51
|
Mancini M, Bloem BR, Horak FB, Lewis SJG, Nieuwboer A, Nonnekes J. Clinical and methodological challenges for assessing freezing of gait: Future perspectives. Mov Disord 2019; 34:783-790. [PMID: 31046191 DOI: 10.1002/mds.27709] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/04/2019] [Accepted: 04/11/2019] [Indexed: 01/04/2023] Open
Abstract
Freezing of gait, defined as sudden and usually brief episodes of inability to produce effective stepping, often results in falls and is both disabling and common in parkinsonism. In this narrative review, sprung from the 2nd International Workshop on freezing of gait in Leuven, we summarize the latest insights into clinical and methodological challenges for assessing freezing of gait. We also highlight the role of emerging wearable technology to improve the management of this debilitating symptom. © 2019 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest, Belgium
| | - Jorik Nonnekes
- Department of Rehabilitation, Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| |
Collapse
|
52
|
Mirelman A, Bonato P, Camicioli R, Ellis TD, Giladi N, Hamilton JL, Hass CJ, Hausdorff JM, Pelosin E, Almeida QJ. Gait impairments in Parkinson's disease. Lancet Neurol 2019; 18:697-708. [PMID: 30975519 DOI: 10.1016/s1474-4422(19)30044-4] [Citation(s) in RCA: 319] [Impact Index Per Article: 63.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 12/19/2022]
Abstract
Gait impairments are among the most common and disabling symptoms of Parkinson's disease. Nonetheless, gait is not routinely assessed quantitatively but is described in general terms that are not sensitive to changes ensuing with disease progression. Quantifying multiple gait features (eg, speed, variability, and asymmetry) under natural and more challenging conditions (eg, dual-tasking, turning, and daily living) enhanced sensitivity of gait quantification. Studies of neural connectivity and structural network topology have provided information on the mechanisms of gait impairment. Advances in the understanding of the multifactorial origins of gait changes in patients with Parkinson's disease promoted the development of new intervention strategies, such as neurostimulation and virtual reality, aimed at alleviating gait impairments and enhancing functional mobility. For clinical applicability, it is important to establish clear links between specific gait impairments, their underlying mechanisms, and disease progression to foster the acceptance and usability of quantitative gait measures as outcomes in future disease-modifying clinical trials.
Collapse
Affiliation(s)
- Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | | | - Terry D Ellis
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, USA
| | - Nir Giladi
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jamie L Hamilton
- Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Chris J Hass
- College of Health and Human Performance, Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Jeffrey M Hausdorff
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elisa Pelosin
- Department of Neuroscience (DINOGMI), University of Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Quincy J Almeida
- Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, ON, Canada
| |
Collapse
|
53
|
Koren Y, Parmet Y, Bar-Haim S. Treading on the unknown increases prefrontal activity: A pilot fNIRS study. Gait Posture 2019; 69:96-100. [PMID: 30690327 DOI: 10.1016/j.gaitpost.2019.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 12/16/2018] [Accepted: 01/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Complex walking conditions (e.g. dual tasking) have been associated with increased prefrontal (PFC) activity. However, most paradigms include a predictable environment, specifically, a predictable walking terrain. In the present study we investigate PFC activity under an unusual walking condition where each foot placement was on unexpected terrain, thus causing a mismatch between visuospatial perception and lower-extremity proprioception. RESEARCH OBJECTIVE To assess whether PFC activity increases under unstable unpredictable conditions compared to unstable but predictable conditions. METHODS This was a prospective study involving twenty healthy adults. Participants walked in two conditions: unstable but predictable, and unstable and unpredictable. To assess walking stability, both stride-time (ST) and stride-time variability (CV) were measured. To assess PFC activity, two wireless near-infrared spectroscopy devices were used. The group hemodynamic response (GHR) was calculated for each condition. For statistical analysis, a linear-mixed-effects model was used. RESULTS Walking with unpredictable perturbations did not change the ST (t = 0.51, p = 0.61) but significantly increased the parameter CV (t = 11.74, p < 0.001). The GHR of both conditions indicated brief per-initiation PFC activity that was similar across conditions. However, when GHRs were calculated relative to normal walking (i.e., the participants' own shoes), continuous activity was evident. Compared to the predictable condition, the unpredictable condition significantly increased this activity during steady-state walking (t = 2.13, p = 0.033). SIGNIFICANCE Observations from the present study suggest that at least two neural components are present in the measured signal-a brief one, occurring per-initiation, and a continuous one, sensitive to the predictability of the terrain. The second component was accompanied by a decrease in walking stability. These results may contribute to our understanding of the control mechanism underlying gait and future planning of rehabilitation protocols.
Collapse
Affiliation(s)
- Yogev Koren
- The Laboratory for Rehabilitation and Motor Control of Walking, Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Simona Bar-Haim
- The Laboratory for Rehabilitation and Motor Control of Walking, Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| |
Collapse
|
54
|
Wagshul ME, Lucas M, Ye K, Izzetoglu M, Holtzer R. Multi-modal neuroimaging of dual-task walking: Structural MRI and fNIRS analysis reveals prefrontal grey matter volume moderation of brain activation in older adults. Neuroimage 2019; 189:745-754. [PMID: 30710680 DOI: 10.1016/j.neuroimage.2019.01.045] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 11/28/2022] Open
Abstract
It has been well established over the last two decades that walking is not merely an automatic, motoric activity; it also utilizes executive function circuits, which play an increasingly important role in walking for older people and those with mobility and cognitive deficits. Dual-task walking, such as walking while performing a cognitive task, is a necessary skill for everyday functioning, and has been shown to activate prefrontal lobe areas in healthy older people. Another well-established point in healthy aging is the loss of grey matter, and in particular loss of frontal lobe grey matter volume. However, the relationship between increased frontal lobe activity during dual-task walking and loss of frontal grey matter in healthy aging remains unknown. In the current study, we combined oxygenated hemoglobin (HbO2) data from functional near-infrared spectroscopy (fNIRS), taken during dual-task walking, with structural MRI volumetrics in a cohort of healthy older subjects to identify this relationship. We studied fifty-five relatively healthy, older participants (≥65 years) during two separate sessions: fNIRS to measure HbO2 changes between single-task (i.e., normal walking) and dual-task walking-while-talking, and high-resolution, structural MRI to measure frontal lobe grey matter volumes. Linear mixed effects modeling was utilized to determine the moderation effect of grey matter volume on the change in prefrontal oxygenated hemoglobin between the two walking tasks, while controlling for covariates including task performance. We found a highly significant interaction effect between frontal grey matter volume and task on HbO2 levels (p < 0.0001). Specifically, increased HbO2 levels during dual-task compared to single-task walking were associated with reduced frontal grey matter volume. Regional analysis identified bilateral superior and rostral middle gyri as the primary areas driving these results. The findings provide support for the concept of neural inefficiency: in the absence of behavioral gains, grey matter loss in relatively healthy, older individuals leads to over-activation of frontal lobe during a cognitively demanding walking task with established clinical and predictive utility.
Collapse
Affiliation(s)
- Mark E Wagshul
- Department of Radiology, Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, NY, USA; Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Melanie Lucas
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Kenny Ye
- Department of Epidemiology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Meltem Izzetoglu
- Villanova University, Electrical and Computer Engineering, Villanova, PA, USA
| | - Roee Holtzer
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
55
|
Dagan M, Herman T, Zhou J, Manor B, Hausdorff JM. Reply to “Anodal tDCS Over Prefrontal Cortex Improves Dual-Task Walking in Patients With Freezing”. Mov Disord 2018; 33:1973-1974. [DOI: 10.1002/mds.27537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 09/17/2018] [Accepted: 09/21/2018] [Indexed: 02/02/2023] Open
Affiliation(s)
- Moria Dagan
- Center for the Study of Movement, Cognition and Mobility; Neurological Institute; Tel Aviv, Sourasky Medical Center Tel Aviv Israel
- Sagol School of Neuroscience; Tel Aviv University; Tel Aviv Israel
| | - Talia Herman
- Center for the Study of Movement, Cognition and Mobility; Neurological Institute; Tel Aviv, Sourasky Medical Center Tel Aviv Israel
| | - Junhong Zhou
- Institute for Aging Research, Hebrew SeniorLife; Harvard Medical School; Boston Massachusetts USA
| | - Brad Manor
- Institute for Aging Research, Hebrew SeniorLife; Harvard Medical School; Boston Massachusetts USA
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and Mobility; Neurological Institute; Tel Aviv, Sourasky Medical Center Tel Aviv Israel
- Sagol School of Neuroscience; Tel Aviv University; Tel Aviv Israel
- Department of Physical Therapy; Sackler Faculty of Medicine; Tel Aviv Israel
- Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery; Rush University Medical Center; Chicago Illinois
| |
Collapse
|
56
|
Allali G, Blumen HM, Devanne H, Pirondini E, Delval A, Van De Ville D. Brain imaging of locomotion in neurological conditions. Neurophysiol Clin 2018; 48:337-359. [PMID: 30487063 PMCID: PMC6563601 DOI: 10.1016/j.neucli.2018.10.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 01/20/2023] Open
Abstract
Impaired locomotion is a frequent and major source of disability in patients with neurological conditions. Different neuroimaging methods have been used to understand the brain substrates of locomotion in various neurological diseases (mainly in Parkinson's disease) during actual walking, and while resting (using mental imagery of gait, or brain-behavior correlation analyses). These studies, using structural (i.e., MRI) or functional (i.e., functional MRI or functional near infra-red spectroscopy) brain imaging, electrophysiology (i.e., EEG), non-invasive brain stimulation (i.e., transcranial magnetic stimulation, or transcranial direct current stimulation) or molecular imaging methods (i.e., PET, or SPECT) reveal extended brain networks involving both grey and white matters in key cortical (i.e., prefrontal cortex) and subcortical (basal ganglia and cerebellum) regions associated with locomotion. However, the specific roles of the various pathophysiological mechanisms encountered in each neurological condition on the phenotype of gait disorders still remains unclear. After reviewing the results of individual brain imaging techniques across the common neurological conditions, such as Parkinson's disease, dementia, stroke, or multiple sclerosis, we will discuss how the development of new imaging techniques and computational analyses that integrate multivariate correlations in "large enough datasets" might help to understand how individual pathophysiological mechanisms express clinically as an abnormal gait. Finally, we will explore how these new analytic methods could drive our rehabilitative strategies.
Collapse
Affiliation(s)
- Gilles Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
| | - Helena M Blumen
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA; Department of Medicine, Division of Geriatrics, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Hervé Devanne
- Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France; EA 7369, URePSSS, Unité de Recherche Pluridisciplinaire Sport Santé Société, Université du Littoral Côte d'Opale, Calais, France
| | - Elvira Pirondini
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland; Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Arnaud Delval
- Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France; Unité Inserm 1171, Faculté de Médecine, Université de Lille, Lille, France
| | - Dimitri Van De Ville
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland; Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| |
Collapse
|
57
|
Mitchell T, Potvin-Desrochers A, Lafontaine AL, Monchi O, Thiel A, Paquette C. Cerebral Metabolic Changes Related to Freezing of Gait in Parkinson Disease. J Nucl Med 2018; 60:671-676. [DOI: 10.2967/jnumed.118.218248] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/25/2018] [Indexed: 01/26/2023] Open
|
58
|
Mancini M, Smulders K, Harker G, Stuart S, Nutt JG. Assessment of the ability of open- and closed-loop cueing to improve turning and freezing in people with Parkinson's disease. Sci Rep 2018; 8:12773. [PMID: 30143726 PMCID: PMC6109152 DOI: 10.1038/s41598-018-31156-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/13/2018] [Indexed: 01/04/2023] Open
Abstract
Turning impairments are common in Parkinson’s disease (PD) and can elicit freezing of gait (FoG). Extensive examination of open-loop cueing interventions has demonstrated that they can ameliorate gait deficits in PD; less is known about efficacy to improve turning. Here, we investigate the immediate effectiveness of open- and closed-loop cueing in improving turning characteristics in people with PD. Twenty-five subjects with and 18 subjects without FoG participated in the study. Subjects turned in place for one minute under single- and dual-task for 3 randomized conditions: (i) Baseline; (ii) Turning to the beat of a metronome (open-loop); and (iii) Turning with phase-dependent tactile biofeedback (closed-loop). Objective measures of freezing, such as % time spent freezing and FoG-ratio, significantly improved when turning with both open-loop and closed-loop cueing compared to baseline. Dual-tasking did not worsen FoG in freezers, but significantly slowed down turns in both groups. Both cueing modalities significantly improved turning smoothness in both groups, but reduced turning velocity and number of turns compared to baseline. Both open and closed-loop cueing markedly improved turning in people with PD. These preliminary observations warrant further exploration of vibrotactile closed-loop cueing to improve mobility in everyday life.
Collapse
Affiliation(s)
- Martina Mancini
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, OP-32, 97239, Portland, OR, USA.
| | - Katrijn Smulders
- Sint Maartenskliniek, Research Department, PO Box 9011, 6500 GM, Nijmegen, The Netherlands
| | - Graham Harker
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, OP-32, 97239, Portland, OR, USA
| | - Samuel Stuart
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, OP-32, 97239, Portland, OR, USA
| | - John G Nutt
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, OP-32, 97239, Portland, OR, USA
| |
Collapse
|
59
|
Jang JH, Kim H, Jung I, Yoo H. Acupuncture for improving gait disturbance in Parkinson’s disease: A study protocol for a pilot randomized controlled trial. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
60
|
Stuart S, Vitorio R, Morris R, Martini DN, Fino PC, Mancini M. Cortical activity during walking and balance tasks in older adults and in people with Parkinson's disease: A structured review. Maturitas 2018; 113:53-72. [PMID: 29903649 DOI: 10.1016/j.maturitas.2018.04.011] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/19/2018] [Accepted: 04/24/2018] [Indexed: 10/17/2022]
Abstract
An emerging body of literature has examined cortical activity during walking and balance tasks in older adults and in people with Parkinson's disease, specifically using functional near infrared spectroscopy (fNIRS) or electroencephalography (EEG). This review provides an overview of this developing area, and examines the disease-specific mechanisms underlying walking or balance deficits. Medline, PubMed, PsychInfo and Scopus databases were searched. Articles that described cortical activity during walking and balance tasks in older adults and in those with PD were screened by the reviewers. Thirty-seven full-text articles were included for review, following an initial yield of 566 studies. This review summarizes study findings, where increased cortical activity appears to be required for older adults and further for participants with PD to perform walking and balance tasks, but specific activation patterns vary with the demands of the particular task. Studies attributed cortical activation to compensatory mechanisms for underlying age- or PD-related deficits in automatic movement control. However, a lack of standardization within the reviewed studies was evident from the wide range of study protocols, instruments, regions of interest, outcomes and interpretation of outcomes that were reported. Unstandardized data collection, processing and reporting limited the clinical relevance and interpretation of study findings. Future work to standardize approaches to the measurement of cortical activity during walking and balance tasks in older adults and people with PD with fNIRS and EEG systems is needed, which will allow direct comparison of results and ensure robust data collection/reporting. Based on the reviewed articles we provide clinical and future research recommendations.
Collapse
Affiliation(s)
- Samuel Stuart
- Oregon Health & Science University, Department of Neurology, Portland, OR, USA
| | - Rodrigo Vitorio
- Universidade Estadual Paulista (UNESP), Instituto de Biociências, Campus Rio Claro, Brazil
| | - Rosie Morris
- Oregon Health & Science University, Department of Neurology, Portland, OR, USA
| | - Douglas N Martini
- Oregon Health & Science University, Department of Neurology, Portland, OR, USA
| | - Peter C Fino
- Oregon Health & Science University, Department of Neurology, Portland, OR, USA
| | - Martina Mancini
- Oregon Health & Science University, Department of Neurology, Portland, OR, USA.
| |
Collapse
|
61
|
Maidan I, Shustak S, Sharon T, Bernad-Elazari H, Geffen N, Giladi N, Hausdorff JM, Mirelman A. Prefrontal cortex activation during obstacle negotiation: What’s the effect size and timing? Brain Cogn 2018; 122:45-51. [DOI: 10.1016/j.bandc.2018.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/09/2018] [Accepted: 02/09/2018] [Indexed: 11/30/2022]
|
62
|
Maidan I, Nieuwhof F, Bernad-Elazari H, Bloem BR, Giladi N, Hausdorff JM, Claassen JAHR, Mirelman A. Evidence for Differential Effects of 2 Forms of Exercise on Prefrontal Plasticity During Walking in Parkinson's Disease. Neurorehabil Neural Repair 2018; 32:200-208. [PMID: 29546797 DOI: 10.1177/1545968318763750] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In a randomized control trial conducted in patients with Parkinson's disease, a treadmill training program combined with virtual reality that targeted motor and cognitive aspects of safe ambulation led to fewer falls, compared with treadmill training alone. OBJECTIVE To investigate if the 2 types of training differentially affected prefrontal activation and if this might explain differences in fall rates after the intervention. METHODS Sixty-four patients with Parkinson's disease were randomized into the treadmill training arm (n = 34, mean age 73.1 ± 1.1 years, 64% men, disease duration 9.7 ± 1.0 years) or treadmill training with virtual reality arm (n = 30, mean age 70.1 ± 1.3 years, 71% men, disease duration 8.9 ± 1.1 years). Prefrontal activation during usual, dual-task, and obstacle negotiation walking was assessed before and after 6 weeks of training, using a functional near-infrared spectroscopy system. RESULTS Treadmill training with and without virtual reality reduced prefrontal activation during walking ( P < .001), with specific interactions related to training arm ( P = .01), lateralization ( P = .05), and walking condition ( P = .001). For example, among the subjects who trained with treadmill training alone, prefrontal activation during dual-task walking and obstacle negotiation increased after training, while in the combined training arm, activation decreased. CONCLUSIONS Prefrontal activation during usual and during more challenging walking conditions can be altered in response to 2 different types of training. The addition of a cognitive training component to a treadmill exercise program apparently modifies the effects of the training on the magnitude and lateralization of prefrontal activation and on falls, extending the understanding of the plasticity of the brain in PD.
Collapse
Affiliation(s)
- Inbal Maidan
- 1 Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,2 Tel Aviv University, Tel Aviv, Israel
| | - Freek Nieuwhof
- 3 Radboud University, Nijmegen, Netherlands.,4 Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Bastiaan R Bloem
- 3 Radboud University, Nijmegen, Netherlands.,4 Radboud University Medical Center, Nijmegen, Netherlands
| | - Nir Giladi
- 1 Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,2 Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- 1 Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,2 Tel Aviv University, Tel Aviv, Israel.,5 Rush University Medical Center, Chicago, IL, USA
| | - Jurgen A H R Claassen
- 3 Radboud University, Nijmegen, Netherlands.,4 Radboud University Medical Center, Nijmegen, Netherlands
| | - Anat Mirelman
- 1 Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,2 Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
63
|
Mezzarobba S, Grassi M, Valentini R, Bernardis P. Postural control deficit during sit-to-walk in patients with Parkinson's disease and freezing of gait. Gait Posture 2018; 61:325-330. [PMID: 29413805 DOI: 10.1016/j.gaitpost.2018.01.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 01/08/2018] [Accepted: 01/28/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The intricate linkage between Freezing of Gait (FoG) and postural control in Parkinson's disease (PD) is unclear. We analyzed the impact of FoG on dynamic postural control. METHODS 24 PD patients, 12 with (PD + FoG), 12 without FoG (PD-FoG), and 12 healthy controls, were assessed in ON state. Mobility and postural control were measured with clinical scales (UPDRS III, BBS, MPAS) and with kinematic and kinetic analysis during three tasks, characterized by levels of increasing difficulty to plan sequential movement of postural control: walk (W), gait initiation (GI) and sit-to-walk (STW). RESULTS The groups were balanced by age, disease duration, disease severity, mobility and balance. During STW, the spatial distribution of COP trajectories in PD + FoG patients are spread over medial-lateral space more than in the PD-FoG (p < .001). Moreover, the distribution of COP positions. in the transition between sit-to-stand and gait initiation, is not properly shifted toward the leading leg, as in PD-FoG and healthy controls, but it is more centrally dispersed (p < .01) with a delayed weight forward progression (p < .05). In GI task and walk task, COM and COP differences are less evident and even absent between PD patients. CONCLUSION PD + FoG show postural control differences in STW, compared with PD-FoG and healthy. Different spatial distribution of COP trajectories, between two PD groups are probably due to a deficit to plan postural control during a more demanding motor pattern, such as STW.
Collapse
Affiliation(s)
- Susanna Mezzarobba
- Department of Life Sciences, University of Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy
| | - Michele Grassi
- Department of Life Sciences, University of Trieste, Italy
| | - Roberto Valentini
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy
| | | |
Collapse
|
64
|
Pfeifer MD, Scholkmann F, Labruyère R. Signal Processing in Functional Near-Infrared Spectroscopy (fNIRS): Methodological Differences Lead to Different Statistical Results. Front Hum Neurosci 2018; 11:641. [PMID: 29358912 PMCID: PMC5766679 DOI: 10.3389/fnhum.2017.00641] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/18/2017] [Indexed: 11/13/2022] Open
Abstract
Even though research in the field of functional near-infrared spectroscopy (fNIRS) has been performed for more than 20 years, consensus on signal processing methods is still lacking. A significant knowledge gap exists between established researchers and those entering the field. One major issue regularly observed in publications from researchers new to the field is the failure to consider possible signal contamination by hemodynamic changes unrelated to neurovascular coupling (i.e., scalp blood flow and systemic blood flow). This might be due to the fact that these researchers use the signal processing methods provided by the manufacturers of their measurement device without an advanced understanding of the performed steps. The aim of the present study was to investigate how different signal processing approaches (including and excluding approaches that partially correct for the possible signal contamination) affect the results of a typical functional neuroimaging study performed with fNIRS. In particular, we evaluated one standard signal processing method provided by a commercial company and compared it to three customized approaches. We thereby investigated the influence of the chosen method on the statistical outcome of a clinical data set (task-evoked motor cortex activity). No short-channels were used in the present study and therefore two types of multi-channel corrections based on multiple long-channels were applied. The choice of the signal processing method had a considerable influence on the outcome of the study. While methods that ignored the contamination of the fNIRS signals by task-evoked physiological noise yielded several significant hemodynamic responses over the whole head, the statistical significance of these findings disappeared when accounting for part of the contamination using a multi-channel regression. We conclude that adopting signal processing methods that correct for physiological confounding effects might yield more realistic results in cases where multi-distance measurements are not possible. Furthermore, we recommend using manufacturers' standard signal processing methods only in case the user has an advanced understanding of every signal processing step performed.
Collapse
Affiliation(s)
- Mischa D. Pfeifer
- Rehabilitation Center for Children and Adolescents, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
| | - Felix Scholkmann
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rob Labruyère
- Rehabilitation Center for Children and Adolescents, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
65
|
Vitorio R, Stuart S, Rochester L, Alcock L, Pantall A. fNIRS response during walking — Artefact or cortical activity? A systematic review. Neurosci Biobehav Rev 2017; 83:160-172. [DOI: 10.1016/j.neubiorev.2017.10.002] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 11/25/2022]
|
66
|
Herold F, Wiegel P, Scholkmann F, Thiers A, Hamacher D, Schega L. Functional near-infrared spectroscopy in movement science: a systematic review on cortical activity in postural and walking tasks. NEUROPHOTONICS 2017; 4:041403. [PMID: 28924563 PMCID: PMC5538329 DOI: 10.1117/1.nph.4.4.041403] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 06/23/2017] [Indexed: 05/07/2023]
Abstract
Safe locomotion is a crucial aspect of human daily living that requires well-functioning motor control processes. The human neuromotor control of daily activities such as walking relies on the complex interaction of subcortical and cortical areas. Technical developments in neuroimaging systems allow the quantification of cortical activation during the execution of motor tasks. Functional near-infrared spectroscopy (fNIRS) seems to be a promising tool to monitor motor control processes in cortical areas in freely moving subjects. However, so far, there is no established standardized protocol regarding the application and data processing of fNIRS signals that limits the comparability among studies. Hence, this systematic review aimed to summarize the current knowledge about application and data processing in fNIRS studies dealing with walking or postural tasks. Fifty-six articles of an initial yield of 1420 publications were reviewed and information about methodology, data processing, and findings were extracted. Based on our results, we outline the recommendations with respect to the design and data processing of fNIRS studies. Future perspectives of measuring fNIRS signals in movement science are discussed.
Collapse
Affiliation(s)
- Fabian Herold
- Otto von Guericke University Magdeburg, Institute III, Department of Sport Science, Magdeburg, Germany
- Address all correspondence to: Fabian Herold, E-mail:
| | - Patrick Wiegel
- University of Freiburg, Department of Sport Science, Freiburg, Germany
| | - Felix Scholkmann
- University of Zurich, University Hospital Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zurich, Switzerland
| | - Angelina Thiers
- Otto von Guericke University Magdeburg, Institute III, Department of Sport Science, Magdeburg, Germany
| | - Dennis Hamacher
- Otto von Guericke University Magdeburg, Institute III, Department of Sport Science, Magdeburg, Germany
| | - Lutz Schega
- Otto von Guericke University Magdeburg, Institute III, Department of Sport Science, Magdeburg, Germany
| |
Collapse
|
67
|
Palmerini L, Rocchi L, Mazilu S, Gazit E, Hausdorff JM, Chiari L. Identification of Characteristic Motor Patterns Preceding Freezing of Gait in Parkinson's Disease Using Wearable Sensors. Front Neurol 2017; 8:394. [PMID: 28855887 PMCID: PMC5557770 DOI: 10.3389/fneur.2017.00394] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/24/2017] [Indexed: 01/10/2023] Open
Abstract
Freezing of gait (FOG) is a disabling symptom that is common among patients with advanced Parkinson’s disease (PD). External cues such as rhythmic auditory stimulation can help PD patients experiencing freezing to resume walking. Wearable systems for automatic freezing detection have been recently developed. However, these systems detect a FOG episode after it has happened. Instead, in this study, a new approach for the prediction of FOG (before it actually happens) is presented. Prediction of FOG might enable preventive cueing, reducing the likelihood that FOG will occur. Moreover, understanding the causes and circumstances of FOG is still an open research problem. Hence, a quantitative characterization of movement patterns just before FOG (the pre-FOG phase) is of great importance. In this study, wearable inertial sensors were used to identify and quantify the characteristics of gait during the pre-FOG phase and compare them with the characteristics of gait that do not precede FOG. The hypothesis of this study is based on the threshold-based model of FOG, which suggests that before FOG occurs, there is a degradation of the gait pattern. Eleven PD subjects were analyzed. Six features extracted from movement signals recorded by inertial sensors showed significant differences between gait and pre-FOG. A classification algorithm was developed in order to test if it is feasible to predict FOG (i.e., detect it before it happens). The aim of the classification procedure was to identify the pre-FOG phase. Results confirm that there is a degradation of gait occurring before freezing. Results also provide preliminary evidence on the feasibility of creating an automatic algorithm to predict FOG. Although some limitations are present, this study shows promising findings for characterizing and identifying pre-FOG patterns, another step toward a better understanding, prediction, and prevention of this disabling symptom.
Collapse
Affiliation(s)
- Luca Palmerini
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Laura Rocchi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Sinziana Mazilu
- Wearable Computing Laboratory, ETH Zurich, Zurich, Switzerland
| | - Eran Gazit
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy.,Health Science and Technologies Interdepartmental Center for Industrial Research (HST-ICIR), University of Bologna, Bologna, Italy
| |
Collapse
|
68
|
Kim HY, Seo K, Jeon HJ, Lee U, Lee H. Application of Functional Near-Infrared Spectroscopy to the Study of Brain Function in Humans and Animal Models. Mol Cells 2017; 40:523-532. [PMID: 28835022 PMCID: PMC5582298 DOI: 10.14348/molcells.2017.0153] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/03/2017] [Indexed: 01/26/2023] Open
Abstract
Functional near-infrared spectroscopy (fNIRS) is a noninvasive optical imaging technique that indirectly assesses neuronal activity by measuring changes in oxygenated and deoxygenated hemoglobin in tissues using near-infrared light. fNIRS has been used not only to investigate cortical activity in healthy human subjects and animals but also to reveal abnormalities in brain function in patients suffering from neurological and psychiatric disorders and in animals that exhibit disease conditions. Because of its safety, quietness, resistance to motion artifacts, and portability, fNIRS has become a tool to complement conventional imaging techniques in measuring hemodynamic responses while a subject performs diverse cognitive and behavioral tasks in test settings that are more ecologically relevant and involve social interaction. In this review, we introduce the basic principles of fNIRS and discuss the application of this technique in human and animal studies.
Collapse
Affiliation(s)
- Hak Yeong Kim
- Department of Brain and Cognitive Sciences, DGIST, Daegu 42988,
Korea
| | - Kain Seo
- Department of Brain and Cognitive Sciences, DGIST, Daegu 42988,
Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul 06351,
Korea
| | - Unjoo Lee
- Department of Electronic Engineering, Hallym University, Kangwon 24252,
Korea
| | - Hyosang Lee
- Department of Brain and Cognitive Sciences, DGIST, Daegu 42988,
Korea
| |
Collapse
|
69
|
Causse M, Chua Z, Peysakhovich V, Del Campo N, Matton N. Mental workload and neural efficiency quantified in the prefrontal cortex using fNIRS. Sci Rep 2017; 7:5222. [PMID: 28701789 PMCID: PMC5507990 DOI: 10.1038/s41598-017-05378-x] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/30/2017] [Indexed: 11/13/2022] Open
Abstract
An improved understanding of how the brain allocates mental resources as a function of task difficulty is critical for enhancing human performance. Functional near infrared spectroscopy (fNIRS) is a field-deployable optical brain monitoring technology that provides a direct measure of cerebral blood flow in response to cognitive activity. We found that fNIRS was sensitive to variations in task difficulty in both real-life (flight simulator) and laboratory settings (tests measuring executive functions), showing increased concentration of oxygenated hemoglobin (HbO2) and decreased concentration of deoxygenated hemoglobin (HHb) in the prefrontal cortex as the tasks became more complex. Intensity of prefrontal activation (HbO2 concentration) was not clearly correlated to task performance. Rather, activation intensity shed insight on the level of mental effort, i.e., how hard an individual was working to accomplish a task. When combined with performance, fNIRS provided an estimate of the participants' neural efficiency, and this efficiency was consistent across levels of difficulty of the same task. Overall, our data support the suitability of fNIRS to assess the mental effort related to human operations and represents a promising tool for the measurement of neural efficiency in other contexts such as training programs or the clinical setting.
Collapse
Affiliation(s)
- Mickaël Causse
- Institut Supérieur de l'Aéronautique et de l'Espace (ISAE-SUPAERO), Toulouse, France.
- Ecole de psychologie, Université Laval, Québec, Canada.
| | - Zarrin Chua
- Institut Supérieur de l'Aéronautique et de l'Espace (ISAE-SUPAERO), Toulouse, France
| | - Vsevolod Peysakhovich
- Institut Supérieur de l'Aéronautique et de l'Espace (ISAE-SUPAERO), Toulouse, France
| | - Natalia Del Campo
- Centre of Excellence in Neurodegeneration of Toulouse, NeuroToul, CHU Toulouse, France
- Toulouse NeuroImaging Center, ToNIC, University of Toulouse, Inserm, UPS, Toulouse, France
- University of Cambridge, Department of Psychiatry, Addenbrooke's Hospital, Cambridge, UK
| | - Nadine Matton
- Ecole Nationale de l'Aviation Civile, Toulouse, 31055, France
- Laboratoire CLLE-LTC, 5 Allée Antonio Machado, 31100, Toulouse, France
| |
Collapse
|
70
|
Maidan I, Bernad-Elazari H, Giladi N, Hausdorff JM, Mirelman A. When is Higher Level Cognitive Control Needed for Locomotor Tasks Among Patients with Parkinson’s Disease? Brain Topogr 2017; 30:531-538. [DOI: 10.1007/s10548-017-0564-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 04/19/2017] [Indexed: 02/02/2023]
|
71
|
Wittenberg E, Thompson J, Nam CS, Franz JR. Neuroimaging of Human Balance Control: A Systematic Review. Front Hum Neurosci 2017; 11:170. [PMID: 28443007 PMCID: PMC5385364 DOI: 10.3389/fnhum.2017.00170] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/22/2017] [Indexed: 12/13/2022] Open
Abstract
This review examined 83 articles using neuroimaging modalities to investigate the neural correlates underlying static and dynamic human balance control, with aims to support future mobile neuroimaging research in the balance control domain. Furthermore, this review analyzed the mobility of the neuroimaging hardware and research paradigms as well as the analytical methodology to identify and remove movement artifact in the acquired brain signal. We found that the majority of static balance control tasks utilized mechanical perturbations to invoke feet-in-place responses (27 out of 38 studies), while cognitive dual-task conditions were commonly used to challenge balance in dynamic balance control tasks (20 out of 32 studies). While frequency analysis and event related potential characteristics supported enhanced brain activation during static balance control, that in dynamic balance control studies was supported by spatial and frequency analysis. Twenty-three of the 50 studies utilizing EEG utilized independent component analysis to remove movement artifacts from the acquired brain signals. Lastly, only eight studies used truly mobile neuroimaging hardware systems. This review provides evidence to support an increase in brain activation in balance control tasks, regardless of mechanical, cognitive, or sensory challenges. Furthermore, the current body of literature demonstrates the use of advanced signal processing methodologies to analyze brain activity during movement. However, the static nature of neuroimaging hardware and conventional balance control paradigms prevent full mobility and limit our knowledge of neural mechanisms underlying balance control.
Collapse
Affiliation(s)
- Ellen Wittenberg
- Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State UniversityRaleigh, NC, USA
| | - Jessica Thompson
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State UniversityChapel Hill, NC, USA
| | - Chang S Nam
- Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State UniversityRaleigh, NC, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State UniversityChapel Hill, NC, USA
| |
Collapse
|
72
|
Labriffe M, Annweiler C, Amirova LE, Gauquelin-Koch G, Ter Minassian A, Leiber LM, Beauchet O, Custaud MA, Dinomais M. Brain Activity during Mental Imagery of Gait Versus Gait-Like Plantar Stimulation: A Novel Combined Functional MRI Paradigm to Better Understand Cerebral Gait Control. Front Hum Neurosci 2017; 11:106. [PMID: 28321186 PMCID: PMC5337483 DOI: 10.3389/fnhum.2017.00106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/20/2017] [Indexed: 01/27/2023] Open
Abstract
Human locomotion is a complex sensorimotor behavior whose central control remains difficult to explore using neuroimaging method due to technical constraints, notably the impossibility to walk with a scanner on the head and/or to walk for real inside current scanners. The aim of this functional Magnetic Resonance Imaging (fMRI) study was to analyze interactions between two paradigms to investigate the brain gait control network: (1) mental imagery of gait, and (2) passive mechanical stimulation of the plantar surface of the foot with the Korvit boots. The Korvit stimulator was used through two different modes, namely an organized (“gait like”) sequence and a destructured (chaotic) pattern. Eighteen right-handed young healthy volunteers were recruited (mean age, 27 ± 4.7 years). Mental imagery activated a broad neuronal network including the supplementary motor area-proper (SMA-proper), pre-SMA, the dorsal premotor cortex, ventrolateral prefrontal cortex, anterior insula, and precuneus/superior parietal areas. The mechanical plantar stimulation activated the primary sensorimotor cortex and secondary somatosensory cortex bilaterally. The paradigms generated statistically common areas of activity, notably bilateral SMA-proper and right pre-SMA, highlighting the potential key role of SMA in gait control. There was no difference between the organized and chaotic Korvit sequences, highlighting the difficulty of developing a walking-specific plantar stimulation paradigm. In conclusion, this combined-fMRI paradigm combining mental imagery and gait-like plantar stimulation provides complementary information regarding gait-related brain activity and appears useful for the assessment of high-level gait control.
Collapse
Affiliation(s)
- Matthieu Labriffe
- Laboratoire Angevin de Recherche en Ingénierie des Systèmes, EA7315, University of Angers - Université Nantes Angers Le MansAngers, France; Department of Radiology, Angers University Hospital, University of Angers - Université Nantes Angers Le MansAngers, France
| | - Cédric Annweiler
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic - Angers University Hospital; UPRES EA 4638 - University of Angers, Université Nantes Angers Le MansAngers, France; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, LondonON, Canada
| | - Liubov E Amirova
- Laboratoire de Biologie Neuro-Vasculaire et Mitochondriale Intégrée, UMR CNRS 6214 INSERM U1083, University of AngersAngers, France; Institute of Biomedical Problems, Russian Academy of SciencesMoscow, Russia
| | | | - Aram Ter Minassian
- Laboratoire Angevin de Recherche en Ingénierie des Systèmes, EA7315, University of Angers - Université Nantes Angers Le MansAngers, France; Department of Anesthesia and Critical Care, Angers University Hospital - University of Angers, Université Nantes Angers Le MansAngers, France
| | - Louis-Marie Leiber
- Laboratoire Angevin de Recherche en Ingénierie des Systèmes, EA7315, University of Angers - Université Nantes Angers Le MansAngers, France; Department of Radiology, Angers University Hospital, University of Angers - Université Nantes Angers Le MansAngers, France
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, MontrealQC, Canada; Dr. Joseph Kaufmann Chair in Geriatric Medicine, Faculty of Medicine, McGill University, MontrealQC, Canada
| | - Marc-Antoine Custaud
- Laboratoire de Biologie Neuro-Vasculaire et Mitochondriale Intégrée, UMR CNRS 6214 INSERM U1083, University of AngersAngers, France; Clinical Research Center, Angers University Hospital, University of Angers - Université Nantes Angers Le MansAngers, France
| | - Mickaël Dinomais
- Laboratoire Angevin de Recherche en Ingénierie des Systèmes, EA7315, University of Angers - Université Nantes Angers Le MansAngers, France; Department of Physical and Rehabilitation Medicine, Angers University Hospital, University of Angers - Université Nantes Angers Le MansAngers, France
| |
Collapse
|
73
|
Home detection of freezing of gait using support vector machines through a single waist-worn triaxial accelerometer. PLoS One 2017; 12:e0171764. [PMID: 28199357 PMCID: PMC5310916 DOI: 10.1371/journal.pone.0171764] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/25/2017] [Indexed: 11/19/2022] Open
Abstract
Among Parkinson’s disease (PD) symptoms, freezing of gait (FoG) is one of the most debilitating. To assess FoG, current clinical practice mostly employs repeated evaluations over weeks and months based on questionnaires, which may not accurately map the severity of this symptom. The use of a non-invasive system to monitor the activities of daily living (ADL) and the PD symptoms experienced by patients throughout the day could provide a more accurate and objective evaluation of FoG in order to better understand the evolution of the disease and allow for a more informed decision-making process in making adjustments to the patient’s treatment plan. This paper presents a new algorithm to detect FoG with a machine learning approach based on Support Vector Machines (SVM) and a single tri-axial accelerometer worn at the waist. The method is evaluated through the acceleration signals in an outpatient setting gathered from 21 PD patients at their home and evaluated under two different conditions: first, a generic model is tested by using a leave-one-out approach and, second, a personalised model that also uses part of the dataset from each patient. Results show a significant improvement in the accuracy of the personalised model compared to the generic model, showing enhancement in the specificity and sensitivity geometric mean (GM) of 7.2%. Furthermore, the SVM approach adopted has been compared to the most comprehensive FoG detection method currently in use (referred to as MBFA in this paper). Results of our novel generic method provide an enhancement of 11.2% in the GM compared to the MBFA generic model and, in the case of the personalised model, a 10% of improvement with respect to the MBFA personalised model. Thus, our results show that a machine learning approach can be used to monitor FoG during the daily life of PD patients and, furthermore, personalised models for FoG detection can be used to improve monitoring accuracy.
Collapse
|
74
|
Gramigna V, Pellegrino G, Cerasa A, Cutini S, Vasta R, Olivadese G, Martino I, Quattrone A. Near-Infrared Spectroscopy in Gait Disorders: Is It Time to Begin? Neurorehabil Neural Repair 2017; 31:402-412. [PMID: 28196453 DOI: 10.1177/1545968317693304] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Walking is a complex motor behavior with a special relevance in clinical neurology. Many neurological diseases, such as Parkinson's disease and stroke, are characterized by gait disorders whose neurofunctional correlates are poorly investigated. Indeed, the analysis of real walking with the standard neuroimaging techniques poses strong challenges, and only a few studies on motor imagery or walking observation have been performed so far. Functional near-infrared spectroscopy (fNIRS) is becoming an important research tool to assess functional activity in neurological populations or for special tasks, such as walking, because it allows investigating brain hemodynamic activity in an ecological setting, without strong immobility constraints. A systematic review following PRISMA guidelines was conducted on the fNIRS-based examination of gait disorders. Twelve of the initial yield of 489 articles have been included in this review. The lesson learnt from these studies suggest that oxy-hemoglobin levels within the prefrontal and premotor cortices are more sensitive to compensation strategies reflecting postural control and restoration of gait disorders. Although this field of study is in its relative infancy, the evidence provided encourages the translation of fNIRS in clinical practice, as it offers a unique opportunity to explore in depth the activity of the cortical motor system during real walking in neurological patients. We also discuss to what extent fNIRS may be applied for assessing the effectiveness of rehabilitation programs.
Collapse
Affiliation(s)
| | | | - Antonio Cerasa
- 1 University Magna Graecia, Catanzaro, Italy.,3 Istituto di Bioimmagini e Fisiologia Molecolare, National Research Council, Catanzaro, Italy
| | - Simone Cutini
- 4 Department of Developmental Psychology, University of Padova, Padova, Italy
| | | | - Giuseppe Olivadese
- 3 Istituto di Bioimmagini e Fisiologia Molecolare, National Research Council, Catanzaro, Italy
| | | | - Aldo Quattrone
- 1 University Magna Graecia, Catanzaro, Italy.,3 Istituto di Bioimmagini e Fisiologia Molecolare, National Research Council, Catanzaro, Italy
| |
Collapse
|
75
|
Cortical activation during balancing on a balance board. Hum Mov Sci 2017; 51:51-58. [DOI: 10.1016/j.humov.2016.11.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 07/26/2016] [Accepted: 11/07/2016] [Indexed: 01/28/2023]
|
76
|
Cucca A, Biagioni MC, Fleisher JE, Agarwal S, Son A, Kumar P, Brys M, Di Rocco A. Freezing of gait in Parkinson's disease: from pathophysiology to emerging therapies. Neurodegener Dis Manag 2016; 6:431-46. [PMID: 27599588 DOI: 10.2217/nmt-2016-0018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Freezing of gait (FOG) is 'an episodic inability to generate effective stepping in the absence of any known cause other than parkinsonism or high level gait disorders'. FOG is one of the most disabling symptoms in Parkinson's disease, especially in its more advanced stages. Early recognition is important as FOG is related to higher fall risk and poorer prognosis. Although specific treatments are still elusive, there have been recent advances in the development of new therapeutic approaches. The aim of this review is to present the latest knowledge regarding the phenomenology, pathogenesis, diagnostic assessment and conventional treatment of FOG in Parkinson's disease. A review of the evidence supporting noninvasive brain stimulation will follow to highlight the potential of these strategies.
Collapse
Affiliation(s)
- Alberto Cucca
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA.,Department of Medicine, Surgery & Health Sciences, University of Trieste, Clinica Neurologica, Trieste, Italy
| | - Milton C Biagioni
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Jori E Fleisher
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Shashank Agarwal
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Andre Son
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Pawan Kumar
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Miroslaw Brys
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Alessandro Di Rocco
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| |
Collapse
|
77
|
Rosenberg-Katz K, Maidan I, Jacob Y, Giladi N, Mirelman A, Hausdorff JM. Alterations in conflict monitoring are related to functional connectivity in Parkinson's disease. Cortex 2016; 82:277-286. [DOI: 10.1016/j.cortex.2016.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/02/2016] [Accepted: 06/16/2016] [Indexed: 02/03/2023]
|
78
|
Rosenberg-Katz K, Herman T, Jacob Y, Kliper E, Giladi N, Hausdorff JM. Subcortical Volumes Differ in Parkinson's Disease Motor Subtypes: New Insights into the Pathophysiology of Disparate Symptoms. Front Hum Neurosci 2016; 10:356. [PMID: 27462214 PMCID: PMC4939290 DOI: 10.3389/fnhum.2016.00356] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/29/2016] [Indexed: 01/18/2023] Open
Abstract
Objectives: Patients with Parkinson’s disease (PD) can be classified, based on their motor symptoms into the Postural Instability Gait Difficulty (PIGD) subtype or the Tremor Dominant (TD) subtype. Gray matter changes between the subtypes have been reported using whole brain Voxel-Based Morphometry (VBM), however, the evaluation of subcortical gray matter volumetric differences between these subtypes using automated volumetric analysis has only been studied in relatively small sample sizes and needs further study to confirm that the negative findings were not due to the sample size. Therefore, we aimed to evaluate volumetric changes in subcortical regions and their association with PD motor subtypes. Methods: Automated volumetric magnetic resonance imaging (MRI) analysis quantified the subcortical gray matter volumes of patients with PD in the PIGD subtype (n = 30), in the TD subtype (n = 30), and in 28 healthy controls (HCs). Results: Significantly lower amygdala and globus pallidus gray matter volume was detected in the PIGD, as compared to the TD subtype, with a trend for an association between globus pallidus degeneration and higher (worse) PIGD scores. Furthermore, among all the patients with PD, higher hippocampal volumes were correlated with a higher (better) dual tasking gait speed (r = 0.30, p < 0.002) and with a higher global cognitive score (r = 0.36, p < 0.0001). Lower putamen volume was correlated with a higher (worse) freezing of gait score (r = −0.28, p < 0.004), an episodic symptom which is common among the PIGD subtype. As expected, differences detected between HCs and patients in the PD subgroups included regions within the amygdala and the dorsal striatum but not the ventral striatum, a brain region that is generally considered to be more preserved in PD. Conclusions: The disparate patterns of subcortical degeneration can explain some of the differences in symptoms between the PD subtypes such as gait disturbances and cognitive functions. These findings may, in the future, help to inform a personalized therapeutic approach.
Collapse
Affiliation(s)
- Keren Rosenberg-Katz
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical CenterTel Aviv, Israel; Functional Brain Center, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical CenterTel Aviv, Israel
| | - Talia Herman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv, Israel
| | - Yael Jacob
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical CenterTel Aviv, Israel; Functional Brain Center, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical CenterTel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv UniversityTel Aviv, Israel
| | - Efrat Kliper
- Functional Brain Center, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical CenterTel Aviv, Israel; Neurological Institute, Tel Aviv Medical CenterTel Aviv, Israel
| | - Nir Giladi
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical CenterTel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv UniversityTel Aviv, Israel; Neurological Institute, Tel Aviv Medical CenterTel Aviv, Israel; Department of Neurology, Sackler Faculty of Medicine, Tel Aviv UniversityTel Aviv, Israel
| | - Jeffery M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical CenterTel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv UniversityTel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv UniversityTel Aviv, Israel
| |
Collapse
|
79
|
Maidan I, Nieuwhof F, Bernad-Elazari H, Reelick MF, Bloem BR, Giladi N, Deutsch JE, Hausdorff JM, Claassen JAH, Mirelman A. The Role of the Frontal Lobe in Complex Walking Among Patients With Parkinson's Disease and Healthy Older Adults: An fNIRS Study. Neurorehabil Neural Repair 2016; 30:963-971. [PMID: 27221042 DOI: 10.1177/1545968316650426] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gait is influenced by higher order cognitive and cortical control mechanisms. Functional near infrared spectroscopy (fNIRS) has been used to examine frontal activation during walking in healthy older adults, reporting increased oxygenated hemoglobin (HbO2) levels during dual task walking (DT), compared with usual walking. OBJECTIVE To investigate the role of the frontal lobe during DT and obstacle negotiation, in healthy older adults and patients with Parkinson's disease (PD). METHODS Thirty-eight healthy older adults (mean age 70.4 ± 0.9 years) and 68 patients with PD (mean age 71.7 ± 1.1 years,) performed 3 walking tasks: (a) usual walking, (b) DT walking, and (c) obstacles negotiation, with fNIRS and accelerometers. Linear-mix models were used to detect changes between groups and within tasks. RESULTS Patients with PD had higher activation during usual walking (P < .030). During DT, HbO2 increased only in healthy older adults (P < .001). During obstacle negotiation, HbO2 increased in patients with PD (P = .001) and tended to increase in healthy older adults (P = .053). Higher DT and obstacle cost (P < .003) and worse cognitive performance were observed in patients with PD (P = .001). CONCLUSIONS A different pattern of frontal activation during walking was observed between groups. The higher activation during usual walking in patients with PD suggests that the prefrontal cortex plays an important role already during simple walking. However, higher activation relative to baseline during obstacle negotiation and not during DT in the patients with PD demonstrates that prefrontal activation depends on the nature of the task. These findings may have important implications for rehabilitation of gait in patients with PD.
Collapse
Affiliation(s)
- Inbal Maidan
- Neurological Institute, Tel Aviv Medical Center, Israel Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Freek Nieuwhof
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Miriam F Reelick
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands Radboud University Medical Center, Nijmegen, Netherlands
| | - Bas R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands Radboud University Medical Center, Nijmegen, Netherlands
| | - Nir Giladi
- Neurological Institute, Tel Aviv Medical Center, Israel Tel Aviv University, Tel Aviv, Israel
| | | | - Jeffery M Hausdorff
- Neurological Institute, Tel Aviv Medical Center, Israel Tel Aviv University, Tel Aviv, Israel
| | - Jurgen A H Claassen
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands Radboud University Medical Center, Nijmegen, Netherlands
| | - Anat Mirelman
- Neurological Institute, Tel Aviv Medical Center, Israel Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
80
|
Stuart S, Lord S, Hill E, Rochester L. Gait in Parkinson's disease: A visuo-cognitive challenge. Neurosci Biobehav Rev 2016; 62:76-88. [PMID: 26773722 DOI: 10.1016/j.neubiorev.2016.01.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/15/2015] [Accepted: 01/05/2016] [Indexed: 12/18/2022]
Abstract
Vision and cognition have both been related to gait impairment in Parkinson's disease (PD) through separate strands of research. The cumulative and interactive effect of both (which we term visuo-cognition) has not been previously investigated and little is known about the influence of cognition on vision with respect to gait. Understanding the role of vision, cognition and visuo-cognition in gait in PD is critical for data interpretation and to infer and test underlying mechanisms. The purpose of this comprehensive narrative review was to examine the interdependent and interactive role of cognition and vision in gait in PD and older adults. Evidence from a broad range of research disciplines was reviewed and summarised. A key finding was that attention appears to play a pivotal role in mediating gait, cognition and vision, and should be considered emphatically in future research in this field.
Collapse
Affiliation(s)
- Samuel Stuart
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sue Lord
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elizabeth Hill
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Institute of Neuroscience/Newcastle University Institute of Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality Newcastle University, Newcastle upon Tyne, United Kingdom.
| |
Collapse
|
81
|
Vervoort G, Heremans E, Bengevoord A, Strouwen C, Nackaerts E, Vandenberghe W, Nieuwboer A. Dual-task-related neural connectivity changes in patients with Parkinson' disease. Neuroscience 2016; 317:36-46. [PMID: 26762801 DOI: 10.1016/j.neuroscience.2015.12.056] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/19/2015] [Accepted: 12/30/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Dual-task (DT) gait impairment in people with Parkinson's disease (PD) and specifically in those with freezing of gait (FOG), reflects attentional dependency of movement. This study aimed to elucidate resting-state brain connectivity alterations related to DT gait abnormalities in PD with and without FOG. METHODS PD patients (n=73) and healthy age-matched controls (n=20) underwent DT gait analysis and resting-state functional Magnetic Resonance Imaging (rs-MRI) while 'off' medication. Patients were classified as freezer (n=13) or non-freezer (n=60). Functional connectivity (FC) alterations between PD and controls and between patient subgroups were assessed in regions of interest (ROIs) within the fronto-parietal and motor network. RESULTS PD had longer stance times, shorter swing times and more step length asymmetry during DT gait and needed more time and steps during DT turning compared to controls. Additionally, freezers showed similar impairments and longer double support times compared to non-freezers during DT gait. PD demonstrated hyper-connectivity between the inferior parietal lobule and premotor cortex (PMC) and between the cerebellum and the PMC and M1. FOG-specific hypo-connectivity within the striatum and between the caudate and superior temporal lobe and hyper-connectivity between the dorsal putamen and precuneus was correlated with worse DT performance. CONCLUSION PD showed FC alterations in DT-related networks, which were not correlated to DT performance. However, FOG-specific FC alterations in DT-related regions involving the precuneus and striatum were correlated to worse DT performance, suggesting that the balance between cognitive and motor networks is altered.
Collapse
Affiliation(s)
- G Vervoort
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
| | - E Heremans
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
| | - A Bengevoord
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
| | - C Strouwen
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
| | - E Nackaerts
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
| | - W Vandenberghe
- University Hospitals Leuven, Department of Neurology, Leuven, Belgium.
| | - A Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
| |
Collapse
|
82
|
Beck EN, Ehgoetz Martens KA, Almeida QJ. Freezing of Gait in Parkinson's Disease: An Overload Problem? PLoS One 2015; 10:e0144986. [PMID: 26678262 PMCID: PMC4682987 DOI: 10.1371/journal.pone.0144986] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/26/2015] [Indexed: 11/18/2022] Open
Abstract
Freezing of gait (FOG) is arguably the most severe symptom associated with Parkinson's disease (PD), and often occurs while performing dual tasks or approaching narrowed and cluttered spaces. While it is well known that visual cues alleviate FOG, it is not clear if this effect may be the result of cognitive or sensorimotor mechanisms. Nevertheless, the role of vision may be a critical link that might allow us to disentangle this question. Gaze behaviour has yet to be carefully investigated while freezers approach narrow spaces, thus the overall objective of this study was to explore the interaction between cognitive and sensory-perceptual influences on FOG. In experiment #1, if cognitive load is the underlying factor leading to FOG, then one might expect that a dual-task would elicit FOG episodes even in the presence of visual cues, since the load on attention would interfere with utilization of visual cues. Alternatively, if visual cues alleviate gait despite performance of a dual-task, then it may be more probable that sensory mechanisms are at play. In compliment to this, the aim of experiment#2 was to further challenge the sensory systems, by removing vision of the lower-limbs and thereby forcing participants to rely on other forms of sensory feedback rather than vision while walking toward the narrow space. Spatiotemporal aspects of gait, percentage of gaze fixation frequency and duration, as well as skin conductance levels were measured in freezers and non-freezers across both experiments. Results from experiment#1 indicated that although freezers and non-freezers both walked with worse gait while performing the dual-task, in freezers, gait was relieved by visual cues regardless of whether the cognitive demands of the dual-task were present. At baseline and while dual-tasking, freezers demonstrated a gaze behaviour that neglected the doorway and instead focused primarily on the pathway, a strategy that non-freezers adopted only when performing the dual-task. Interestingly, with the combination of visual cues and dual-task, freezers increased the frequency and duration of fixations toward the doorway, compared to non-freezers. These results suggest that although increasing demand on attention does significantly deteriorate gait in freezers, an increase in cognitive demand is not exclusively responsible for freezing (since visual cues were able to overcome any interference elicited by the dual-task). When vision of the lower limbs was removed in experiment#2, only the freezers' gait was affected. However, when visual cues were present, freezers' gait improved regardless of the dual-task. This gait behaviour was accompanied by greater amount of time spent looking at the visual cues irrespective of the dual-task. Since removing vision of the lower-limbs hindered gait even under low attentional demand, restricted sensory feedback may be an important factor to the mechanisms underlying FOG.
Collapse
Affiliation(s)
- Eric N. Beck
- Sun Life Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Kaylena A. Ehgoetz Martens
- Sun Life Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Quincy J. Almeida
- Sun Life Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
- * E-mail:
| |
Collapse
|
83
|
Mazilu S, Calatroni A, Gazit E, Mirelman A, Hausdorff JM, Troster G. Prediction of Freezing of Gait in Parkinson's From Physiological Wearables: An Exploratory Study. IEEE J Biomed Health Inform 2015; 19:1843-54. [DOI: 10.1109/jbhi.2015.2465134] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|