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Moraca GAG, Orcioli-Silva D, Legutke BR, Gutierrez PP, Sirico TM, Zampier VC, Beretta VS, Gobbi LTB, Barbieri FA. Aerobic exercise on the treadmill combined with transcranial direct current stimulation on the gait of people with Parkinson's disease: A protocol for a randomized clinical trial. PLoS One 2024; 19:e0300243. [PMID: 38662740 PMCID: PMC11045059 DOI: 10.1371/journal.pone.0300243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/28/2024] Open
Abstract
Gait impairments negatively affect the quality of life of people with Parkinson's disease (PwPD). Aerobic exercise (AE) is an alternative to alleviate these impairments and its combination with transcranial direct current stimulation (tDCS) has demonstrated synergistic effects. However, the effect of multitarget tDCS application (i.e., motor, and prefrontal cortices simultaneously) combined with physical exercise on gait impairments is still little known. Thus, the proposed randomized clinical trial will verify the acute effects of AE combined with tDCS applied on motor and prefrontal cortices separately and simultaneously on gait (spatial-temporal and cortical activity parameters) in PwPD. Twenty-four PwPD in Hoehn & Yahr stages I-III will be recruited for this crossover study. PwPD will practice AE on treadmill simultaneously with the application of anodal tDCS during four intervention sessions on different days (∼ one week of interval). Active tDCS will be applied to the primary motor cortex, prefrontal cortex, and both areas simultaneously (multitarget), with an intensity of 2 mA for 20 min. For sham, the stimulation will remain at 2 mA for 10 s. The AE will last a total of 30 min, consisting of warm-up, main part (20 min with application of tDCS), and recovery. Exercise intensity will be controlled by heart rate. Spatial-temporal and cortical activity parameters will be acquired before and after each session during overground walking, walking with obstacle avoidance, and walking with a cognitive dual task at self-preferred velocity. An accelerometer will be positioned on the fifth lumbar vertebra to obtain the spatial-temporal parameters (i.e., step length, duration, velocity, and swing phase duration). Prefrontal cortex activity will be recorded from a portable functional near-infrared spectroscopy system and oxygenated and deoxygenated hemoglobin concentrations will be analyzed. Two-way ANOVAs with repeated measures for stimulation and moment will be performed. The findings of the study may contribute to improving gait in PwPD. Trial registration: Brazilian Clinical Trials Registry (RBR-738zkp7).
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Affiliation(s)
- Gabriel Antonio Gazziero Moraca
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
- Human Movement Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University, Bauru, São Paulo, Brazil
| | - Diego Orcioli-Silva
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Beatriz Regina Legutke
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Pedro Paulo Gutierrez
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Thiago Martins Sirico
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Vinicius Cavassano Zampier
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
- Human Movement Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University, Bauru, São Paulo, Brazil
| | - Victor Spiandor Beretta
- School of Technology and Sciences, Department of Physical Education, São Paulo State University, Presidente Prudente, São Paulo, Brazil
| | - Lilian Teresa Bucken Gobbi
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Fabio Augusto Barbieri
- Human Movement Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University, Bauru, São Paulo, Brazil
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Legutke BR, Gobbi LTB, Orcioli-Silva D, Santos PCRD, Moraca GAG, Vitório R, Beretta VS. Transcranial direct current stimulation suggests not improving postural control during adapted tandem position in people with Parkinson's disease: A pilot study. Behav Brain Res 2023; 452:114581. [PMID: 37453515 DOI: 10.1016/j.bbr.2023.114581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Balance impairments in people with Parkinson's disease (PD) demonstrated mainly in challenging postural tasks, such as increased body oscillation may be attributed to the deficits in the brain structures functionality involved in postural control (e.g., motor cortex, midbrain, and brainstem). Although promising results, the effect of transcranial direct current stimulation (tDCS) on postural control in people with PD is unclear, especially in objective measures such as the center of pressure (CoP) parameters. Thus, we analyzed the effects of a single session of tDCS on the CoP parameters during the adapted tandem position in people with PD. METHODS Nineteen people with PD participated in this crossover, randomized, and double-blind study. Anodal tDCS was applied over the primary motor cortex in two conditions of stimulation (2 mA/active and sham) on two different days for 20 min immediately before the postural control evaluation. Participants remained standing in an adapted tandem position for the postural control assessment for 30 s (three trials). CoP parameters were acquired by a force plate. RESULTS No significant differences were demonstrated between stimulation conditions (p-value range = 0.15-0.89). CONCLUSIONS Our results suggested that a single session of tDCS with 2 mA does not improve the postural control of people with PD during adapted tandem.
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Affiliation(s)
- Beatriz Regina Legutke
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Campinas (UNICAMP), School of Applied Sciences (FCA), Laboratory of Applied Sport Physiology (LAFAE), Limeira, Brazil
| | - Paulo Cezar Rocha Dos Santos
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Israel; The Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel
| | - Gabriel Antonio Gazziero Moraca
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Rodrigo Vitório
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil; São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, São Paulo, Brazil.
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Vitório R, Lirani-Silva E, Orcioli-Silva D, Beretta VS, Oliveira AS, Gobbi LTB. Electrocortical Dynamics of Usual Walking and the Planning to Step over Obstacles in Parkinson's Disease. Sensors (Basel) 2023; 23:4866. [PMID: 37430780 DOI: 10.3390/s23104866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 07/12/2023]
Abstract
The neural correlates of locomotion impairments observed in people with Parkinson's disease (PD) are not fully understood. We investigated whether people with PD present distinct brain electrocortical activity during usual walking and the approach phase of obstacle avoidance when compared to healthy individuals. Fifteen people with PD and fourteen older adults walked overground in two conditions: usual walking and obstacle crossing. Scalp electroencephalography (EEG) was recorded using a mobile 64-channel EEG system. Independent components were clustered using a k-means clustering algorithm. Outcome measures included absolute power in several frequency bands and alpha/beta ratio. During the usual walk, people with PD presented a greater alpha/beta ratio in the left sensorimotor cortex than healthy individuals. While approaching obstacles, both groups reduced alpha and beta power in the premotor and right sensorimotor cortices (balance demand) and increased gamma power in the primary visual cortex (visual demand). Only people with PD reduced alpha power and alpha/beta ratio in the left sensorimotor cortex when approaching obstacles. These findings suggest that PD affects the cortical control of usual walking, leading to a greater proportion of low-frequency (alpha) neuronal firing in the sensorimotor cortex. Moreover, the planning for obstacle avoidance changes the electrocortical dynamics associated with increased balance and visual demands. People with PD rely on increased sensorimotor integration to modulate locomotion.
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Affiliation(s)
- Rodrigo Vitório
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Ellen Lirani-Silva
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Diego Orcioli-Silva
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
| | - Victor Spiandor Beretta
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- School of Technology and Sciences, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
| | | | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
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Beretta VS, Santos PCR, Orcioli-Silva D, Zampier VC, Vitório R, Gobbi LTB. Transcranial direct current stimulation for balance rehabilitation in neurological disorders: A systematic review and meta-analysis. Ageing Res Rev 2022; 81:101736. [PMID: 36116750 DOI: 10.1016/j.arr.2022.101736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 01/31/2023]
Abstract
Postural instability is common in neurological diseases. Although transcranial direct current stimulation (tDCS) seems to be a promising complementary therapy, emerging evidence indicates mixed results and protocols' characteristics. We conducted a systematic review and meta-analysis on PubMed, EMBASE, Scopus, and Web of Science to synthesize key findings of the effectiveness of single and multiple sessions of tDCS alone and combined with other interventions on balance in adults with neurological disorders. Thirty-seven studies were included in the systematic review and 33 in the meta-analysis. The reviewed studies did not personalize the stimulation protocol to individual needs/characteristics. A random-effects meta-analysis indicated that tDCS alone (SMD = -0.44; 95%CI = -0.69/-0.19; p < 0.001) and combined with another intervention (SMD = -0.31; 95%CI = -0.51/-0.11; p = 0.002) improved balance in adults with neurological disorders (small to moderate effect sizes). Balance improvements were evidenced regardless of the number of sessions and targeted area. In summary, tDCS is a promising therapy for balance rehabilitation in adults with neurological disorders. However, further clinical trials should identify factors that influence responsiveness to tDCS for a more tailored approach, which may optimize the clinical use of tDCS.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | | | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Campinas (UNICAMP), School of Applied Sciences (FCA), Laboratory of Applied Sport Physiology (LAFAE), Limeira, Brazil
| | - Vinicius Cavassano Zampier
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Rodrigo Vitório
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
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Beretta VS, Santos PCR, Orcioli-Silva D, Jaimes DAR, Pereira MP, Barbieri FA, Gobbi LTB. Cumulative additional information does not improve the neuromuscular control during postural responses to perturbations in postural instability/gait disorders subtype of Parkinson's disease. Exp Gerontol 2022; 166:111892. [PMID: 35811017 DOI: 10.1016/j.exger.2022.111892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/15/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Postural response impairments in postural instability and gait disorders (PIGD) subtype patients may be attributed to Parkinson's disease (PD)-deterioration in central-set (programing/modulating of central outputs during motor responses). Although additional information improves some PD motor impairments, an unanswered question is whether additional information can benefit postural response in PIGD subtype. OBJECTIVE To analyze the effect of cumulative additional information on postural responses after perturbation in PIGD and neurologically healthy older adults (CG). METHODS Perturbations were applied in 16 PIGD and 19 CG by the support-base translation. Participants performed 3 blocks of 5 trials without additional information (B1-B3, Day 1) and 5 trials of each cumulative additional information (C1-C4, Day 2): information about perturbation (C1), visual (C2), verbal (C3), and somatosensory information (C4). Electromyography and center of pressure (CoP) parameters were analyzed by ANOVAs with Group (PIGD × CG) and Block (B1 × B2 × B3) and with Group (PIGD × CG) and Condition (B3 × C1 × C2 × C3 × C4). RESULTS PIGD decreased the range of CoP in B3 while CG decreased both range of CoP and the integral of antagonist's muscle activity (iEMG) in B2. Also, PIGD decreased the recovery time in C4 while CG increased the iEMG of agonist's muscle in C2 and antagonist's muscle in all conditions except C2. CONCLUSION Additional information provided before postural control assessment influences the postural response in PIGD and CG differently. PIGD demonstrated inflexibility of central-set in modulating the neuromuscular control regardless of additional information. CG presents a flexible system evidenced by the increase of agonist muscle iEMG when provided visual information.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Paulo Cezar Rocha Santos
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Israel
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Campinas (UNICAMP), School of Applied Sciences (FCA), Laboratory of Applied Sport Physiology (LAFAE), Limeira, Brazil
| | - Diego Alejandro Rojas Jaimes
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of San Buenaventura Medellin, Graduate Program in Physical Education and Sports, Medellín, Colombia
| | - Marcelo Pinto Pereira
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Fabio Augusto Barbieri
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
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Orcioli-Silva D, Islam A, Baker MR, Gobbi LTB, Rochester L, Pantall A. Bi-Anodal Transcranial Direct Current Stimulation Combined With Treadmill Walking Decreases Motor Cortical Activity in Young and Older Adults. Front Aging Neurosci 2021; 13:739998. [PMID: 34924993 PMCID: PMC8681021 DOI: 10.3389/fnagi.2021.739998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/01/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Walking in the "real world" involves motor and cognitive processes. In relation to this, declines in both motor function and cognition contribute to age-related gait dysfunction. Transcranial direct current stimulation (tDCS) and treadmill walking (STW) have potential to improve gait, particularly during dual-task walking (DTW); walking whilst performing a cognitive task. Our aims were to analyze effects of combined anodal tDCS + STW intervention on cortical activity and gait during DTW. Methods: Twenty-three young adults (YA) and 21 older adults (OA) were randomly allocated to active or sham tDCS stimulation groups. Participants performed 5-min of mixed treadmill walking (alternating 30 s bouts of STW and DTW) before and after a 20-min intervention of active or sham tDCS + STW. Anodal electrodes were placed over the left prefrontal cortex (PFC) and the vertex (Cz) using 9 cm2 electrodes at 0.6 mA. Cortical activity of the PFC, primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA) bilaterally were recorded using a functional near-infrared spectroscopy (fNIRS) system. Oxygenated hemoglobin (HbO2) levels were analyzed as indicators of cortical activity. An accelerometer measured gait parameters. We calculated the difference between DTW and STW for HbO2 and gait parameters. We applied linear mixed effects models which included age group (YA vs. OA), stimulation condition (sham vs. active), and time (pre- vs. post-intervention) as fixed effects. Treadmill belt speed was a covariate. Partial correlation tests were also performed. Results: A main effect of age group was observed. OA displayed higher activity bilaterally in the PFC and M1, unilaterally in the right PMC and higher gait variability than YA. M1 activity decreased in both YA and OA following active tDCS + STW. There was no overall effect of tDCS + STW on PFC activity or gait parameters. However, negative correlations were observed between changes in left PFC and stride length variability following active tDCS + STW intervention. Conclusion: Increased activity in multiple cortical areas during DTW in OA may act as a compensatory mechanism. Reduction in M1 activity following active tDCS + STW with no observed gait changes suggests improved neural efficiency.
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Affiliation(s)
- Diego Orcioli-Silva
- Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Aisha Islam
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark R Baker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Lynn Rochester
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Annette Pantall
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Beretta VS, Orcioli-Silva D, Conceição NR, Nóbrega-Sousa P, Pereira MP, Gobbi LTB, Vitório R. tDCS application for postural control in Parkinson's disease: Effects are associated with baseline characteristics. Parkinsonism Relat Disord 2021; 93:62-65. [PMID: 34808519 DOI: 10.1016/j.parkreldis.2021.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/25/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Transcranial direct current stimulation (tDCS) improves postural response to perturbation in patients with Parkinson's disease (PwPD). However, the influence of baseline characteristics such as clinical/cognitive and postural performance on the response to tDCS remains unclear. OBJECTIVE To investigate whether baseline level of postural control (performance during sham condition) and clinical/cognitive characteristics are associated with tDCS-related changes in postural responses to external perturbations in PwPD. METHODS Twenty-four PwPD participated in this study. Clinical assessment included disease severity, disease duration, levodopa equivalent dose and global cognition. Anodal tDCS protocols targeting the primary motor cortex were applied in two separate sessions (at least 2 weeks apart): active (2 mA for 20 min) and sham stimulation. Seven trials with the backward translation of the support base (20 cm/s and 5 cm) were performed after tDCS. Postural outcomes included the recovery time to stable position and onset latency of the medial gastrocnemius (MG). Pearson and Spearman correlation tests were performed. RESULTS No significant correlations were observed between clinical/cognitive characteristics and tDCS-related changes in postural responses. Negative associations were observed between the baseline level of postural control and tDCS-related changes in postural responses for the recovery time (r = -0.657; p < 0.001) and the MG onset latency (rs = -0.539; p = 0.007). PwPD with worse baseline postural control demonstrated greater improvement after active stimulation. CONCLUSIONS Findings suggest that tDCS-related effects on postural response to perturbation are related to the baseline level of postural control, but not to clinical characteristics in PwPD. Those with worse baseline postural control responded better to tDCS.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Núbia Ribeiro Conceição
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Priscila Nóbrega-Sousa
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Marcelo Pinto Pereira
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Rodrigo Vitório
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom.
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Belli VD, Orcioli-Silva D, Beretta VS, Vitório R, Zampier VC, Nóbrega-Sousa P, Conceição NRD, Gobbi LTB. Prefrontal Cortical Activity During Preferred and Fast Walking in Young and Older Adults: An fNIRS Study. Neuroscience 2021; 473:81-89. [PMID: 34455013 DOI: 10.1016/j.neuroscience.2021.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 12/11/2022]
Abstract
Age-related changes may affect the performance during fast walking speed. Although, several studies have been focused on the contribution of the prefrontal cortex (PFC) during challenging walking tasks, the neural mechanism underling fast walking speed in older people remain poorly understood. Therefore, the aim of this study was to investigate the influence of aging on PFC activity during overground walking at preferred and fast speeds. Twenty-five older adults (67.37 ± 5.31 years) and 24 young adults (22.70 ± 1.30 years) walked overground in two conditions: preferred speed and fast walking speed. Five trials were performed for each condition. A wireless functional near-infrared spectroscopy (fNIRS) system measured PFC activity. Gait parameters were evaluated using the GAITRite system. Overall, older adults presented higher PFC activity than young adults in both conditions. Speed-related change in PFC activity was observed for older adults, but not for young adults. Older adults significantly increased activity in the left PFC from the preferred to fast walking condition whereas young adults had similar levels of PFC activity across conditions. Our findings suggest that older adults need to recruit additional prefrontal cognitive resources to control walking, indicating a compensatory mechanism. In addition, left PFC seems to be involved in the modulation of gait speed in older adults.
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Affiliation(s)
- Vinicius de Belli
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Victor Spiandor Beretta
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Rodrigo Vitório
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil; Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Vinicius Cavassano Zampier
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Priscila Nóbrega-Sousa
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Núbia Ribeiro da Conceição
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil.
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Pelicioni PHS, Pereira MP, Lahr J, dos Santos PCR, Gobbi LTB. Assessment of Force Production in Parkinson's Disease Subtypes. Int J Environ Res Public Health 2021; 18:ijerph181910044. [PMID: 34639343 PMCID: PMC8507744 DOI: 10.3390/ijerph181910044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/13/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022]
Abstract
Muscle weakness is a secondary motor symptom of Parkinson's disease (PD), especially in the subtype characterized by postural instability and gait difficulty (PIGD). Since the PIGD subtype also presents worse bradykinesia, we hypothesized that it also shows a decreased rate of force development, which is linked to an increased risk of falling in PD. Therefore, we investigated the effects of PD and PD subtypes on a force production profile and correlated the force production outcomes with clinical symptoms for each PD subtype. We assessed three groups of participants: 14 healthy older adults (OA), 10 people with PD composing the PIGD group, and 14 people with PD composing the tremor-dominant group. Three knee extension maximum voluntary isometric contractions were performed in a leg extension machine equipped with a load cell to assess the force production. The outcome measures were: peak force and rate of force development (RFD) at 50 ms (RFD50), 100 ms (RFD100), and 200 ms (RFD200). We observed lower peak force, RFD50, RFD100, and RFD200 in people with PD, regardless of subtypes, compared with the OA group (p < 0.05 for all comparisons). Together, our results indicated that PD affects the capacity to produce maximal and rapid force. Therefore, future interventions should consider rehabilitation programs for people with PD based on muscle power and fast-force production, and consequently reduce the likelihood of people with PD falling from balance-related events, such as from an unsuccessful attempt to avoid a tripping hazard or a poor and slower stepping response.
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Affiliation(s)
- Paulo Henrique Silva Pelicioni
- School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin 9016, New Zealand
- Posture and Locomotion Studies Laboratory, Universidade Estadual Paulista (UNESP), Rio Claro 13506-900, Brazil; (M.P.P.); (J.L.); (P.C.R.d.S.); (L.T.B.G.)
- Correspondence:
| | - Marcelo Pinto Pereira
- Posture and Locomotion Studies Laboratory, Universidade Estadual Paulista (UNESP), Rio Claro 13506-900, Brazil; (M.P.P.); (J.L.); (P.C.R.d.S.); (L.T.B.G.)
| | - Juliana Lahr
- Posture and Locomotion Studies Laboratory, Universidade Estadual Paulista (UNESP), Rio Claro 13506-900, Brazil; (M.P.P.); (J.L.); (P.C.R.d.S.); (L.T.B.G.)
| | - Paulo Cezar Rocha dos Santos
- Posture and Locomotion Studies Laboratory, Universidade Estadual Paulista (UNESP), Rio Claro 13506-900, Brazil; (M.P.P.); (J.L.); (P.C.R.d.S.); (L.T.B.G.)
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Lilian Teresa Bucken Gobbi
- Posture and Locomotion Studies Laboratory, Universidade Estadual Paulista (UNESP), Rio Claro 13506-900, Brazil; (M.P.P.); (J.L.); (P.C.R.d.S.); (L.T.B.G.)
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Dos Santos PCR, Lamoth CJC, Gobbi LTB, Zijdewind I, Barbieri FA, Hortobágyi T. Older Compared With Younger Adults Performed 467 Fewer Sit-to-Stand Trials, Accompanied by Small Changes in Muscle Activation and Voluntary Force. Front Aging Neurosci 2021; 13:679282. [PMID: 34267644 PMCID: PMC8276699 DOI: 10.3389/fnagi.2021.679282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/25/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Repetitive sit-to-stand (rSTS) is a fatigue perturbation model to examine the age-effects on adaptability in posture and gait, yet the age-effects on muscle activation during rSTS per se are unclear. We examined the effects of age and exhaustive rSTS on muscle activation magnitude, onset, and duration during ascent and descent phases of the STS task. Methods: Healthy older (n = 12) and younger (n = 11) adults performed rSTS, at a controlled frequency dictated by a metronome (2 s for cycle), to failure or for 30 min. We assessed muscle activation magnitude, onset, and duration of plantar flexors, dorsiflexors, knee flexors, knee extensors, and hip stabilizers during the initial and late stages of rSTS. Before and after rSTS, we measured maximal voluntary isometric knee extension force, and rate of perceived exertion, which was also recorded during rSTS task. Results: Older vs. younger adults generated 35% lower maximum voluntary isometric knee extension force. During the initial stage of rSTS, older vs. younger adults activated the dorsiflexor 60% higher, all 5 muscle groups 37% longer, and the hip stabilizers 80% earlier. Older vs. younger adults completed 467 fewer STS trials and, at failure, their rate of perceived exertion was ~17 of 20 on the Borg scale. At the end of the rSTS, maximum voluntary isometric knee extension force decreased 16% similarly in older and younger, as well as the similar age groups decline in activation of the dorsiflexor and knee extensor muscles (all p < 0.05). Conclusion: By performing 467 fewer STS trials, older adults minimized the potential effects of fatigability on muscle activation, voluntary force, and motor function. Such a sparing effect may explain the minimal changes in gait after rSTS reported in previous studies, suggesting a limited scope of this perturbation model to probe age-effects on muscle adaptation in functional tasks.
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Affiliation(s)
- Paulo Cezar Rocha Dos Santos
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Claudine J C Lamoth
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lilian Teresa Bucken Gobbi
- Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Inge Zijdewind
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Fabio Augusto Barbieri
- Department of Physical Education, Graduate Program in Movement Sciences, Human Movement Research Laboratory, São Paulo State University (UNESP), Bauru, Brazil
| | - Tibor Hortobágyi
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Sport Biology, Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, Pécs, Hungary.,Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
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11
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Santos PCRD, Barbieri FA, Orcioli-Silva D, Beretta VS, Hortobágyi T, Gobbi LTB. Being physically active minimizes the effects of leg muscle fatigue on obstacle negotiation in people with Parkinson's disease. J Biomech 2021; 124:110568. [PMID: 34171679 DOI: 10.1016/j.jbiomech.2021.110568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 01/31/2023]
Abstract
It is challenging for people with Parkinson's disease (PwPD) to adjust their gait to perturbations, including fatigue. Obstacle negotiation increases the risk of tripping and falling in PD. Being physically active can improve gait control and the ability to negotiate obstacles while walking under fatigue state. We thus determined the effects of Parkinson's disease, fatigue, and level of physical activity on gait during the approach to and crossing an obstacle during gait. Forty participants were stratified to people with Parkinson's disease active and inactive, and control individuals active and inactive. Participants walked on an 8 m walkway and stepped over an obstacle placed at the middle (4 m). They performed three trials before and after repeated sit-to-stand (rSTS)-induced fatigue state. Maximum voluntary force was assessed before and after rSTS. We measured the length, width, duration, and velocity of the approach (stride before obstacle) and crossing (step over the obstacle) phases and the leading and trailing placements and clearance during crossing phase. Fatigue trait was determined by multidimensional fatigue inventory. Before rSTS, people with Parkinson's disease inactive vs. other subgroups approached the obstacle using 18-28% shorter, wider and slower steps and crossed the obstacle slower (all p < 0.04). After rSTS, people with Parkinson's disease inactive increased (23-34%) stride length and velocity and decreased (-21%) the step width (p < 0.01). People with Parkinson's disease approached the obstacle similarly to control individuals. Physical activity minimizes Parkinson's disease-typical gait impairments during obstacle negotiation and affords a protective effect against fatigue-effects on obstacle negotiation.
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Affiliation(s)
- Paulo Cezar Rocha Dos Santos
- São Paulo State University (UNESP), Graduate Program in Movement Sciences, Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil.
| | - Fabio Augusto Barbieri
- São Paulo State University (UNESP), Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, São Paulo, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (UNESP), Graduate Program in Movement Sciences, Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Victor Spiandor Beretta
- São Paulo State University (UNESP), Graduate Program in Movement Sciences, Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Tibor Hortobágyi
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands; Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, Pécs, Hungary; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Graduate Program in Movement Sciences, Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
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12
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Conceição NR, Gobbi LTB, Nóbrega-Sousa P, Orcioli-Silva D, Beretta VS, Lirani-Silva E, Okano AH, Vitório R. Aerobic Exercise Combined With Transcranial Direct Current Stimulation Over the Prefrontal Cortex in Parkinson Disease: Effects on Cortical Activity, Gait, and Cognition. Neurorehabil Neural Repair 2021; 35:717-728. [PMID: 34047235 DOI: 10.1177/15459683211019344] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since people with Parkinson disease (PD) rely on limited prefrontal executive resources for the control of gait, interventions targeting the prefrontal cortex (PFC) may help in managing PD-related gait impairments. Transcranial direct current stimulation (tDCS) can be used to modulate PFC excitability and improve prefrontal cognitive functions and gait. OBJECTIVE We investigated the effects of adding anodal tDCS applied over the PFC to a session of aerobic exercise on gait, cognition, and PFC activity while walking in people with PD. METHODS A total of 20 people with PD participated in this randomized, double-blinded, sham-controlled crossover study. Participants attended two 30-minute sessions of aerobic exercise (cycling at moderate intensity) combined with different tDCS conditions (active- or sham-tDCS), 1 week apart. The order of sessions was counterbalanced across the sample. Anodal tDCS (2 mA for 20 minutes [active-tDCS] or 10 s [sham-tDCS]) targeted the PFC in the most affected hemisphere. Spatiotemporal gait parameters, cognitive functions, and PFC activity while walking were assessed before and immediately after each session. RESULTS Compared with the pre-assessment, participants decreased step time variability (effect size: -0.4), shortened simple and choice reaction times (effect sizes: -0.73 and -0.57, respectively), and increased PFC activity in the stimulated hemisphere while walking (effect size: 0.54) only after aerobic exercise + active-tDCS. CONCLUSION The addition of anodal tDCS over the PFC to a session of aerobic exercise led to immediate positive effects on gait variability, processing speed, and executive control of walking in people with PD.
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Affiliation(s)
- Núbia Ribeiro Conceição
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Rio Claro, SP, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Rio Claro, SP, Brazil
| | - Priscila Nóbrega-Sousa
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Rio Claro, SP, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Rio Claro, SP, Brazil
| | - Victor Spiandor Beretta
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Rio Claro, SP, Brazil
| | - Ellen Lirani-Silva
- Oregon Health and Science University, Department of Neurology, Portland, OR, USA
| | - Alexandre Hideki Okano
- Federal University of ABC (UFABC), Center for Mathematics, Computation and Cognition, São Bernardo do Campo, SP, Brazil
| | - Rodrigo Vitório
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Rio Claro, SP, Brazil.,Oregon Health and Science University, Department of Neurology, Portland, OR, USA
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Beretta VS, Carpenter MG, Barbieri FA, Santos PCR, Orcioli-Silva D, Pereira MP, Gobbi LTB. Does the impaired postural control in Parkinson's disease affect the habituation to non-sequential external perturbation trials? Clin Biomech (Bristol, Avon) 2021; 85:105363. [PMID: 33932865 DOI: 10.1016/j.clinbiomech.2021.105363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND How people with Parkinson's disease habituate their postural response to unpredictable translation perturbation is not totally understood. We compared the capacity to change the postural responses after unexpected external perturbation and investigated the habituation plateaus of postural responses to non-sequential perturbation trials in people with Parkinson's disease and healthy older adults. METHODS In people with Parkinson's disease (n = 37) and older adults (n = 20), sudden posterior support-surface translational were applied in 7 out of 17 randomized trials to ensure perturbation unpredictability. Electromyography and center of pressure parameters of postural response were analyzed by ANOVAs (Group vs. Trials). Two simple planned contrasts were performed to determine at which trial the responses first significantly habituate, and by which trials the habituation plateaus. FINDINGS Older adults demonstrated a first response change in trial 5 and habituation plateaus after trial 4, while for people with Parkinson's disease, the first change occurred in trial 2 and habituation plateau after trial 5 observed by center of pressure range. People with Parkinson's disease demonstrated a greater center of pressure range in trial 1 compared to older adults. Independent of trial, people with Parkinson's disease vs. older adults demonstrated a greater ankle muscle co-activation and recovery time. INTERPRETATION Despite the greater center of pressure range in the first trial, people with Parkinson's disease can habituate to unpredictable perturbations. This is reflected by little, to no difference in the time-course of adaptation for all but 2 parameters that showed only marginal differences between people with Parkinson's disease and older adults.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Mark Gregory Carpenter
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabio Augusto Barbieri
- São Paulo State University (Unesp), School of Sciences, Graduate Program in Movement Sciences, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Paulo Cezar Rocha Santos
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Marcelo Pinto Pereira
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
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Orcioli-Silva D, Vitório R, Nóbrega-Sousa P, Beretta VS, Conceição NRD, Oliveira AS, Pereira MP, Gobbi LTB. Cortical Activity Underlying Gait Improvements Achieved With Dopaminergic Medication During Usual Walking and Obstacle Avoidance in Parkinson Disease. Neurorehabil Neural Repair 2021; 35:406-418. [PMID: 33754884 DOI: 10.1177/15459683211000736] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dopaminergic medication improves gait in people with Parkinson disease (PD). However, it remains unclear if dopaminergic medication modulates cortical activity while walking. OBJECTIVE We investigated the effects of dopaminergic medication on cortical activity during unobstructed walking and obstacle avoidance in people with PD. METHODS A total of 23 individuals with PD, in both off (PDOFF) and on (PDON) medication states, and 30 healthy older adults (control group [CG]) performed unobstructed walking and obstacle avoidance conditions. Cortical activity was acquired through a combined functional near-infrared spectroscopy electroencephalography (EEG) system, along with gait parameters, through an electronic carpet. Prefrontal cortex (PFC) oxygenated hemoglobin (HbO2) and EEG absolute power from FCz, Cz, and CPz channels were calculated. RESULTS HbO2 concentration reduced for people with PDOFF during obstacle avoidance compared with unobstructed walking. In contrast, both people with PDON and the CG had increased HbO2 concentration when avoiding obstacles compared with unobstructed walking. Dopaminergic medication increased step length, step velocity, and β and γ power in the CPz channel, regardless of walking condition. Moreover, dopaminergic-related changes (ie, on-off) in FCz/CPz γ power were associated with dopaminergic-related changes in step length for both walking conditions. CONCLUSIONS PD compromises the activation of the PFC during obstacle avoidance, and dopaminergic medication facilitates its recruitment. In addition, PD medication increases sensorimotor integration during walking by increasing posterior parietal cortex (CPz) activity. Increased γ power in the CPz and FCz channels is correlated with step length improvements achieved with dopaminergic medication during unobstructed walking and obstacle avoidance in PD.
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Affiliation(s)
- Diego Orcioli-Silva
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Rodrigo Vitório
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Priscila Nóbrega-Sousa
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Victor Spiandor Beretta
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Núbia Ribeiro da Conceição
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | | | - Marcelo Pinto Pereira
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
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Moraca GAG, Beretta VS, Dos Santos PCR, Nóbrega-Sousa P, Orcioli-Silva D, Vitório R, Gobbi LTB. Center of pressure responses to unpredictable external perturbations indicate low accuracy in predicting fall risk in people with Parkinson's disease. Eur J Neurosci 2021; 53:2901-2911. [PMID: 33561905 DOI: 10.1111/ejn.15143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Abstract
Falls are associated with impairment in postural control in people with Parkinson's disease (PwPD). We aimed to predict the fall risk through models combining postural responses with clinical and cognitive measures. Also, we compared the center of pressure (CoP) between PwPD fallers and non-fallers after unpredictable external perturbations. We expected that CoP parameters combined with clinical and cognitive measures would predict fall risk. Seventy-five individuals participated in the study. CoP parameters were measured during postural responses through five trials with unpredictable translations of the support-surface in posterior direction. Range and peak of CoP were analyzed in two periods: early and late responses. Time to peak (negative peak) and recovery time were analyzed regardless of the periods. Models included the CoP parameters in early (model 1), late responses (model 2), and temporal parameters (model 3). Clinical and cognitive measures were entered into all models. Twenty-nine participants fell at least once, and 46 PwPD did not fall during 12 months following the postural assessment. Range of CoP in late responses was associated with fall risk (p = .046). However, although statistically non-significant, this parameter indicated low accuracy in predicting fall risk (area under the curve = 0.58). Fallers presented a higher range of CoP in early responses than non-fallers (p = .033). In conclusion, although an association was observed between fall risk and range of CoP in late responses, this parameter indicated low accuracy in predicting fall risk in PwPD. Also, fallers demonstrate worse postural control during early responses after external perturbations than non-fallers, measured by CoP parameters.
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Affiliation(s)
- Gabriel Antonio Gazziero Moraca
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil
| | - Victor Spiandor Beretta
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil
| | - Paulo Cezar Rocha Dos Santos
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil.,Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Priscila Nóbrega-Sousa
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil
| | - Diego Orcioli-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil
| | - Rodrigo Vitório
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil.,Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (Unesp), Rio Claro, Brazil
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Gobbi LTB, Pelicioni PHS, Lahr J, Lirani-Silva E, Teixeira-Arroyo C, Santos PCRD. Effect of different types of exercises on psychological and cognitive features in people with Parkinson's disease: A randomized controlled trial. Ann Phys Rehabil Med 2020; 64:101407. [PMID: 32561505 DOI: 10.1016/j.rehab.2020.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative and progressive disease marked by the presence of motor and non-motor symptoms, as psychological and cognitive impairment. Physical exercises have been prescribed as complementary therapy for PD, and the type of intervention and duration of the intervention should be taken into account. OBJECTIVE We aimed to compare the effect of different exercise modalities (functional mobility, multimodal and cognitive) and length (4 and 8 months) on psychological and cognition in people with PD. This study followed the CONSORT extension for non-pharmacological trials. METHODS In this randomized controlled trial, we assessed 107 participants between 2011 and 2013. At the end of 3 years, participants with PD (mild to moderate stages) who achieved the criteria were assessed considering 3 different groups of exercise: Multimodal (n=38), Functional Mobility (n=33) and Mental/Leisure (n=36). All 3 interventions were performed for 32 weeks, twice a week, with 60min for each session (64 sessions in total). Psychological and cognitive function were assessed at baseline and after 4 and 8 months. RESULTS The Functional Mobility and Mental/Leisure training had a potential effect on maintaining cognitive function (executive function, attention and work memory). The Multimodal training did not show a benefit for cognitive features and was not even able to delay the progressive decline in cognitive functions; however, this modality had a positive effect on physical stress after 8 months of exercise. CONCLUSIONS An intervention that requires high complexity and specific activities, such as locomotor and cognitive exercise, provides a maintenance effect against the degeneration in cognition associated with the progression of PD and thus can delay the progressive decline in cognitive function in PD.
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Affiliation(s)
- Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Post-graduation Program in Movement Sciences, Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
| | - Paulo Henrique Silva Pelicioni
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Juliana Lahr
- São Paulo State University (UNESP), Post-graduation Program in Movement Sciences, Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Ellen Lirani-Silva
- São Paulo State University (UNESP), Post-graduation Program in Movement Sciences, Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | | | - Paulo Cezar Rocha Dos Santos
- São Paulo State University (UNESP), Post-graduation Program in Movement Sciences, Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
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Beretta VS, Vitório R, Nóbrega-Sousa P, Conceição NR, Orcioli-Silva D, Pereira MP, Gobbi LTB. Effect of Different Intensities of Transcranial Direct Current Stimulation on Postural Response to External Perturbation in Patients With Parkinson’s Disease. Neurorehabil Neural Repair 2020; 34:1009-1019. [DOI: 10.1177/1545968320962513] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Habituation of postural response to perturbations is impaired in people with Parkinson’s disease (PD) due to deficits in cortico-basal pathways. Although transcranial direct current stimulation (tDCS) modulate cortico-basal networks, it remains unclear if it can benefit postural control in PD. Objective To analyze the effect of different intensities of anodal tDCS on postural responses and prefrontal cortex (PFC) activity during the habituation to the external perturbation in patients with PD (n = 24). Methods Anodal tDCS was applied over the primary motor cortex (M1) with 1 mA, 2 mA, and sham stimulation in 3 different sessions (~2 weeks apart) during 20 minutes immediately before the postural assessment. External perturbation (7 trials) was applied by a support base posterior translation (20 cm/s and 5 cm). Primary outcome measures included lower limb electromyography and center of pressure parameters. Measures of PFC activity are reported as exploratory outcomes. Analyses of variance (Stimulation Condition × Trial) were performed. Results Habituation of perturbation was evidenced independent of the stimulation conditions. Both active stimulation intensities had shorter recovery time and a trend for lower cortical activity in the stimulated hemisphere when compared to sham condition. Shorter onset latency of the medial gastrocnemius as well as lower cortical activity in the nonstimulated hemisphere were only observed after 2 mA concerning the sham condition. Conclusions tDCS over M1 improved the postural response to external perturbation in PD, with better response observed for 2 mA compared with 1 mA. However, tDCS seems to be inefficient in modifying the habituation of perturbation.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Rodrigo Vitório
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
- Oregon Health & Science University, Portland, OR, USA
| | - Priscila Nóbrega-Sousa
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Núbia Ribeiro Conceição
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Marcelo Pinto Pereira
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
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Dos Santos PCR, Lamoth CJC, Barbieri FA, Zijdewind I, Gobbi LTB, Hortobágyi T. Age-specific modulation of intermuscular beta coherence during gait before and after experimentally induced fatigue. Sci Rep 2020; 10:15854. [PMID: 32985547 PMCID: PMC7522269 DOI: 10.1038/s41598-020-72839-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/07/2020] [Indexed: 12/19/2022] Open
Abstract
We examined the effects of age on intermuscular beta-band (15–35 Hz) coherence during treadmill walking before and after experimentally induced fatigue. Older (n = 12) and younger (n = 12) adults walked on a treadmill at 1.2 m/s for 3 min before and after repetitive sit-to-stand, rSTS, to induce muscle fatigability. We measured stride outcomes and coherence from 100 steps in the dominant leg for the synergistic (biceps femoris (BF)-semitendinosus, rectus femoris (RF)-vastus lateralis (VL), gastrocnemius lateralis (GL)-Soleus (SL), tibialis anterior (TA)-peroneus longus (PL)) and for the antagonistic (RF-BF and TA-GL) muscle pairs at late swing and early stance. Older vs. younger adults had 43–62% lower GL-SL, RF-VL coherence in swing and TA-PL and RF-VL coherence in stance. After rSTS, RF-BF coherence in late swing decreased by ~ 20% and TA-PL increased by 16% independent of age (p = 0.02). Also, GL-SL coherence decreased by ~ 23% and increased by ~ 23% in younger and older, respectively. Age affects the oscillatory coupling between synergistic muscle pairs, delivered presumably via corticospinal tracts, during treadmill walking. Muscle fatigability elicits age-specific changes in the common fluctuations in muscle activity, which could be interpreted as a compensation for muscle fatigability to maintain gait performance.
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Affiliation(s)
- Paulo Cezar Rocha Dos Santos
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. .,Posture and Gait Studies Laboratory (LEPLO), Institute of Biosciences, Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil. .,Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
| | - Claudine J C Lamoth
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Fabio Augusto Barbieri
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Graduate Program in Movement Sciences, São Paulo State University (UNESP), Bauru, Brazil
| | - Inge Zijdewind
- Department of Biomedical Sciences of Cells and Systems, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lilian Teresa Bucken Gobbi
- Posture and Gait Studies Laboratory (LEPLO), Institute of Biosciences, Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Tibor Hortobágyi
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Nóbrega-Sousa P, Gobbi LTB, Orcioli-Silva D, Conceição NRD, Beretta VS, Vitório R. Prefrontal Cortex Activity During Walking: Effects of Aging and Associations With Gait and Executive Function. Neurorehabil Neural Repair 2020; 34:915-924. [DOI: 10.1177/1545968320953824] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Declines in gait parameters are common with aging and more pronounced in tasks with increased executive demand. However, the neural correlates of age-related gait impairments are not fully understood yet. Objectives To investigate ( a) the effects of aging on prefrontal cortex (PFC) activity and gait parameters during usual walking, obstacle crossing and dual-task walking and ( b) the association between PFC activity and measures of gait and executive function. Methods Eighty-eight healthy individuals were distributed into 6 age-groups: 20-25 (G20), 30-35 (G30), 40-45 (G40), 50-55 (G50), 60-65 (G60), and 70-75 years (G70). Participants walked overground under 3 conditions: usual walking, obstacle crossing, and dual-task walking. Changes in oxygenated and deoxygenated hemoglobin in the PFC were recorded using functional near-infrared spectroscopy. Gait spatiotemporal parameters were assessed using an electronic walkway. Executive function was assessed through validated tests. Results Between-group differences on PFC activity were observed for all conditions. Multiple groups (ie, G30, G50, G60, and G70) showed increased PFC activity in at least one of the walking conditions. Young adults (G20 and G30) had the lowest levels of PFC activity while G60 had the highest levels. Only G70 showed reduced executive function and gait impairments (which were more pronounced during obstacle crossing and dual-task walking). PFC activity was related to gait and executive function. Conclusions Aging causes a gradual increase in PFC activity during walking. This compensatory mechanism may reach the resource ceiling in the 70s, when reduced executive function limits its efficiency and gait impairments are observed.
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Affiliation(s)
| | | | | | | | | | - Rodrigo Vitório
- São Paulo State University–UNESP, Rio Claro, Sao Paulo, Brazil
- Oregon Health and Science University, Portland, OR, USA
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Orcioli-Silva D, Vitório R, Beretta VS, da Conceição NR, Nóbrega-Sousa P, Oliveira AS, Gobbi LTB. Is Cortical Activation During Walking Different Between Parkinson’s Disease Motor Subtypes? J Gerontol A Biol Sci Med Sci 2020; 76:561-567. [DOI: 10.1093/gerona/glaa174] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
Parkinson’s disease (PD) is often classified into tremor dominant (TD) and postural instability gait disorder (PIGD) subtypes. Degeneration of subcortical/cortical pathways is different between PD subtypes, which leads to differences in motor behavior. However, the influence of PD subtype on cortical activity during walking remains poorly understood. Therefore, we aimed to investigate the influence of PD motor subtypes on cortical activity during unobstructed walking and obstacle avoidance. Seventeen PIGD and 19 TD patients performed unobstructed walking and obstacle avoidance conditions. Brain activity was measured using a mobile functional near-infrared spectroscopy–electroencephalography (EEG) systems, and gait parameters were analyzed using an electronic carpet. Concentrations of oxygenated hemoglobin (HbO2) of the prefrontal cortex (PFC) and EEG absolute power from alpha, beta, and gamma bands in FCz, Cz, CPz, and Oz channels were calculated. These EEG channels correspond to supplementary motor area, primary motor cortex, posterior parietal cortex, and visual cortex, respectively. Postural instability gait disorder patients presented higher PFC activity than TD patients, regardless of the walking condition. Tremor dominant patients presented reduced beta power in the Cz channel during obstacle avoidance compared to unobstructed walking. Both TD and PIGD patients decreased alpha and beta power in the FCz and CPz channels. In conclusion, PIGD patients need to recruit additional cognitive resources from the PFC for walking. Both TD and PIGD patients presented changes in the activation of brain areas related to motor/sensorimotor areas in order to maintain balance control during obstacle avoidance, being that TD patients presented further changes in the motor area (Cz channel) to avoid obstacles.
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Affiliation(s)
- Diego Orcioli-Silva
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Rodrigo Vitório
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
- Department of Neurology, Oregon Health and Science University, Portland
| | - Victor Spiandor Beretta
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Núbia Ribeiro da Conceição
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Priscila Nóbrega-Sousa
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | | | - Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
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21
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Beretta VS, Conceição NR, Nóbrega-Sousa P, Orcioli-Silva D, Dantas LKBF, Gobbi LTB, Vitório R. Transcranial direct current stimulation combined with physical or cognitive training in people with Parkinson's disease: a systematic review. J Neuroeng Rehabil 2020; 17:74. [PMID: 32539819 PMCID: PMC7296764 DOI: 10.1186/s12984-020-00701-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/21/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Pharmacologic therapy is the primary treatment used to manage Parkinson's disease (PD) symptoms. However, it becomes less effective with time and some symptoms do not respond to medication. Complementary interventions are therefore required for PD. Recent studies have implemented transcranial direct current stimulation (tDCS) in combination with other modalities of interventions, such as physical and cognitive training. Although the combination of tDCS with physical and cognitive training seems promising, the existing studies present mixed results. Therefore, a systematic review of the literature is necessary. AIMS This systematic review aims to (i) assess the clinical effects of tDCS when applied in combination with physical or cognitive therapies in people with PD and; (ii) analyze how specific details of the intervention protocols may relate to findings. METHODS The search strategy detailed the technique of stimulation, population and combined interventions (i.e. cognitive and/or physical training). Only controlled studies were included. RESULTS Seventeen of an initial yield of 408 studies satisfied the criteria. Studies involved small sample sizes. tDCS protocols and characteristics of combined interventions varied. The reviewed studies suggest that synergistic effects may be obtained for cognition, upper limb function, gait/mobility and posture when tDCS is combined with cognitive and/or motor interventions in PD. CONCLUSION The reported results encourage further research to better understand the therapeutic utility of tDCS and to inform optimal clinical use in PD. Future studies in this field should focus on determining optimal stimulation parameters and intervention characteristics for maximal benefits in people with PD.
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Affiliation(s)
- Victor Spiandor Beretta
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Núbia Ribeiro Conceição
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Priscila Nóbrega-Sousa
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Diego Orcioli-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Luana Karla Braz Fonseca Dantas
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil
| | - Rodrigo Vitório
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (Unesp), Avenue 24-A, 1515, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil.
- Graduate Program in Movement Sciences, São Paulo State University - UNESP, Rio Claro, São Paulo State, Brazil.
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA.
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Orcioli-Silva D, Vitório R, Nóbrega-Sousa P, da Conceição NR, Beretta VS, Lirani-Silva E, Gobbi LTB. Levodopa Facilitates Prefrontal Cortex Activation During Dual Task Walking in Parkinson Disease. Neurorehabil Neural Repair 2020; 34:589-599. [DOI: 10.1177/1545968320924430] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background. Although dopaminergic medication improves dual task walking in people with Parkinson disease (PD), the underlying neural mechanisms are not yet fully understood. As prefrontal cognitive resources are involved in dual task walking, evaluation of the prefrontal cortex (PFC) is required. Objective. To investigate the effect of dopaminergic medication on PFC activity and gait parameters during dual task walking in people with PD. Methods. A total of 20 individuals with PD (69.8 ± 5.9 years) and 30 healthy older people (68.0 ± 5.6 years) performed 2 walking conditions: single and dual task (walking while performing a digit vigilance task). A mobile functional near infrared spectroscopy system and an electronic sensor carpet were used to analyze PFC activation and gait parameters, respectively. Relative concentrations of oxygenated hemoglobin (HbO2) from the left and right PFC were measured. Results. People with PD in the off state did not present changes in HbO2 level in the left PFC across walking conditions. In contrast, in the on state, they presented increased HbO2 levels during dual task compared with single task. Regardless of medication state, people with PD presented increased HbO2 levels in the right PFC during dual task walking compared with single task. The control group demonstrated increased PFC activity in both hemispheres during dual task compared with single task. People with PD showed increases in both step length and velocity in the on state compared with the off state. Conclusions. PD limits the activation of the left PFC during dual task walking, and dopaminergic medication facilitates its recruitment.
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Affiliation(s)
- Diego Orcioli-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Rodrigo Vitório
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Priscila Nóbrega-Sousa
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Núbia Ribeiro da Conceição
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Victor Spiandor Beretta
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Ellen Lirani-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
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dos Santos PCR, Barbieri FA, Zijdewind I, Gobbi LTB, Lamoth C, Hortobágyi T. Effects of experimentally induced fatigue on healthy older adults' gait: A systematic review. PLoS One 2019; 14:e0226939. [PMID: 31887182 PMCID: PMC6936857 DOI: 10.1371/journal.pone.0226939] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/27/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction While fatigue is ubiquitous in old age and visibly interferes with mobility, studies have not yet examined the effects of self-reported fatigue on healthy older adults’ gait. As a model that simulates this daily phenomenon, we systematically reviewed eleven studies that compared the effects of experimentally induced muscle and mental performance fatigability on gait kinematics, variability, kinetics, and muscle activity in healthy older adults. Methods We searched for studies in databases (PubMed and Web of Science) using Fatigue, Gait, and Clinical conditions as the main terms and extracted the data only from studies that experimentally induced fatigue by sustained muscle or mental activities in healthy older adults. Results Eleven studies were included. After muscle performance fatigability, six of nine studies observed increases in stride length, width, gait velocity (Effect Size [ES] range: 0.30 to 1.22), inter-stride trunk acceleration variability (ES: 2.06), and ankle muscle coactivation during gait (ES: 0.59, n = 1 study). After sustained mental activity, the coefficient of variation of stride outcomes increased (ES: 0.59 to 0.67, n = 1 study) during dual-task but not single-task walking. Conclusion Muscle performance fatigability affects spatial and temporal features of gait and, mainly, inter-stride trunk acceleration variability. In contrast, sustained mental activity tends only to affect step variability during dual tasking. A critical and immediate step for future studies is to determine the effects of self-reported fatigue on gait biomechanics and variability in healthy older adults to verify the viability of experimentally induced fatigue as a model for the study of gait adaptability in old age.
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Affiliation(s)
- Paulo Cezar Rocha dos Santos
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Posture and Gait Studies Laboratory (LEPLO), Graduate Program in Movement Sciences, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil
- * E-mail: ,
| | - Fabio Augusto Barbieri
- Human Movement Research Laboratory (MOVI-LAB), Graduate Program in Movement Sciences, Department of Physical Education, São Paulo State University (UNESP), Bauru, Brazil
| | - Inge Zijdewind
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lilian Teresa Bucken Gobbi
- Posture and Gait Studies Laboratory (LEPLO), Graduate Program in Movement Sciences, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Claudine Lamoth
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tibor Hortobágyi
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Beretta VS, Santos PCR, Jaimes DAR, Pestana MB, Jimenez AMF, Scarabottolo CC, Gobbi LTB. POSTURAL ADJUSTMENTS OF ACTIVE YOUTHS IN PERTURBATION AND DUAL-TASK CONDITIONS. REV BRAS MED ESPORTE 2019. [DOI: 10.1590/1517-869220192505189240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Introduction Cognitive components are necessary to maintain posture during external perturbations. However, few studies have investigated postural control when external perturbations are associated with a concomitant cognitive task (DT). Objectives To analyze the behavior of reactive adjustments after perturbation with different intensities and displacements in active young adults; and to analyze the influence of DT on predictive and reactive adjustments in different perturbation conditions. Methods Twenty-eight physically active young adults stood on an item of equipment that produced displacements of the base. Four experimental conditions were introduced in a single task (ST) and DT (cognitive-report how many times a pre-established number appeared in the audio): 1 (5 cm and 10 cm/s); 2 (5 cm and 25 cm/s); 3 (12 cm and 10 cm/s) and 4 (12 cm and 25 cm/s). Three attempts were carried out for each condition (total=24). Center of pressure (CoP) parameters were analyzed considering the following windows: predictive (-250 to +50 ms), reactive 1 (+50 to +200 ms) and reactive 2 (+200 to +700 ms), in comparison to the start of the CoP activity. One-way ANOVAs were performed to analyze predictive adjustments, while two-way ANOVAs with factor for task (STxDT) and condition (1x2x3x4), with repeated measurements, were performed for the reactive adjustments. Results One-way ANOVA (predictive) indicated that the subjects had higher CoP parameters in ST vs DT. In reactive adjustments 1 and 2, ANOVA indicated greater CoP parameters in condition 2 and 4 when compared to 1 and 3, and in the ST vs DT. The subjects took longer to recover stable position in conditions 1 and 3 than in conditions 2 and 4. Conclusion Perturbation intensity has a greater influence on postural adjustments to maintain balance than on magnitude. Moreover, the association of cognitive tasks with external perturbation decreases CoP oscillation. Therefore, cognitive resources play an important role in postural control after perturbation. Level of evidence III; Study of nonconsecutive patients, with no “gold” standard applied uniformly.
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Affiliation(s)
| | - Paulo Cezar Rocha Santos
- Universidade Estadual Paulista, Brazil; University Medical Center Groningen, Netherlands; University of Groningen, Netherlands
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Santos PCRD, Hortobágyi T, Zijdewind I, Bucken Gobbi LT, Barbieri FA, Lamoth C. Minimal effects of age and prolonged physical and mental exercise on healthy adults' gait. Gait Posture 2019; 74:205-211. [PMID: 31561118 DOI: 10.1016/j.gaitpost.2019.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait adaptability in old age can be examined by responses to various perturbations. Fatigability due to mental or muscle exercises can perturb internal cognitive and muscle resources, necessitating adaptations in gait. RESEARCH QUESTION What are the effects of age and mental and muscle fatigability on stride outcomes and gait variability? METHODS Twelve older (66-75yrs) and twelve young (20-25 yrs) adults walked at 1.2 m/s before and after two fatigue conditions in two separate sessions. Fatigue conditions were induced by repetitive sit-to-stand task (RSTS) and by 30-min of mental tasks and randomized between days (about a week apart). We calculated the average and coefficient of variation of stride length, width, single support, swing time and cadence, and the detrended fluctuations analysis (DFA) based on 120 strides time intervals. We also calculated multi-scale sample entropy (MSE) and the maximal Lyapunov exponent (λmax) of mediolateral (ML) and anteroposterior (AP) of the Center of Pressure (CoP) trajectories. RESULTS In both age groups, RSTS modestly affected stride length, single support time, cadence, and CV of stride length (p ≤ 0.05), while the mental task did not affect gait. After fatigability, λmax - ML increased (p ≤ 0.05), independent of fatigue condition. All observed effects were small (η²: 0.001 to 0.02). SIGNIFICANCE Muscle and mental fatigability had minimal effects on gait in young and healthy older adults possibly because treadmill walking makes gait uniform. It is still possible that age-dependent muscle activation underlies the uniform gait on the treadmill. Age- and fatigability effects might be more overt during real life compared with treadmill walking, creating a more effective model for examining gait and age adaptability to fatigability perturbations.
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Affiliation(s)
- Paulo Cezar Rocha Dos Santos
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands; São Paulo State University (UNESP), Post-graduation Program in Movement Sciences, Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
| | - Tibor Hortobágyi
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands
| | - Inge Zijdewind
- Department of Biomedical Sciences of Cells and Systems, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Post-graduation Program in Movement Sciences, Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Fabio Augusto Barbieri
- São Paulo State University (UNESP), Post-graduation Program in Movement Sciences, Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, Bauru, Brazil
| | - Claudine Lamoth
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands
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Conceição NRD, Nóbrega de Sousa P, Pereira MP, Gobbi LTB, Vitório R. Utility of center of pressure measures during obstacle crossing in prediction of fall risk in people with Parkinson’s disease. Hum Mov Sci 2019; 66:1-8. [PMID: 30889495 DOI: 10.1016/j.humov.2019.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Postural instability during walking and tripping over obstacles are the main causes of falls in people with Parkinson's disease (PD). Preliminary limited evidence suggests that the length of the prospective follow-up period affects falls prediction in PD, with shorter periods leading to more accurate prediction. Thus, the primary aim of the present study was to test the performance of center of pressure (CoP) variables during obstacle crossing to predict fall risk in people with PD during subsequent periods of four, six, and 12 months. We also compared CoP variables during obstacle crossing between fallers and non-fallers. METHODS Forty-two individuals with PD, in mild to moderate stages, completed the baseline obstacle crossing assessment and reported falls for 12 months. Participants walked at their self-selected pace and were instructed to cross an obstacle (half knee height) positioned in the middle of an 8-m long pathway. A force platform was used to analyze CoP parameters of the stance phase of the trailing limb (most affected limb). The ability of each outcome measure to predict fall risk at four, six, and 12 months was assessed using receiver operating characteristic curve analyses. RESULTS Ten individuals (23.8%) were considered fallers at four months, twelve individuals (28.5%) at six months, and twenty-one individuals (50%) at 12 months. CoP amplitude and CoP velocity in the mediolateral direction significantly predicted fall risk at four, six, and 12 months. As judged by the area under the curve, mediolateral CoP velocity showed the best performance at four months, while mediolateral CoP amplitude showed the best performance at six months. Fallers presented greater values of mediolateral CoP velocity and amplitude than non-fallers. CONCLUSION These findings suggest that mediolateral CoP velocity and amplitude during obstacle crossing might be useful to predict fall risk in people with PD. Therefore, larger studies are encouraged.
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Nóbrega-Sousa P, Orcioli-Silva D, Lirani-Silva E, Beretta VS, Vitório R, Gobbi LTB. Usual walking and obstacle avoidance are influenced by depressive and anxiety symptoms in patients with Parkinson's disease. Geriatr Gerontol Int 2019; 19:868-873. [PMID: 31290261 DOI: 10.1111/ggi.13731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/21/2019] [Accepted: 06/09/2019] [Indexed: 01/22/2023]
Abstract
AIM The aim of the present study was to analyze the association of depressive and anxiety symptoms with usual walking and obstacle avoidance in patients with Parkinson's disease. METHODS Patients were divided into three groups: without depressive and anxiety symptoms (n = 28); depressive symptoms only (n = 15); and depressive and anxiety symptoms (n = 19). Symptoms of depression and anxiety were evaluated by the Hospital Anxiety and Depression scale. Participants walked across a pathway in two experimental conditions: usual walking and obstacle avoidance. Kinematic data were recorded using an optoelectronic three-dimensional system. RESULTS During usual walking, the depressive and anxiety symptoms group presented shorter stride length and longer double support phase compared with the without depressive and anxiety symptoms group, and lower velocity than the without depressive and anxiety symptoms and depressive symptoms groups. During the approach phase of obstacle avoidance, the depressive and anxiety symptoms group decreased the stride length and velocity, whereas the without depressive and anxiety symptoms and depressive symptoms groups did not modulate these parameters. The depressive and anxiety symptoms group also showed shorter step length and velocity, longer step duration, and wider step width during obstacle crossing. Additionally, the depressive and anxiety symptoms group presented shorter foot-to-obstacle horizontal distances, and lower horizontal mean velocities during obstacle crossing. Partial correlation analyses showed that both depressive and anxiety symptoms were associated with spatiotemporal gait parameters. CONCLUSION Combined symptoms of depression and anxiety are associated with walking impairments in patients with Parkinson's disease in both usual walking and obstacle avoidance. Geriatr Gerontol Int 2019; 19: 868-873.
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Affiliation(s)
- Priscila Nóbrega-Sousa
- Department of Physical Education, São Paulo State University (Unesp), Institute of Biosciences, Rio Claro, Brazil.,Department of Physical Education, Graduate Program in Movement Sciences, São Paulo State University-UNESP, Rio Claro, Brazil
| | - Diego Orcioli-Silva
- Department of Physical Education, São Paulo State University (Unesp), Institute of Biosciences, Rio Claro, Brazil.,Department of Physical Education, Graduate Program in Movement Sciences, São Paulo State University-UNESP, Rio Claro, Brazil
| | - Ellen Lirani-Silva
- Department of Physical Education, São Paulo State University (Unesp), Institute of Biosciences, Rio Claro, Brazil
| | - Victor Spiandor Beretta
- Department of Physical Education, São Paulo State University (Unesp), Institute of Biosciences, Rio Claro, Brazil.,Department of Physical Education, Graduate Program in Movement Sciences, São Paulo State University-UNESP, Rio Claro, Brazil
| | - Rodrigo Vitório
- Department of Physical Education, São Paulo State University (Unesp), Institute of Biosciences, Rio Claro, Brazil.,Department of Physical Education, Graduate Program in Movement Sciences, São Paulo State University-UNESP, Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- Department of Physical Education, São Paulo State University (Unesp), Institute of Biosciences, Rio Claro, Brazil.,Department of Physical Education, Graduate Program in Movement Sciences, São Paulo State University-UNESP, Rio Claro, Brazil
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Simieli L, Barbieri FA, Orcioli-Silva D, Lirani-Silva E, Beretta VS, Santos PCRD, Gobbi LTB. Author Correction: Variability of crossing phase in older people with Parkinson's disease is dependent of obstacle height. Sci Rep 2019; 9:6344. [PMID: 30988447 PMCID: PMC6465558 DOI: 10.1038/s41598-019-40318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lucas Simieli
- São Paulo State University (Unesp) - Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, Brazil. .,São Paulo State University (Unesp) - Campus Bauru, Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, Bauru, Brazil.
| | - Fabio Augusto Barbieri
- São Paulo State University (Unesp) - Campus Bauru, Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, Bauru, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp) - Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, Brazil
| | - Ellen Lirani-Silva
- São Paulo State University (Unesp) - Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, Brazil
| | - Victor Spiandor Beretta
- São Paulo State University (Unesp) - Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, Brazil
| | - Paulo Cezar Rocha Dos Santos
- São Paulo State University (Unesp) - Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp) - Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, Brazil
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Pereira MP, Orcioli-Silva D, de Sousa PN, Beretta VS, Gobbi LTB. The effects of habitual footwear in gait outcomes in people with Parkinson's disease. Gait Posture 2019; 68:111-114. [PMID: 30471619 DOI: 10.1016/j.gaitpost.2018.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 10/05/2018] [Accepted: 11/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait is impaired in individuals with Parkinson's disease (PD). Although the effect of habitual footwear on gait spatiotemporal parameters has already been established in neurologically healthy individuals, its effects on people with PD is unknown. RESEARCH QUESTION This study aimed to investigate the impact of habitual footwear on the step spatiotemporal parameters in people with PD. METHODS Sixteen individuals with PD (G-PD) and 15 neurologically healthy individuals (G-HC) were assessed. Participants walked on an 8 m long pressure sensitive walkway at their preferred speed with and without their habitual footwear (3 trials per condition). Footwear included flip-flops, shoes, sneakers and sandals. The average, variability and asymmetry for step length, width, duration, and velocity and the percentage time in the swing and stance phases were calculated. RESULTS The results showed in both groups a reduced percentage time in the swing phase and an increased step width, duration and length with footwear (F(1,29)>5.64; p<0.02). Additionally, habitual footwear increased step width variability in G-PD and G-HC (F(1,29)=3.97; p=0.06). Interestingly, only G-HC showed a higher step length asymmetry in the footwear condition than in the barefoot condition (p=0.02). Finally, only when habitual footwear was used, G-HC showed a higher step velocity asymmetry than G-PD (p=0.04). SIGNIFICANCE These results indicate a negative influence of footwear on gait spatiotemporal parameters in both groups. Furthermore, footwear induced differences between groups. These findings indicate that footwear use is an influencing factor in studies comparing people with PD and healthy elderly. Further data are needed before definitive recommendations are made.
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Affiliation(s)
- Marcelo Pinto Pereira
- São Paulo State University, Institute of Biosciences, Posture and Locomotion Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-graduation Program in Movement Science, São Paulo State University - UNESP
| | - Diego Orcioli-Silva
- São Paulo State University, Institute of Biosciences, Posture and Locomotion Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-graduation Program in Movement Science, São Paulo State University - UNESP
| | - Priscila Nóbrega de Sousa
- São Paulo State University, Institute of Biosciences, Posture and Locomotion Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-graduation Program in Movement Science, São Paulo State University - UNESP
| | - Victor Spiandor Beretta
- São Paulo State University, Institute of Biosciences, Posture and Locomotion Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-graduation Program in Movement Science, São Paulo State University - UNESP
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University, Institute of Biosciences, Posture and Locomotion Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-graduation Program in Movement Science, São Paulo State University - UNESP
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Barbieri FA, Carpenter M, Beretta VS, Orcioli-Silva D, Simieli L, Vitório R, Gobbi LTB. Postural control, falls and Parkinson’s disease: Are fallers more asymmetric than non-fallers? Hum Mov Sci 2019; 63:129-137. [DOI: 10.1016/j.humov.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 10/10/2018] [Accepted: 10/17/2018] [Indexed: 10/27/2022]
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Beretta VS, Vitório R, Santos PCRD, Orcioli-Silva D, Gobbi LTB. Postural control after unexpected external perturbation: Effects of Parkinson's disease subtype. Hum Mov Sci 2019; 64:12-18. [PMID: 30639706 DOI: 10.1016/j.humov.2019.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/20/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
Different clinical subtypes of Parkinson's disease (PD) have long been recognized. Recent studies have focused on two PD subtypes: Postural Instability and Gait Difficulty (PIGD) and Tremor Dominant (TD). PIGD patients have greater difficulties in postural control in relation to TD. However, knowledge about the differences in reactive adjustment mechanisms following a perturbation in TD and PIGD is limited. This study aimed to compare reactive postural adjustments under unexpected external perturbation in TD, PIGD, and control group (CG) subjects. Forty-five individuals (15 TD, 15 PIGD, and 15 CG) participated in this study. Postural perturbation was applied by the posterior displacement of the support surface in an unexpected condition. The velocity (15 cm/s) and displacement (5 cm/s) of perturbation were the same for all participants. Center of pressure (CoP) and center of mass (CoM) were analyzed for two reactive windows after the perturbation (0-200 ms and 200-700 ms). The Bonferroni post hoc test indicated a higher range of CoP in the PIGD when compared to the CG (p = 0.021). The PIGD demonstrated greater time to recover the stable posture compared to the TD (p = 0.017) and CG (p = 0.003). Furthermore, the TD showed higher AP-acceleration peak of CoM when compared to the PIGD (p = 0.048) and CG (p = 0.013), and greater AP-acceleration range of CoM in relation to the CG (p = 0.022). These findings suggest that PD patients present worse reactive postural control after perturbation compared to healthy older individuals. CoP and CoM parameters are sensitive to understand and detect the differences in reactive postural mechanisms in PD subtypes.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-Graduation Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Rodrigo Vitório
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-Graduation Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Paulo Cezar Rocha Dos Santos
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-Graduation Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-Graduation Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Post-Graduation Program in Movement Sciences, São Paulo State University - UNESP, Brazil.
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Alota Ignacio Pereira V, Augusto Barbieri F, Moura Zagatto A, Cezar Rocha Dos Santos P, Simieli L, Augusto Barbieri R, Pivetta Carpes F, Teresa Bucken Gobbi L. Muscle Fatigue Does Not Change the Effects on Lower Limbs Strength Caused by Aging and Parkinson's Disease. Aging Dis 2018; 9:988-998. [PMID: 30574412 PMCID: PMC6284767 DOI: 10.14336/ad.2018.0203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/03/2018] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to determine the impact of aging and Parkinson’s disease (PD) on lower limb muscle strength before and after muscle fatigue. One hundred thirty-five individuals were distributed over seven groups according to their age (20, 30, 40, 50, 60, 70 years old) and disease. Participants performed maximum voluntary isometric contractions (MVIC) in a leg press device followed by the muscle fatigue protocol (repeated sit-to-stand task). Immediately after muscle fatigue (less than 2 min), the MVIC were repeated. The peak force, peak rate of force development (first 50, 100, 200 ms), and root mean square and peak values of the vastus lateralis and vastus medialis muscle activity during MVIC were calculated before and after muscle fatigue. We found more pronounced reductions in lower limb muscle strength parameters (lower limb force, RFD-100 and RFD-200 - p<0.05) in individuals over 50 years of age and with PD. In addition, there was an inverse relation between aging and lower limb muscle strength parameters. The main findings were the lack of changes in peak force, RFDs and muscle activity of the vastus lateralis and vastus medialis after muscle fatigue according to aging and PD, and similar lower limb muscle strength parameters (before and after muscle fatigue) and effect of muscle fatigue in PD compared to the aged groups (60 and 70 years old groups).
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Affiliation(s)
- Vinicius Alota Ignacio Pereira
- 1Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, Sao Paulo State University (Unesp), Bauru, Brazil
| | - Fabio Augusto Barbieri
- 1Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, Sao Paulo State University (Unesp), Bauru, Brazil
| | - Alessandro Moura Zagatto
- 1Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, Sao Paulo State University (Unesp), Bauru, Brazil
| | - Paulo Cezar Rocha Dos Santos
- 2Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Sao Paulo State University (Unesp), Rio Claro, Brazil
| | - Lucas Simieli
- 1Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, Sao Paulo State University (Unesp), Bauru, Brazil
| | - Ricardo Augusto Barbieri
- 3Graduate Program in Physical Education and Sport at School of Physical Education and Sport of Ribeirao Preto (EEFERP), University of Sao Paulo, Centro Universitário Estacio de Ribeirao Preto, Brazil
| | - Felipe Pivetta Carpes
- 4Applied Neuromechanics Group, Laboratory of Neuromechanics, Federal University of Pampa, Uruguaiana, Brazil
| | - Lilian Teresa Bucken Gobbi
- 2Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Sao Paulo State University (Unesp), Rio Claro, Brazil
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Simieli L, Barbieri FA, Orcioli-Silva D, Lirani-Silva E, Beretta VS, Santos PCRD, Gobbi LTB. Variability of crossing phase in older people with Parkinson's disease is dependent of obstacle height. Sci Rep 2018; 8:14852. [PMID: 30291294 PMCID: PMC6173742 DOI: 10.1038/s41598-018-33312-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 09/24/2018] [Indexed: 11/08/2022] Open
Abstract
Our aim was investigating variability in spatiotemporal parameters and kinetics of obstacle avoidance steps of different height obstacles in people with Parkinson's disease (PD) and healthy older people. Twenty-eight participants have included (15 PD - stage disease: 2.1 ± 0.4 pts) and 13 healthy older people (control group). Each subject performed 10 trials of the following tasks: low obstacle, intermediate obstacle and high obstacle. The presentation order was randomized by block for each condition and participant. The spatiotemporal parameters was collected by GAITRite. An optoelectronic system (Optotrak Northern Digital Inc.) with 100 Hz of frequency was used to collect obstacle parameters. The kinect parameters (propulsion impulse and braking impulse) were acquire through two force plates (AccuGait), with a frequency of acquisition 200 Hz. Intersteps variability was calculated throughout mean values, standard deviation and coefficient of variation of two obstacle avoidance steps for each trial. PD group presented greater variability than control group on vertical and horizontal distances to the obstacle. Obstacle height did not change kinect's parameters for both groups. The combination of task complexity (obstacle height) and disease impairments (gait alteration, loss of balance, etc) contributing for greater variability of Parkinson's group. Besides, low obstacle and high obstacle seem to exacerbate variability of distance between obstacle and foot.
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Affiliation(s)
- Lucas Simieli
- São Paulo State University (Unesp) - Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, Brazil.
- São Paulo State University (Unesp) - Campus Bauru, Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, Bauru, Brazil.
| | - Fabio Augusto Barbieri
- São Paulo State University (Unesp) - Campus Bauru, Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, Bauru, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp) - Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, Brazil
| | - Ellen Lirani-Silva
- São Paulo State University (Unesp) - Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, Brazil
| | - Victor Spiandor Beretta
- São Paulo State University (Unesp) - Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, Brazil
| | - Paulo Cezar Rocha Dos Santos
- São Paulo State University (Unesp) - Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp) - Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, Brazil
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Barbieri FA, Polastri PF, Gobbi LTB, Simieli L, Pereira VIA, Baptista AM, Moretto GF, Fiorelli CM, Imaizumi LFI, Rodrigues ST. Obstacle circumvention and eye coordination during walking to least and most affected side in people with Parkinson's disease. Behav Brain Res 2018; 346:105-114. [PMID: 29180136 DOI: 10.1016/j.bbr.2017.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The mechanisms that contribute to gait asymmetry in people with Parkinson's disease (PD) are unclear, mainly during gait with greater environmental demand, such as when an obstacle is circumvented while walking. OBJECTIVE The aim of this study was to investigate the effects of obstacle circumvention of the least and most affected side on motor and gaze behavior in people with PD under/without the effects of dopaminergic medication. METHODS Fifteen people with PD and 15 matched-control individuals were instructed to walk along a pathway, at a self-selected velocity, and to circumvent an obstacle, avoiding contact with it. Each participant performed five trials for each side. Kinematic parameters, mediolateral and horizontal body clearance to the obstacle, strategy to circumvent the obstacle, and gaze behavior were calculated. Parameters were grouped according to the side that the obstacle was circumvented and compared by three-way ANOVAs. RESULTS Both people with PD and the control group presented asymmetry to circumvent an obstacle during walking, however this was exacerbated in people with PD. Individuals with PD presented safe strategies (largest mediolateral and horizontal body clearance to the obstacle, "lead-out" strategy, and higher number and time of fixations on the obstacle) during obstacle circumvention for the least affected side compared to the most affected side. In addition, positive effects of dopaminergic medication on body clearance, spatial-temporal parameters, and gaze behavior were evidenced only when the obstacle was circumvented to the least affected side. CONCLUSIONS The obstacle circumvention to the most affected side is risky for people with PD.
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Affiliation(s)
- Fabio Augusto Barbieri
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil.
| | - Paula Favaro Polastri
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, SP, Brazil
| | - Lucas Simieli
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Vinicius Ignácio Alota Pereira
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - André Macari Baptista
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Gabriel Felipe Moretto
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Carolina Menezes Fiorelli
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil; Universidade Sagrado Coração, Bauru, SP, Brazil
| | - Luis Felipe Itikawa Imaizumi
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Sérgio Tosi Rodrigues
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
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Orcioli-Silva D, Vitório R, Lirani-Silva E, Santos PCR, Beretta VS, Gobbi LTB. Objective measures of unobstructed walking and obstacle avoidance in Parkinson's disease subtypes. Gait Posture 2018; 62:405-408. [PMID: 29627500 DOI: 10.1016/j.gaitpost.2018.03.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/26/2018] [Accepted: 03/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Objective measures of gait in Parkinson's disease (PD) patients according to motor subtypes are not yet fully understood. Although recent advances have been made for unobstructed walking, further work is required on locomotor tasks challenging postural stability, such as obstacle avoidance. RESEARCH QUESTION This study aimed to investigate the influence of PD motor subtypes on objective measures of locomotion during unobstructed walking and obstacle avoidance. METHODS Thirty-five PD patients classified as postural instability and gait disorder (PIGD) and 30 as tremor dominant (TD), as well as 45 healthy controls (CG) walked along an 8-m pathway under two conditions: (a) unobstructed walking and (b) obstacle avoidance. Outcome measures included spatiotemporal parameters recorded by an optoelectronic tridimensional system. RESULTS During unobstructed walking, the PIGD group exhibited shorter stride length, slower velocity, and longer double support phase compared to the TD and CG groups. The TD group also presented slower stride velocity compared to the CG. The PIGD and TD groups presented shorter stride duration than the CG. Regarding obstacle avoidance, the PIGD group exhibited shorter distances for leading foot placement before obstacle, trailing foot placement after obstacle and trailing crossing step length compared to the TD and CG groups. The PIGD group exhibited wider leading crossing step width, lower trailing toe clearance, and slower leading and trailing velocity during obstacle avoidance compared to the CG. SIGNIFICANCE PIGD subtype patients showed worse modifications in objective measures of unobstructed walking and obstacle avoidance. The observed modifications may contribute to increased fall occurrence in PIGD patients.
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Affiliation(s)
- Diego Orcioli-Silva
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
| | - Rodrigo Vitório
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Ellen Lirani-Silva
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Paulo Cezar Rocha Santos
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Victor Spiandor Beretta
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
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Orcioli-Silva D, Barbieri FA, Simieli L, Santos PCRD, Beretta VS, Coelho FGDM, Andrade LPD, Gobbi LTB. A program of physical activity improves gait impairment in people with Alzheimer's disease. Motriz: rev educ fis 2018. [DOI: 10.1590/s1980-6574201800010009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Silva-Batista C, Corcos DM, Kanegusuku H, Piemonte MEP, Gobbi LTB, de Lima-Pardini AC, de Mello MT, Forjaz CLM, Ugrinowitsch C. Balance and fear of falling in subjects with Parkinson's disease is improved after exercises with motor complexity. Gait Posture 2018; 61:90-97. [PMID: 29310015 DOI: 10.1016/j.gaitpost.2017.12.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 12/12/2017] [Accepted: 12/27/2017] [Indexed: 02/07/2023]
Abstract
Resistance training with instability (RTI) uses exercises with high motor complexity that impose high postural control and cognitive demands that may be important for improving postural instability and fear of falling in subjects with Parkinson's disease (PD). Here, we hypothesized that: 1) RTI will be more effective than resistance training (RT) in improving balance (Balance Evaluation Systems Test [BESTest] and overall stability index [Biodex Balance System®]) and fear of falling (Falls Efficacy Scale-International [FES-I] score) of subjects with Parkinson's disease (PD); and 2) changes in BESTest and FES-I after RTI will be associated with changes in cognitive function (Montreal Cognitive Assessment [MoCA] score - previously published) induced by RTI. Thirty-nine subjects with moderate PD were randomly assigned to a nonexercising control, RT, and RTI groups. While RT and RTI groups performed progressive RT twice a week for 12 weeks, the RTI group added progressive unstable devices to increase motor complexity of the resistance exercises. There were significant group × time interactions for BESTest, overall stability index, and FES-I scores (P < 0.05). Only RTI improved BESTest, overall stability index and FES-I scores, and RTI was more effective than RT in improving biomechanical constraints and stability in gait (BESTest sections) at post-training (P < 0.05). There were strong correlations between relative changes in BESTest and MoCA (r = 0.72, P = 0.005), and FES-I and MoCA (r = -0.75, P = 0.003) after RTI. Due to the increased motor complexity in RTI, RTI is recommended for improving balance and fear of falling, which are associated with improvement in cognitive function of PD.
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Affiliation(s)
- Carla Silva-Batista
- Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, Brazil.
| | - Daniel M Corcos
- Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, Illinois, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Hélcio Kanegusuku
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, Brazil
| | | | | | - Andrea C de Lima-Pardini
- Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, Brazil; Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil; LIM-44, Department of Radiology, University of São Paulo, São Paulo, Brazil
| | - Marco Túlio de Mello
- Department of Psychobiology, Center for Psychobiology and Exercise Studies University Federal de São Paulo, São Paulo, Brazil
| | - Claudia L M Forjaz
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, Brazil
| | - Carlos Ugrinowitsch
- Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, Brazil
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Orcioli-Silva D, Barbieri FA, Simieli L, Vitorio R, Santos PCRD, Beretta VS, Gobbi LTB. Walking behavior over multiple obstacles in people with Parkinson's disease. Gait Posture 2017; 58:510-515. [PMID: 28957776 DOI: 10.1016/j.gaitpost.2017.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 02/02/2023]
Abstract
The presence of a second obstacle changed the planning and adjustments for obstacle avoidance performance, but this context is poorly understood in Parkinson's disease (PD). The aim of this study was to investigate the walking behavior over multiple obstacles in people with PD. Nineteen people with PD and 19 healthy individuals walked across an 8m pathway, performing three trials for following conditions: unobstructed walking, walking with one obstacle avoidance (Single), and walking with two obstacles avoidance (Double). In the Double condition, the analysis was performed only for the first obstacle (First Double). The dependent variables were calculated separately for the approach and crossing phases in the obstacle conditions. The main results show that people with PD decreased single support and increased double support phase in both Single and Double conditions compared to the unobstructed walking. Both groups increased stride duration during approach phase in the Double condition compared to the unobstructed walking and Single conditions. The presence of the second obstacle led to a decrease in trailing toe clearance during obstacle avoidance of the First Double. In conclusion, people with PD use a conservative strategy while approaching obstacles. Both groups need more time to obtain and process environmental information and plan the action in environments with multiple obstacles. The smaller leading toe clearance might be an indicative that the presence of a second obstacle increase the likelihood of tripping during obstacle avoidance in both people with PD and healthy individuals.
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Affiliation(s)
- Diego Orcioli-Silva
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
| | - Fabio Augusto Barbieri
- Universidade Estadual Paulista (Unesp), Faculdade de Ciências, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Lucas Simieli
- Universidade Estadual Paulista (Unesp), Faculdade de Ciências, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Rodrigo Vitorio
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Paulo Cezar Rocha Dos Santos
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Victor Spiandor Beretta
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
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Lirani-Silva E, Vitório R, Barbieri FA, Orcioli-Silva D, Simieli L, Gobbi LTB. Continuous use of textured insole improve plantar sensation and stride length of people with Parkinson's disease: A pilot study. Gait Posture 2017; 58:495-497. [PMID: 28946113 DOI: 10.1016/j.gaitpost.2017.09.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/24/2017] [Accepted: 09/17/2017] [Indexed: 02/02/2023]
Abstract
Findings involving the acute benefits of textured insoles on gait in people with Parkinson's disease (PD) are still controversial. To our best acknowledge, the continuous use of textured insoles on gait in people with PD has not been investigated yet. The aim of this pilot study was to obtain preliminary data of the effects of textured insoles on gait and plantar sensation in people with PD after one-week intervention and one-week follow-up period. Nineteen patients with PD were distributed into two groups: experimental group and control group. Initially, the plantar sensation was assessed through Semmes-Weinstein Monofilaments. Then, participants performed 5 trials of walking (without insoles) at a self-selected speed. Gait data were collected using an optoelectronic system. Plantar sensation and gait assessments were repeated in three moments: before and after one-week wearing the group-specific insoles, and after one week wearing conventional insoles (follow-up). The textured insole had half-sphere elevations placed in the distal phalanx of the hallux, heads of metatarsophalangeal joints and heel. Results revealed that the use of textured insole for one week improved plantar sensation and stride length. However, only benefits on plantar sensation were maintained after the follow-up period. Our results suggest that the continuous use of textured insoles for one week benefits plantar sensation and gait in patients with PD. These results support the hypothesis that enhanced somatosensory feedback to the sensory system result in an improved motor output of gait.
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Affiliation(s)
- Ellen Lirani-Silva
- São Paulo State University (UNESP), Bioscience Institute, Campus Rio Claro, 1515 24-A Avenue, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil.
| | - Rodrigo Vitório
- São Paulo State University (UNESP), Bioscience Institute, Campus Rio Claro, 1515 24-A Avenue, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
| | - Fabio Augusto Barbieri
- São Paulo State University (UNESP), Faculty of Science, Campus Bauru, 14 Luís Edmundo Carrijo Coube Avenue, Vargem Limpa, Bauru, São Paulo State, 17033-360, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (UNESP), Bioscience Institute, Campus Rio Claro, 1515 24-A Avenue, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
| | - Lucas Simieli
- São Paulo State University (UNESP), Faculty of Science, Campus Bauru, 14 Luís Edmundo Carrijo Coube Avenue, Vargem Limpa, Bauru, São Paulo State, 17033-360, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Bioscience Institute, Campus Rio Claro, 1515 24-A Avenue, Bela Vista, Rio Claro, São Paulo State, 13506-900, Brazil
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Silva-Batista C, Corcos DM, Roschel H, Kanegusuku H, Gobbi LTB, Piemonte MEP, Mattos ECT, DE Mello MT, Forjaz CLM, Tricoli V, Ugrinowitsch C. Resistance Training with Instability for Patients with Parkinson's Disease. Med Sci Sports Exerc 2017; 48:1678-87. [PMID: 27054681 DOI: 10.1249/mss.0000000000000945] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE This randomized controlled trial compared the effects of resistance training (RT) and RT with instability (RTI) on the timed up and go test (TUG), on-medication Unified Parkinson's Disease Rating Scale part III motor subscale score (UPDRS-III), Montreal Cognitive Assessment (MoCA) score, Parkinson's Disease Questionnaire (PDQ-39) score, and muscle strength in the leg press exercise (one-repetition maximum) of patients with Parkinson's disease (PD). METHODS Thirty-nine patients with moderate to severe PD were randomly assigned to a nonexercising control group (C), RT group, and RTI group. The RT and RTI groups performed progressive RT twice a week for 12 wk. However, only the RTI group used high motor complexity exercises (i.e., progressive RT with unstable devices), for example, half squat exercise on the BOSU® device. The primary outcome was mobility (TUG). The secondary outcomes were on-medication motor signs (UPDRS-III), cognitive impairment (MoCA), quality of life (PDQ-39), and muscle strength (one-repetition maximum). RESULTS There were no differences between RTI and RT groups for any of the outcomes at posttraining (P > 0.05). However, there were differences between RTI and C groups in the TUG, MoCA, and muscle strength values at posttraining (P < 0.05). Only the RTI group improved the TUG (-1.9 s), UPDRS-III score (-4.5 score), MoCA score (6.0 score), and PDQ-39 score (-5.2 score) from pre- to posttraining (P < 0.001). Muscle strength improved for both training groups (P < 0.001). No adverse events were reported during the trial. CONCLUSIONS Both training protocols improved muscle strength, but only RTI improved the mobility, motor signs, cognitive impairment, and quality of life, likely because of the usage of high motor complexity exercises. Thus, RTI may be recommended as an innovative adjunct therapeutic intervention for patients with PD.
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Affiliation(s)
- Carla Silva-Batista
- 1Laboratory of Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, BRAZIL; 2Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL; 3Department of Neurological Sciences, Rush University Medical Center, Chicago, IL; 4Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, BRAZIL; 5Posture and Gait Studies Lab, São Paulo State University at Rio Claro, Rio Claro, BRAZIL; 6Faculty of Medical Science, University of São Paulo, São Paulo, BRAZIL; 7Department of Psychobiology, Center for Psychobiology and Exercise Studies, University Federal de São Paulo, São Paulo, BRAZIL
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Barbieri FA, Simieli L, Orcioli-Silva D, Baptista AM, Borkowske Pestana M, Spiandor Beretta V, Dos Santos PCR, Bucken Gobbi LT. Obstacle Avoidance Increases Asymmetry of Crossing Step in Individuals With Parkinson's Disease and Neurologically Healthy Individuals. J Mot Behav 2017. [PMID: 28632105 DOI: 10.1080/00222895.2016.1271303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The authors' aim was to investigate gait asymmetry of crossing step during obstacle avoidance while walking in people with Parkinson's disease (PD) under and without the effects of dopaminergic medication. Thirteen individuals with PD and 13 neurologically healthy individuals performed 5 trials of unobstructed gait and 10 trials of obstacle crossing during gait (5 trials with each leg) and spatiotemporal parameters were analyzed. Obstacle crossing increased step duration of the crossing step for the most-affected or nondominant limb compared to the crossing step with the least-affected or dominant limb. Individuals with PD without the effects of medication increased step duration for the step with the least-affected limb compared to the step with the most-affected limb during obstacle crossing.
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Affiliation(s)
- Fabio Augusto Barbieri
- a Human Movement Research Laboratory (MOVI-LAB), Faculty of Science, Department of Physical Education , Universidade Estadual Paulista-UNESP , Bauru , Brazil.,b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Lucas Simieli
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Diego Orcioli-Silva
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - André Macari Baptista
- a Human Movement Research Laboratory (MOVI-LAB), Faculty of Science, Department of Physical Education , Universidade Estadual Paulista-UNESP , Bauru , Brazil.,b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Mayara Borkowske Pestana
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Victor Spiandor Beretta
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Paulo Cezar Rocha Dos Santos
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Lilian Teresa Bucken Gobbi
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
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Santos PCR, Gobbi LTB, Orcioli-Silva D, Simieli L, van Dieën JH, Barbieri FA. Effects of leg muscle fatigue on gait in patients with Parkinson's disease and controls with high and low levels of daily physical activity. Gait Posture 2016; 47:86-91. [PMID: 27264409 DOI: 10.1016/j.gaitpost.2016.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/17/2016] [Accepted: 04/01/2016] [Indexed: 02/02/2023]
Abstract
Patients with Parkinson's disease (PD) are more susceptible to muscle fatigue, which can damage their gait. Physical activity can improve muscle condition, which is an important aspect during walking. The aim of this study was to analyze the effects of lower limb muscle fatigue on gait in patients with PD and healthy individuals, grouped according to physical activity level. Twenty Patients with PD (PD group) and 20 matched individuals (control group) were distributed according to physical activity level into four subgroups of ten individuals (active and inactive). Participants performed three walking trials before and after lower limb muscle fatigue, induced by a repeated sit-to-stand task on a chair. Kinematic (stride length, width, duration, velocity and percentage of time in double support) and kinetic (propulsive and breaking anterior-posterior and medio-lateral impulse) gait parameters were analyzed. In both groups, participants increased stride length and velocity and decreased stride duration and braking vertical impulse after lower limb muscle fatigue. The PD groups presented higher step width and percentage of double time support than the control groups before muscle fatigue. The control groups increased step width and decreased percentage of time in double support, while the PD groups did not change these parameters. For physical activity level, active individuals presented longer stride length, greater stride velocity, higher braking and propulsive anterior-posterior impulse and shorter step width than inactive individuals. Groups sought more balance and safety after lower limb muscle fatigue. Physical activity level does not appear to modify the effects of lower limb muscle fatigue during unobstructed walking in individuals with PD or controls.
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Affiliation(s)
| | | | | | - Lucas Simieli
- UNESP, Univ Estadual Paulista at Rio Claro - LEPLO, São Paulo, Brazil
| | - Jaap H van Dieën
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Fabio Augusto Barbieri
- UNESP, Univ Estadual Paulista at Rio Claro - LEPLO, São Paulo, Brazil; UNESP, Univ Estadual Paulista at Bauru - UNESP - LIVIA, São Paulo, Brazil
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Barbieri FA, Beretta SS, Pereira VAI, Simieli L, Orcioli-Silva D, dos Santos PCR, van Dieën JH, Gobbi LTB. Recovery of gait after quadriceps muscle fatigue. Gait Posture 2016; 43:270-4. [PMID: 26531768 DOI: 10.1016/j.gaitpost.2015.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 02/02/2023]
Abstract
The aim of this study was to investigate the effect of recovery time after quadriceps muscle fatigue on gait in young adults. Forty young adults (20-40 years old) performed three 8-m gait trials at preferred velocity before and after muscle fatigue, and after 5, 10 and 20min of passive rest. In addition, at each time point, two maximal isometric voluntary contractions were preformed. Muscle fatigue was induced by repeated sit-to-stand transfers until task failure. Spatio-temporal, kinetic and muscle activity parameters, measured in the central stride of each trial, were analyzed. Data were compared between before and after the muscle fatigue protocol and after the recovery periods by one-way repeated measures ANOVA. The voluntary force was decreased after the fatigue protocol (p<0.001) and after 5, 10 and 20min of recovery compared to before the fatigue protocol. Step width (p<0.001) and RMS of biceps femoris (p<0.05) were increased immediately after the fatigue protocol and remained increased after the recovery periods. In addition, stride duration was decreased immediately after the fatigue protocol compared to before and to after 10 and 20min of rest (p<0.001). The anterior-posterior propulsive impulse was also decreased after the fatigue protocol (p<0.001) and remained low after 5, 10 and 20min of rest. We conclude that 20min is not enough to see full recovery of gait after exhaustive quadriceps muscle fatigue.
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Affiliation(s)
- Fabio Augusto Barbieri
- Univ Estadual Paulista, Posture and Gait Studies Laboratory, Rio Claro, Brazil; Univ Estadual Paulista, Laboratory of Information, Vision, and Action, Bauru, Brazil.
| | | | - Vinicius A I Pereira
- Univ Estadual Paulista, Posture and Gait Studies Laboratory, Rio Claro, Brazil; Univ Estadual Paulista, Laboratory of Information, Vision, and Action, Bauru, Brazil
| | - Lucas Simieli
- Univ Estadual Paulista, Posture and Gait Studies Laboratory, Rio Claro, Brazil
| | - Diego Orcioli-Silva
- Univ Estadual Paulista, Posture and Gait Studies Laboratory, Rio Claro, Brazil
| | | | - Jaap H van Dieën
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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Lahr J, Pereira MP, Pelicioni PHS, De Morais LC, Gobbi LTB. PARKINSON'S DISEASE PATIENTS WITH DOMINANT HEMIBODY AFFECTED BY THE DISEASE RELY MORE ON VISION TO MAINTAIN UPRIGHT POSTURAL CONTROL. Percept Mot Skills 2015; 121:923-34. [PMID: 26654986 DOI: 10.2466/15.pms.121c26x0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study assesses the association between disease onset side (dominant or non-dominant) and vision on postural control of Parkinson's disease patients. Patient volunteers composed two groups, according to the onset side affected: Dominant group (n=9; M age=66.1 yr., SD=7.2; 6 women, 3 men) and Non-dominant group (n=9; M age=67.4 yr., SD=6.4; 6 women, 3 men). The groups' postural control was assessed by posturography during quiet upright stance in two conditions, Eyes open and Eyes closed. Two-way analyses of variance (ANOVAs; group×condition) with repeated measures for the second factor assessed the differences associated with affected hemibody and vision on postural control. Analyses indicated that patients with the dominant side affected also presented significantly greater variation in center of pressure than those with the non-dominant side affected, mainly in the Eyes closed condition. The results demonstrate a higher reliance on vision in the dominant side, possibly to compensate somatosensory system impairments. These results also highlight the importance of analyzing the hemibody affected by the disease when postural control is assessed in this population.
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Pereira VAI, Barbieri FA, Vitório R, Simieli L, Lirani-Silva E, Orcioli-Silva D, Gobbi LTB. The motor deficits caused by Parkinson's disease are not able to block adjustments for a safe strategy during obstacle crossing in individuals with moderate disease. Motriz: rev educ fis 2015. [DOI: 10.1590/s1980-65742015000400014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract The aim of this study was to verify whether patients with Parkinson's disease (PD) are able to adjust their motor behavior according to restrictions imposed by the task instruction during walking with obstacle crossing. Eighteen elderly people (moderate motor compromise) with a diagnosis of PD walked on a pathway and cross an obstacle according to the following conditions: walking at preferred velocity; walking at maximum vertical elevation of the feet to cross the obstacle; walking at maximum step length to cross the obstacle; walking at maximum velocity. The modulations were directly related to the instructions provided to patients with PD before performing each task, which seems to indicate that attentional cues can influence and benefit strategies during obstacle crossing. In conclusion, patients with PD are able to adjust walking during obstacle crossing according to instructions given to them, which increases their safety.
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Beretta VS, Gobbi LTB, Lirani-Silva E, Simieli L, Orcioli-Silva D, Barbieri FA. Challenging Postural Tasks Increase Asymmetry in Patients with Parkinson's Disease. PLoS One 2015; 10:e0137722. [PMID: 26367032 PMCID: PMC4569579 DOI: 10.1371/journal.pone.0137722] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 08/20/2015] [Indexed: 11/19/2022] Open
Abstract
The unilateral predominance of Parkinson’s disease (PD) symptoms suggests that balance control could be asymmetrical during static tasks. Although studies have shown that balance control asymmetries exist in patients with PD, these analyses were performed using only simple bipedal standing tasks. Challenging postural tasks, such as unipedal or tandem standing, could exacerbate balance control asymmetries. To address this, we studied the impact of challenging standing tasks on postural control asymmetry in patients with PD. Twenty patients with PD and twenty neurologically healthy individuals (control group) participated in this study. Participants performed three 30s trials for each postural task: bipedal, tandem adapted and unipedal standing. The center of pressure parameter was calculated for both limbs in each of these conditions, and the asymmetry between limbs was assessed using the symmetric index. A significant effect of condition was observed, with unipedal standing and tandem standing showing greater asymmetry than bipedal standing for the mediolateral root mean square (RMS) and area of sway parameters, respectively. In addition, a group*condition interaction indicated that, only for patients with PD, the unipedal condition showed greater asymmetry in the mediolateral RMS and area of sway than the bipedal condition and the tandem condition showed greater asymmetry in the area of sway than the bipedal condition. Patients with PD exhibited greater asymmetry while performing tasks requiring postural control when compared to neurologically healthy individuals, especially for challenging tasks such as tandem and unipedal standing.
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Affiliation(s)
- Victor Spiandor Beretta
- Univ Estadual Paulista, UNESP, Posture and Gait Studies Laboratory, Department of Physical Education, Bioscience Institute, Rio Claro, São Paulo, Brazil
| | - Lilian Teresa Bucken Gobbi
- Univ Estadual Paulista, UNESP, Posture and Gait Studies Laboratory, Department of Physical Education, Bioscience Institute, Rio Claro, São Paulo, Brazil
| | - Ellen Lirani-Silva
- Univ Estadual Paulista, UNESP, Posture and Gait Studies Laboratory, Department of Physical Education, Bioscience Institute, Rio Claro, São Paulo, Brazil
| | - Lucas Simieli
- Univ Estadual Paulista, UNESP, Posture and Gait Studies Laboratory, Department of Physical Education, Bioscience Institute, Rio Claro, São Paulo, Brazil
| | - Diego Orcioli-Silva
- Univ Estadual Paulista, UNESP, Posture and Gait Studies Laboratory, Department of Physical Education, Bioscience Institute, Rio Claro, São Paulo, Brazil
| | - Fabio Augusto Barbieri
- Univ Estadual Paulista, UNESP, Posture and Gait Studies Laboratory, Department of Physical Education, Bioscience Institute, Rio Claro, São Paulo, Brazil
- Univ Estadual Paulista, UNESP, Laboratory of Information, Vision and Action, Department of Physical Education, Faculty of Science, Bauru, São Paulo, Brazil
- * E-mail:
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47
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Lirani-Silva E, Vitório R, Barbieri FA, Baptista AM, Santos PCRD, Gobbi LTB. Different types of additional somatosensory information do not promote immediate benefits on gait in patients with Parkinson's disease and older adults. Motriz: rev educ fis 2015. [DOI: 10.1590/s1980-65742015000300004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
AbstractPlantar cutaneous stimulation has been shown to improve gait in Parkinson's disease (PD), but the effects of different types of insoles have not been tested. We evaluated the immediate effect of different types of insoles on gait in PD patients and healthy older adults. Nineteen PD patients and nineteen healthy older adults performed and performed a walking task at their self-selected speed in three conditions: conventional insole, insole with a raised ridge around the foot perimeter, and insole with half-spheres. Plantar sensation was evaluated before and after the walking protocol. There were no differences between groups for plantar sensation before and after the walking task. PD patients demonstrated reduced stride length and stride velocity. There were no immediate benefits offered by the insoles on gait of either group. The increased plantar cutaneous stimulation does not promote immediate benefits on gait in PD patients and healthy older adults.
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Simieli L, Barbieri FA, Orcioli-Silva D, Lirani-Silva E, Stella F, Gobbi LTB. Obstacle crossing with dual tasking is a danger for individuals with Alzheimer's disease and for healthy older people. J Alzheimers Dis 2015; 43:435-41. [PMID: 25096621 DOI: 10.3233/jad-140807] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to analyze the effects of dual tasking on obstacle crossing during walking by individuals with Alzheimer's disease (AD) and by healthy older people. METHODS Thirty four elderly individuals (16 healthy subjects and 18 individuals with AD) were recruited to participate in this study. Three AD individuals and one control participant were excluded due to exclusion criteria. The participants were instructed to walk barefoot at their own speed along an 8 m long pathway. Each participant performed five trials for each condition (unobstructed walking, unobstructed walking with dual tasking, and obstacle crossing during walking with dual tasking). The trials were completely randomized for each participant. The mid-pathway stride was measured in the unobstructed walking trials and the stride that occurred during the obstacle avoidance was measured in the trials that involved obstacle crossing. RESULTS/CONCLUSION The behavior of the healthy elderly subjects and individuals with AD was similar for obstacle crossing during walking with dual tasking. Both groups used the "posture first" strategy to prioritize stability and showed decreased attention to executive tasking while walking. Additionally, AD had a strong influence on the modifications that are made by the elderly while walking under different walking conditions.
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Affiliation(s)
- Lucas Simieli
- UNESP, Univ Estadual Paulista at Rio Claro, Rio Claro/SP, Brazil
| | - Fabio Augusto Barbieri
- UNESP, Univ Estadual Paulista at Rio Claro, Rio Claro/SP, Brazil UNESP, Univ Estadual Paulista at Bauru/Brazil, Presidente G/Bauru/SP, Brazil
| | | | | | - Florindo Stella
- UNESP, Univ Estadual Paulista at Rio Claro, Rio Claro/SP, Brazil UNICAMP - Campinas State University at Campinas/Brazil, Campus Universitário Zeferino Vaz, Campinas/SP, Brazil
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Pelicioni PHS, Pereira MP, Lahr J, Gobbi LTB. Análise cinética e cinemática do levantar e andar em jovens e idosos. Revista Brasileira de Ciências do Esporte 2015. [DOI: 10.1016/j.rbce.2013.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
PURPOSE: To compare the speech and voice of Parkinson's disease (PD) patients and neurologically healthy elderly adults (control group, CG), to find out whether these features are related to the disease or the normal aging process, and investigate the impact that dysarthria has on the Quality of Life (QoL) of these individuals. METHODS: This is a cross-sectional study involving 25 individuals, 13 patients with PD and 12 CG. All the participants underwent vocal assessment, perceptual and acoustic analysis, based on "Dysarthria Assessment Protocol" and analysis of QoL using a questionnaire, "Living with Dysarthria". The data underwent statistical analysis to compare the groups in each parameter. RESULTS: In the assessment of dysarthria, patients with PD showed differences in prosody parameter (p=0.012), at the habitual frequency for females (p=0.025) and males (p=0.028), and the extent of intensity (p=0.039) when compared to CG. In QoL questionnaire, it was observed that patients with PD showed more negative impact on the QoL compared to CG, as indicated by the total score (p=0.005) with various aspects influencing this result. CONCLUSION: The degree of modification of speech and voice of patients with PD resembles those seen in normal aging process, with the exception of prosody and the habitual frequency, which are related to the greatest negative impact on the QoL of patients with PD.
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