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Jiang W, Zhou H, Wu J, Chen H, Li L, Wu Y, Meng T, Zuo G, Fan W, Shi C. Short Step Length Estimation for Parkinson's Disease Patients by Using Fusion Data From Camera-IMU in Smart Glasses. IEEE Trans Biomed Eng 2024; 71:2265-2275. [PMID: 38376981 DOI: 10.1109/tbme.2024.3367923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Shortened step length is a prominent motor abnormality in Parkinson's disease (PD) patients. Current methods for estimating short step length have the limitation of relying on laboratory scenarios, wearing multiple sensors, and inaccurate estimation results from a single sensor. In this paper, we proposed a novel method for estimating short step length for PD patients by fusing data from camera and inertial measurement units in smart glasses. A simultaneous localization and mapping technique and acceleration thresholding-based step detection technique were combined to realize the step length estimation. Two sets of experiments were conducted to demonstrate the performance of our method. In the first set of experiments with 12 healthy subjects, the proposed method demonstrated an average error of 8.44% across all experiments including six fixed step lengths below 30 cm. The second set of straightly walking experiments were implemented with 12 PD patients, the proposed method exhibited an average error of 4.27% compared to a standard gait evaluation technique in total walking distance. Notably, among the results of step lengths below 40 cm, our method agreed with the standard technique (R 2=0.8659). This study offers a promising approach for estimating short step length for PD patients during smart glasses-based gait training.
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Fujii S, Takamura Y, Ikuno K, Morioka S, Kawashima N. A comprehensive multivariate analysis of the center of pressure during quiet standing in patients with Parkinson's disease. J Neuroeng Rehabil 2024; 21:59. [PMID: 38654376 PMCID: PMC11036778 DOI: 10.1186/s12984-024-01358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND We hypothesized that postural instability observed in individuals with Parkinson's disease (PD) can be classified as distinct subtypes based on comprehensive analyses of various evaluated parameters obtained from time-series of center of pressure (CoP) data during quiet standing. The aim of this study was to characterize the postural control patterns in PD patients by performing an exploratory factor analysis and subsequent cluster analysis using CoP time-series data during quiet standing. METHODS 127 PD patients, 47 aged 65 years or older healthy older adults, and 71 healthy young adults participated in this study. Subjects maintain quiet standing for 30 s on a force platform and 23 variables were calculated from the measured CoP time-series data. Exploratory factor analysis and cluster analysis with a Gaussian mixture model using factors were performed on each variable to classify subgroups based on differences in characteristics of postural instability in PD. RESULTS The factor analysis identified five factors (magnitude of sway, medio-lateral frequency, anterio-posterior frequency, component of high frequency, and closed-loop control). Based on the five extracted factors, six distinct subtypes were identified, which can be considered as subtypes of distinct manifestations of postural disorders in PD patients. Factor loading scores for the clinical classifications (younger, older, and PD severity) overlapped, but the cluster classification scores were clearly separated. CONCLUSIONS The cluster categorization clearly identifies symptom-dependent differences in the characteristics of the CoP, suggesting that the detected clusters can be regarded as subtypes of distinct manifestations of postural disorders in patients with PD.
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Affiliation(s)
- Shintaro Fujii
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Yusaku Takamura
- Department of Rehabilitation for Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, 359-0042, Japan
| | - Koki Ikuno
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Shu Morioka
- Graduate School of Health Sciences, Kio University, Nara, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Noritaka Kawashima
- Department of Rehabilitation for Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, 359-0042, Japan.
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Leroy T, Baggen RJ, Lefeber N, Herssens N, Santens P, De Letter M, Maes L, Bouche K, Van Bladel A. Effects of Oral Levodopa on Balance in People with Idiopathic Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023; 13:3-23. [PMID: 36617752 PMCID: PMC9912739 DOI: 10.3233/jpd-223536] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Balance impairment is a frequent cause of morbidity and mortality in people with Parkinson's disease (PD). As opposed to the effects of appendicular motor symptoms, the effects of Levodopa on balance impairment in idiopathic PD are less clear. OBJECTIVE To review the literature on the effects of oral Levodopa on clinical balance test performance, posturography, step initiation, and responses to perturbation in people with idiopathic PD (PwPD). METHODS A systematic search of three scientific databases (Pubmed, Embase, and Web of Science) was conducted in accordance with PRISMA guidelines. For the pilot meta-analysis, standardized mean differences with 95% confidence intervals were calculated using an inverse variance random effects model. Data not suitable for implementation in the meta-analysis (missing means or standard deviations, and non-independent outcomes) were analyzed narratively. RESULTS A total of 2772 unique studies were retrieved, of which 18 met the eligibility criteria and were analyzed, including data of 710 idiopathic PwPD. Levodopa had a significant positive effect on the Berg Balance Scale, the Push and Release test, and jerk and frequency parameters during posturography. In contrast, some significant negative effects on velocity-based sway parameters were found during posturography and step initiation. However, Levodopa had no significant effect on most step initiation- and all perturbation parameters. CONCLUSION The effects of Levodopa on balance in PwPD vary depending on the outcome parameters and patient inclusion criteria. A systematic approach with well-defined outcome parameters, and prespecified, sensitive and reliable tests is needed in future studies to unravel the effects of oral Levodopa on balance.
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Affiliation(s)
- Tim Leroy
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Remco J. Baggen
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Correspondence to: Dr. Remco Baggen, Department of Rehabilitation Sciences, Ghent University, Campus UZ Gent, Corneel Heymanslaan 10, 9000 Gent, Belgium. E-mail:
| | - Nina Lefeber
- Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nolan Herssens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Space Medicine Team, European Astronaut Centre, European Space Agency, Cologne, Germany
| | - Patrick Santens
- Department of Neurology, Ghent University Hospital, Ghent, Belgium,Research Group BrainComm, Ghent University, Ghent, Belgium
| | - Miet De Letter
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Research Group BrainComm, Ghent University, Ghent, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Katie Bouche
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Anke Van Bladel
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium,Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
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de Oliveira CEN, Ribeiro de Souza C, Treza RDC, Hondo SM, Los Angeles E, Bernardo C, Shida TKF, dos Santos de Oliveira L, Novaes TM, de Campos DDSF, Gisoldi E, Carvalho MDJ, Coelho DB. A Public Data Set With Ground Reaction Forces of Human Balance in Individuals With Parkinson's Disease. Front Neurosci 2022; 16:865882. [PMID: 35516808 PMCID: PMC9063313 DOI: 10.3389/fnins.2022.865882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Claudia Eunice Neves de Oliveira
- Department of Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, Brazil
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | | | - Renata de Castro Treza
- Department of Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Sandy Mikie Hondo
- Department of Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Emanuele Los Angeles
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Claudionor Bernardo
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | | | | | - Thayna Magalhães Novaes
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | | | - Emerson Gisoldi
- Ambulatório de Distúrbios de Movimento, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | - Daniel Boari Coelho
- Department of Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, Brazil
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
- *Correspondence: Daniel Boari Coelho
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Quantitative Analysis of Postural Instability in Patients with Parkinson's Disease. PARKINSONS DISEASE 2021; 2021:5681870. [PMID: 33936583 PMCID: PMC8060093 DOI: 10.1155/2021/5681870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022]
Abstract
Introduction Postural instability is commonly observed in Parkinson's disease, leading to an increasing risk of falling and worsening as the disease progresses. We found that limit of stability can be applied to reflect the dynamic evolution of postural instability in patients with Parkinson's disease. Methods Forty-three patients (9 of Hoehn and Yahr stage I, 12 of stage II, 14 of stage III, and 8 of stage IV) met the criteria for the diagnosis of idiopathic Parkinson's disease and could stand independently for at least 10 minutes. Twelve healthy controls with no sign of parkinsonism were also recruited. Postural instability was assessed by posturography in different directions (forward, backward, right, left, forward-right, forward-left, backward-right, and backward-left). This study trial was registered with the Chinese Clinical Trial Registry (no. ChiCTR1900022715). Results All participants were able to complete the limit of stability tasks without any complications. Patients in stages II to IV exhibited smaller end point excursion and slower time to complete than controls, suggesting an impaired limit of stability. The patients in stage II exhibited a remarkable decline in most directions compared to controls, except for right and left, and forward and backward decline occurred the earliest. For patients in stage III, right was the only direction with no significant difference from controls. In stage IV patients, the limit of stability declined significantly in all directions (p < 0.05). Conclusions The postural abnormalities of Parkinson's disease can occur at early stages, and the pattern of decline is more severe in the forward-backward direction. This trial is registered with ChiCTR1900022715.
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Schülein S, Sieber CC, Gaßmann KG, Ritt M. Frail Older Individuals Maintaining a Steady Standing Position: Associations Between Sway Measurements with Frailty Status Across Four Different Frailty Instruments. Clin Interv Aging 2020; 15:451-467. [PMID: 32273688 PMCID: PMC7106653 DOI: 10.2147/cia.s223056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 12/13/2019] [Indexed: 01/27/2023] Open
Abstract
Objective An analysis of the relationships between static equilibrium parameters and frailty status and/or severity across four different frailty measures. Design Cross-sectional analysis. Setting Geriatric wards of a general hospital. Participants One hundred twenty-three geriatric inpatients comprising 70 women (56.5%) and 53 men (42.7%) with an age range of 68–95 years. Methods The variation in the center of pressure (CoP), ie, the length of sway, the area of sway, and the mean speed, was assessed for different positions/tasks: 1) wide standing with eyes open (WSEO); 2) wide standing with eyes closed (WSEC); 3) narrow standing with eyes open (NSEO) and 4) narrow standing with eyes closed (NSEC), using a force plate. Frailty status and/or frailty severity were evaluated using the frailty phenotype (FP), the clinical frailty scale (CFS), the 14-item frailty index based on a comprehensive geriatric assessment (FI-CGA), and a 47-item frailty index (FI). Results WSEO length of sway (FP, CFS, FI-CGA, FI), WSEO area of sway (FP, CFS, FI-CGA, FI), and WSEO mean speed (FP, CFS, FI-CGA, FI), WSEC length of sway (FP, FI-CGA, FI), WSEC area of sway (FP, FI-CGA, FI) and WSEC mean speed (FI-CGA, FI), NSEO length of sway (FP, FI-CGA, FI), NSEO area of sway (FP, CFS, FI-CGA, FI), and NSEO mean speed (FP, CFS, FI-CGA, FI), NSEC length of sway (FI-CGA, FI), NSEC area of sway (FI-CGA, FI) and NSEC mean speed (FI-CGA, FI) were associated with the frailty status and/or severity across the four different frailty instruments (all p < 0.05, respectively). Conclusion Greater fluctuations in CoP with increasing frailty status and/or severity were a uniform finding across various major frailty instruments.
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Affiliation(s)
- Samuel Schülein
- Geriatrics Centre Erlangen, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
| | - Cornel Christian Sieber
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Nürnberg, Germany.,Department of Internal Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Karl-Günter Gaßmann
- Geriatrics Centre Erlangen, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany.,Institute for Biomedicine of Aging (IBA), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Nürnberg, Germany
| | - Martin Ritt
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Nürnberg, Germany.,Department of Internal Medicine III, Klinikum Neumarkt, Kliniken des Landkreises Neumarkt i. d. OPf, Neumarkt, Germany
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Halmi Z, Dinya E, Málly J. Destroyed non-dopaminergic pathways in the early stage of Parkinson's disease assessed by posturography. Brain Res Bull 2019; 152:45-51. [PMID: 31295517 DOI: 10.1016/j.brainresbull.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The early stage of Parkinson's disease (PD) (Hoehn-Yahr (HY) I-II stages) is characterized by a negative pull test, which clinically excludes postural instability. Previous studies with dynamic posturography detected balance disturbances even at the onset of the disease but the age dependency or prediction of dyskinesia with dynamic posturography are not known. OBJECTIVE/HYPOTHESIS We hypothesized that the postural instability evoked by dynamic posturography was part of the early stage of PD. Furthermore, we studied how we can provoke dyskinesia. METHODS Postural instability with static and dynamic posturography (passing balls with different weights around the body) was studied in 45 patients with PD in their HY I, II stages. They were compared with 35 age-matched healthy controls. Eighteen patients with dyskinesia were involved in the study. Fourteen patients were followed for two years. RESULTS The pathway and velocity of the movement assessed by static and the dynamic posturography were significantly higher in the group >65 years than that of age-matched healthy controls, while the group ≤65 years showed a significant increment only in the antero-posterior sway during dynamic posturography. The imbalance of patients with dyskinesia was significantly (p < 0.05) provoked by dynamic posturography compared to patients with PD without dyskinesia. The results were independent of age. CONCLUSION Postural instability is part of the early symptoms of PD. Non-dopaminergic pathways may be involved in the early stage of PD.
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Affiliation(s)
- Zsófia Halmi
- Dept. Developmental Neurology, Saint Margaret Hospital, Budapest, Hungary
| | - Elek Dinya
- Semmelweis Univ. Digital Health Dept., Budapest, Hungary
| | - Judit Málly
- Inst. of Neurorehabilitation, Sopron, Hungary.
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Delamarre A, Tison F, Li Q, Galitzky M, Rascol O, Bezard E, Meissner WG. Assessment of plasma creatine kinase as biomarker for levodopa-induced dyskinesia in Parkinson's disease. J Neural Transm (Vienna) 2019; 126:789-793. [PMID: 31098725 DOI: 10.1007/s00702-019-02015-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
Abstract
We tested in a translational approach the usefulness of plasma creatine kinase (CK) as an objective biomarker for levodopa-induced dyskinesia (LID). Plasma CK levels were measured in five dyskinetic parkinsonian non-human primates (NHP) and in ten PD patients with LID who participated in a treatment trial with simvastatin. Plasma CK levels were increased in dyskinetic NHP and correlated with LID severity while they were not affected by LID severity in PD patients.
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Affiliation(s)
- Anna Delamarre
- Service de Neurologie, Hôpital Pellegrin, CHU de Bordeaux, 33000, Bordeaux, France.,Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, 146 rue Léo Saignat, 33000, Bordeaux Cedex, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France
| | - François Tison
- Service de Neurologie, Hôpital Pellegrin, CHU de Bordeaux, 33000, Bordeaux, France.,Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, 146 rue Léo Saignat, 33000, Bordeaux Cedex, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France
| | - Qin Li
- Institute of Laboratory Animal Sciences, China Academy of Medical Sciences, Beijing, China.,Motac Neuroscience, Manchester, UK
| | | | - Olivier Rascol
- CIC Toulouse, Toulouse, France.,Départements de Pharmacologie Clinique et Neurosciences, INSERM CIC9302, CHU de Toulouse, Toulouse, France.,Service de Pharmacologie, Faculté de Médecine, CHU de Toulouse, Université de Toulouse, Toulouse, France
| | - Erwan Bezard
- Service de Neurologie, Hôpital Pellegrin, CHU de Bordeaux, 33000, Bordeaux, France.,Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, 146 rue Léo Saignat, 33000, Bordeaux Cedex, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France.,Institute of Laboratory Animal Sciences, China Academy of Medical Sciences, Beijing, China.,Motac Neuroscience, Manchester, UK
| | - Wassilios G Meissner
- Service de Neurologie, Hôpital Pellegrin, CHU de Bordeaux, 33000, Bordeaux, France. .,Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, 146 rue Léo Saignat, 33000, Bordeaux Cedex, France. .,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France. .,Department Medicine, University of Otago, Christchurch, New Zealand. .,New Zealand Brain Research Institute, Christchurch, New Zealand.
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Feller KJ, Peterka RJ, Horak FB. Sensory Re-weighting for Postural Control in Parkinson's Disease. Front Hum Neurosci 2019; 13:126. [PMID: 31057379 PMCID: PMC6478764 DOI: 10.3389/fnhum.2019.00126] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/27/2019] [Indexed: 12/15/2022] Open
Abstract
Postural instability in Parkinson's disease (PD) is characterized by impaired postural responses to transient perturbations, increased postural sway in stance and difficulty transitioning between tasks. In addition, some studies suggest that loss of dopamine in the basal ganglia due to PD results in difficulty in using proprioceptive information for motor control. Here, we quantify the ability of subjects with PD and age-matched control subjects to use and re-weight sensory information for postural control during steady-state conditions of continuous rotations of the stance surface or visual surround. We measure the postural sway of subjects in response to a pseudorandom, surface-tilt stimulus with eyes closed, and in response to a pseudorandom, visual-tilt stimulus. We use a feedback control model of the postural control system to interpret our results, focusing on sensory weighting as a function of stimulus amplitude. We find that subjects with PD can re-weight their dependence upon sensory information in response to changes in surface- or visual-stimulus amplitude. Specifically, subjects with PD behaved like age-matched control subjects by decreasing proprioceptive contribution to stance control with increasing surface-tilt amplitude and decreasing visual contribution with increasing visual-tilt amplitude. However, subjects with PD do not decrease their reliance on proprioception as much as age-matched controls for small increases in surface-stimulus amplitudes. Levodopa medication did not affect sensory re-weighting behaviors for postural control. The impairment in PD subject's ability to respond differently to small changes in surface rotation amplitudes is consistent with an increased threshold for perceiving proprioceptive signals, which may result from decreased signal-to-noise in the dopaminergic pathways associated with sensory processing and/or sensory integration.
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Affiliation(s)
- Kelly J. Feller
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, United States,Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Robert J. Peterka
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States,Veterans Adminstration Portland Health Care System, Portland, OR, United States
| | - Fay B. Horak
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, United States,Department of Neurology, Oregon Health & Science University, Portland, OR, United States,Veterans Adminstration Portland Health Care System, Portland, OR, United States,*Correspondence: Fay B. Horak
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10
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Chen T, Fan Y, Zhuang X, Feng D, Chen Y, Chan P, Du Y. Postural sway in patients with early Parkinson's disease performing cognitive tasks while standing. Neurol Res 2018; 40:491-498. [PMID: 29869975 DOI: 10.1080/01616412.2018.1451017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES We investigated postural sway in patients with early Parkinson's disease (PD) to test the hypothesis that the postural control system was affected already at an early stage of PD. Moreover, we identified cases of dysfunction of stereopsis in PD patients. METHODS We examined 23 patients with early PD and 23 healthy, sex- and age-matched control subjects. Postural sway was measured with an accelerometer at the center of mass at the lower spine. Subjects were asked to stand quietly for 30 s under two usual conditions (eyes open and eyes closed) and two dual tasks conditions (eyes open with dual task, eyes closed with dual task). Stereopsis was assessed using the Titmus fly test. RESULTS In the usual conditions, no differences were found between the control group and PD group. With increasing task difficulty, PD patients showed an increase of RMS values of sway acceleration, compared to control subjects. These differences reached significance during cognitive task performance. PD patients showed larger JERK values with increasing difficulty of the sway task which also reached significance during cognitive task performance. Relative to controls, PD patients showed decreased stereopsis function. But, there were no statistically significant correlations between log seconds of arc of the Titmus test and JERK, even during cognitive task performance. CONCLUSION Our results indicate that patients with early PD have subtle signs of postural instability when their attention is diverted or reduced. In addition, deficits of stereopsis may be common in early PD patients. St Abbreviations: ACC: Accelerometers; ANOVA: Analysis of variance; AP: Antero-posterior; COP: Center of pressure; EC: Eyes closed; ECDT: eyes closed with dual task; EO: Eyes open; EODT: Eyes open with dual task; GDS: Geriatric depression scale; JERK: Jerkiness of sway; ML: Medio-lateral; MMSE: Mini mental state examination; MoCA: Montreal cognitive assessment; PD: Parkinson's disease; PDAbS: PD Patients with abnormal stereopsis; PDNrS: PD Patients with normal stereopsis; PIGD: Postural instability and gait disorder; RMS: Root mean square; UPDRS: Unified Parkinson's disease rating scale.
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Affiliation(s)
- Tuanzhi Chen
- a Department of Neurology , Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University , Liaocheng , China
| | - Yan Fan
- a Department of Neurology , Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University , Liaocheng , China
| | - Xianbo Zhuang
- a Department of Neurology , Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University , Liaocheng , China
| | - Depeng Feng
- a Department of Neurology , Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University , Liaocheng , China
| | - Yanxiu Chen
- a Department of Neurology , Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University , Liaocheng , China
| | - Piu Chan
- b Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Department of Neurobiology, Beijing Institute of Geriatrics , Xuanwu Hospital, Capital Medical University , Beijing , China
| | - Yifeng Du
- c Department of Neurology , Provincial Hospital Affiliated to Shandong University , Jinan , China
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Chung KA, Lobb BM, Murchison CF, Mancini M, Hogarth P, Nutt JG. Assessment of an Objective Method of Dyskinesia Measurement in Parkinson's Disease. Mov Disord Clin Pract 2018; 5:160-164. [PMID: 30363374 DOI: 10.1002/mdc3.12583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/17/2017] [Accepted: 12/05/2017] [Indexed: 11/06/2022] Open
Abstract
Background The goal of this study was to validate an objective method of measuring levodopa induced dyskinesia in Parkinson's disease (PD). Methods To characterize agreement between the clinician-based measure and a force plate, we assessed dyskinesia in PD subjects participating in a randomized and blinded clinical trial of an adenosine A2A anatagonist. Convergent validity and intra-class correlations were evaluated between the objective force plate measure and clinician assessments. Results All measures correlated across time and detected differences in treatments. Conclusion Our results indicate that objective measure from a force plate is in scale agreement with clinical ratings of dyskinesia severity, indicating it as a reliable method to measure LID objectively but with greater resolution to detect changes in LID.
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Affiliation(s)
- Kathryn A Chung
- VA Portland Health Care System Portland Oregon USA.,Oregon Health & Science University Portland Oregon USA
| | | | | | | | | | - John G Nutt
- Oregon Health & Science University Portland Oregon USA
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12
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Shahmohammadi R, Sharifi GR, Melvin JMA, Sadeghi-Demneh E. A comparison between aquatic and land-based physical exercise on postural sway and quality of life in people with Parkinson’s disease: a randomized controlled pilot study. SPORT SCIENCES FOR HEALTH 2017. [DOI: 10.1007/s11332-017-0363-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Continuous leg dyskinesia assessment in Parkinson's disease –clinical validity and ecological effect. Parkinsonism Relat Disord 2016; 26:41-6. [DOI: 10.1016/j.parkreldis.2016.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 01/31/2016] [Accepted: 02/05/2016] [Indexed: 01/22/2023]
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14
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Abstract
People with Parkinson's disease exhibit debilitating gait impairments, including gait slowness, increased step variability, and poor postural control. A widespread supraspinal locomotor network including the cortex, cerebellum, basal ganglia, and brain stem contributes to the control of human locomotion, and altered activity of these structures underlies gait dysfunction due to Parkinson's disease.
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Affiliation(s)
- D S Peterson
- Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon; and Oregon Health & Science University, Department of Neurology, Portland, Oregon
| | - F B Horak
- Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon; and Oregon Health & Science University, Department of Neurology, Portland, Oregon
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15
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Siddiqi SH, Abraham NK, Geiger CL, Karimi M, Perlmutter JS, Black KJ. The Human Experience with Intravenous Levodopa. Front Pharmacol 2016; 6:307. [PMID: 26779024 PMCID: PMC4701937 DOI: 10.3389/fphar.2015.00307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/11/2015] [Indexed: 11/24/2022] Open
Abstract
Objective: To compile a comprehensive summary of published human experience with levodopa given intravenously, with a focus on information required by regulatory agencies. Background: While safe intravenous (IV) use of levodopa has been documented for over 50 years, regulatory supervision for pharmaceuticals given by a route other than that approved by the U.S. Food and Drug Administration (FDA) has become increasingly cautious. If delivering a drug by an alternate route raises the risk of adverse events, an investigational new drug (IND) application is required, including a comprehensive review of toxicity data. Methods: Over 200 articles referring to IV levodopa were examined for details of administration, pharmacokinetics, benefit, and side effects. Results: We identified 142 original reports describing IVLD use in humans, beginning with psychiatric research in 1959–1960 before the development of peripheral decarboxylase inhibitors. At least 2760 subjects have received IV levodopa, and reported outcomes include parkinsonian signs, sleep variables, hormone levels, hemodynamics, CSF amino acid composition, regional cerebral blood flow, cognition, perception and complex behavior. Mean pharmacokinetic variables were summarized for 49 healthy subjects and 190 with Parkinson's disease. Side effects were those expected from clinical experience with oral levodopa and dopamine agonists. No articles reported deaths or induction of psychosis. Conclusion: At least 2760 patients have received IV levodopa with a safety profile comparable to that seen with oral administration.
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Affiliation(s)
- Shan H Siddiqi
- Department of Psychiatry, Washington University School of Medicine St. Louis, MO, USA
| | - Natalia K Abraham
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa Ottawa, ON, Canada
| | | | - Morvarid Karimi
- Department of Neurology, Washington University School of Medicine St. Louis, MO, USA
| | - Joel S Perlmutter
- Programs in Occupational Therapy and Physical Therapy, Division of Biology and Biomedical Sciences, Departments of Neurology, Radiology, and Anatomy and Neurobiology, Washington University School of Medicine St. Louis, MO, USA
| | - Kevin J Black
- Division of Biology and Biomedical Sciences, Departments of Psychiatry, Neurology, Radiology, and Anatomy and Neurobiology, Washington University School of Medicine St. Louis, MO, USA
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16
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Effect of augmenting cholinergic function on gait and balance. BMC Neurol 2015; 15:264. [PMID: 26697847 PMCID: PMC4690312 DOI: 10.1186/s12883-015-0523-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/15/2015] [Indexed: 11/17/2022] Open
Abstract
Background Impaired mobility and falls are clinically important complications of Parkinson’s disease (PD) and a major detractor from quality of life for which there are limited therapies. Pathological, neuroimaging and clinical evidence suggest that degeneration of cholinergic systems may contribute to impairments of balance and gait in PD. The proposed trial will examine the effects of augmentation of the cholinergic system on balance and gait. Design The study is a single-site, proof of concept, randomized, double-blind, cross-over trial in patients with PD. Each treatment period will be 6 weeks with a 6-week washout between treatments for a total of 18 weeks for each subject. Donepezil in 2.5 mg capsules or identical appearing placebo capsules will be increased from two per day (5 mg) to four capsules (10 mg) after 3 weeks, if tolerated. Subjects will have idiopathic Parkinson’s disease, Hoehn and Yahr stages 2 to 4. We anticipate recruiting up to 100 subjects for screening to have 54 enrolled and 44 subjects complete both phases of treatment. Dropouts will be replaced. As this is a crossover trial, all subjects will be exposed to both donepezil and to placebo. The primary outcome measures will be the root mean square of the mediolateral sway when standing and the variability of the stride duration when walking for two minutes. Secondary outcomes will be the computerized Attention Network Test to examine three domains of attention and the Short-latency Afferent Inhibition (SAI), a physiological marker obtained with transcranial magnetic stimulation as a putative marker of cholinergic activity. Discussion The results of this study will be the most direct test of the hypothesized role of cholinergic neurotransmission in gait and balance. The study is exploratory because we do not know whether donepezil will affect gait, balance or attention, nor which measures of gait, balance or attention will be sensitive to drug manipulation. We hypothesize that change in cholinergic activity, as measured with SAI, will predict the relative effectiveness of donepezil on gait and balance. Our immediate goal is to determine the potential utility of cholinergic manipulation as a strategy for preventing or treating balance and gait dysfunction in PD. The findings of this trial are intended to lead to more sharply focused questions about the role of cholinergic neurotransmission in balance and gait and eventually to Phase II B trials to determine clinical utility of cholinergic manipulation to prevent falls and improve mobility. Trial registration This trial is registered at clinical trials.gov (NCT02206620).
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17
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Curtze C, Nutt JG, Carlson-Kuhta P, Mancini M, Horak FB. Levodopa Is a Double-Edged Sword for Balance and Gait in People With Parkinson's Disease. Mov Disord 2015; 30:1361-70. [PMID: 26095928 PMCID: PMC4755510 DOI: 10.1002/mds.26269] [Citation(s) in RCA: 248] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/23/2015] [Accepted: 04/13/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The effects of levodopa on balance and gait function in people with Parkinson's disease (PD) is controversial. This study compared the relative responsiveness to l-dopa on six domains of balance and gait: postural sway in stance; gait pace; dynamic stability; gait initiation; arm swing; and turning in people with mild and severe PD, with and without dyskinesia. METHODS We studied 104 subjects with idiopathic PD (H & Y II [n = 52] and III-IV [n = 52]) and 64 age-matched controls. Subjects performed a mobility task in the practical off state and on l-dopa: standing quietly for 30 seconds, initiating gait, walking 7 meters, and turning 180 degrees. Thirty-four measures of mobility were computed from inertial sensors. Standardized response means were used to determine relative responsiveness to l-dopa. RESULTS The largest improvements with l-dopa were found for arm swing and pace-related gait measures. Gait dynamic stability was unaffected by PD and not responsive to l-dopa. l-dopa reduced turning duration, but only in subjects with severe PD. In contrast to gait, postural sway in quiet standing increased with l-dopa, especially in the more severely affected subjects. The increase in postural sway, as well as decrease in turning duration and exaggerated arm swing with l-dopa was observed only for subjects with dyskinesia at the time of testing. CONCLUSIONS The observed spectrum of l-dopa responsiveness in balance and gait measures suggests that multiple neural circuits control balance and gait. Many of the negative effects of l-dopa may be directly or indirectly caused by dyskinesia.
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Affiliation(s)
- Carolin Curtze
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - John G Nutt
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Patricia Carlson-Kuhta
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Martina Mancini
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Fay B Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- VA Portland Health Care System, Portland, Oregon, USA
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18
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Lopane G, Mellone S, Chiari L, Cortelli P, Calandra-Buonaura G, Contin M. Dyskinesia detection and monitoring by a single sensor in patients with Parkinson's disease. Mov Disord 2015; 30:1267-71. [PMID: 26179817 DOI: 10.1002/mds.26313] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 05/19/2015] [Accepted: 05/25/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Giovanna Lopane
- IRCCS-Institute of Neurological Sciences of Bologna; Bologna Italy
| | - Sabato Mellone
- Biomedical Engineering Unit; Department of Electrical; Electronic; and Information Engineering; University of Bologna; Bologna Italy
| | - Lorenzo Chiari
- Biomedical Engineering Unit; Department of Electrical; Electronic; and Information Engineering; University of Bologna; Bologna Italy
- Health Sciences and Technologies-Interdepartmental Center for Industrial Research; University of Bologna; Bologna Italy
| | - Pietro Cortelli
- IRCCS-Institute of Neurological Sciences of Bologna; Bologna Italy
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Giovanna Calandra-Buonaura
- IRCCS-Institute of Neurological Sciences of Bologna; Bologna Italy
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
| | - Manuela Contin
- IRCCS-Institute of Neurological Sciences of Bologna; Bologna Italy
- Department of Biomedical and Neuromotor Sciences; University of Bologna; Bologna Italy
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Džoljić E, Novaković I, Krajinovic M, Grbatinić I, Kostić V. Pharmacogenetics of drug response in Parkinson's disease. Int J Neurosci 2014; 125:635-44. [PMID: 25226559 DOI: 10.3109/00207454.2014.963851] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Parkinson's disease (PD) is a debilitating, demoralizing and financially devastating condition affecting 1% of population at the age of 60 years. Thus, very important issue to address is individual therapy optimization. Recent results have shown evidence that variable efficacy of treatment and risk of motor and mental complications could have genetic origin. Significant roles in that process play (pharmaco)genomic/genetic studies of PD. Variability in genes coding for drug-metabolizing enzymes, drug receptors and proteins involved in drug pathway signaling is an important factor determining inter-individual variability in drug responses. Interpersonal differences in drug responses are clearly documented although individualized treatment of PD is not widely known. Treatment with antiparkinsonian drugs is associated with the development of complications, such as L-DOPA-induced dyskinesia (LID), hallucinations and excessive daytime sleepiness. Carriers of specific genetic polymorphisms are particularly susceptible to development of some of these drug adverse effects. Pharmacogenomics aims to understand the relationship between genetic factors and inter-individual variations in drug responses, and to translate this information in therapy tailored to individual patient genetics. Relatively few efforts have been made to investigate the role of pharmacogenetics in the individual response to anti-PD drugs. Thus, many genetic variations and polymorphisms in myriad of different proteins can influence individual response to anti-PD drugs.
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Affiliation(s)
- Eleonora Džoljić
- 1Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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20
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Maetzler W, Nieuwhof F, Hasmann SE, Bloem BR. Emerging therapies for gait disability and balance impairment: promises and pitfalls. Mov Disord 2014; 28:1576-86. [PMID: 24132846 DOI: 10.1002/mds.25682] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/13/2013] [Accepted: 08/13/2013] [Indexed: 12/31/2022] Open
Abstract
Therapeutic management of gait and balance impairment during aging and neurodegeneration has long been a neglected topic. This has changed considerably during recent years, for several reasons: (1) an increasing recognition that gait and balance deficits are among the most relevant determinants of an impaired quality of life and increased mortality for affected individuals; (2) the arrival of new technology, which has allowed for new insights into the anatomy and functional (dis)integrity of gait and balance circuits; and (3) based in part on these improved insights, the development of new, more specific treatment strategies in the field of pharmacotherapy, deep brain surgery, and physiotherapy. The initial experience with these emerging treatments is encouraging, although much work remains to be done. The objective of this narrative review is to discuss several promising developments in the field of gait and balance treatment. We also address several pitfalls that can potentially hinder a fast and efficient continuation of this vital progress. Important issues that should be considered in future research include a clear differentiation between gait and balance as two distinctive targets for treatment and recognition of compensatory mechanisms as a separate target for therapeutic intervention.
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Affiliation(s)
- Walter Maetzler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DNZE), Tübingen, Germany
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21
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Schoneburg B, Mancini M, Horak F, Nutt JG. Framework for understanding balance dysfunction in Parkinson's disease. Mov Disord 2013; 28:1474-82. [PMID: 23925954 PMCID: PMC4001822 DOI: 10.1002/mds.25613] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/06/2013] [Accepted: 06/25/2013] [Indexed: 12/23/2022] Open
Abstract
People with Parkinson's disease (PD) suffer from progressive impairment in their mobility. Locomotor and balance dysfunction that impairs mobility in PD is an important cause of physical and psychosocial disability. The recognition and evaluation of balance dysfunction by the clinician are an essential component of managing PD. In this review, we describe a framework for understanding balance dysfunction in PD to help clinicians recognize patients who are at risk for falling and impaired mobility.
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Affiliation(s)
| | | | - Fay Horak
- Dept. of Neurology, Oregon Health & Science University
| | - John G. Nutt
- Dept. of Neurology, Oregon Health & Science University
- Portland VA Medical Center
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22
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Maetzler W, Domingos J, Srulijes K, Ferreira JJ, Bloem BR. Quantitative wearable sensors for objective assessment of Parkinson's disease. Mov Disord 2013; 28:1628-37. [PMID: 24030855 DOI: 10.1002/mds.25628] [Citation(s) in RCA: 207] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 05/26/2013] [Accepted: 07/01/2013] [Indexed: 12/20/2022] Open
Abstract
There is a rapidly growing interest in the quantitative assessment of Parkinson's disease (PD)-associated signs and disability using wearable technology. Both persons with PD and their clinicians see advantages in such developments. Specifically, quantitative assessments using wearable technology may allow for continuous, unobtrusive, objective, and ecologically valid data collection. Also, this approach may improve patient-doctor interaction, influence therapeutic decisions, and ultimately ameliorate patients' global health status. In addition, such measures have the potential to be used as outcome parameters in clinical trials, allowing for frequent assessments; eg, in the home setting. This review discusses promising wearable technology, addresses which parameters should be prioritized in such assessment strategies, and reports about studies that have already investigated daily life issues in PD using this new technology.
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Affiliation(s)
- Walter Maetzler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
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23
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Six-week combined vibration and wobble board training on balance and stability in footballers with functional ankle instability. Clin J Sport Med 2013; 23:384-91. [PMID: 23657122 DOI: 10.1097/jsm.0b013e318291d22d] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the effectiveness of a combination of vibration and wobble board training against wobble board training alone in footballers suffering from functional ankle instability (FAI). DESIGN A 2 × 3 prefactorial-postfactorial design. SETTING University research laboratory. PARTICIPANTS Thirty-three male semiprofessional footballers with self-reported unilateral FAI were randomly assigned in 3 groups: vibration and wobble board (mean age 22.2 years), wobble board (mean age 22.7 years), and control (mean age 23.1 years). INTERVENTIONS Participants in each intervention group performed a 6-week progressive rehabilitation program using a wobble board, either with or without the addition of vibration stimulus. MAIN OUTCOME MEASURES Absolute center of mass (COM) distribution during single-leg stance, modified star excursion balance test (SEBT) reach distances, and single-leg triple hop for distance (SLTHD) were measured before and after 6-week intervention. RESULTS Combined vibration and wobble board training resulted in reduced COM distribution [P ≤ 0.001, effect size (ES) = 0.66], increased SEBT reach distances (P ≤ 0.01 and P ≤ 0.002, ES = 0.19 and 0.29, respectively), and increased SLTHD (P ≤ 0.001, ES = 0.33) compared with wobble board training alone during the course of the 6-week training intervention. CONCLUSIONS Combined vibration and wobble board training improves COM distribution, modified SEBT scores, and SLTHD among footballers suffering FAI compared with wobble board training alone.
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Holmes JD, Jenkins ME, Johnson AM, Hunt MA, Clark RA. Validity of the Nintendo Wii® balance board for the assessment of standing balance in Parkinson’s disease. Clin Rehabil 2012; 27:361-6. [DOI: 10.1177/0269215512458684] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Impaired postural stability places individuals with Parkinson’s at an increased risk for falls. Given the high incidence of fall-related injuries within this population, ongoing assessment of postural stability is important. Objective: To evaluate the validity of the Nintendo Wii® balance board as a measurement tool for the assessment of postural stability in individuals with Parkinson’s. Subjects: Twenty individuals with Parkinson’s participated. Intervention: Subjects completed testing on two balance tasks with eyes open and closed on a Wii® balance board and biomechanical force platform. Main Measures: Bland–Altman plots and a two-way, random-effects, single measure intraclass correlation coefficient model were used to assess concurrent validity of centre-of-pressure data. Results: Concurrent validity was demonstrated to be excellent across balance tasks (intraclass correlation coefficients = 0.96, 0.98, 0.92, 0.94). Conclusions: This study suggests that the Wii® balance board is a valid tool for the quantification of postural stability among individuals with Parkinson’s.
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Affiliation(s)
- Jeffrey D Holmes
- School of Occupational Therapy, The University of Western Ontario, Canada
| | - Mary E Jenkins
- Clinical Neurological Sciences, The University of Western Ontario, Canada
| | - Andrew M Johnson
- School of Health Studies, The University of Western Ontario, Canada
| | - Michael A Hunt
- Department of Physical Therapy, The University of British Columbia, Canada
| | - Ross A Clark
- Department of Physiotherapy, The University of Melbourne, Australia
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Trunk accelerometry reveals postural instability in untreated Parkinson's disease. Parkinsonism Relat Disord 2011; 17:557-62. [PMID: 21641263 DOI: 10.1016/j.parkreldis.2011.05.010] [Citation(s) in RCA: 192] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Revised: 05/11/2011] [Accepted: 05/14/2011] [Indexed: 11/22/2022]
Abstract
While several studies have shown that subjects with advanced Parkinson's disease (PD) exhibit abnormalities in sway parameters during quiet standing, abnormalities of postural sway associated with untreated PD have not been reported. Although not clinically apparent, we hypothesized that spontaneous sway in quiet stance is abnormal in people with untreated PD. We examined 13 subjects, recently diagnosed with PD, who were not yet taking any anti-parkinsonian medications and 12 healthy, age-matched control subjects. Postural sway was measured with a linear accelerometer on the posterior trunk (L5 level) and compared with traditional force plate measures of sway. Subjects stood for 2 min under two conditions: eyes open (EO) and eyes closed (EC). One of the most discriminative measures of postural changes in subjects with untreated PD was the increased 'JERK' of lower trunk in the EO condition, measured with the accelerometer. Root mean square and the frequency dispersion of postural sway in the EO condition also discriminated sway in untreated PD subjects compared to control subjects. We conclude that accelerometer-based sway metrics could be used as objective measures of postural instability in untreated PD. Accelerometer-based analysis of spontaneous sway may provide a powerful tool for early clinical trials and for monitoring the effects of treatment of balance disorders in subjects with PD.
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