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Staring WHA, van Duijnhoven HJR, Roelofs JMB, Zandvliet S, den Boer J, Lem FC, Geurts ACH, Weerdesteyn V. Improvements in spatiotemporal outcomes, but not in recruitment of automatic postural responses, are correlated with improved step quality following perturbation-based balance training in chronic stroke. Front Sports Act Living 2022; 4:1008236. [DOI: 10.3389/fspor.2022.1008236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
IntroductionPeople with stroke often exhibit balance impairments, even in the chronic phase. Perturbation-based balance training (PBT) is a therapy that has yielded promising results in healthy elderly and several patient populations. Here, we present a threefold approach showing changes in people with chronic stroke after PBT on the level of recruitment of automatic postural responses (APR), step parameters and step quality. In addition, we provide insight into possible correlations across these outcomes and their changes after PBT.MethodsWe performed a complementary analysis of a recent PBT study. Participants received a 5-week PBT on the Radboud Fall simulator. During pre- and post-intervention assessments participants were exposed to platform translations in forward and backward directions. We performed electromyography of lower leg muscles to identify changes in APR recruitment. In addition, 3D kinematic data of stepping behavior was collected. We determined pre-post changes in muscle onset, magnitude and modulation of recruitment, step characteristics, and step quality. Subsequently, we determined whether improvements in step or muscle characteristics were correlated with improved step quality.ResultsWe observed a faster gastrocnemius muscle onset in the stance and stepping leg during backward stepping. During forward stepping we found a trend toward a faster tibialis anterior muscle onset in the stepping leg. We observed no changes in modulation or magnitude of muscle recruitment. Leg angles improved by 2.3° in forward stepping and 2.5° in backward stepping. The improvement in leg angle during forward stepping was accompanied by a −4.1°change in trunk angle, indicating a more upright position. Step length, duration and velocity improved in both directions. Changes in spatiotemporal characteristics were strongly correlated with improvements in leg angle, but no significant correlations were observed of muscle onset or recruitment with leg or trunk angle.ConclusionPBT leads to a multi-factorial improvement in onset of APR, spatiotemporal characteristics of stepping, and reactive step quality in people with chronic stroke. However, current changes in APR onset were not correlated with improvement in step quality. Therefore, we suggest that, in addition to spatiotemporal outcomes, other characteristics of muscle recruitment or behavioral substitution may induce step quality improvement after PBT.
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Impaired reach-to-grasp kinematics in parkinsonian patients relates to dopamine-dependent, subthalamic beta bursts. NPJ Parkinsons Dis 2021; 7:53. [PMID: 34188058 PMCID: PMC8242004 DOI: 10.1038/s41531-021-00187-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/17/2021] [Indexed: 11/17/2022] Open
Abstract
Excessive beta-band oscillations in the subthalamic nucleus are key neural features of Parkinson’s disease. Yet the distinctive contributions of beta low and high bands, their dependency on striatal dopamine, and their correlates with movement kinematics are unclear. Here, we show that the movement phases of the reach-to-grasp motor task are coded by the subthalamic bursting activity in a maximally-informative beta high range. A strong, three-fold correlation linked beta high range bursts, imbalanced inter-hemispheric striatal dopaminergic tone, and impaired inter-joint movement coordination. These results provide new insight into the neural correlates of motor control in parkinsonian patients, paving the way for more informative use of beta-band features for adaptive deep brain stimulation devices.
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Eshghi M, Stipancic KL, Mefferd A, Rong P, Berry JD, Yunusova Y, Green JR. Assessing Oromotor Capacity in ALS: The Effect of a Fixed-Target Task on Lip Biomechanics. Front Neurol 2019; 10:1288. [PMID: 31866935 PMCID: PMC6906194 DOI: 10.3389/fneur.2019.01288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022] Open
Abstract
Alternating motion rate (AMR) is a standard measure often included in neurological examinations to assess orofacial neuromuscular integrity. AMR is typically derived from recordings of patients producing repetitions of a single syllable as fast and clear as possible on one breath. Because the task places high demands on oromotor performance, particularly articulatory speed, AMRs are widely considered to be tests of maximum performance and, therefore, likely to reveal underlying neurologic deficits. Despite decades of widespread use, biomechanical studies have shown that speakers often circumvent the presumed speed challenge of the standard AMR task. Specifically, speakers are likely to manipulate their displacements (movement amplitude) instead of speed because this strategy requires less motor effort. The current study examined the effectiveness of a novel fixed-target paradigm for minimizing the truncation of articulatory excursions and maximizing motor effort. We compared the standard AMR task to that of a fixed-target AMR task and focused specifically on the tasks' potential to detect decrements in lip motor performance in persons with dysarthria due to amyotrophic lateral sclerosis (ALS). Our participants were 14 healthy controls and 17 individuals with ALS. For the standard AMR task, participants were instructed to produce the syllable /bα/ as quickly and accurately as possible on one breath. For the fixed-target AMR task, participants were given the same instructions, but were also required to strike a physical target placed under the jaw during the opening phase of each syllable. Lip kinematic data were obtained using 3D electromagnetic articulography. 16 kinematic features were extracted using an algorithmic approach. Findings revealed that compared to the standard task, the fixed-target AMR task placed increased motor demands on the oromotor system by eliciting larger excursions, faster speeds, and greater spatiotemporal variability. In addition, participants with ALS exhibited limited ability to adapt to the higher articulatory demands of the fixed-target task. Between the two AMR tasks, the maximum speed during the fixed-target task showed a moderate association with the ALSFRS-R bulbar subscore. Employment of both standard and fixed-target AMR tasks is, however, needed for comprehensive assessment of oromotor function and for elucidating profiles of task adaptation.
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Affiliation(s)
- Marziye Eshghi
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA, United States
| | - Kaila L Stipancic
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA, United States
| | - Antje Mefferd
- Speech Kinematics and Acoustics Lab, Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Panying Rong
- Speech Science and Disorders Lab, Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, KS, United States
| | - James D Berry
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Yana Yunusova
- Speech Production Lab, Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| | - Jordan R Green
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, MA, United States
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Lang KC, Hackney ME, Ting LH, McKay JL. Antagonist muscle activity during reactive balance responses is elevated in Parkinson's disease and in balance impairment. PLoS One 2019; 14:e0211137. [PMID: 30682098 PMCID: PMC6347183 DOI: 10.1371/journal.pone.0211137] [Citation(s) in RCA: 29] [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: 08/02/2018] [Accepted: 01/08/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Abnormal antagonist leg muscle activity could indicate increased muscle co-contraction and clarify mechanisms of balance impairments in Parkinson's disease (PD). Prior studies in carefully selected patients showed PD patients demonstrate earlier, longer, and larger antagonist muscle activation during reactive balance responses to perturbations. RESEARCH QUESTION Here, we tested whether antagonist leg muscle activity was abnormal in a group of PD patients who were not selected for phenotype and most of whom had volunteered for exercise-based rehabilitation. METHODS We compared antagonist activation during reactive balance responses to multidirectional support-surface translation perturbations in 31 patients with mild-moderate PD (age 68±9; H&Y 1-3; UPDRS-III 32±10) and 13 matched individuals (age 65±9). We quantified modulation of muscle activity (i.e., the ability to activate and inhibit muscles appropriately according to the perturbation direction) using modulation indices (MI) derived from minimum and maximum EMG activation levels observed across perturbation directions. RESULTS Antagonist leg muscle activity was abnormal in unselected PD patients compared to controls. Linear mixed models identified significant associations between impaired modulation and PD (P<0.05) and PD severity (P<0.01); models assessing the entire sample without referencing PD status identified associations with balance ability (P<0.05), but not age (P = 0.10). SIGNIFICANCE Antagonist activity is increased during reactive balance responses in PD patients who are not selected on phenotype and are candidates for exercise-based rehabilitation. This activity may be a mechanism of balance impairment in PD and a potential rehabilitation target or outcome measure.
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Affiliation(s)
- Kimberly C. Lang
- Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, Georgia, United States of America
| | - Madeleine E. Hackney
- Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Rehabilitation R&D Center, Atlanta VA Medical Center, Atlanta, Georgia, United States of America
| | - Lena H. Ting
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia, United States of America
- The Wallace H. Coulter Department of Biomedical Engineering at Emory University and Georgia Tech, Atlanta, Georgia, United States of America
| | - J. Lucas McKay
- The Wallace H. Coulter Department of Biomedical Engineering at Emory University and Georgia Tech, Atlanta, Georgia, United States of America
- * E-mail:
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Suppa A, Bologna M, Conte A, Berardelli A, Fabbrini G. The effect of L-dopa in Parkinson’s disease as revealed by neurophysiological studies of motor and sensory functions. Expert Rev Neurother 2016; 17:181-192. [DOI: 10.1080/14737175.2016.1219251] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Antonio Suppa
- Department of Neurology and Psychiatry, Sapienza University of Rome and Neuromed Institute IRCCS, Pozzilli, Italy
| | - Matteo Bologna
- Department of Neurology and Psychiatry, Sapienza University of Rome and Neuromed Institute IRCCS, Pozzilli, Italy
| | - Antonella Conte
- Department of Neurology and Psychiatry, Sapienza University of Rome and Neuromed Institute IRCCS, Pozzilli, Italy
| | - Alfredo Berardelli
- Department of Neurology and Psychiatry, Sapienza University of Rome and Neuromed Institute IRCCS, Pozzilli, Italy
| | - Giovanni Fabbrini
- Department of Neurology and Psychiatry, Sapienza University of Rome and Neuromed Institute IRCCS, Pozzilli, Italy
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Schaefer SY, Hengge CR. Testing the concurrent validity of a naturalistic upper extremity reaching task. Exp Brain Res 2015; 234:229-40. [PMID: 26438508 DOI: 10.1007/s00221-015-4454-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/22/2015] [Indexed: 01/02/2023]
Abstract
Point-to-point reaching has been widely used to study upper extremity motor control. We have been developing a naturalistic reaching task that adds tool manipulation and object transport to this established paradigm. The purpose of this study was to determine the concurrent validity of a naturalistic reaching task in a sample of healthy adults. This task was compared to the criterion measure of standard point-to-point reaching. Twenty-eight adults performed unconstrained out-and-back movements in three different directions relative to constant start location along midline using their nondominant arm. In the naturalistic task, participants manipulated a tool to transport objects sequentially between physical targets anchored to the planar workspace. In the standard task, participants moved a digital cursor sequentially between virtual targets, veridical to the planar workspace. In both tasks, the primary measure of performance was trial time, which indicated the time to complete 15 reaches (five cycles of three reaches/target). Two other comparator tasks were also designed to test concurrent validity when components of the naturalistic task were added to the standard task. Spearman's rank correlation coefficients indicated minimal relationship between the naturalistic and standard tasks due to differences in progressive task difficulty. Accounting for this yielded a moderate linear relationship, indicating concurrent validity. The comparator tasks were also related to both the standard and naturalistic task. Thus, the principles of motor control and learning that have been established by the wealth of point-to-point reaching studies can still be applied to the naturalistic task to a certain extent.
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Affiliation(s)
- S Y Schaefer
- Motor Rehabilitation and Learning Laboratory, Utah State University, 7000 Old Main Hill, Logan, UT, 84322, USA.
- Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA.
- The Center on Aging, University of Utah, 30 North 1900 East, AB193 SOM, Salt Lake City, UT, 84132, USA.
| | - C R Hengge
- Motor Rehabilitation and Learning Laboratory, Utah State University, 7000 Old Main Hill, Logan, UT, 84322, USA
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Mefferd AS, Green JR, Pattee G. A novel fixed-target task to determine articulatory speed constraints in persons with amyotrophic lateral sclerosis. JOURNAL OF COMMUNICATION DISORDERS 2012; 45:35-45. [PMID: 22000045 PMCID: PMC3251716 DOI: 10.1016/j.jcomdis.2011.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 09/06/2011] [Accepted: 09/19/2011] [Indexed: 05/12/2023]
Abstract
PURPOSE The goal of this study was to determine if talkers with ALS are limited in their ability to increase lower lip and jaw speed at an early stage of the disease when their speaking rate and intelligibility are only minimally or not affected. METHOD A novel metronome paced fixed-target task was used to assess movement speed capacities during lower lip and jaw oscillations in seven talkers with ALS and seven age and gender matched controls. RESULTS Lower lip peak speeds were significantly lower in talkers with mild ALS than in healthy talkers suggesting a lower lip speed constraint in talkers with mild ALS. Jaw peak speeds tended to be lower, but jaw displacements tended to be larger in talkers with mild ALS than in healthy talkers. Because greater speeds are typically expected for larger displacements, outcomes also suggest a jaw speed constraint in talkers with mild ALS. CONCLUSIONS Lower lip and jaw peak speeds may be sensitive measures to identify bulbar motor performance decline at an early stage of the disease when speaking rate and intelligibility are only minimally affected. LEARNING OUTCOMES The reader will be able to explain two different articulatory strategies to increase speaking rate and understand why fast speech tasks and diadochokinetic pseudo-speech tasks are not suited to assess articulatory speed capacity in healthy and impaired talkers. The reader will also be able to explain how orofacial movement speed capacity can be tested using a fixed-target task and how ALS affects lower lip and jaw speed capacities during the early stages of the disease.
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Affiliation(s)
- Antje S Mefferd
- Department of Special Education and Communication Disorders, University of Nebraska, Lincoln, United States.
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Bidet-Ildei C, Pollak P, Kandel S, Fraix V, Orliaguet JP. Handwriting in patients with Parkinson disease: Effect of l-dopa and stimulation of the sub-thalamic nucleus on motor anticipation. Hum Mov Sci 2011; 30:783-91. [DOI: 10.1016/j.humov.2010.08.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 05/31/2010] [Accepted: 08/18/2010] [Indexed: 10/18/2022]
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Ringenbach SDR, van Gemmert AWA, Shill HA, Stelmach GE. Auditory instructional cues benefit unimanual and bimanual drawing in Parkinson's disease patients. Hum Mov Sci 2010; 30:770-82. [PMID: 21168929 DOI: 10.1016/j.humov.2010.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 08/17/2010] [Accepted: 08/26/2010] [Indexed: 10/18/2022]
Abstract
The present study investigated performance of unimanual and bimanual anti-phase and in-phase upper limb line drawing using three different types of cues. Fifteen Parkinson's disease (PD) patients, 15 elderly, and 15 young adults drew lines away from and towards their body on a tabletop every 1000 ms for 30 s under three different cueing conditions: (1) verbal ('up', 'down'); (2) auditory (high tone, low tone); (3) visual (target line switched from top to bottom). PD patients had larger and more variable amplitudes which may be related to the finding that they also produced more curvilinear movements than young and elderly adults. Consistent with previous research, when compared to the elderly and young adult group PD patients produced a mean relative phase which deviated more from the instructed coordination modes and they showed larger variability of relative phase in bimanual coordination, especially in anti-phase conditions. For all groups, auditory and verbal cues resulted in lower coefficient of variance of cycle time, lower variability of amplitude and lower variability of relative phase than visual cues. The benefit of auditory cues may be related to the timing nature of the task or factors related to the auditory cues (e.g., reduced attentional demands, more kinesthetic focus).
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Affiliation(s)
- Shannon D R Ringenbach
- Program of Kinesiology, Arizona State University, P.O. Box 870701, Tempe, AZ 85287-0701, USA.
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Submovements during pointing movements in Parkinson’s disease. Exp Brain Res 2008; 193:529-44. [PMID: 19048238 DOI: 10.1007/s00221-008-1656-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 11/11/2008] [Indexed: 10/21/2022]
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Increased bradykinesia in Parkinson’s disease with increased movement complexity: elbow flexion–extension movements. J Comput Neurosci 2008; 25:501-19. [DOI: 10.1007/s10827-008-0091-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Revised: 02/23/2008] [Accepted: 03/12/2008] [Indexed: 12/18/2022]
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Smiley-Oyen AL, Lowry KA, Kerr JP. Planning and control of sequential rapid aiming in adults with Parkinson's disease. J Mot Behav 2007; 39:103-14. [PMID: 17428756 DOI: 10.3200/jmbr.39.2.103-114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Eight people with Parkinson's disease (PD), 8 age-matched older adults, and 8 young adults executed 3-dimensional rapid aiming movements to 1, 3, 5, and 7 targets. Reaction time, flight time, and time after peak velocity to the 1st target indicated that both neurologically healthy groups implemented a plan on the basis of anticipation of upcoming targets, whereas the PD group did not. One suggested reason for the PD group's deficiency in anticipatory control is the greater variability in their initial force impulse. Although the PD group scaled peak velocity and time to peak velocity similarly to the other groups, their coefficients of variation were greater, making consistent prediction of the movement outcome difficult and thus making it less advantageous to plan too far in advance. A 2nd finding was that the PD group exhibited increased slowing in time after peak velocity in the final segments of the longest sequence, whereas the other 2 groups did not. The increased slowing could be the result of a different movement strategy, increased difficulty modulating the agonist and antagonist muscle groups later in the sequence, or both. The authors conclude that people with PD use more segmented planning and control strategies than do neurologically healthy older and young adults when executing movement sequences and that the locus of increased bradykinesia in longer sequences is in the deceleration phase of movement.
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Affiliation(s)
- A L Smiley-Oyen
- Motor Control and Learning Research Laboratory, Department of Health and Human Performance, Iowa State University, Ames 50011, USA.
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