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Capato TTC, Chen J, Miranda JDA, Chien HF. Assisted technology in Parkinson's disease gait: what's up? Arq Neuropsiquiatr 2024; 82:1-10. [PMID: 38395424 PMCID: PMC10890908 DOI: 10.1055/s-0043-1777782] [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] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/21/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Gait disturbances are prevalent and debilitating symptoms, diminishing mobility and quality of life for Parkinson's disease (PD) individuals. While traditional treatments offer partial relief, there is a growing interest in alternative interventions to address this challenge. Recently, a remarkable surge in assisted technology (AT) development was witnessed to aid individuals with PD. OBJECTIVE To explore the burgeoning landscape of AT interventions tailored to alleviate PD-related gait impairments and describe current research related to such aim. METHODS In this review, we searched on PubMed for papers published in English (2018-2023). Additionally, the abstract of each study was read to ensure inclusion. Four researchers searched independently, including studies according to our inclusion and exclusion criteria. RESULTS We included studies that met all inclusion criteria. We identified key trends in assistive technology of gait parameters analysis in PD. These encompass wearable sensors, gait analysis, real-time feedback and cueing techniques, virtual reality, and robotics. CONCLUSION This review provides a resource for guiding future research, informing clinical decisions, and fostering collaboration among researchers, clinicians, and policymakers. By delineating this rapidly evolving field's contours, it aims to inspire further innovation, ultimately improving the lives of PD patients through more effective and personalized interventions.
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Affiliation(s)
- Tamine T. C. Capato
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands.
| | - Janini Chen
- Universidade de São Paulo, Faculdade de Medicina FMUSP, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil.
| | - Johnny de Araújo Miranda
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
| | - Hsin Fen Chien
- Universidade de São Paulo, Faculdade de Medicina FMUSP, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil.
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Neumann S, Bauer CM, Nastasi L, Läderach J, Thürlimann E, Schwarz A, Held JPO, Easthope CA. Accuracy, concurrent validity, and test-retest reliability of pressure-based insoles for gait measurement in chronic stroke patients. Front Digit Health 2024; 6:1359771. [PMID: 38633383 PMCID: PMC11021704 DOI: 10.3389/fdgth.2024.1359771] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Wearables are potentially valuable tools for understanding mobility behavior in individuals with neurological disorders and how it changes depending on health status, such as after rehabilitation. However, the accurate detection of gait events, which are crucial for the evaluation of gait performance and quality, is challenging due to highly individual-specific patterns that also vary greatly in movement and speed, especially after stroke. Therefore, the purpose of this study was to assess the accuracy, concurrent validity, and test-retest reliability of a commercially available insole system in the detection of gait events and the calculation of stance duration in individuals with chronic stroke. Methods Pressure insole data were collected from 17 individuals with chronic stroke during two measurement blocks, each comprising three 10-min walking tests conducted in a clinical setting. The gait assessments were recorded with a video camera that served as a ground truth, and pressure insoles as an experimental system. We compared the number of gait events and stance durations between systems. Results and discussion Over all 3,820 gait events, 90.86% were correctly identified by the insole system. Recall values ranged from 0.994 to 1, with a precision of 1 for all measurements. The F1 score ranged from 0.997 to 1. Excellent absolute agreement (Intraclass correlation coefficient, ICC = 0.874) was observed for the calculation of the stance duration, with a slightly longer stance duration recorded by the insole system (difference of -0.01 s). Bland-Altmann analysis indicated limits of agreement of 0.33 s that were robust to changes in walking speed. This consistency makes the system well-suited for individuals post-stroke. The test-retest reliability between measurement timepoints T1 and T2 was excellent (ICC = 0.928). The mean difference in stance duration between T1 and T2 was 0.03 s. We conclude that the insole system is valid for use in a clinical setting to quantitatively assess continuous walking in individuals with stroke.
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Affiliation(s)
- Saskia Neumann
- DART, Lake Lucerne Institute, Vitznau, Switzerland
- Cereneo Foundation, Vitznau, Switzerland
| | | | - Luca Nastasi
- DART, Lake Lucerne Institute, Vitznau, Switzerland
- Cereneo Foundation, Vitznau, Switzerland
| | | | - Eva Thürlimann
- Vascular Neurology and Neurorehabilitation, University of Zurich, Zurich, Switzerland
| | - Anne Schwarz
- Vascular Neurology and Neurorehabilitation, University of Zurich, Zurich, Switzerland
| | - Jeremia P. O. Held
- Vascular Neurology and Neurorehabilitation, University of Zurich, Zurich, Switzerland
| | - Chris A. Easthope
- DART, Lake Lucerne Institute, Vitznau, Switzerland
- Cereneo Foundation, Vitznau, Switzerland
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Crecchi A, Tozzini A, Benedetti R, Maltinti M, Bonfiglio L. Case report: Intensive rehabilitation program delivered before and after single-event multilevel surgery in a girl with diplegic cerebral palsy. Front Neurol 2024; 14:1323697. [PMID: 38283677 PMCID: PMC10811248 DOI: 10.3389/fneur.2023.1323697] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Diplegic cerebral palsy (CP) is often associated with musculoskeletal disorders that contribute to worsen walking function. The standard care in these cases is single-event multilevel surgery (SEMLS) followed by rehabilitation. Our aim was to investigate whether a rehabilitation program starting even before SEML could add a benefit with respect to standard postoperative programs considered by previous research. Methods From 2 months before to 13 months after SEMLS (except for the first month after surgery), the participant underwent a motor training focused on ROM exercises with tactile and kinaesthetic feedback. Walking performance, walking capacity, and quality-of-life were assessed before and after SEMLS at different follow-up times. Results Walking capacity improved 3 months after SEMLS (i.e., earlier than in current literature) and walking performance improved 12 months after SEMLS (instead of simply returning to baseline as previously reported), with a positive impact on quality-of-life. Conclusions This case suggests that a rehabilitation program starting even before SEMLS could add benefits over walking function and quality-of-life of children with diplegic CP compared to postoperative programs only.
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Affiliation(s)
- Alessandra Crecchi
- Unit of Developmental Neurorehabilitation, Maternal and Child Department, Pisa University Hospital, Pisa, Italy
| | - Alessandra Tozzini
- Unit of Developmental Neurorehabilitation, Maternal and Child Department, Pisa University Hospital, Pisa, Italy
| | - Roberta Benedetti
- Department of Translational Research on New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marco Maltinti
- 1st Unit of Orthopaedics and Trauma, Pisa University Hospital, Pisa, Italy
| | - Luca Bonfiglio
- Unit of Developmental Neurorehabilitation, Maternal and Child Department, Pisa University Hospital, Pisa, Italy
- Department of Translational Research on New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
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Nuic D, van de Weijer S, Cherif S, Skrzatek A, Zeeboer E, Olivier C, Corvol JC, Foulon P, Pastor JZ, Mercier G, Lau B, Bloem BR, De Vries NM, Welter ML. Home-based exergaming to treat gait and balance disorders in patients with Parkinson's disease: A phase II randomized controlled trial. Eur J Neurol 2024; 31:e16055. [PMID: 37691341 DOI: 10.1111/ene.16055] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/26/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Exergaming has been proposed to improve gait and balance disorders in Parkinson's disease (PD) patients. We aimed to assess the efficacy of a home-based, tailored, exergaming training system designed for PD patients with dopa-resistant gait and/or balance disorders in a controlled randomized trial. METHODS We recruited PD patients with dopa-resistant gait and/or balance disorders. Patients were randomly assigned (1:1 ratio) to receive 18 training sessions at home by playing a tailored exergame with full-body movements using a motion capture system (Active group), or by playing the same game with the computer's keyboard (Control group). The primary endpoint was the between-group difference in the Stand-Walk-Sit Test (SWST) duration change after training. Secondary outcomes included parkinsonian clinical scales, gait recordings, and safety. RESULTS Fifty PD patients were enrolled and randomized. After training, no significant difference in SWST change was found between groups (mean change SWST duration [SD] -3.71 [18.06] s after Active versus -0.71 [3.41] s after Control training, p = 0.61). Some 32% of patients in the Active and 8% in the Control group were considered responders to the training program (e.g., SWST duration change ≥2 s, p = 0.03). The clinical severity of gait and balance disorders also significantly decreased after Active training, with a between-group difference in favor of the Active training (p = 0.0082). Home-based training induced no serious adverse events. CONCLUSIONS Home-based training using a tailored exergame can be performed safely by PD patients and could improve gait and balance disorders. Future research is needed to investigate the potential of exergaming.
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Affiliation(s)
- Dijana Nuic
- Paris Brain Institute, CNRS UMR 7225, INSERM 1127, Sorbonne University, Paris, France
- LabCom Brain e-Novation, Paris Brain Institute, Paris, France
| | - Sjors van de Weijer
- Donders Institute for Brain, Cognition, and Behavior and Department of Neurology, Center of Expertise for Parkinson and Movement, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Saoussen Cherif
- Paris Brain Institute, CNRS UMR 7225, INSERM 1127, Sorbonne University, Paris, France
- LabCom Brain e-Novation, Paris Brain Institute, Paris, France
| | - Anna Skrzatek
- Paris Brain Institute, CNRS UMR 7225, INSERM 1127, Sorbonne University, Paris, France
| | - Eline Zeeboer
- Donders Institute for Brain, Cognition, and Behavior and Department of Neurology, Center of Expertise for Parkinson and Movement, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Claire Olivier
- Paris Brain Institute, CNRS UMR 7225, INSERM 1127, Sorbonne University, Paris, France
- PANAM core facility, INSERM 1127, Paris Brain Institute, Paris, France
| | - Jean-Christophe Corvol
- Paris Brain Institute, CNRS UMR 7225, INSERM 1127, Sorbonne University, Paris, France
- Clinical Investigation Center, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierre Foulon
- LabCom Brain e-Novation, Paris Brain Institute, Paris, France
- GENIOUS Healthcare, Montpellier, France
| | - Jénica Z Pastor
- Biostatistics Department, CHU de Montpellier, Montpellier, France
| | - Gregoire Mercier
- Biostatistics Department, CHU de Montpellier, Montpellier, France
- IDESP UA11, Université de Montpellier, INSERM, Montpellier, France
| | - Brian Lau
- Paris Brain Institute, CNRS UMR 7225, INSERM 1127, Sorbonne University, Paris, France
| | - Bastiaan R Bloem
- Donders Institute for Brain, Cognition, and Behavior and Department of Neurology, Center of Expertise for Parkinson and Movement, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nienke M De Vries
- Donders Institute for Brain, Cognition, and Behavior and Department of Neurology, Center of Expertise for Parkinson and Movement, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marie-Laure Welter
- Paris Brain Institute, CNRS UMR 7225, INSERM 1127, Sorbonne University, Paris, France
- LabCom Brain e-Novation, Paris Brain Institute, Paris, France
- PANAM core facility, INSERM 1127, Paris Brain Institute, Paris, France
- CHU Rouen, Neurophysiology Department, Rouen University, Rouen, France
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Rabearisoa PH, Rasaholiarison NF, Razafimahefa J, Tehindrazanarivelo AD. Gait and cognitive disorders revealing massive neurocysticercosis: a case report. Oxf Med Case Reports 2024; 2024:omad145. [PMID: 38292156 PMCID: PMC10823322 DOI: 10.1093/omcr/omad145] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 02/01/2024] Open
Abstract
Neurocysticercosis is frequent in Madagascar. Its clinical presentations depends on the topography of the lesions. We report a case with gait and cognitive disorders. A 49-year-old man, right-handed, with progressive gait disorders (small steps with magnetization). On examination, he had gait disorders, associated with frontal syndrome with Frontal Assessment Battery (FAB) scale of 10/18, a Mini-Mental Status Examination (MMSE) scale of 24/30, a constructive apraxia and a clock test disturbance. The brain CT scan showed massive lesions of fronto-parietal and temporal neurocysticercosis, meningeal neurocysticercosis with racemose forms. Lesions had different ages associated with a communicating hydrocephalus. Gait disturbance and cognitive function were improved after an evacuating lumbar puncture and cysticidal treatments. This case illustrate the importance of neurological examination in a patient with neurocysticercosis. Neurocysticercosis could be a curable cause of dementia.
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Affiliation(s)
- Parany Haja Rabearisoa
- Neurology Department, Befelatanana University Teaching Hospital, Antananarivo, Madagascar
| | | | - Julien Razafimahefa
- Neurology Department, Befelatanana University Teaching Hospital, Antananarivo, Madagascar
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Robinson A, Boggs L, Ebersole MG, Vaidya R. Presence of Post-traumatic Limps in an Adult Population Diagnosed on a "Catwalk Video": A Comparative Study Between Healthcare and Nonhealthcare Individuals. Cureus 2023; 15:e46369. [PMID: 37927645 PMCID: PMC10621884 DOI: 10.7759/cureus.46369] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Background Walking is an everyday activity but also complex in nature. Gait disorders have the potential to drastically affect an individual's quality of life and their ability to be independent. The causes of gait disorders are numerous. To identify abnormal gait, clinicians utilize gait analysis. The aim of this study is to assess how well individuals can identify limps in postoperative traumatized individuals with lower extremity deformities. Methods Participants observed a video compiled of individuals with various gait abnormalities and severities of limps. In the video, there were nine abnormal gait presentations, four obvious limps, and five subtle limps, while the other 10 gait presentations were normal gaits. Classifications for gait presentations were assigned by the research team. Participants assigned a classification to each limp case presented in the video on a survey. The participants were separated into two groups: those with healthcare experience and lay individuals. A Mann-Whitney U-test was used to compare healthcare experience and lay individuals' ability to identify limps correctly. In addition, the observers were evaluated on their ability to perform a screening diagnosis of a limp. Results A total of 100 participants were included in the study, 46 with healthcare experience and 54 individuals without. All tests, identification of limp and subtle limp, using the Mann-Whitney U-test yielded non-significant differences between healthcare and nonhealthcare experience. Overall lowest correctness between both groups came when attempting to identify subtle limp (healthcare = 57.39%, nonhealthcare = 56.67%) while the highest correctness yield was when identifying limp (healthcare = 96.74%, nonhealthcare = 95.37%). Analysis of the observers' ability to perform a screening diagnosis of limp provided close to gold standard results (sensitivity = 96.0%, specificity = 98.7%, positive predictive value = 99.2%, negative predictive value = 98.4%). Conclusion This study showed that nonhealthcare individuals can accurately perform gait analysis from a video, particularly in identifying the presence of a limp, to a similar extent as individuals with healthcare experience. The implementation of two-dimensional catwalk videos taken from a smartphone is beneficial due to accessibility and cost-effectiveness. It also suggested that limp diagnosis can be done as a screening test, using individuals as the screener.
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Affiliation(s)
- Andrew Robinson
- Orthopedic Surgery, Wayne State University Detroit Medical Center, Detroit, USA
| | - Lauryn Boggs
- Orthopedic Surgery, Wayne State University Detroit Medical Center, Detroit, USA
| | - Maiko G Ebersole
- Family Medicine, University of Kansas Health System, Kansas City, USA
| | - Rahul Vaidya
- Orthopedic Surgery, Wayne State University Detroit Medical Center, Detroit, USA
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Faccioli S, Cavalagli A, Falocci N, Mangano G, Sanfilippo I, Sassi S. Gait analysis patterns and rehabilitative interventions to improve gait in persons with hereditary spastic paraplegia: a systematic review and meta-analysis. Front Neurol 2023; 14:1256392. [PMID: 37799279 PMCID: PMC10548139 DOI: 10.3389/fneur.2023.1256392] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023] Open
Abstract
Background Hereditary spastic paraplegias (HSPs) are a group of inheritance diseases resulting in gait abnormalities, which may be detected using instrumented gait analysis. The aim of this systematic review was 2-fold: to identify specific gait analysis patterns and interventions improving gait in HSP subjects. Methods A systematic review was conducted in PubMed, Cochrane Library, REHABDATA, and PEDro databases, in accordance with reporting guidelines of PRISMA statement and Cochrane's recommendation. The review protocol was recorded on the PROSPERO register. Patients with pure and complicated HSP of any age were included. All types of studies were included. Risk of bias, quality assessment, and meta-analysis were performed. Results Forty-two studies were included: 19 were related to gait analysis patterns, and 24 were intervention studies. The latter ones were limited to adults. HSP gait patterns were similar to cerebral palsy in younger subjects and stroke in adults. Knee hyperextension, reduced range of motion at knee, ankle, and hip, reduced foot lift, and increased rapid trunk and arm movements were reported. Botulinum injections reduced spasticity but uncovered weakness and improved gait velocity at follow-up. Weak evidence supported intrathecal baclofen, active intensive physical therapy (i.e., robot-assisted gait training, functional exercises, and hydrotherapy), and functional electrical stimulation. Some improvements but adverse events were reported after transcranial magnetic stimulation, transcutaneous spinal direct current stimulation, and spinal cord stimulation implant. Conclusion Knee hyperextension, non-sagittal pelvic movements, and reduced ROM at the knee, ankle, and hip represent the most peculiar patterns in HSP, compared to diplegic cerebral palsy and stroke. Botulinum improved comfortable gait velocity after 2 months. Nonetheless, interventions reducing spasticity might result in ineffective functional outcomes unveiling weakness. Intensive active physical therapy and FES might improve gait velocity in the very short term.
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Affiliation(s)
- Silvia Faccioli
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Angela Cavalagli
- Children Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy
| | - Nicola Falocci
- Office of Policy Evaluation and Statistical Studies, Umbria Legislative Assembly, Perugia, Italy
| | - Giulia Mangano
- Department of Physical Medicine and Rehabilitation, Azienda Sanitaria Provinciale 3 (ASP 3), Acireale Hospital, Catania, Italy
| | | | - Silvia Sassi
- Children Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Voisard C, de l'Escalopier N, Vienne-Jumeau A, Moreau A, Quijoux F, Bompaire F, Sallansonnet M, Brechemier ML, Taifas I, Tafani C, Drouard E, Vayatis N, Ricard D, Oudre L. Innovative multidimensional gait evaluation using IMU in multiple sclerosis: introducing the semiogram. Front Neurol 2023; 14:1237162. [PMID: 37780706 PMCID: PMC10540441 DOI: 10.3389/fneur.2023.1237162] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Background Quantifying gait using inertial measurement units has gained increasing interest in recent years. Highly degraded gaits, especially in neurological impaired patients, challenge gait detection algorithms and require specific segmentation and analysis tools. Thus, the outcomes of these devices must be rigorously tested for both robustness and relevancy in order to recommend their routine use. In this study, we propose a multidimensional score to quantify and visualize gait, which can be used in neurological routine follow-up. We assessed the reliability and clinical coherence of this method in a group of severely disabled patients with progressive multiple sclerosis (pMS), who display highly degraded gait patterns, as well as in an age-matched healthy subjects (HS) group. Methods Twenty-two participants with pMS and nineteen HS were included in this 18-month longitudinal follow-up study. During the follow-up period, all participants completed a 10-meter walk test with a U-turn and back, twice at M0, M6, M12, and M18. Average speed and seven clinical criteria (sturdiness, springiness, steadiness, stability, smoothness, synchronization, and symmetry) were evaluated using 17 gait parameters selected from the literature. The variation of these parameters from HS values was combined to generate a multidimensional visual tool, referred to as a semiogram. Results For both cohorts, all criteria showed moderate to very high test-retest reliability for intra-session measurements. Inter-session quantification was also moderate to highly reliable for all criteria except smoothness, which was not reliable for HS participants. All partial scores, except for the stability score, differed between the two populations. All partial scores were correlated with an objective but not subjective quantification of gait severity in the pMS population. A deficit in the pyramidal tract was associated with altered scores in all criteria, whereas deficits in cerebellar, sensitive, bulbar, and cognitive deficits were associated with decreased scores in only a subset of gait criteria. Conclusions The proposed multidimensional gait quantification represents an innovative approach to monitoring gait disorders. It provides a reliable and informative biomarker for assessing the severity of gait impairments in individuals with pMS. Additionally, it holds the potential for discriminating between various underlying causes of gait alterations in pMS.
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Affiliation(s)
- Cyril Voisard
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Nicolas de l'Escalopier
- Université Paris Cité, Université Paris Saclay, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Paris, France
- Service de Chirurgie Orthopédique, Traumatologique et Réparatrice des Membres, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Aliénor Vienne-Jumeau
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
| | - Albane Moreau
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
| | - Flavien Quijoux
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
| | - Flavie Bompaire
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
- Université Paris Cité, Université Paris Saclay, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Paris, France
| | - Magali Sallansonnet
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Marie-Laure Brechemier
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Irina Taifas
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Camille Tafani
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Eve Drouard
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Nicolas Vayatis
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
| | - Damien Ricard
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
- Université Paris Cité, Université Paris Saclay, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Paris, France
- Ecole du Val-de-Grâce, Service de Santé des Armées, Paris, France
| | - Laurent Oudre
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
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9
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Ratanasutiranont C, Srisilpa K, Termsarasab P, Ruthiraphong P. Smart ankle bracelet-laser device to improve gait and detect freezing of gait in Parkinsonism patients: a case series. Assist Technol 2023; 35:417-424. [PMID: 36136608 DOI: 10.1080/10400435.2022.2113179] [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] [Accepted: 08/02/2022] [Indexed: 10/14/2022] Open
Abstract
Freezing of gait (FOG) is one of the most disabling symptoms of Parkinsonism. Moreover, it does not respond well to medication. Visual cues have been shown to alleviate FOG in Parkinsonism; however, their efficacy is inconsistent. Currently, most mobile cueing devices are used as an open-loop cueing system, which requires manual control to enable constant visual cues. Thus, such devices may not be suitable for some people, especially those who have attention deficits. In addition, objective measurements of FOG in real-life situations remain challenging. Therefore, we developed a smart-ankle laser as a closed-loop cueing system that can detect the patient's walking pattern and automatically project a laser line that follows each walking step, thus requires less attention. Real-time motion was also recorded within the device for FOG measurement. We studied the efficacy of the device in three Parkinsonism patients with FOG (one man and two women, aged 58-76 years) immediately after use and two patients at 1-week follow-up. Gait speed, Timed Up and Go test performance, stride length, and % FOG improved with the use of the laser, without adverse effects.
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Affiliation(s)
- Chompoonuch Ratanasutiranont
- Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kwan Srisilpa
- Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichet Termsarasab
- Department of Medicine, Division of Neurology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Peeraya Ruthiraphong
- Department of Rehabilitation Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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10
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Li H, Gao M, Chen Z, Zhou Z, Li W, Zhang X, Jiang X, Luo L, Li F, Wang G, Zhang Y, Huang X, Zhu J, Fan S, Wu X, Huang C. Hordenine improves Parkinsonian-like motor deficits in mice and nematodes by activating dopamine D2 receptor-mediated signaling. Phytother Res 2023; 37:3296-3308. [PMID: 36883794 DOI: 10.1002/ptr.7790] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 03/09/2023]
Abstract
Parkinson's disease (PD) is a chronic neurodegenerative disease characterized by selective loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc) and the striatum, leading to dopamine (DA) deficiency in the striatum and typical motor symptoms. A small molecule as a dietary supplement for PD would be ideal for practical reasons. Hordenine (HOR) is a phenolic phytochemical marketed as a dietary supplement found in cereals and germinated barley, as well as in beer, a widely consumed beverage. This study was aimed to identify HOR as a dopamine D2 receptor (DRD2) agonist in living cells, and investigate the alleviative effect and mechanism of HOR on PD-like motor deficits in mice and nematodes. Our results firstly showed that HOR is an agonist of DRD2, but not DRD1, in living cells. Moreover, HOR could improve the locomotor dysfunction, gait, and postural imbalance in MPTP- or 6-OHDA-induced mice or Caenorhabditis elegans, and prevent α-synuclein accumulation via the DRD2 pathway in C. elegans. Our results suggested that HOR could activate DRD2 to attenuate the PD-like motor deficits, and provide scientific evidence for the safety and reliability of HOR as a dietary supplement.
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Affiliation(s)
- Hongli Li
- Drug Discovery Laboratory, School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Gao
- Drug Discovery Laboratory, School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ziyu Chen
- Shanghai Key Laboratory of Compound Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhenyu Zhou
- Drug Discovery Laboratory, School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei Li
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Physiology, and Institute for Brain Sciences, School of Life Sciences, Nanjing University, Nanjing, China
| | - Xiaoyang Zhang
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Physiology, and Institute for Brain Sciences, School of Life Sciences, Nanjing University, Nanjing, China
| | - Xi Jiang
- Drug Discovery Laboratory, School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lingling Luo
- Drug Discovery Laboratory, School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fei Li
- Drug Discovery Laboratory, School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gaorui Wang
- Shanghai Key Laboratory of Compound Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu Zhang
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
| | - Xingxu Huang
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
| | - Jingning Zhu
- State Key Laboratory of Pharmaceutical Biotechnology, Department of Physiology, and Institute for Brain Sciences, School of Life Sciences, Nanjing University, Nanjing, China
| | - Shengjie Fan
- Drug Discovery Laboratory, School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaojun Wu
- Shanghai Key Laboratory of Compound Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Cheng Huang
- Drug Discovery Laboratory, School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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11
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Cinnera AM, Marrano S, De Bartolo D, Iosa M, Bisirri A, Leone E, Stefani A, Koch G, Ciancarelli I, Paolucci S, Morone G. Convergent Validity of the Timed Walking Tests with Functional Ambulatory Category in Subacute Stroke. Brain Sci 2023; 13:1089. [PMID: 37509020 PMCID: PMC10377380 DOI: 10.3390/brainsci13071089] [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: 06/22/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
Determining the walking ability of post-stroke patients is crucial for the design of rehabilitation programs and the correct functional information to give to patients and their caregivers at their return home after a neurorehabilitation program. We aimed to assess the convergent validity of three different walking tests: the Functional Ambulation Category (FAC) test, the 10-m walking test (10MeWT) and the 6-minute walking test (6MWT). Eighty walking participants with stroke (34 F, age 64.54 ± 13.02 years) were classified according to the FAC score. Gait speed evaluation was performed with 10MeWT and 6MWT. The cut-off values for FAC and walking tests were calculated using a receiver-operating characteristic (ROC) curve. Area under the curve (AUC) and Youden's index were used to find the cut-off value. Statistical differences were found in all FAC subgroups with respect to walking speed on short and long distances, and in the Rivermead Mobility Index and Barthel Index. Mid-level precision (AUC > 0.7; p < 0.05) was detected in the walking speed with respect to FAC score (III vs. IV and IV vs. V). The confusion matrix and the accuracy analysis showed that the most sensitive test was the 10MeWT, with cut-off values of 0.59 m/s and 1.02 m/s. Walking speed cut-offs of 0.59 and 1.02 m/s were assessed with the 10MeWT and can be used in FAC classification in patients with subacute stroke between the subgroups able to walk with supervision and independently on uniform and non-uniform surfaces. Moreover, the overlapping walking speed registered with the two tests, the 10MeWT showed a better accuracy to drive FAC classification.
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Affiliation(s)
- Alex Martino Cinnera
- Santa Lucia Foundation, Scientific Institute for Research, Hospitalization and Health Care (IRCCS), 00179 Rome, Italy
| | - Serena Marrano
- Santa Lucia Foundation, Scientific Institute for Research, Hospitalization and Health Care (IRCCS), 00179 Rome, Italy
| | - Daniela De Bartolo
- Santa Lucia Foundation, Scientific Institute for Research, Hospitalization and Health Care (IRCCS), 00179 Rome, Italy
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences & Institute for Brain and Behaviour Amsterdam, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Marco Iosa
- Santa Lucia Foundation, Scientific Institute for Research, Hospitalization and Health Care (IRCCS), 00179 Rome, Italy
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessio Bisirri
- Villa Sandra Institute, Via Portuense, 798, 00148 Rome, Italy
| | - Enza Leone
- School of Allied Health Professions, Faculty of Medicine and Health Sciences, Keele University, Staffordshire ST5 5BG, UK
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Alessandro Stefani
- Department of System Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giacomo Koch
- Santa Lucia Foundation, Scientific Institute for Research, Hospitalization and Health Care (IRCCS), 00179 Rome, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara and Center for Translational Neurophysiology of Speech and Communication (CTNSC), Italian Institute of Technology (IIT), 44121 Ferrara, Italy
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Stefano Paolucci
- Santa Lucia Foundation, Scientific Institute for Research, Hospitalization and Health Care (IRCCS), 00179 Rome, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
- San Raffaele Institute of Sulmona, Viale dell'Agricoltura, 67039 Sulmona, Italy
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12
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Ben-Zacharia AB, Lee JM, Kahle JS, Lord B. Shared decision-making in multiple sclerosis physical symptomatic care: a systematic review. Ther Adv Chronic Dis 2023; 14:20406223231172920. [PMID: 37324408 PMCID: PMC10265321 DOI: 10.1177/20406223231172920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/14/2023] [Indexed: 06/17/2023] Open
Abstract
Background Multiple sclerosis (MS) is a chronic autoimmune inflammatory, demyelinating, and neurodegenerative disease affecting young adults. People with MS are highly interested in engaging in physical symptom management and decision-making but are often not actively engaged in symptom management discussions. Research examining the benefit of shared decision-making in the management of physical MS symptoms is sparse. Objectives This study aimed to identify and synthesize the evidence on the use of shared decision-making in physical MS symptom management. Design This study is a systematic review of published evidence on the use of shared decision-making in physical MS symptom management. Data sources and methods MEDLINE, CINAHL, EMBASE, and CENTRAL databases were searched in April 2021, June 2022, and April 2, 2023, for primary, peer-reviewed studies of shared decision-making in the management of MS physical symptoms. Citations were screened, data extracted, and study quality assessed according to Cochrane guidelines for systematic reviews, including risk of bias assessment. Statistical synthesis of the included study results was not appropriate; results were summarized in a nonstatistical manner using the vote-counting method to estimate beneficial versus harmful effects. Results Of 679 citations, 15 studies met the inclusion criteria. Six studies addressed shared decision-making in the management of pain, spasms, neurogenic bladder, fatigue, gait disorder, and/or balance issues, and nine studies addressed physical symptoms in general. One study was a randomized controlled trial; most studies were observational studies. All study results and study author conclusions indicated that shared decision-making is important to the effective management of physical MS symptoms. No study results suggested that shared decision-making was harmful or delayed the management of physical MS symptoms. Conclusion Reported results consistently indicate that shared decision-making is important in effective MS symptomatic care. Further rigorous randomized controlled trials are warranted to investigate the effectiveness of shared decision-making associated with MS physical symptomatic care. Registration PROSPERO: CRD42023396270.
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Affiliation(s)
- Aliza Bitton Ben-Zacharia
- Assistant Professor, Hunter Bellevue School of Nursing, 425 East 25 Street, New York, NY 10010, USA
- Mount Sinai Hospital, New York, NY, USA
| | - Jong-Mi Lee
- Neuroscience Clinic, Stanford Health Care, CA, USA
| | - Jennifer S. Kahle
- Department of Psychological Sciences, University of San Diego, San Diego, CA, USA
- IHS International, San Diego, CA, USA
| | - Bonnie Lord
- A patient living with multiple sclerosis since 2003
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13
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Gagliardo A, Grippo A, Di Stefano V, Carrai R, Scarpino M, Martini M, Falsini C, Rimmaudo G, Brighina F. Spatial and Temporal Gait Characteristics in Patients Admitted to a Neuro-Rehabilitation Department with Age-Related White Matter Changes: A Gait Analysis and Clinical Study. Neurol Int 2023; 15:708-724. [PMID: 37368328 DOI: 10.3390/neurolint15020044] [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: 03/14/2023] [Revised: 05/01/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Patients with age-related white matter changes (ARWMC) frequently present a gait disorder, depression and cognitive impairment. Our aims are to define which alterations in the gait parameters are associated with motor or neuro-psychological impairment and to assess the role of motor, mood or cognitive dysfunction in explaining the variance of the gait parameters. METHODS Patients with gait disorders admitted to a Neuro-rehabilitation Department, affected by vascular leukoencephalopathy who had ARWMC confirmed by a brain MRI, were consecutively enrolled, classified by a neuroradiological scale (Fazekas 1987) and compared to healthy controls. We excluded subjects unable to walk independently, subjects with hydrocephalus or severe aphasia, with orthopaedic and other neurological pathologies conditioning the walking pattern. Patients and controls were assessed by clinical and functional scales (Mini Mental State Examination, Geriatric Depression Scale, Nevitt Motor Performance Scale, Berg Balance Scale, Functional Independence Measure), and computerised gait analysis was performed to assess the spatial and temporal gait parameters in a cross-sectional study. RESULTS We recruited 76 patients (48 males, aged 78.3 ± 6.2 years) and 14 controls (6 males, aged 75.8 ± 5 years). In the multiple regression analysis, the gait parameter with overall best model summary values, associated with the ARWMC severity, was the stride length even after correction for age, sex, weight and height (R2 = 0.327). The motor performances justified at least in part of the gait disorder (R2 change = 0.220), but the mood state accounted independently for gait alterations (R2 change = 0.039). The increase in ARWMC severity, the reduction of motor performance and a depressed mood state were associated with a reduction of stride length (R = 0.766, R2 = 0.587), reduction of gait speed (R2 = 0.573) and an increase in double support time (R2 = 0.421). CONCLUSION The gait disorders in patients with ARWMC are related to motor impairment, but the presence of depression is an independent factor for determining gait alterations and functional status. These data pave the way for longitudinal studies, including gait parameters, to quantitatively assess gait changes after treatment or to monitor the natural progression of the gait disorders.
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Affiliation(s)
- Andrea Gagliardo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- Clinical Neurophysiology Unit, "Clinical Course", 90143 Palermo, Italy
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Vincenzo Di Stefano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Riccardo Carrai
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Maenia Scarpino
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Monica Martini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
| | | | - Giulia Rimmaudo
- Clinical Neurophysiology Unit, "Clinical Course", 90143 Palermo, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
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14
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Bourgarel E, Risser C, Blanc F, Vogel T, Kaltenbach G, Meyer M, Schmitt E. Spatio-Temporal Gait Parameters of Hospitalized Older Patients: Comparison of Fallers and Non-Fallers. Int J Environ Res Public Health 2023; 20:4563. [PMID: 36901573 PMCID: PMC10001499 DOI: 10.3390/ijerph20054563] [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] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Gait disorders are predisposing factors for falls. They are accessible to rehabilitation and can be analyzed using tools that collect spatio-temporal parameters of walking, such as the GAITRite® mat. The objective of this retrospective study was to find differences between the spatio-temporal parameters in patients who had fallen compared to patients who did not fall in a population of older patients hospitalized in acute geriatrics department. Patients over 75 years were included. For each patient, spatio-temporal parameters were collected using the GAITRite® mat. The patients were divided into two groups according to whether they had a history of fall. The spatio-temporal parameters were compared between the two groups and in relation to the general population. Sixty-seven patients, with an average age of 85.9 ± 6 years, were included. The patients had comorbidities, cognitive impairment and were polymedicated. The mean walking speed was 51.4 cm/s in non-fallers group and 47.3 cm/s in fallers group (p = 0.539), indicating pathological walking in comparison with the general population of the same age (average 100 cm/s). No association was found between the spatio-temporal parameters and fall, probably linked to many confounding factors such as the pathogenicity of walking of our patients and their comorbidities.
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Affiliation(s)
- Emilie Bourgarel
- Department of Geriatrics, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, 83 Rue Himmerich, 67000 Strasbourg, France
| | - Clémence Risser
- Department of Public Health, Methods in Clinical Research, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Frederic Blanc
- Department of Geriatrics, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, 83 Rue Himmerich, 67000 Strasbourg, France
| | - Thomas Vogel
- Department of Geriatrics, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, 83 Rue Himmerich, 67000 Strasbourg, France
- Mitochondria, Oxidative Stress and Muscular Protection Group (EA-3072), Faculty of Medicine, University of Strasbourg, 67000 Strasbourg, France
| | - Georges Kaltenbach
- Department of Geriatrics, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, 83 Rue Himmerich, 67000 Strasbourg, France
| | - Maxence Meyer
- Department of Geriatrics, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, 83 Rue Himmerich, 67000 Strasbourg, France
| | - Elise Schmitt
- Department of Geriatrics, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, 83 Rue Himmerich, 67000 Strasbourg, France
- Mitochondria, Oxidative Stress and Muscular Protection Group (EA-3072), Faculty of Medicine, University of Strasbourg, 67000 Strasbourg, France
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15
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Ferrario C, Condoluci C, Tarabini M, Manzia CM, Di Girolamo G, Pau M, Galli M. Influence of Foot Morphology on the Center of Pressure Pattern in Patients with Down Syndrome. Int J Environ Res Public Health 2023; 20:2769. [PMID: 36833467 PMCID: PMC9957500 DOI: 10.3390/ijerph20042769] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The primary aim of this study was to assess how different conformations of the foot in individuals with Down syndrome affected the CoP during walking, and the secondary aim was to evaluate the effect of an excess of mass in young adults and children with Down syndrome and flat foot. The greater investigation of these aspects will allow for more targeted rehabilitation treatments to improve a patient's quality of life. METHODS The tests were carried out on 217 subjects with Down syndrome, 65 children and 152 young adults, and on 30 healthy individuals, 19 children and 11 young adults. All subjects underwent gait analysis, and the group with Down syndrome was also assessed with baropodometric tests to evaluate foot morphology. RESULTS The statistical analysis showed that within both the young adult and child groups, the CoP pattern in the anterior-posterior direction reflected a difficulty in proceeding in the walking direction compensated by a medio-lateral swing. The gait of children with Down syndrome was more impaired than that of young adults. In both young adults and children, a higher severity of impairment was found in overweight and obese female individuals. CONCLUSIONS These results suggest that the sensory deficits and the development of hypotonic muscles and lax ligaments of the syndrome lead to morphological alterations of the foot that, combined with the physical characteristics of short stature and obesity, negatively impact the CoP pattern of people with Down syndrome during walking.
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Affiliation(s)
- Cristina Ferrario
- Department of Mechanical Engineering, Politecnico di Milano, 20133 Milano, Italy
- Department of Electronics, Information of Bioengineering, Politecnico di Milano, 20133 Milano, Italy
| | | | - Marco Tarabini
- Department of Mechanical Engineering, Politecnico di Milano, 20133 Milano, Italy
| | | | | | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy
| | - Manuela Galli
- Department of Electronics, Information of Bioengineering, Politecnico di Milano, 20133 Milano, Italy
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16
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Leroy V, Martinet V, Nunkessore O, Dentel C, Durand H, Mockler D, Puisieux F, Fougère B, Chen Y. The Nebulous Association between Cognitive Impairment and Falls in Older Adults: A Systematic Review of the Literature. Int J Environ Res Public Health 2023; 20:2628. [PMID: 36767992 PMCID: PMC9915123 DOI: 10.3390/ijerph20032628] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND In older people, dementia is a well-established risk factor for falls. However, the association and the causal relationship between falls and the earlier stages of cognitive impairment remains unclear. The purpose of the study was to review the literature data on the association between falls and cognitive impairment, no dementia, including Mild Cognitive Impairment. METHODS According to PRISMA guidelines, we searched five electronic databases (EMBASE, Web of Science, Medline, CINAHL, and PsychINFO) for articles published between January 2011 and August 2022 on observational studies of older people with a cognitive assessment and/or cognitive impairment diagnosis and a recording of falls. Their quality was reviewed according to the STROBE checklist. RESULTS We selected 42 of the 4934 initially retrieved publications. In 24 retrospective studies, a statistically significant association between falls and cognitive status was found in only 15 of the 32 comparisons (47%). Of the 27 cross-sectional analyses in prospective studies, only eight (30%) were positive and significant. We counted four longitudinal analyses, half of which suggested a causal relationship between falls and cognitive impairment. The investigational methods varied markedly from one study to another. CONCLUSION It is still not clear whether falls are associated with cognitive impairment, no dementia. Data in favor of a causal relationship are scarce. Further studies are needed to clarify their relationship.
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Affiliation(s)
- Victoire Leroy
- Division of Geriatric Medicine, Tours University Hospital, 37000 Tours, France
- EA 7505 (Education, Ethics, Health), University of Medicine of Tours, 37000 Tours, France
- Memory Clinic, Tours University Hospital, 37000 Tours, France
| | - Valérie Martinet
- Department of Geriatrics, Saint-Pierre Hospital, ULB, 1000 Brussels, Belgium
| | | | | | - Hélène Durand
- Department of Neurology, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - David Mockler
- Medical Library, Trinity Centre for the Health Sciences, St James’ Hospital, D08 W9RT Dublin, Ireland
| | - François Puisieux
- Department of Gerontology, Lille University Hospital, 59000 Lille, France
- EA2694, Lille University, 59000 Lille, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, 37000 Tours, France
- EA 7505 (Education, Ethics, Health), University of Medicine of Tours, 37000 Tours, France
| | - Yaohua Chen
- Department of Gerontology, Lille University Hospital, 59000 Lille, France
- INSERM UMR-S 1172, Vascular and Degenerative Cognitive Disorders, University of Lille, 59000 Lille, France
- Global Brain Health Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
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Peimankar A, Winther TS, Ebrahimi A, Wiil UK. A Machine Learning Approach for Walking Classification in Elderly People with Gait Disorders. Sensors (Basel) 2023; 23:679. [PMID: 36679471 PMCID: PMC9866459 DOI: 10.3390/s23020679] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/25/2022] [Accepted: 01/02/2023] [Indexed: 06/17/2023]
Abstract
Walking ability of elderly individuals, who suffer from walking difficulties, is limited, which restricts their mobility independence. The physical health and well-being of the elderly population are affected by their level of physical activity. Therefore, monitoring daily activities can help improve the quality of life. This becomes especially a huge challenge for those, who suffer from dementia and Alzheimer's disease. Thus, it is of great importance for personnel in care homes/rehabilitation centers to monitor their daily activities and progress. Unlike normal subjects, it is required to place the sensor on the back of this group of patients, which makes it even more challenging to detect walking from other activities. With the latest advancements in the field of health sensing and sensor technology, a huge amount of accelerometer data can be easily collected. In this study, a Machine Learning (ML) based algorithm was developed to analyze the accelerometer data collected from patients with walking difficulties, who live in one of the municipalities in Denmark. The ML algorithm is capable of accurately classifying the walking activity of these individuals with different walking abnormalities. Various statistical, temporal, and spectral features were extracted from the time series data collected using an accelerometer sensor placed on the back of the participants. The back sensor placement is desirable in patients with dementia and Alzheimer's disease since they may remove visible sensors to them due to the nature of their diseases. Then, an evolutionary optimization algorithm called Particle Swarm Optimization (PSO) was used to select a subset of features to be used in the classification step. Four different ML classifiers such as k-Nearest Neighbors (kNN), Random Forest (RF), Stacking Classifier (Stack), and Extreme Gradient Boosting (XGB) were trained and compared on an accelerometry dataset consisting of 20 participants. These models were evaluated using the leave-one-group-out cross-validation (LOGO-CV) technique. The Stack model achieved the best performance with average sensitivity, positive predictive values (precision), F1-score, and accuracy of 86.85%, 93.25%, 88.81%, and 93.32%, respectively, to classify walking episodes. In general, the empirical results confirmed that the proposed models are capable of classifying the walking episodes despite the challenging sensor placement on the back of the patients, who suffer from walking disabilities.
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18
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Sanders JC, MacWilliams BA, Prasad S, Mahan MA. Highly selective motor nerve block and movement analysis for preoperative evaluation of complex spastic gait. NeuroRehabilitation 2023; 53:131-141. [PMID: 37424482 DOI: 10.3233/nre-230016] [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] [Indexed: 07/11/2023]
Abstract
BACKGROUND Lower-extremity spasticity and impaired gait control after central nervous system injury are challenging to improve, because spasticity limits residual motor control while providing mechanical support. Highly selective partial neurectomies (HSPNs) can substantially reduce spasticity but may have greater risks in patients with complex lower-extremity spastic gait. OBJECTIVE To examine the potential of ultrasound- and stimulation-guided highly selective motor nerve blocks (HSMNBs) to assess the potential impact of reduced spasticity on gait. METHODS In this retrospective series, six patients underwent HSMNBs with movement assessment before and after the block. Range of motion, strength, position angles, surface electromyography, lower limb kinematics, and patient satisfaction were assessed. RESULTS Pre- and post-HSMNB movement analysis yielded dichotomous gait kinematics, which facilitated surgical decisions. Of the 59 metrics evaluated, 82% demonstrated a positive improvement post-block (62% improved more than one standard deviation (SD) of typically developing means, 49% improved > 2 SD) and 16% demonstrated a negative change (2% worsened > 1 SD). CONCLUSION HSMNB provided clear efficacy in changing clinical, surface electromyography, and gait parameters. Movement analysis provided clear and robust objective and patient-centered evidence for surgical guidance. This protocol may provide utility in evaluation of patients being considered for HSPNs for complex spastic gait patterns.
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Affiliation(s)
- John C Sanders
- Shriners Hospitals for Children, Salt Lake City, UT, USA
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Bruce A MacWilliams
- Shriners Hospitals for Children, Salt Lake City, UT, USA
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Sarada Prasad
- Shriners Hospitals for Children, Salt Lake City, UT, USA
- Kalamazoo College, Kalamazoo, MI, USA
| | - Mark A Mahan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
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19
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Navarro-Lozano F, Kiper P, Carmona-Pérez C, Rutkowski S, Pinero-Pinto E, Luque-Moreno C. Effects of Non-Immersive Virtual Reality and Video Games on Walking Speed in Parkinson Disease: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11. [PMID: 36431086 DOI: 10.3390/jcm11226610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022] Open
Abstract
People with Parkinson disease suffer from a loss of dopaminergic neurons, which are involved in walking speed. Currently, virtual reality (VR) has emerged as a useful tool for the rehabilitation of people with neurological diseases, optimizing results in balance and gait. This review aimed to evaluate the effectiveness of VR or video games (through face-to-face sessions and not telerehabilitation) in improving walking speed and other spatio-temporal parameters of gait, balance, and quality of life in patients with Parkinson disease. A bibliographic search was carried out in the MEDLINE, Web of Science, Scopus, and PEDro databases. This systematic review adhered to the PRISMA guideline statement and was registered in PROSPERO (CRD42020180836). From a total of 119 records, 5 studies met the inclusion criteria for qualitative analysis, of which 3 contributed to the meta-analysis; inconclusive findings were found on gait speed, balance, and quality of life after the use of non-immersive VR systems face-to-face. A greater number of studies are necessary, with a greater number of participants, to differentiate between those VR specific systems (specifically designed for rehabilitation) from commercial video games, including immersive systems, and obtain more conclusive evidence. Furthermore, it would be interesting to compare the administration of this treatment in person versus its administration via telerehabilitation, which will help plan treatment programs.
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20
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Shah VV, Vitorio R, Hasegawa N, Carlson-Kuhta P, Nutt JG, King LA, Mancini M, Horak FB. Effects of a Cognitively Challenging Agility Boot Camp Program on Balance and Gait in People With Parkinson's Disease: Does Freezing of Gait Status Matter? Neurorehabil Neural Repair 2022; 36:603-612. [PMID: 36004814 DOI: 10.1177/15459683221119757] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIM Individuals with Parkinson's disease (PD) with and without freezing of Gait (FoG) may respond differently to exercise interventions for several reasons, including disease duration. This study aimed to determine whether both people with and without FoG benefit from the Agility Boot Camp with Cognitive Challenges (ABC-C) program. METHODS This secondary analysis of our ABC-C trial included 86 PD subjects: 44 without FoG (PD-FoG) and 42 with FoG (PD + FoG). We collected measures of standing sway balance, anticipatory postural adjustments, postural responses, and a 2-minute walk with and without a cognitive task. Two-way repeated analysis of variance, with disease duration as covariate, was used to investigate the effects of ABC-C program. Effect sizes were calculated using standardized response mean (SRM) for PD-FoG and PD + FoG, separately. RESULTS The ABC-C program was effective in improving gait performance in both PD-FoG and PD + FoG, even after controlling for disease duration. Specifically, dual-task gait speed (P < .0001), dual-cost stride length (P = .012), and these single-task measures: arm range of motion (P < .0001), toe-off angle (P = .005), gait cycle duration variability (P = .019), trunk coronal range of motion (P = .042), and stance time (P = .046) improved in both PD-FoG and PD + FoG. There was no interaction effect between time (before and after exercise) and group (PD-FoG/PD + FoG) in all 24 objective measures of balance and gait. Dual-task gait speed improved the most in PD + FoG (SRM = 1.01), whereas single-task arm range of motion improved the most in PD-FoG (SRM = 1.01). CONCLUSION The ABC-C program was similarly effective in improving gait (and not balance) performance in both PD-FoG and PD + FoG.
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Affiliation(s)
- Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, UK
| | - Naoya Hasegawa
- Department of Rehabilitation Science, Hokkaido University, Sapporo, Hokkaido, Japan
| | | | - John G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- APDM Wearable Technologies, A Clario company, Portland, OR, USA
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21
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Cathomen A, Sirucek L, Killeen T, Abel R, Maier D, Weidner N, Rupp R, Hothorn T, Steeves JD, Curt A, Bolliger M. Inclusive Trial Designs in Acute Spinal Cord Injuries: Prediction-Based Stratification of Clinical Walking Outcome and Projected Enrolment Frequencies. Neurorehabil Neural Repair 2022; 36:274-285. [PMID: 35164574 PMCID: PMC9003761 DOI: 10.1177/15459683221078302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 11/17/2022]
Abstract
Background New therapeutic approaches in neurological disorders are progressing into clinical development. Past failures in translational research have underlined the critical importance of selecting appropriate inclusion criteria and primary outcomes. Narrow inclusion criteria provide sensitivity, but increase trial duration and cost to the point of infeasibility, while broader requirements amplify confounding, increasing the risk of trial failure. This dilemma is perhaps most pronounced in spinal cord injury (SCI), but applies to all neurological disorders with low frequency and/or heterogeneous clinical manifestations. Objective Stratification of homogeneous patient cohorts to enable the design of clinical trials with broad inclusion criteria. Methods Prospectively–gathered data from patients with acute cervical SCI were analysed using an unbiased recursive partitioning conditional inference tree (URP–CTREE) approach. Performance in the 6-minute walk test at 6 months after injury was classified based on standardized neurological assessments within the first 15 days of injury. Functional and neurological outcomes were tracked throughout rehabilitation up to 6 months after injury. Results URP–CTREE identified homogeneous outcome cohorts in a study group of 309 SCI patients. These cohorts were validated by an internal, yet independent, validation group of 172 patients. The study group cohorts identified demonstrated distinct recovery profiles throughout rehabilitation. The baseline characteristics of the analysed groups were compared to a reference group of 477 patients. Conclusion URP–CTREE enables inclusive trial design by revealing the distribution of outcome cohorts, discerning distinct recovery profiles and projecting potential patient enrolment by providing estimates of the relative frequencies of cohorts to improve the design of clinical trials in SCI and beyond.
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Affiliation(s)
- Adrian Cathomen
- Spinal Cord Injury Center, 31031Balgrist University Hospital, Zurich, Switzerland.,ETH Zurich, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Laura Sirucek
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland.,Integrative Spinal Research, Department of Chiropractic Medicine, 31031Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Tim Killeen
- Spinal Cord Injury Center, 31031Balgrist University Hospital, Zurich, Switzerland
| | - Rainer Abel
- Trauma Center Bayreuth, Bayreuth, Germany.,EMSCI Study Group
| | - Doris Maier
- EMSCI Study Group.,Trauma Center Murnau, Murnau, Germany
| | - Norbert Weidner
- EMSCI Study Group.,Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Rüdiger Rupp
- EMSCI Study Group.,Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Torsten Hothorn
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - John D Steeves
- ICORD, Blusson Spinal Cord Centre, University of British Columbia and Vancouver Coastal Health, Vancouver, BC, Canada
| | - Armin Curt
- Spinal Cord Injury Center, 31031Balgrist University Hospital, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland.,EMSCI Study Group
| | - Marc Bolliger
- Spinal Cord Injury Center, 31031Balgrist University Hospital, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland.,EMSCI Study Group
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22
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Yaqub A, Darweesh SKL, Dommershuijsen LJ, Vernooij MW, Ikram MK, Wolters FJ, Ikram MA. Risk factors, neuroimaging correlates and prognosis of the motoric cognitive risk syndrome: a population-based comparison with mild cognitive impairment. Eur J Neurol 2022; 29:1587-1599. [PMID: 35147272 PMCID: PMC9306517 DOI: 10.1111/ene.15281] [Citation(s) in RCA: 3] [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: 12/08/2021] [Accepted: 02/08/2022] [Indexed: 11/27/2022]
Abstract
Background and purpose This study was undertaken to compare risk factors, neuroimaging characteristics and prognosis between two clinical prodromes of dementia, namely, the motoric cognitive risk syndrome (MCRS) and mild cognitive impairment (MCI). Methods Between 2009 and 2015, dementia‐free participants of the population‐based Rotterdam Study were classified with a dementia prodrome if they had subjective cognitive complaints and scored >1 SD below the population mean of gait speed (MCRS) or >1.5 SD below the population mean of cognitive test scores (MCI). Using multinomial logistic regression models, we determined cross‐sectional associations of risk factors and structural neuroimaging markers with MCRS and MCI, followed by subdistribution hazard models, to determine risk of incident dementia until 2016. Results Of 3025 included participants (mean age = 70.4 years, 54.7% women), 231 had MCRS (7.6%), 132 had MCI (4.4%), and 62 (2.0%) fulfilled criteria for both. Although many risk factors were shared, a higher body mass index predisposed to MCRS, whereas male sex and hypercholesterolemia were associated with MCI only. Gray matter volumes, hippocampal volumes, white matter hyperintensities, and structural white matter integrity were worse in both MCRS and MCI. During a mean follow‐up of 3.9 years, 71 individuals developed dementia and 200 died. Five‐year cumulative risk of dementia was 7.0% (2.5%–11.5%) for individuals with MCRS, versus 13.3% (5.8%–20.8%) with MCI and only 2.3% (1.5%–3.1%) in unaffected individuals. Conclusions MCRS is associated with imaging markers of neurodegeneration and risk of dementia, even in the absence of MCI, highlighting the potential of motor function assessment in early risk stratification for dementia.
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Affiliation(s)
- Amber Yaqub
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Sirwan K L Darweesh
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
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23
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Guimarães TG, Cury RG. Troubleshooting Gait Problems in Parkinson's Disease Patients with Subthalamic Nucleus Deep Brain Stimulation. J Parkinsons Dis 2022; 12:737-741. [PMID: 34924400 DOI: 10.3233/jpd-212771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Subthalamic nucleus deep brain stimulation (STN DBS) is an established therapy for a subset of patients with Parkinson's disease, and the adjustment of DBS parameters is typically guided by the patients' rigidity and tremor. Although these cardinal symptoms remain relatively stable over time, progressive worsening of axial symptoms compromise motor function and quality of life. Because many patients report improvements in their global mobility after gait improvement, we have been adjusting DBS parameters during the long-term after surgery based on gait analysis. Here, we describe a practical strategy for troubleshooting gait problems in PD DBS patients by revising stimulation parameters through "hands-on" programming, which can be a useful alternative approach for improving patients' outcomes after STN DBS.
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Affiliation(s)
| | - Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, University of São Paulo, São Paulo, Brazil
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24
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Okawara H, Tashiro S, Sawada T, Sugai K, Matsubayashi K, Kawakami M, Nori S, Tsuji O, Nagoshi N, Matsumoto M, Nakamura M. Neurorehabilitation using a voluntary driven exoskeletal robot improves trunk function in patients with chronic spinal cord injury: a single-arm study. Neural Regen Res 2022; 17:427-432. [PMID: 34269219 PMCID: PMC8463976 DOI: 10.4103/1673-5374.317983] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Body weight-supported treadmill training with the voluntary driven exoskeleton (VDE-BWSTT) has been shown to improve the gait function of patients with chronic spinal cord injury. However, little is known whether VDE-BWSTT can effectively improve the trunk function of patients with chronic spinal cord injury. In this open-label, single-arm study, nine patients with chronic spinal cord injury at the cervical or thoracic level (six males and three females, aged 37.8 ± 15.6 years, and time since injury 51.1 ± 31.8 months) who underwent outpatient VDE-BWSTT training program at Keio University Hospital, Japan from September 2017 to March 2019 were included. All patients underwent twenty 60-minute gait training sessions using VDE. Trunk muscular strength, i.e., the maximum force against which patient could maintain a sitting posture without any support, was evaluated in four directions: anterior, posterior, and lateral (right and left) after 10 and 20 training sessions. After intervention, lateral muscular strength significantly improved. In addition, a significant positive correlation was detected between the change in lateral trunk muscular strength after 20 training sessions relative to baseline and gait speed. The change in trunk muscular strength after 20 training sessions relative to baseline was greatly correlated with patient age. This suggests that older adult patients with chronic spinal cord injury achieved a greater improvement in trunk muscle strength following VDE-BWSTT. All these findings suggest that VDE-BWSTT can improve the trunk function of patients with chronic spinal cord injury and the effect might be greater in older adult patients. The study was approved by the Keio University of Medicine Ethics Committee (IRB No. 20150355-3) on September 26, 2017.
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Affiliation(s)
- Hiroki Okawara
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Syoichi Tashiro
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomonori Sawada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Sugai
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Matsubayashi
- Department of Orthopedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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25
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D'Cruz N, Seuthe J, De Somer C, Hulzinga F, Ginis P, Schlenstedt C, Nieuwboer A. Dual Task Turning in Place: A Reliable, Valid, and Responsive Outcome Measure of Freezing of Gait. Mov Disord 2021; 37:269-278. [PMID: 34939224 DOI: 10.1002/mds.28887] [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: 08/13/2021] [Revised: 10/31/2021] [Accepted: 11/24/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Freezing of gait (FOG) is a complex symptom in Parkinson's disease (PD) that is both elusive to elicit and varied in its presentation. These complexities present a challenge to measuring FOG in a sensitive and reliable way, precluding therapeutic advancement. OBJECTIVE We investigated the reliability, validity, and responsiveness of manual video annotations of the turning-in-place task and compared it to the sensor-based FOG ratio. METHODS Forty-five optimally medicated people with PD and FOG performed rapid alternating 360° turns without and with an auditory stroop dual task, thrice over two consecutive days. The tasks were video recorded, and inertial sensors were placed on the lower back and shins. Interrater reliability between three raters, criterion validity with self-reported FOG, and responsiveness to single-session split-belt treadmill (SBT) training were investigated and contrasted with the sensor-based FOG ratio. RESULTS Visual ratings showed excellent agreement between raters for the percentage time frozen (%TF) (ICC [intra-class correlation coefficient] = 0.99), the median duration of a FOG episode (ICC = 0.90), and the number of FOG episodes (ICC = 0.86). Dual tasking improved the sensitivity and validity of visual FOG ratings resulting in increased FOG detection, criterion validity with self-reported FOG ratings, and responsiveness to a short SBT intervention. The sensor-based FOG ratio, on the contrary, showed complex FOG presentation-contingent relationships with visual and self-reported FOG ratings and limited responsiveness to SBT training. CONCLUSIONS Manual video annotations of FOG during dual task turning in place generate reliable, valid, and sensitive outcomes for investigating therapeutic effects on FOG. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Nicholas D'Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Jana Seuthe
- Department of Neurology, Christian-Albrechts-University (CAU) Kiel, University Hospital Schleswig-Holstein, Kiel, Germany.,Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Clara De Somer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Femke Hulzinga
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Pieter Ginis
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Christian Schlenstedt
- Department of Neurology, Christian-Albrechts-University (CAU) Kiel, University Hospital Schleswig-Holstein, Kiel, Germany.,Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
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26
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Janeh O, Steinicke F. A Review of the Potential of Virtual Walking Techniques for Gait Rehabilitation. Front Hum Neurosci 2021; 15:717291. [PMID: 34803632 PMCID: PMC8595292 DOI: 10.3389/fnhum.2021.717291] [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: 05/30/2021] [Accepted: 10/06/2021] [Indexed: 12/04/2022] Open
Abstract
Virtual reality (VR) technology has emerged as a promising tool for studying and rehabilitating gait disturbances in different cohorts of patients (such as Parkinson's disease, post-stroke, or other neurological disorders) as it allows patients to be engaged in an immersive and artificial environment, which can be designed to address the particular needs of each individual. This review demonstrates the state of the art in applications of virtual walking techniques and related technologies for gait therapy and rehabilitation of people with movement disorders makes recommendations for future research and discusses the use of VR in the clinic. However, the potential for using these techniques in gait rehabilitation is to provide a more personalized approach by simulate the experience of natural walking, while patients with neurological disorders are maintained localized in the real world. The goal of our work is to investigate how the human nervous system controls movement in health and neurodegenerative disease.
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Affiliation(s)
- Omar Janeh
- Department of Computer Engineering, University of Technology, Baghdad, Iraq
| | - Frank Steinicke
- Human-Computer Interaction, Department of Informatics, Universität Hamburg, Hamburg, Germany
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27
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Abstract
Freezing of gait (FOG) is a common and challenging clinical symptom in Parkinson’s disease. In this review, we summarise the recent insights into freezing of gait and highlight the strategies that should be considered to improve future treatment. There is a need to develop individualised and on-demand therapies, through improved detection and wearable technologies. Whilst there already exist a number of pharmacological (e.g., dopaminergic and beyond dopamine), non-pharmacological (physiotherapy and cueing, cognitive training, and non-invasive brain stimulation) and surgical approaches to freezing (i.e., dual-site deep brain stimulation, closed-loop programming), an integrated collaborative approach to future research in this complex area will be necessary to systematically investigate new therapeutic avenues. A review of the literature suggests standardising how gait freezing is measured, enriching patient cohorts for preventative studies, and harnessing the power of existing data, could help lead to more effective treatments for freezing of gait and offer relief to many patients.
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Affiliation(s)
- Cathy K Cui
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, The University of Sydney, Camperdown, NSW, Australia
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28
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Luque-Moreno C, Kiper P, Solís-Marcos I, Agostini M, Polli A, Turolla A, Oliva-Pascual-Vaca A. Virtual Reality and Physiotherapy in Post-Stroke Functional Re-Education of the Lower Extremity: A Controlled Clinical Trial on a New Approach. J Pers Med 2021; 11:1210. [PMID: 34834562 PMCID: PMC8622451 DOI: 10.3390/jpm11111210] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 01/10/2023] Open
Abstract
Numerous Virtual Reality (VR) systems address post-stroke functional recovery of the lower extremity (LE), most of them with low early applicability due to the gait autonomy they require. The aim of the present study was to evaluate the feasibility of a specific VR treatment and its clinical effect on LE functionality, gait, balance, and trunk control post-stroke. A controlled, prospective, clinical trial was carried out with 20 stroke patients, who were divided into two groups: the first group (VR + CP; n = 10) received combined therapy of 1 h VR and 1 h of conventional physiotherapy (CP) and the second group (CP; n = 10) received 2 h of CP (5 days/week, for 3 weeks). The following pre-post-intervention measuring scales were used: Functional Ambulatory Scale (FAC), Functional Independence Measure (FIM), Fugl-Meyer Assessment (FM), Berg Balance Scale (BBS), and Trunk Control Test (TCT). Only VR + CP showed a significant improvement in FAC. In FIM, CP presented a tendency to significance, whereas VR + CP showed significance. Both groups improved significantly in FM (especially in amplitude/pain in VR + CP and in sensitivity in CP) and in BBS. In TCT, there was a non-significant improvement in both groups. The results indicate that the intervention with VR is a feasible treatment in the post-stroke functional re-education of the LE, with the potential to be an optimal complement of CP.
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Affiliation(s)
- Carlos Luque-Moreno
- Department of Physiotherapy, University of Seville, 41009 Seville, Spain;
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS, 30126 Venezia, Italy;
| | - Pawel Kiper
- Physical Medicine and Rehabilitation Unit, Azienda ULSS 3 Serenissima, 30126 Venice, Italy;
| | - Ignacio Solís-Marcos
- Unit of Humans in the Transport System, Swedish National Road and Transport Research Institute (VTI), Linköping University, 58330 Linköping, Sweden;
| | - Michela Agostini
- Department of Neuroscience, Section of Rehabilitation, University-General Hospital of Padova, 35128 Padova, Italy;
| | - Andrea Polli
- Pain in Motion International Research Group, Department of Physiotherapy, Vrije University Brussel, 1050 Brussel, Belgium;
| | - Andrea Turolla
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS, 30126 Venezia, Italy;
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29
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Belizón-Bravo N, Romero-Galisteo RP, Cano-Bravo F, Gonzalez-Medina G, Pinero-Pinto E, Luque-Moreno C. Effects of Dynamic Suit Orthoses on the Spatio-Temporal Gait Parameters in Children with Cerebral Palsy: A Systematic Review. Children (Basel) 2021; 8:children8111016. [PMID: 34828729 PMCID: PMC8621824 DOI: 10.3390/children8111016] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
Dynamic suit orthoses (DSO) are currently used as a complementary treatment method in children with Cerebral Palsy (cwCP). The aim of this review was to assess the effects of interventions with DSO on the altered spatio-temporal gait parameters (STGPs) in cwCP. An electronic search was conducted in the Web of Science, Scopus, PEDro, Cochrane Library, MEDLINE/PubMed, and CINAHL databases up to July 2021. We included a total of 12 studies, which showed great heterogeneity in terms of design type, sample size, and intervention performed (two employed a Therasuit, three employed the Adeli suit, three employed Theratogs, one employed elastomeric tissue dynamic orthosis, one employed a full-body suit, one employed external belt orthosis, and one employed dynamic orthosis composed of trousers and T-shirt). The Cochrane collaboration’s tool and the Checklist for Measuring Study Quality were used to assess the risk of bias and the methodological quality of the studies. It was variable according to the Checklist for Measuring Study Quality, and it oscillated between eight and 23. The studies of higher methodological quality showed significant post-intervention changes in walking speed (which is the most widely evaluated parameter), cadence, stride length, and step length symmetry. Although the evidence is limited, the intervention with DSO combined with a programme of training/physical therapy seems to have positive effects on the STGPs in cwCP, with the functional improvements that it entails. Despite the immediate effect after one session, a number of sessions between 18 and 60 is recommended to obtain optimum results. Future studies should measure all STGPs, and not only the main ones, such as gait speed, in order to draw more accurate conclusions on the functional improvement of gait after the use of this type of intervention.
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Affiliation(s)
- Natalia Belizón-Bravo
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (N.B.-B.); (G.G.-M.); (C.L.-M.)
| | - Rita Pilar Romero-Galisteo
- Department of Physiotherapy, Biomedical Research Institute of Malaga (IBIMA), University of Málaga, 29071 Málaga, Spain
- Correspondence: ; Tel.: +0034-951-052-862
| | - Fatima Cano-Bravo
- Pediatric Rehabilitation Unit, Virgen del Rocío Hospital, 41013 Sevilla, Spain;
| | - Gloria Gonzalez-Medina
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (N.B.-B.); (G.G.-M.); (C.L.-M.)
| | - Elena Pinero-Pinto
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41004 Sevilla, Spain;
| | - Carlos Luque-Moreno
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (N.B.-B.); (G.G.-M.); (C.L.-M.)
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41004 Sevilla, Spain;
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Deniz V, Guzel NA, Lobet S, Antmen AB, Sasmaz HI, Kilci A, Boyraz OC, Gunaştı O, Kurdak SS. Effects of a supervised therapeutic exercise program on musculoskeletal health and gait in patients with haemophilia: A pilot study. Haemophilia 2021; 28:166-175. [PMID: 34687122 DOI: 10.1111/hae.14444] [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: 12/04/2020] [Revised: 09/30/2021] [Accepted: 10/12/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Episodes of bleeding in patients with haemophilia (PwH) are associated with haemophilic arthropathy, limitations in physical performance, reduced quality of life (QoL), and gait disorders. AIM This non-randomized, controlled, interventional, prospective, single-centre pilot study aimed to assess the effects of an 8-week supervised therapeutic exercise program on musculoskeletal health, gait kinematic parameters (GKP), functional capacity, and QoL in adult PwH. METHODS Nineteen PwH were allocated to an exercise group (n = 10) or a control group (n = 9). The patients in the exercise group followed an 8-week supervised therapeutic exercise program. The Haemophilia Joint Health Score (HJHS), a two-dimensional video-based gait kinematic analysis (2D-GKA), the 6-min walking test (6MWT), and the Haemophilia Quality of Life Questionnaire for Adults (Haem-A-Qol) were used as the outcome measures at baseline, after the exercise program (at the 8th week), and at the 6th-month follow-up. RESULTS A significant improvement was observed in the exercise group in the HJHS-Total and Haem-A-Qol Total scores and the 6MWT value after the exercise program. Moreover, the 2D-GKA revealed improvement in most of the GKP (knee extension during the midstance and late swing phases, ankle dorsiflexion during the midstance phase, and ankle plantar flexion during the preswing phase). However, the gain obtained by the exercise program was not maintained at the 6th-month follow-up for the HJHS-Total and Hem-A-QoL-Total scores and GKP. CONCLUSION The 8-week supervised therapeutic exercise program was successful in achieving improvement in joint health, GKP, functional capacity, and QoL in PwH.
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Affiliation(s)
- Volkan Deniz
- Department of Physiotherapy and Rehabilitation, Gazi University Faculty of Health Sciences, Ankara, Turkey
| | - Nevin Atalay Guzel
- Department of Physiotherapy and Rehabilitation, Gazi University Faculty of Health Sciences, Ankara, Turkey
| | - Sébastien Lobet
- Service d'hématologie, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.,Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal Lab (NMSK), Brussels, Belgium.,Cliniques universitaires Saint-Luc, Secteur de kinésithérapie, Brussels, Belgium
| | - Ali Bülent Antmen
- Department of Pediatric Hematology and Oncology, Acıbadem Hospital, Adana, Turkey
| | - Hatice Ilgen Sasmaz
- Department of Pediatric Hematology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Abdullah Kilci
- Faculty of Sport Sciences, Çukurova University, Adana, Turkey
| | | | - Ozgür Gunaştı
- Division of Sport Physiology, Department of Physiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sanli Sadi Kurdak
- Division of Sport Physiology, Department of Physiology, Faculty of Medicine, Çukurova University, Adana, Turkey
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Schymick J, Leahy P, Cowan T, Ruzhnikov MRZ, Gates R, Fernandez L, Pramanik G, Yarlagadda V, Wheeler M, Bernstein JA, Enns GM, Lee C. Variable clinical severity in TANGO2 deficiency: Case series and literature review. Am J Med Genet A 2021; 188:473-487. [PMID: 34668327 DOI: 10.1002/ajmg.a.62543] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/15/2021] [Revised: 09/21/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022]
Abstract
Biallelic pathogenic variants in the TANGO2 (transport and Golgi organization 2 homolog) gene have been identified as causing a rare metabolic disorder characterized by susceptibility to recurrent rhabdomyolysis, lactic acidosis, encephalopathy, and life-threatening tachyarrhythmias. Recently published reports suggest variable clinical severity and phenotypes. This study details five new patients from two families with biallelic pathogenic variants in the TANGO2 gene identified by whole exome sequencing and includes the largest number of affected individuals from a single family reported to date. We document significant intrafamilial variability and highlight that milder phenotypes may be underrecognized. We present biochemical and clinical data to help highlight the features that aid in consideration of this condition in the differential with disorders of fatty acid oxidation. We also present a comprehensive literature review summarizing the molecular, clinical, and biochemical findings for 92 individuals across 13 publications. Of the 27 pathogenic variants reported to date, the recurrent exons 3-9 deletion represents the most common variant seen in 42% of individuals with TANGO2 deficiency. Common clinical features seen in >70% of all individuals include acute metabolic crisis, rhabdomyolysis, neurologic abnormalities, developmental delay, and intellectual disability. Findings such as elevated creatine kinase, hypothyroidism, ketotic hypoglycemia, QT prolongation, or abnormalities of long-chain acylcarnitines and urine dicarboxylic acids should raise clinical suspicion for this life-threatening condition.
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Affiliation(s)
- Jennifer Schymick
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Department of Pediatrics, Santa Clara Valley Health and Hospital System, San Jose, California, USA
| | - Peter Leahy
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Tina Cowan
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Maura R Z Ruzhnikov
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,Stanford Center for Undiagnosed Diseases, Stanford, California, USA
| | - Ryan Gates
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Gopal Pramanik
- Stanford Center for Undiagnosed Diseases, Stanford, California, USA
| | | | - Vamsi Yarlagadda
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Matthew Wheeler
- Stanford Center for Undiagnosed Diseases, Stanford, California, USA.,Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathan A Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Stanford Center for Undiagnosed Diseases, Stanford, California, USA
| | - Gregory M Enns
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Chung Lee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Huang HC, Chen CM, Lu MK, Liu BL, Li CI, Chen JC, Wang GJ, Lin HC, Duann JR, Tsai CH. Gait-Related Brain Activation During Motor Imagery of Complex and Simple Ambulation in Parkinson's Disease With Freezing of Gait. Front Aging Neurosci 2021; 13:731332. [PMID: 34630069 PMCID: PMC8492994 DOI: 10.3389/fnagi.2021.731332] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Freezing of gait (FOG) in Parkinson's disease (PD) is a devastating clinical phenomenon that has a detrimental impact on patients. It tends to be triggered more often during turning (complex) than during forwarding straight (simple) walking. The neural mechanism underlying this phenomenon remains unclear and requires further elucidation. Objective: To investigate the differences in cerebral functional magnetic resonance imaging responses between PD patients with and without FOG during explicitly video-guided motor imagery (MI) of various complex (normal, freezing) and simple (normal, freezing) walking conditions. Methods: We recruited 34 PD patients, namely, 20 with FOG and 14 without FOG, and 15 normal controls. Participants underwent video-guided MI of turning and straight walking, with and without freezing, while their brain blood oxygen level-dependent (BOLD) activities were measured. Gait analysis was performed. Results: While comparing FOG turning with FOG straight walking, freezers showed higher activation of the superior occipital gyrus, left precentral gyrus, and right postcentral gyrus compared with non-freezers. Normal controls also manifest similar findings compared with non-freezers, except no difference was noted in occipital gyrus activity between the two groups. Freezers also displayed a higher effect size in the locomotor regions than non-freezers during imagery of normal turning. Conclusions: Our findings suggest that freezers require a higher drive of cortical and locomotion regions to overcome the overinhibition of the pathways in freezers than in non-freezers. Compared with simple walking, increased dorsal visual pathway and deep locomotion region activities might play pivotal roles in tackling FOG in freezers during complex walking.
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Affiliation(s)
- Hui-Chun Huang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chun-Ming Chen
- Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Kuei Lu
- Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan
| | - Bey-Ling Liu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Ing Li
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Jui-Cheng Chen
- Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Guei-Jane Wang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Department of Health and Nutrition Biotechnology, Asia University, Taichung, Taiwan
| | - Hsiu-Chen Lin
- Department of Physical Therapy, China Medical University, Taichung, Taiwan
| | - Jeng-Ren Duann
- Institute of Education, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Institute for Neural Computation, University of California, San Diego, La Jolla, CA, United States
| | - Chon-Haw Tsai
- Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan
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Haruyama K, Kawakami M, Okada K, Okuyama K, Tsuzuki K, Liu M. Pelvis-Toe Distance: 3-Dimensional Gait Characteristics of Functional Limb Shortening in Hemiparetic Stroke. Sensors (Basel) 2021; 21:s21165417. [PMID: 34450859 PMCID: PMC8401521 DOI: 10.3390/s21165417] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 12/17/2022]
Abstract
We aimed to investigate whether a newly defined distance in the lower limb can capture the characteristics of hemiplegic gait compared to healthy controls. Three-dimensional gait analyses were performed on 42 patients with chronic stroke and 10 age-matched controls. Pelvis-toe distance (PTD) was calculated as the absolute distance between an anterior superior iliac spine marker and a toe marker during gait normalized by PTD in the bipedal stance. The shortening peak during the swing phase was then quantified as PTDmin. The sagittal clearance angle, the frontal compensatory angle, gait speed, and the observational gait scale were also collected. PTDmin in the stroke group showed less shortening on the affected side and excessive shortening on the non-affected side compared to controls. PTDmin on the affected side correlated negatively with the sagittal clearance peak angle and positively with the frontal compensatory peak angle in the stroke group. PTDmin in stroke patients showed moderate to high correlations with gait speed and observational gait scale. PTDmin adequately reflected gait quality without being affected by apparent improvements due to frontal compensatory patterns. Our results showed that various impairments and compensations were included in the inability to shorten PTD, which can provide new perspectives on gait rehabilitation in stroke patients.
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Ahmad I, Verma S, Noohu MM, Hussain ME. Effect of sensorimotor training on spatiotemporal parameters of gait among middle and older age adults with diabetic peripheral neuropathy. Somatosens Mot Res 2021; 38:230-240. [PMID: 34334087 DOI: 10.1080/08990220.2021.1955671] [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] [Indexed: 10/20/2022]
Abstract
PURPOSE The study aimed to evaluate the effect of sensorimotor training on spatiotemporal parameters of gait among middle-aged and older adults with diabetic peripheral neuropathy (DPN). METHODS A randomised controlled study with four parallel arms (two intervention groups and two control groups) was conducted. Thirty-seven DPN patients were selected on the basis of inclusion and exclusion criteria. Of these, 16 middle-aged and 21 older adults were randomly allocated to the intervention and control groups. Participants in the intervention group were administered eight weeks (three days/week) of sensorimotor training along with diabetes and foot care education whereas participants in the control group received only diabetes and foot care education. Outcome measures involved spatiotemporal parameters of gait at self-paced and maximal-paced, measured before and after eight weeks. RESULTS Age difference was found to be significant in velocity (p ≤ 0.013) and stride length (p ≤ 0.017) at self-paced and maximal-paced walking. After the intervention, velocity was found to be a significant group effect and time × group interaction at self-paced (p = 0.003) and maximal-paced (p = 0.003) walking. Stride length (p = 0.006) was found to be a significant group effect and time × group interaction at self-paced only. Cadence (p = 0.041) and gait cycle (p = 0.05) were found to be significant time × group interaction only at maximal-paced walking. Stance (p ≤ 0.047) and double limb support (p ≤ 0.02) were found to be significant group effect and time × group interaction at self-paced and maximal-paced walking. CONCLUSION Sensorimotor training improves spatiotemporal parameters of gait after eight weeks in similar fashion in middle-aged and older age DPN patients, regardless of age.
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Affiliation(s)
- Irshad Ahmad
- Diabetes Research Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India.,Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India
| | - Shalini Verma
- Diabetes Research Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India
| | - Majumi Mohamad Noohu
- Diabetes Research Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India
| | - Mohd Ejaz Hussain
- Diabetes Research Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India.,Faculty of Allied Health Sciences and Physiotherapy, SGT University, GuruGram, Haryana, India
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Castiglia SF, Tatarelli A, Trabassi D, De Icco R, Grillo V, Ranavolo A, Varrecchia T, Magnifica F, Di Lenola D, Coppola G, Ferrari D, Denaro A, Tassorelli C, Serrao M. Ability of a Set of Trunk Inertial Indexes of Gait to Identify Gait Instability and Recurrent Fallers in Parkinson's Disease. Sensors (Basel) 2021; 21:3449. [PMID: 34063468 DOI: 10.3390/s21103449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/08/2021] [Accepted: 05/13/2021] [Indexed: 12/24/2022]
Abstract
The aims of this study were to assess the ability of 16 gait indices to identify gait instability and recurrent fallers in persons with Parkinson’s disease (pwPD), regardless of age and gait speed, and to investigate their correlation with clinical and kinematic variables. The trunk acceleration patterns were acquired during the gait of 55 pwPD and 55 age-and-speed matched healthy subjects using an inertial measurement unit. We calculated the harmonic ratios (HR), percent recurrence, and percent determinism (RQAdet), coefficient of variation, normalized jerk score, and the largest Lyapunov exponent for each participant. A value of ≤1.50 for the HR in the antero-posterior direction discriminated between pwPD at Hoehn and Yahr (HY) stage 3 and healthy subjects with a 67% probability, between pwPD at HY 3 and pwPD at lower HY stages with a 73% probability, and it characterized recurrent fallers with a 77% probability. Additionally, HR in the antero-posterior direction was correlated with pelvic obliquity and rotation. RQAdet in the antero-posterior direction discriminated between pwPD and healthy subjects with 67% probability, regardless of the HY stage, and was correlated with stride duration and cadence. Therefore, HR and RQAdet in the antero-posterior direction can both be used as age- and-speed-independent markers of gait instability.
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Meiner Z, Ayers E, Bennett DA, Wang C, Verghese J. Risk factors for the progression of motoric cognitive risk syndrome to dementia: Retrospective cohort analysis of two populations. Eur J Neurol 2021; 28:1859-1867. [PMID: 33780585 DOI: 10.1111/ene.14841] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 02/09/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Motoric cognitive risk syndrome (MCR) is a predementia syndrome characterized by cognitive complaints and slow gait. MCR is associated with increased risk of cognitive decline and incident dementia. Predictors of transition to dementia in MCR patients are still obscure. METHODS We examined clinical, biological and lifestyle parameters related to conversion to dementia using Cox models in 439 older adults with prevalent MCR (mean age 79.87 ± 8.13 years, 70% women) from two cohorts, 268 from the Chicago-based Rush Memory and Aging project (MAP) and 171 from the Religious Orders Study (ROS), which enrolled religious clergy across the United States. RESULTS In the pooled sample, 439 (13.2%) had prevalent MCR (268 MAP and 171 ROS). There were 140 (31.9%) incident dementia cases over a median follow up of 4.0 years. Age predicted conversion from MCR to dementia in both cohorts. Male gender was a risk factor only in ROS. In the pooled data, only higher depressive symptoms were associated with higher risk of conversion to dementia (adjusted hazard ratio [aHR] 1.13, 95% CI 1.03-1.24). Lower cognitive activity participation (aHR 0.59, 95% CI 0.44-0.79) and apolipoprotein E ε4 allele (aHR 2.57, 95% CI 1.48-4.45) predicted conversion to dementia in MAP. CONCLUSIONS Depressive symptoms and other cohort-specific risk factors were identified as predictors of transition to dementia in individuals with MCR. These findings suggest common pathological mechanisms underlying mood, gait and cognitive declines in aging, which could help develop preventive strategies.
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Affiliation(s)
- Zeev Meiner
- Department of Physical Medicine and Rehabilitation, Hadassah Mount Scopus, Jerusalem, Israel
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David A Bennett
- Department of Neurology, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Cuiling Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Navarro-López V, Molina-Rueda F, Jiménez-Jiménez S, Alguacil-Diego IM, Carratalá-Tejada M. Effects of Transcranial Direct Current Stimulation Combined with Physiotherapy on Gait Pattern, Balance, and Functionality in Stroke Patients. A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11040656. [PMID: 33916442 PMCID: PMC8066876 DOI: 10.3390/diagnostics11040656] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/25/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 01/24/2023] Open
Abstract
Background: The effectiveness of transcranial direct current stimulation (tDCS) together with conventional physiotherapy in motor rehabilitation after stroke has been widely studied. Despite this, few studies have focused on its application in gait and balance rehabilitation. This review aimed to determine the efficacy of transcranial direct current stimulation combined with conventional physiotherapy on gait, balance, and the functionality of the lower limb after stroke. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases were systematically searched for relevant articles. Randomized clinical trials in English or Spanish that evaluated the use of the transcranial direct current stimulation, combined with physiotherapy, to improve gait, balance, and lower limb functionality after stroke were included. Main results: 10 articles were included, with a total of 222 subjects. Data about population, assessment tools, protocols, sessions, and results were extracted. The methodological quality of the included studies ranged between 3 and 5. Conclusion: The use of transcranial direct current stimulation combined with physiotherapy improves gait parameters, static and dynamic balance, and lower limb functionality in stroke patients. Long-term effects have not yet been demonstrated.
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Affiliation(s)
- Víctor Navarro-López
- International Doctoral School, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain;
| | - Francisco Molina-Rueda
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (F.M.-R.); (M.C.-T.)
| | | | - Isabel M Alguacil-Diego
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (F.M.-R.); (M.C.-T.)
- Correspondence:
| | - María Carratalá-Tejada
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (F.M.-R.); (M.C.-T.)
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Janssen S, Heijs J, Bittner M, Droog E, Bloem BR, Van Wezel R, Heida T. Visual cues added to a virtual environment paradigm do not improve motor arrests in Parkinson's disease. J Neural Eng 2021; 18. [PMID: 33540389 DOI: 10.1088/1741-2552/abe356] [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: 03/27/2020] [Accepted: 02/04/2021] [Indexed: 11/12/2022]
Abstract
Objective. Elucidating how cueing alleviates freezing of gait (FOG) in Parkinson's disease (PD) would enable the development of more effective, personalized cueing strategies. Here, we aimed to validate a visual cueing virtual environment (VE) paradigm for future use in e.g. neuroimaging studies and behavioral studies on motor timing and scaling in PD patients with FOG.Approach. We included 20 PD patients with FOG and 16 age-matched healthy control subjects. Supine participants were confronted with a VE displaying either no cues, bars or staircases. They navigated forward using alternate suppression of foot pedals. Motor arrests (as proxy for FOG), and measures of motor timing and scaling were compared across the three VE conditions for both groups.Main results. VE cues (bars and staircases) did not reduce motor arrests in PD patients and healthy control subjects. The VE cues did reduce pedal amplitude in healthy control subjects, without effects on other motor parameters.Conclusion. We could not validate a visual cueing VE paradigm to study FOG. The VE cues possibly failed to convey the necessary spatial and temporal information to support motor timing and scaling. We discuss avenues for future research.
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Affiliation(s)
- S Janssen
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands.,Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | - Jja Heijs
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands
| | - M Bittner
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands.,Current Address: VicarVision, Amsterdam, The Netherlands
| | - E Droog
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands
| | - B R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | - Rja Van Wezel
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands.,Department of Biophysics, Donders Institute of Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - T Heida
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands
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Yang J, Liang R, Wang L, Zheng C, Xiao X, Ming D. Repetitive Transcranial Magnetic Stimulation (rTMS) Improves the Gait Disorders of Rats Under Simulated Microgravity Conditions Associated With the Regulation of Motor Cortex. Front Physiol 2021; 12:587515. [PMID: 33613305 PMCID: PMC7890125 DOI: 10.3389/fphys.2021.587515] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Abstract
In previous studies, it has been proved that repetitive transcranial magnetic stimulation (rTMS) improves dyskinesia induced by conditions such as spinal cord injury, Parkinson diseases and cerebral ischemia. However, it is still unknown whether it can be used as a countermeasure for gait disorders in astronauts during space flight. In this study, we evaluated the effects of rTMS on the rat gait function under simulated microgravity (SM) conditions. The SM procedure continued for consecutive 21 days in male Wistar rats. Meanwhile, the high-frequency rTMS (10 Hz) was applied for 14 days from the eighth day of SM procedure. The behavioral results showed that SM could cause gait disorders such as decreased walking ability and contralateral limb imbalance in rats, which could be reversed by rTMS. Furthermore, rTMS affected the neural oscillations of motor cortex, enhancing in δ (2–4 Hz) band, suppressing in θ (4–7 Hz), and α (7–12 Hz) bands. Additionally, rTMS could activate mTOR in the motor cortex. These data suggests that the improvement effects of rTMS on gait disorders in rats under SM conditions might be associated with its regulation on neural oscillations in the cerebral motor cortex and the expression of some motor-related proteins which may enhance the control of nervous system on muscle function. Based on our results, rTMS can be used as an potential effective supplement in the field of clinical and rehabilitation research to reduce gait disorders caused by the space environment.
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Affiliation(s)
- Jiajia Yang
- Institute of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.,School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China
| | - Rong Liang
- Institute of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Ling Wang
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China
| | - Chenguang Zheng
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China
| | - Xi Xiao
- Institute of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China
| | - Dong Ming
- Institute of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China.,School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Brain Science and Neural Engineering, Tianjin University, Tianjin, China
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Lheureux A, Warlop T, Cambier C, Chemin B, Stoquart G, Detrembleur C, Lejeune T. Influence of Autocorrelated Rhythmic Auditory Stimulations on Parkinson's Disease Gait Variability: Comparison With Other Auditory Rhythm Variabilities and Perspectives. Front Physiol 2021; 11:601721. [PMID: 33424625 PMCID: PMC7786048 DOI: 10.3389/fphys.2020.601721] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/04/2020] [Indexed: 11/13/2022] Open
Abstract
Parkinson's Disease patients suffer from gait impairments such as reduced gait speed, shortened step length, and deterioration of the temporal organization of stride duration variability (i.e., breakdown in Long-Range Autocorrelations). The aim of this study was to compare the effects on Parkinson's Disease patients' gait of three Rhythmic Auditory Stimulations (RAS), each structured with a different rhythm variability (isochronous, random, and autocorrelated). Nine Parkinson's Disease patients performed four walking conditions of 10-15 min each: Control Condition (CC), Isochronous RAS (IRAS), Random RAS (RRAS), and Autocorrelated RAS (ARAS). Accelerometers were used to assess gait speed, cadence, step length, temporal organization (i.e., Long-Range Autocorrelations computation), and magnitude (i.e., coefficient of variation) of stride duration variability on 512 gait cycles. Long-Range Autocorrelations were assessed using the evenly spaced averaged Detrended Fluctuation Analysis (α-DFA exponent). Spatiotemporal gait parameters and coefficient of variation were not modified by the RAS. Long-Range Autocorrelations were present in all patients during CC and ARAS although all RAS conditions altered them. The α-DFA exponents were significantly lower during IRAS and RRAS than during CC, exhibiting anti-correlations during IRAS in seven patients. α-DFA during ARAS was the closest to the α-DFA during CC and within normative data of healthy subjects. In conclusion, Isochronous RAS modify patients' Long-Range Autocorrelations and the use of Autocorrelated RAS allows to maintain an acceptable level of Long-Range Autocorrelations for Parkinson's Disease patients' gait.
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Affiliation(s)
- Alexis Lheureux
- Institute of NeuroScience, Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium.,Department of Physical and Rehabilitation Medicine, Cliniques universitaires Saint-Luc, Woluwe-Saint-Lambert, Belgium
| | - Thibault Warlop
- Institute of NeuroScience, Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium
| | - Charline Cambier
- NeuroMusculoSkeletal Lab (NSMK), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium
| | - Baptiste Chemin
- Institute of NeuroScience, Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium
| | - Gaëtan Stoquart
- Department of Physical and Rehabilitation Medicine, Cliniques universitaires Saint-Luc, Woluwe-Saint-Lambert, Belgium.,NeuroMusculoSkeletal Lab (NSMK), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium
| | - Christine Detrembleur
- NeuroMusculoSkeletal Lab (NSMK), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium
| | - Thierry Lejeune
- Department of Physical and Rehabilitation Medicine, Cliniques universitaires Saint-Luc, Woluwe-Saint-Lambert, Belgium.,NeuroMusculoSkeletal Lab (NSMK), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Woluwe-Saint-Lambert, Belgium
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41
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Pierce W. Review on the monograph "Improving quality of life for individuals with cerebral palsy through treatment of gait impairment". J Pediatr Rehabil Med 2021; 14:301-302. [PMID: 34057106 DOI: 10.3233/prm-210029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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42
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Luque-Moreno C, Granja-Domínguez A, Moral-Munoz JA, Izquierdo-Ayuso G, Lucena-Anton D, Heredia-Rizo AM. Effectiveness of Dry Needling versus Placebo on Gait Performance, Spasticity, Electromyographic Activity, Pain, Range-of-Movement and Quality of Life in Patients with Multiple Sclerosis: A Randomized Controlled Trial Protocol. Brain Sci 2020; 10:997. [PMID: 33561042 DOI: 10.3390/brainsci10120997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 12/27/2022] Open
Abstract
Dry needling (DN) is an emerging technique commonly used in neurological and musculoskeletal pain conditions, but there have been no previous studies in patients with multiple sclerosis (pwMS). This trial aims to assess the efficacy of deep DN, compared with sham placebo DN, on gait performance, spasticity level, pain, electromyographic activity, range-of-movement (ROM) and quality of life in pwMS. Forty adults with MS were randomly assigned to one study group. The DN group will undergo 2 sessions (once per week) using DN over the rectus femoris (RF) and gastrocnemius medialis (GM) muscles at the lower extremity with higher spasticity. The placebo group will receive the same protocol using a sham placebo needle (Dong Bang needle). Outcome measures will include gait performance, using the GaitRite® system, spasticity level with the Modified Ashworth Scale, superficial electromyographic activity of RF and GM, pain (pressure algometer), ROM (goniometer), and quality of life (Musiqol). This study is the first investigating the short-term effect of DN, compared with placebo, in pwMS, and taking into account the possible changes in the electromyographic activity of the lower limb. Therefore, the results may help to understand the suitability of using this technique in the clinical setting for this population. Trial registration: ACTRN12619000880145.
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Ruan X, Li Y, Li E, Xie F, Zhang G, Luo Z, Du Y, Jiang X, Li M, Wei X. Impaired Topographical Organization of Functional Brain Networks in Parkinson's Disease Patients With Freezing of Gait. Front Aging Neurosci 2020; 12:580564. [PMID: 33192473 PMCID: PMC7609969 DOI: 10.3389/fnagi.2020.580564] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 07/06/2020] [Accepted: 09/18/2020] [Indexed: 12/04/2022] Open
Abstract
Objective: This study aimed to explore alterations in the topological properties of the functional brain network in primary Parkinson’s disease (PD) patients with freezing of gait (PD-FOG). Methods: Resting-state functional magnetic resonance imaging (Rs-fMRI) data were obtained in 23 PD-FOG patients, 33 PD patients without FOG (PD-nFOG), and 24 healthy control (HC) participants. The whole-brain functional connectome was constructed by thresholding the Pearson correlation matrices of 90 brain regions, and topological properties were analyzed by using graph theory approaches. The network-based statistics (NBS) method was used to determine the suprathreshold connected edges (P < 0.05; threshold T = 2.725), and statistical significance was estimated by using the non-parametric permutation method (5,000 permutations). Statistically significant topological properties were further evaluated for their relationship with clinical neurological scales. Results: The topological properties of the functional brain network in PD-FOG and PD-nFOG showed no abnormalities at the global level. However, compared with HCs, PD-FOG patients showed decreased nodal local efficiency in several brain regions, including the bilateral striatum, frontoparietal areas, visual cortex, and bilateral superior temporal gyrus, increased nodal local efficiency in the left gyrus rectus. When compared with PD-nFOG patients and HCs, PD-FOG showed increased betweenness centrality in the left hippocampus. Moreover, compared to HCs, both PD-FOG and PD-nFOG patients displayed reduced network connections by using the NBS method, mainly involving the sensorimotor cortex (SM), visual network (VN), default mode network (DMN), auditory network (AN), dorsal attention network (DAN), subcortical regions, and limbic network (LIM). The local node efficiency of the right temporal pole: superior temporal gyrus in PD-FOG patients was positively correlated with the Freezing of Gait Questionnaire (FOGQ) scores. Conclusions: This study demonstrates the disrupted regional topological organization in PD-FOG patients, especially associated with damage to the subcortical regions and multiple cortical regions. Our results provide insights into the dysfunctional mechanisms of the relevant networks and indicate potential neuroimaging biomarkers of PD-FOG.
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Affiliation(s)
- Xiuhang Ruan
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yuting Li
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - E Li
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fang Xie
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Guoqin Zhang
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | | | - Yuchen Du
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xinqing Jiang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Mengyan Li
- Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xinhua Wei
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.,Department of Radiology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
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Lheureux A, Lebleu J, Frisque C, Sion C, Stoquart G, Warlop T, Detrembleur C, Lejeune T. Immersive Virtual Reality to Restore Natural Long-Range Autocorrelations in Parkinson's Disease Patients' Gait During Treadmill Walking. Front Physiol 2020; 11:572063. [PMID: 33071825 PMCID: PMC7538859 DOI: 10.3389/fphys.2020.572063] [Citation(s) in RCA: 6] [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: 06/12/2020] [Accepted: 08/31/2020] [Indexed: 12/03/2022] Open
Abstract
Effects of treadmill walking on Parkinson’s disease (PD) patients’ spatiotemporal gait parameters and stride duration variability, in terms of magnitude [coefficient of variation (CV)] and temporal organization [long range autocorrelations (LRA)], are known. Conversely, effects on PD gait of adding an optic flow during treadmill walking using a virtual reality headset, to get closer to an ecological walk, is unknown. This pilot study aimed to compare PD gait during three conditions: Overground Walking (OW), Treadmill Walking (TW), and immersive Virtual Reality on Treadmill Walking (iVRTW). Ten PD patients completed the three conditions at a comfortable speed. iVRTW consisted in walking at the same speed as TW while wearing a virtual reality headset reproducing an optic flow. Gait parameters assessed were: speed, step length, cadence, magnitude (CV) and temporal organization (evenly spaced averaged Detrended Fluctuation Analysis, α exponent) of stride duration variability. Motion sickness was assessed after TW and iVRTW using the Simulator Sickness Questionnaire (SSQ). Step length was greater (p = 0.008) and cadence lower (p = 0.009) during iVRTW compared to TW while CV was similar (p = 0.177). α exponent was similar during OW (0.77 ± 0.07) and iVRTW (0.76 ± 0.09) (p = 0.553). During TW, α exponent (0.85 ± 0.07) was higher than during OW (p = 0.039) and iVRTW (p = 0.016). SSQ was similar between TW and iVRTW (p = 0.809). iVRTW is tolerable, could optimize TW effects on spatiotemporal parameters while not increasing CV in PD. Furthermore, iVRTW could help to capture the natural LRA of PD gait in laboratory settings and could potentially be a challenging second step in PD gait rehabilitation.
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Affiliation(s)
- Alexis Lheureux
- Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium.,Department of Physical and Rehabilitation Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Julien Lebleu
- Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Caroline Frisque
- Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Corentin Sion
- Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Gaëtan Stoquart
- Department of Physical and Rehabilitation Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Thibault Warlop
- Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium
| | - Christine Detrembleur
- Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Thierry Lejeune
- Department of Physical and Rehabilitation Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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Abstract
BACKGROUND Current available therapies for Parkinson disease (PD) have strong limitations, and patients usually present with refractory symptoms despite all efforts. Deep brain stimulation (DBS), which has been used in PD patients for decades (since 1987), has best indications for symptoms like tremor, motor fluctuations, or dyskinesia. However, postural instability and gait disturbances (PIGD) have restricted benefits with DBS. In 2009, spinal cord stimulation (SCS), a well-established therapy for chronic pain, has emerged as a potential alternative therapy that may help control unresponsive symptoms such as bradykinesia, PIGD, and freezing of gait. METHODS The main studies regarding SCS in PD are reviewed here from the first studies in animal models to the latest clinical trials. CONCLUSIONS Despite promising findings, the heterogeneity of methodologies used and small samples in human studies pose a challenging problem to be addressed in order to have robust clinical evidence to support SCS as a viable PD treatment.
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Affiliation(s)
- Bruno Braz Garcia
- Edmond and Lily Safra International Institute of Neuroscience, Macaiba, Brazil
| | | | - Mariana Ferreira Pereira de Araújo
- Edmond and Lily Safra International Institute of Neuroscience, Macaiba, Brazil.,Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Hougelle Simplício
- Edmond and Lily Safra International Institute of Neuroscience, Macaiba, Brazil.,Santos Dumont Institute, Macaíba, Brazil.,State University of Rio Grande do Norte, Mossoró, Brazil.,Brain Research and Development Co, Natal, Brazil
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46
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Pagnussat AS, Salazar AP, Pinto C, Redivo Marchese R, Rieder CRM, Alves Filho JO, Franco AR, Kleiner AFR. Plantar stimulation alters brain connectivity in idiopathic Parkinson's disease. Acta Neurol Scand 2020; 142:229-238. [PMID: 32299120 DOI: 10.1111/ane.13253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/26/2020] [Revised: 03/25/2020] [Accepted: 04/11/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Individuals with Parkinson's disease (PD) and freezing of gait (FOG) present peripheral and central sensitivity disturbances that impair motor performance. This study aimed to investigate long-term effects of plantar sensory stimulation on brain activity, brain connectivity, and gait velocity of individuals with PD and FOG. METHODS Twenty-five participants were enrolled in this clinical trial (NCT02594540). Plantar sensory stimulation was delivered using the Automated Mechanical Peripheral Stimulation therapy (AMPS). Volunteers were randomly assigned to real or placebo AMPS groups and received eight sessions of treatment. The primary outcome was brain activity (task-based fMRI-active ankle dorsi-plantar flexion). Secondary outcomes were brain connectivity (resting state-RS fMRI) and gait velocity. fMRI was investigated on the left, right, and mid-sensory motor regions, left and right basal ganglia. RESULTS No changes in brain activity were observed when task-based fMRI was analyzed. After real AMPS, RS functional connectivity between basal ganglia and sensory-related brain areas increased (insular and somatosensory cortices). Gait velocity also increased after real AMPS. A positive correlation was found between gait velocity and the increased connectivity between sensory, motor and supplementary motor cortices. CONCLUSION Plantar sensory stimulation through AMPS was not able to modify brain activity. AMPS increased the RS brain connectivity mainly in areas related to sensory processing and sensorimotor integration. Plantar stimulation could be a way to improve plantar sensitivity and consequently ameliorate gait performance. However, the mechanisms behind the way AMPS influences brain pathways are still not completely known.
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Affiliation(s)
- Aline Souza Pagnussat
- Graduate Program in Rehabilitation Sciences Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
- Movement Analysis and Rehabilitation Laboratory Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | - Ana Paula Salazar
- Graduate Program in Rehabilitation Sciences Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
- Movement Analysis and Rehabilitation Laboratory Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | - Camila Pinto
- Graduate Program in Rehabilitation Sciences Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
- Movement Analysis and Rehabilitation Laboratory Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | - Ritchele Redivo Marchese
- Graduate Program in Rehabilitation Sciences Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
- Movement Analysis and Rehabilitation Laboratory Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | - Carlos R. M. Rieder
- Graduate Program in Rehabilitation Sciences Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Porto Alegre Brazil
| | | | - Alexandre R. Franco
- Center for Biomedical Imaging and Neuromodulation Nathan S. Kline Institute for Psychiatric Research Orangeburg NY USA
- Center for the Developing Brain Child Mind Institute New York NY USA
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Vienne-Jumeau A, Oudre L, Moreau A, Quijoux F, Edmond S, Dandrieux M, Legendre E, Vidal PP, Ricard D. Personalized Template-Based Step Detection From Inertial Measurement Units Signals in Multiple Sclerosis. Front Neurol 2020; 11:261. [PMID: 32373047 PMCID: PMC7186475 DOI: 10.3389/fneur.2020.00261] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/20/2019] [Accepted: 03/20/2020] [Indexed: 01/21/2023] Open
Abstract
Background: Objective gait assessment is key for the follow-up of patients with progressive multiple sclerosis (pMS). Inertial measurement units (IMUs) provide reliable and yet easy quantitative gait assessment in routine clinical settings. However, to the best of our knowledge, no automated step-detection algorithm performs well in detecting severely altered pMS gait. Method: This article elaborates on a step-detection method based on personalized templates tested against a gold standard. Twenty-two individuals with pMS and 10 young healthy subjects (HSs) were instructed to walk on an electronic walkway wearing synchronized IMUs. Templates were derived from the IMU signals by using Initial and Final Contact times given by the walkway. These were used to detect steps from other gait trials of the same individual (intra-individual template-based detection, IITD) or another participant from the same group (pMS or HS) (intra-group template-based detection, IGTD). All participants were seen twice with a 6-month interval, with two measurements performed at each visit. Performance and accuracy metrics were computed, along with a similarity index (SId), which was computed as the mean distance between detected steps and their respective closest template. Results: For HS participants, both the IITD and the IGTD algorithms had precision and recall of 1.00 for detecting steps. For pMS participants, precision and recall ranged from 0.94 to 1.00 for IITD and 0.85 to 0.95 for IGTD depending on the level of disability. The SId was correlated with performance and the accuracy of the result. An SId threshold of 0.957 (IITD) and 0.963 (IGTD) could rule out decreased performance (F-measure ≤ 0.95), with negative predictive values of 0.99 and 0.96 with the IITD and IGTD algorithms. Also, the SId computed with the IITD and IGTD algorithms could distinguish individuals showing changes at 6-month follow-up. Conclusion: This personalized step-detection method has high performance for detecting steps in pMS individuals with severely altered gait. The algorithm can be self-evaluating with the SI, which gives a measure of the confidence the clinician can have in the detection. What is more, the SId can be used as a biomarker of change in disease severity occurring between the two measurement times.
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Affiliation(s)
- Aliénor Vienne-Jumeau
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées, University Paris Descartes, Paris, France
| | - Laurent Oudre
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées, University Paris Descartes, Paris, France.,L2TI, University Paris 13, Villetaneuse, France.,CMLA (UMR 8536), CNRS ENS Paris-Saclay, Cachan, France
| | - Albane Moreau
- Service de Neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
| | - Flavien Quijoux
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées, University Paris Descartes, Paris, France.,ORPEA Group, Puteaux, France
| | - Sébastien Edmond
- Service de Neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
| | - Mélanie Dandrieux
- Service de Neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
| | - Eva Legendre
- Service de Neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
| | - Pierre Paul Vidal
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées, University Paris Descartes, Paris, France.,Hangzhou Dianzi University, Zhejiang, China
| | - Damien Ricard
- COGNAC-G (UMR 8257), CNRS Service de Santé des Armées, University Paris Descartes, Paris, France.,Service de Neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France.,École du Val-de-Grâce, Ecole de Santé des Armées, Paris, France
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48
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Abstract
To identify basic gait features and abnormal gait patterns that are common to different neurological or musculoskeletal conditions, such as cerebral stroke, Parkinsonian disorders, radiculopathy, and musculoskeletal pain.In this retrospective study, temporal-spatial, kinematic, and kinetic gait parameters were analyzed in 424 patients with hemiplegia after stroke, 205 patients with Parkinsonian disorders, 216 patients with radiculopathy, 167 patients with musculoskeletal pain, and 316 normal controls (total, 1328 subjects). We assessed differences according to the condition and used a community detection algorithm to identify subgroups within each condition. Additionally, we developed a prediction model for subgroup classification according to gait speed and maximal hip extension in the stance phase.The main findings can be summarized as follows. First, there was an asymmetric decrease of the knee/ankle flexion angles in hemiplegia and a marked reduction of the hip/knee range of motion with increased moment in Parkinsonian disorders. Second, three abnormal gait patterns, including fast gait speed with adequate maximal hip extension, fast gait speed with inadequate maximal hip extension, and slow gait speed, were found throughout the conditions examined. Third, our simple prediction model based on gait speed and maximal hip extension angle was characterized by a high degree of accuracy in predicting subgroups within a condition.Our findings suggest the existence of specific gait patterns within and across conditions. Our novel subgrouping algorithm can be employed in routine clinical settings to classify abnormal gait patterns in various neurological disorders and guide the therapeutic approach and monitoring.
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Affiliation(s)
- Sunghyon Kyeong
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine
| | | | - Suk Jung
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Republic of Korea
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D'Cruz N, Vervoort G, Fieuws S, Moreau C, Vandenberghe W, Nieuwboer A. Repetitive Motor Control Deficits Most Consistent Predictors of Conversion to Freezing of Gait in Parkinson's Disease: A Prospective Cohort Study. J Parkinsons Dis 2020; 10:559-571. [PMID: 32039860 DOI: 10.3233/jpd-191759] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The onset of freezing of gait (FOG) represents a turning point in the lives of patients with Parkinson's disease (PD). FOG increases fall risk and is associated with worse physical and mental health related quality of life, thus increasing disease burden. Moreover, therapeutic studies aiming to ameliorate freezing have had limited success. In a step towards pre-emptive therapy to delay or prevent the onset of FOG, this prospective cohort study set out to uncover clinical markers of conversion to FOG. OBJECTIVE Investigate clinical markers of conversion to FOG. METHODS Sixty PD patients without FOG were followed up for two years and underwent extensive clinical testing each year. FOG classification was made with the New Freezing of Gait Questionnaire. Clinical predictors of conversion to FOG were investigated using univariate analysis and through building a multivariable model using all measured components. RESULTS Twelve patients developed FOG during the study (Incidence: 11.5% per year). Due to the large number of predictors, univariate analyses did not survive multiple comparison correction, precluding strong inference on any one predictor. Overall, the effect sizes suggested that motor deficits including difficulties with repetitive movement scaling (AUC: 0.71), coordination (AUC: 0.73) and consistency (AUC: 0.76) as well as gait asymmetry (AUC: 0.79) and variability (AUC: 0.71) were most predictive of conversion. Further, converters reported more subjective cognitive difficulty (AUC: 0.74), although their measured performance was similar to non-converters. Multivariable analyses further showed that the two components most consistently selected in the predictive model were: 1) an MDS-UPDRS component with worse axial motor, hand use and non-motor symptoms; and 2) finger tapping abnormalities. CONCLUSION Conversion to FOG was predicted mainly by objective and clinical measures of motor dyscontrol, as non-motor disturbances were surfacing. Although based on a small cohort with limited converters, this novel finding informs future studies aimed at FOG prevention.
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Affiliation(s)
- Nicholas D'Cruz
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Griet Vervoort
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
| | - Steffen Fieuws
- KU Leuven, Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
| | - Caroline Moreau
- University of Lille, Expert Center for Parkinson Disease, CHU Lille, Inserm UMR, France
| | - Wim Vandenberghe
- KU Leuven, Department of Neurosciences, Laboratory for Parkinson Research, Leuven, Belgium
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
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Lord SR, Bindels H, Ketheeswaran M, Brodie MA, Lawrence AD, Close JCT, Whone AL, Ben-Shlomo Y, Henderson EJ. Freezing of Gait in People with Parkinson's Disease: Nature, Occurrence, and Risk Factors. J Parkinsons Dis 2020; 10:631-640. [PMID: 32116261 DOI: 10.3233/jpd-191813] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is a common symptom of Parkinson's disease (PD) which can result in falls and fall related injuries, poor quality of life and reduced functional independence. It is a heterogeneous phenomenon that is difficult to quantify and eludes a unified pathophysiological framework. OBJECTIVE Our aim was to document the occurrence and nature of freezing, cognitive stops and stumbles in people with PD during walks with varying cognitive loads and conditions designed to elicit FOG. METHODS 130 people with PD walked under four conditions (normal walking, walking plus easy and hard dual-tasks, and a FOG elicitation condition. Video and accelerometry recordings were examined to document freezes and other gait disruptions. RESULTS Participants experienced 391 freezes, 97 cognitive stops and 73 stumbles in the trial walks; with total gait disruptions increasing with task complexity. Most freezes in the FOG elicitation condition occurred during turning and approach destination. People who experienced freezing during the walks were more likely to have Postural Instability and Gait Difficulty (PIGD) subtype, longer disease duration and more severe UPDRS part II and part III sub-scores than people who did not freeze. They also took higher doses of levodopa, reported freezing in the past month, more prior falls, had poorer executive function, poorer proprioception, slower reaction time, poorer standing and leaning balance, more depressive symptoms, lower quality of life and greater fear of falling. PD disease duration, reduced controlled leaning balance and poor proprioception were identified as independent and significant determinants of freezing in logistic regression analysis. CONCLUSION The multiple motor and cognitive factors identified as being associated with freezing, including poor proprioception and impaired controlled leaning balance provide new insights into this debilitating PD symptom and may contribute to potential new targets for rehabilitation.
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Affiliation(s)
- Stephen R Lord
- Neuroscience Research Australia, UNSW, Sydney, Australia
| | - Helen Bindels
- Department of Applied Health Sciences, University of Applied Sciences, Bochum, Germany
| | | | | | - Andrew D Lawrence
- School of Psychology and Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, UK
| | - Jacqueline C T Close
- Neuroscience Research Australia, UNSW, Sydney, Australia
- Prince of Wales Clinical School, UNSW, Sydney, NSW, Australia
| | - Alan L Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol, UK
- Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- Royal United Hospitals NHS Bath Foundation Trust, Combe Park, Bath, UK
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