects and
Methods] Twenty-nine community-dwelling older adults were divided into either fallers or
non-fallers according to a self-report related to falling history within a year. Every
participant performed 4 different tasks (static postural control tasks comprising quiet
stance with eyes open and eyes closed and dynamic postural control tasks comprising stance
with arm lifting and with trunk flexion) on force plates. [Results] The fallers
demonstrated decreased AP and ML CoP parameters, and ML CoP distance was significantly
smaller than in the non-fallers during both dynamic postural control tasks. [Conclusions]
ML CoP parameters were able to differentiate the fallers from the non-fallers in a
community-dwelling elderly population.
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Affiliation(s)
- Ji Won Park
- Department of Physical Therapy, College of Medical Science, Catholic University of Daegu, Republic of Korea
| | - Misook Jung
- Department of Physical Therapy, College of Medical Science, Catholic University of Daegu, Republic of Korea
| | - Migyoung Kweon
- Department of Physical Therapy, College of Medical Science, Catholic University of Daegu, Republic of Korea
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Schoneburg B, Mancini M, Horak F, Nutt JG. Framework for understanding balance dysfunction in Parkinson's disease. Mov Disord 2013; 28:1474-82. [PMID: 23925954 PMCID: PMC4001822 DOI: 10.1002/mds.25613] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/06/2013] [Accepted: 06/25/2013] [Indexed: 12/23/2022] Open
Abstract
People with Parkinson's disease (PD) suffer from progressive impairment in their mobility. Locomotor and balance dysfunction that impairs mobility in PD is an important cause of physical and psychosocial disability. The recognition and evaluation of balance dysfunction by the clinician are an essential component of managing PD. In this review, we describe a framework for understanding balance dysfunction in PD to help clinicians recognize patients who are at risk for falling and impaired mobility.
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Affiliation(s)
| | | | - Fay Horak
- Dept. of Neurology, Oregon Health & Science University
| | - John G. Nutt
- Dept. of Neurology, Oregon Health & Science University
- Portland VA Medical Center
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Gallamini M. Treating balance disorders by ultra-low-level laser stimulation of acupoints. J Acupunct Meridian Stud 2013; 6:119-23. [PMID: 23591007 DOI: 10.1016/j.jams.2013.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 12/17/2012] [Accepted: 12/20/2012] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Balance disorders, a widespread problem in the senior population, are very often related to painful musculoskeletal disabilities and/or to degenerative neurologic pathologies. In a previous work, we investigated the beneficial effects of acupuncture such as laser photobiostimulation, regardless of the etiological origin of the balance dysfunction. AIMS Attention was focused on two individuals showing balance deficits with different etiologies. One healthy control individual was receiving treatment, one healthy control individual did not receive any treatment. Balance performances were measured before and after ultra-low-level laser (ULLL) stimulation as a basis for the design of further investigations. METHODS Romberg's parameters were measured on a force platform. Of the four tested individuals, one showed dizziness symptoms, one was affected by a mild form of Parkinson's disease, and two showed no dysfunction and were used as controls. RESULTS It was found that a ULLL stimulation of peripheral Traditional Chinese Medicine (TCM) acupuncture points can be effective, regardless of the pathology. DISCUSSION A specific clinical analysis of the stability of the beneficial result as a function of homogeneous groups of dysfunctional individuals is needed.
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Affiliation(s)
- Michele Gallamini
- International Society for Posture and Gait Research (ISPGR), Genova, Italy.
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