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Pellegrini F, Pozzi NG, Palmisano C, Marotta G, Buck A, Haufe S, Isaias IU. Cortical networks of parkinsonian gait: a metabolic and functional connectivity study. Ann Clin Transl Neurol 2024. [PMID: 39186320 DOI: 10.1002/acn3.52173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/03/2024] [Accepted: 07/08/2024] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVE Locomotion is an automated voluntary movement sustained by coordinated neural synchronization across a distributed brain network. The cerebral cortex is central for adapting the locomotion pattern to the environment and alterations of cortical network dynamics can lead to gait impairments. Gait problems are a common symptom with a still unclear pathophysiology and represent an unmet therapeutical need in Parkinson's disease. Little is known about the cortical network dynamics of locomotor control in these patients. METHODS We studied the cortical basis of parkinsonian gait by combining metabolic brain imaging with high-density EEG recordings and kinematic measurements performed at rest and during unperturbed overground walking. RESULTS We found significant changes in functional connectivity between frontal, sensorimotor, and visuomotor cortical areas during walking as compared to resting. Specifically, hypokinetic gait was associated with poor information flow from the supplementary motor area (SMA) to precuneus and from calcarine to lingual gyrus, as well as high information flow from calcarine to cuneus. INTERPRETATION Our findings support a role for visuomotor integration processes in PD-related hypokinetic gait and suggest that reinforcing visual information may act as a compensatory strategy to allow SMA-mediated feedforward locomotor control in PD.
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Affiliation(s)
- Franziska Pellegrini
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin Center for Advanced Neuroimaging (BCAN), Berlin, Germany
- Bernstein Center for Computational Neuroscience, Berlin, Germany
| | - Nicoló G Pozzi
- Department of Neurology, University Hospital of Würzburg and The Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and The Julius Maximilian University of Würzburg, Würzburg, Germany
- Parkinson Institute of Milan, ASST G. Pini-CTO, Milano, Italy
| | - Giorgio Marotta
- Department of Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andreas Buck
- Department of Nuclear Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Stefan Haufe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin Center for Advanced Neuroimaging (BCAN), Berlin, Germany
- Bernstein Center for Computational Neuroscience, Berlin, Germany
- Uncertainty, Inverse Modeling and Machine Learning Group, Faculty IV Electrical Engineering and Computer Science, Technische Universität Berlin, Berlin, Germany
- Physikalisch-Technische Bundesanstalt Braunschweig und Berlin, Berlin, Germany
| | - Ioannis U Isaias
- Department of Neurology, University Hospital of Würzburg and The Julius Maximilian University of Würzburg, Würzburg, Germany
- Parkinson Institute of Milan, ASST G. Pini-CTO, Milano, Italy
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Rostami Z, Salari M, Mahdavi S, Etemadifar M. Abnormal multisensory temporal discrimination in Parkinson's disease. Brain Res 2024; 1834:148901. [PMID: 38561085 DOI: 10.1016/j.brainres.2024.148901] [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: 10/27/2023] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
Cognitive deficits are prevalent in Parkinson's disease (PD), ranging from mild deficits in perception and executive function to severe dementia. Multisensory integration (MSI), the ability to pool information from different sensory modalities to form a combined, coherent perception of the environment, is known to be impaired in PD. This study investigated the disruption of audiovisual MSI in PD patients by evaluating temporal discrimination ability between auditory and visual stimuli with different stimulus onset asynchronies (SOAs). The experiment was conducted with Fifteen PD patients and fifteen age-matched healthy controls where participants were requested to report whether the audiovisual stimuli pairs were temporal simultaneous. The temporal binding window (TBW), the time during which sensory modalities are perceived as synchronous, was adapted as the comparison index between PD patients and healthy individuals. Our results showed that PD patients had a significantly wider TBW than healthy controls, indicating abnormal audiovisual temporal discrimination. Furthermore, PD patients had more difficulty in discriminating temporal asynchrony in visual-first, but not in auditory-first stimuli, compared to healthy controls. In contrast, no significant difference was observed for auditory-first stimuli. PD patients also had shorter reaction times than healthy controls regardless of stimulus priority. Together, our findings point to abnormal audiovisual temporal discrimination, a major component of MSI irregularity, in PD patients. These results have important implications for future models of MSI experiments and models that aim to uncover the underlying mechanism of MSI in patients afflicted with PD.
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Affiliation(s)
- Zahra Rostami
- Clinical Research Development Unit, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehri Salari
- Clinical Research Development Unit, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Sara Mahdavi
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Masoud Etemadifar
- Faculty of Medicine, Isfahan University of Medical Science, Isfahan, Iran
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Phuenpathom W, Panyakaew P, Vateekul P, Surangsrirat D, Bhidayasiri R. Residual effects of combined vibratory and plantar stimulation while seated influences plantar pressure and spatiotemporal gait measures in individuals with Parkinson's disease exhibiting freezing of gait. Front Aging Neurosci 2024; 15:1280324. [PMID: 38264550 PMCID: PMC10803580 DOI: 10.3389/fnagi.2023.1280324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Combined plantar pressure and vibratory stimulation has been shown to decrease freezing of gait (FOG) episodes and improve spatiotemporal gait parameters compared to single stimulation in Parkinson's disease (PD) patients with FOG. However, the effect of combined plantar stimulations on plantar pressure analysis has never been explored. Methods Forty PD patients with frequent FOG were allocated to either FOG shoes embedded with a 100 Hz vibratory stimulation at the Achilles tendons and a soft thickened silicone pad at the hallux and sole, or sham shoes with a non-working vibratory motor and a flat non-pressure silicone pad (20 patients per arm) while seated for 96 s. The objective gait and plantar pressure analysis were measured immediately after the stimulation. Outcomes included the normalized percentage of changes in percent FOG (%FOG) and plantar pressure in the heel-strike and push-off phase that were compared between pre- and post-stimulations. Results The FOG shoes group showed significantly decreased %FOG (81.5 ± 28.9% vs. 6.8 ± 22.1%, p < 0.001), plantar pressure in the heel-strike (47.8 ± 43.7% vs. 4.3 ± 9.8%, p < 0.001), plantar pressure in the push-off (57.7 ± 59.6% vs. 6.2 ± 11.6%, p < 0.001), force time integral (FTI) (40.9 ± 32.5% vs. 6.6 ± 17.3%, p < 0.001), and decreased heel contact time (19.3 ± 12.3% vs. 22.7 ± 32.5%, p < 0.001) when compared to the sham group. There was a strong negative correlation between %FOG and peak plantar pressure (r = -0.440, p = 0.005), plantar pressure in the heel-strike (r = -0.847, p < 0.001). Conclusion Our study demonstrated that the FOG shoe could decrease FOG episodes by improving the heel-strike pressure, toe push-off and normalized heel-to-toe plantar pressure, suggesting that modification inputs from the peripheral sensory systems might significant improvement in FOG in PD.
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Affiliation(s)
- Warongporn Phuenpathom
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Peerapon Vateekul
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Decho Surangsrirat
- Assistive Technology and Medical Devices Research Center, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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Vitório R, Lirani-Silva E, Orcioli-Silva D, Beretta VS, Oliveira AS, Gobbi LTB. Electrocortical Dynamics of Usual Walking and the Planning to Step over Obstacles in Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2023; 23:4866. [PMID: 37430780 DOI: 10.3390/s23104866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 07/12/2023]
Abstract
The neural correlates of locomotion impairments observed in people with Parkinson's disease (PD) are not fully understood. We investigated whether people with PD present distinct brain electrocortical activity during usual walking and the approach phase of obstacle avoidance when compared to healthy individuals. Fifteen people with PD and fourteen older adults walked overground in two conditions: usual walking and obstacle crossing. Scalp electroencephalography (EEG) was recorded using a mobile 64-channel EEG system. Independent components were clustered using a k-means clustering algorithm. Outcome measures included absolute power in several frequency bands and alpha/beta ratio. During the usual walk, people with PD presented a greater alpha/beta ratio in the left sensorimotor cortex than healthy individuals. While approaching obstacles, both groups reduced alpha and beta power in the premotor and right sensorimotor cortices (balance demand) and increased gamma power in the primary visual cortex (visual demand). Only people with PD reduced alpha power and alpha/beta ratio in the left sensorimotor cortex when approaching obstacles. These findings suggest that PD affects the cortical control of usual walking, leading to a greater proportion of low-frequency (alpha) neuronal firing in the sensorimotor cortex. Moreover, the planning for obstacle avoidance changes the electrocortical dynamics associated with increased balance and visual demands. People with PD rely on increased sensorimotor integration to modulate locomotion.
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Affiliation(s)
- Rodrigo Vitório
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Ellen Lirani-Silva
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Diego Orcioli-Silva
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
| | - Victor Spiandor Beretta
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- School of Technology and Sciences, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
| | | | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
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Phuenpathom W, Panyakaew P, Vateekul P, Surangsrirat D, Hiransuthikul A, Bhidayasiri R. Vibratory and plantar pressure stimulation: Steps to improve freezing of gait in Parkinson's disease. Parkinsonism Relat Disord 2022; 105:43-51. [PMID: 36347154 DOI: 10.1016/j.parkreldis.2022.10.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Freezing of gait (FOG) is a devastating symptom that develops in patients with advanced Parkinson's disease (PD) and is often unresponsive to pharmacological treatment. Recent research suggests that FOG may result from dysfunctional plantar peripheral sensory systems. The impact of combined plantar pressure and vibratory stimulation over vibratory or pressure alone on FOG remains unexplored. METHODS PD patients with FOG were randomised into four groups and treated with combined vibratory and pressure stimulation, vibratory stimulation alone, pressure stimulation alone, or controls (no stimulation). Vibratory stimulation targeted both Achilles' tendons. Simultaneous bilateral pressure stimulation was applied to the first hallux, first metatarsal bone, and the sole. The primary outcome included normalized percent changes in percent FOG measured both pre- and immediately post-stimulation. Other outcomes including clinical rating scale, response to questionnaires, number and duration of freezing episodes, and spatiotemporal gait parameters at pre- and freezing episodes were also explored. RESULTS Sixty PD patients participated in the study. Patients who were treated with combined vibratory and pressure stimulation responded with significant decreases in normalized percent changes of percent FOG (62.75 ± 25.54%, p < 0.001) compared with those treated with vibration alone (11.38 ± 8.29%, p < 0.001), pressure alone (15.15 ± 16.18%, p < 0.001), or controls (8.59 ± 16.85%, p < 0.001). CONCLUSION Our study demonstrated the benefit of combined vibratory and pressure stimulation on FOG suggesting that this strategy might be developed as a novel treatment modality for PD patients with FOG.
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Affiliation(s)
- Warongporn Phuenpathom
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Doctor of Philosophy Programme in Medicine (Neurology), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Peerapon Vateekul
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Decho Surangsrirat
- Assistive Technology and Medical Devices Research Center, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Akarin Hiransuthikul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; The Academy of Science, The Royal Society of Thailand, Bangkok, 10330, Thailand.
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Chen JW, Guan Y, Zheng YL, Zhu K. Research trends and frontiers in exercise for movement disorders: A bibliometric analysis of global research from 2010 to 2021. Front Aging Neurosci 2022; 14:977100. [PMID: 36158546 PMCID: PMC9491729 DOI: 10.3389/fnagi.2022.977100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo conduct a bibliometric analysis of trends and frontiers on exercise-based non-pharmacological treatments for movement disorders published between 2010 and 2021.MethodsThe Web of Science (WOS) Core Collection database was searched for articles published between 2010 and 2021. The CiteSpace software was used for in-depth analysis of the countries, institutions, journals, and collaboration networks among authors and their types of articles, developmental directions, references, and hot keywords of published articles.ResultsA total of 2,626 published articles were retrieved by search formula and included in the analysis. The number of publications fluctuated during this period, with 96 countries, 3,058 institutions, and 886 academic journals having published articles in this area, with subject classifications that focused on Clinical Neurology and Neurosciences. The United States has maintained its dominant and most influential position in exercise-based non-pharmacological research on movement disorders. Among research institutions and journals, the League of European Research Universities and Movement Disorders journals published the highest number of academic articles. In the last five years, the hot research topics by burst keyword analysis, are focused on treatments, research advances, and clinical treatments.ConclusionResearch on exercise-based non-pharmacological treatments for movement disorders is generally on the rise from 2010 to 2021. The bibliometric analysis of this area will help provide potential collaborations among researchers, frontiers, and directions for development.
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Affiliation(s)
- Ji-Wei Chen
- School of Physical Education, Shanghai University of Sport, Shanghai, China
| | - Yue Guan
- Shanghai Sports University Library, Shanghai University of Sport, Shanghai, China
| | - Yi-Li Zheng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- *Correspondence: Yi-Li Zheng,
| | - Kun Zhu
- School of Physical Education, Shanghai University of Sport, Shanghai, China
- Kun Zhu,
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Bernardinis M, Atashzar SF, Patel RV, Jog MS. Abnormal Vision-Based Displacement Perception in Parkinson's Disease. Front Neurosci 2021; 15:676469. [PMID: 34393703 PMCID: PMC8359811 DOI: 10.3389/fnins.2021.676469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022] Open
Abstract
In this work, we investigate the effect of Parkinson’s disease (PD), and common corresponding therapies on vision-based perception of motion, a critical perceptual ability required for performing a wide range of activities of daily livings. While PD has been recognized as mainly a motor disorder, sensory manifestation of PD can also play a major role in the resulting disability. In this paper, for the first time, the effect of disease duration and common therapies on vision-based perception of displacement were investigated. The study is conducted in a movement-independent manner, to reject the shadowing effects and isolate the targeted perceptual disorder to the maximum possible extent. Data was collected using a computerized graphical tool on 37 PD patients [6 early-stage de novo, 25 mid-stage using levodopa therapy, six later-stage using deep brain stimulation (DBS)] and 15 control participants. Besides the absolute measurement of perception through a psychometric analysis on two tested position reference magnitudes, we also investigated the linearity in perception using Weber’s fraction. The results showed that individuals with PD displayed significant perceptual impairments compared to controls, though early-stage patients were not impaired. Mid-stage patients displayed impairments at the greater of the two tested reference magnitudes, while late-stage patients were impaired at both reference magnitudes. Levodopa and DBS use did not cause statistically significant differences in absolute displacement perception. The findings suggest abnormal visual processing in PD increasing with disease development, perhaps contributing to sensory-based impairments of PD such as bradykinesia, visuospatial deficits, and abnormal object recognition.
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Affiliation(s)
- Matthew Bernardinis
- School of Biomedical Engineering, Western University, London, ON, Canada.,Canadian Surgical Technologies and Advanced Robotics, London Health Sciences Centre (LHSC), London, ON, Canada.,London Movement Disorders Centre, LHSC, London, ON, Canada
| | - S Farokh Atashzar
- Electrical and Computer Engineering, Mechanical and Aerospace Engineering, New York University (NYU), New York, NY, United States
| | - Rajni V Patel
- School of Biomedical Engineering, Western University, London, ON, Canada.,Canadian Surgical Technologies and Advanced Robotics, London Health Sciences Centre (LHSC), London, ON, Canada.,Department of Clinical Neurological Sciences and Electrical and Computer Engineering, Western University, London, ON, Canada
| | - Mandar S Jog
- School of Biomedical Engineering, Western University, London, ON, Canada.,London Movement Disorders Centre, LHSC, London, ON, Canada.,Department of Clinical Neurological Sciences and Electrical and Computer Engineering, Western University, London, ON, Canada
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Sharon T, Kurz I, Bernad-Elazari H, Shustak S, Galperin I, Giladi N, Mirelman A, Hausdorff JM, Maidan I. Which obstacle attributes place additional demands on higher-level cognitive function in patients with Parkinson's disease? Parkinsonism Relat Disord 2020; 78:178-183. [PMID: 32927415 DOI: 10.1016/j.parkreldis.2020.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 06/11/2020] [Accepted: 08/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous reports show that patients with Parkinson's disease (PD) rely on prefrontal activation to compensate for impaired motor function during complex activities such as obstacle negotiation. However, the influence of the properties of the obstacles on prefrontal activation has not been systematically evaluated. Here, we examined the effects of obstacle height and anticipation time on prefrontal activation in patients with PD and older adults. METHODS 34 patients with PD (age: 67.4 ± 5.7 years; 14 women) and 26 older adults (age: 71.3 ± 8.9 years; 11 women) walked in an obstacle course while negotiating anticipated and unanticipated obstacles (long/short available time response, ART) at heights of 50 mm and 100 mm. Prefrontal activation was measured using functional Near-Infrared Spectroscopy (fNIRS); obstacle negotiation performance was measured using Kinect cameras. RESULTS PD patients showed greater increases in prefrontal activation during and after obstacle crossing compared to the older adults (p < 0.001). Obstacle height affected prefrontal activity only when crossing anticipated obstacles (ARTxheight interaction, p = 0.011), in which case higher obstacles were accompanied by higher prefrontal activity. PD patients showed higher levels of activation during unanticipated obstacles, compared to older adults (groupXART: p = 0.015). Different correlations between prefrontal activation and obstacle negotiation strategies were observed in patients and controls. CONCLUSIONS These results point to the use of prefrontal activation as a compensatory mechanism in PD. Moreover, the higher activation observed when negotiating more challenging obstacles suggests that there is greater reliance on cognitive resources in these demanding situations that may contribute to the higher risk of falls in PD patients.
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Affiliation(s)
- T Sharon
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - I Kurz
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - H Bernad-Elazari
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel
| | - S Shustak
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel
| | - I Galperin
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel
| | - N Giladi
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - A Mirelman
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - J M Hausdorff
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel; 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
| | - I Maidan
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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Sensory focused exercise improves anxiety in Parkinson's disease: A randomized controlled trial. PLoS One 2020; 15:e0230803. [PMID: 32298270 PMCID: PMC7162490 DOI: 10.1371/journal.pone.0230803] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/06/2020] [Indexed: 12/13/2022] Open
Abstract
Anxiety has been implicated as one of the greatest influences on quality of life in Parkinson’s disease (PD). The etiology of anxiety is unclear, although previous work suggests that anxiety may be linked to sensory deficits that cause uncertainty in movement. Thus, the current study examined whether focusing attention on sensory feedback during goal-based exercise has the potential to provide benefits to anxiety in PD. Thirty-five participants with PD were randomized to either a Sensory Attention Focused Exercise (SAFEx) (i.e. internal focus of attention, n = 18) or Sham Exercise control (i.e. external focus of attention, n = 17) and completed 33 one-hour attention-based exercise sessions over 11-weeks. Before and after the program (pre and post), participants completed the Parkinson Anxiety Scale (PAS) questionnaire. The PAS includes three anxiety sections: persistent, episodic, and avoidance. Changes in the total PAS score and within each section of the PAS were subjected to two-factor mixed repeated measures ANCOVA. Significant group by time interactions demonstrated that from pre to post, total PAS scores (p = 0.007) and episodic anxiety scores (p = 0.010) significantly decreased in the SAFEx group only (ΔTotal PAS = -5.2, F(1,27) = 5.41, p = 0.028, ηp2 = 0.17; ΔEpisodic Score = -1.8, F(1,27) = 6.89, p = 0.014, ηp2 = 0.20). In conclusion, focusing attention on sensory feedback while completing goal-based exercises may provide significant benefits to improving anxiety in PD. As such, sensory attention focused exercise may be a critical adjunct therapy for improving anxiety, and ultimately quality of life in people with PD.
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Bong SM, McKay JL, Factor SA, Ting LH. Perception of whole-body motion during balance perturbations is impaired in Parkinson's disease and is associated with balance impairment. Gait Posture 2020; 76:44-50. [PMID: 31731133 PMCID: PMC7015810 DOI: 10.1016/j.gaitpost.2019.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/09/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND In addition to motor deficits, Parkinson's disease (PD) may cause perceptual impairments. The role of perceptual impairments in sensorimotor function is unclear, and has typically been studied in single-joint motions. RESEARCH QUESTION We hypothesized that perception of whole-body motion is impaired in PD and contributes to balance impairments. We tested (1) whether directional acuity to whole body perturbations during standing was worse in people with PD compared to neurotypical older adults (NOA), and (2) whether balance ability, as assessed by the MiniBESTest, was associated with poor directional acuity in either group. METHODS Participants were exposed to pairs of support-surface translation perturbations in a two-alternative forced choice testing paradigm developed previously in a young healthy population. The first perturbation of each pair that was to be judged by participants was directly backward, and the second perturbation deviated from the left or right from the backward direction by 1°-44°. Participants reported whether the perturbations in each pair were in the "same" or "different" direction. Judgements from 24 to 67 perturbation pairs were used to calculate directional acuity thresholds corresponding to "just-noticeable differences" in perturbation direction. Linear mixed models determined associations between directional thresholds and clinical variables including MDS-UPDRS-III score, age, and MiniBESTest score. RESULTS 20 PD (64 ± 7 y, 12 male, ≥12 h since last intake of antiparkinsonian medications) and 12 NOA (64 ± 8, 6 male) were assessed. Directional thresholds were higher (worse) among PD participants (17.6 ± 5.9° vs. 12.8 ± 3.3°, P < 0.01). Linear mixed models further showed that higher thresholds were associated with MDS-UPDRS-III score (P < 0.01), and were associated with poorer balance ability among PD participants (P < 0.01), but not among NOA participants (P = 0.40). SIGNIFICANCE Perception of whole-body motion is impaired in PD and may contribute to impaired balance and falls.
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Affiliation(s)
- Sistania M. Bong
- Wallace H. Coulter Department of Biomedical Engineering,
Emory University and Georgia Tech, Atlanta, Georgia, USA
| | - J. Lucas McKay
- Wallace H. Coulter Department of Biomedical Engineering,
Emory University and Georgia Tech, Atlanta, Georgia, USA
| | - Stewart A. Factor
- Jean & Paul Amos PD & Movement Disorders Program,
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia,
USA
| | - Lena H. Ting
- Wallace H. Coulter Department of Biomedical Engineering,
Emory University and Georgia Tech, Atlanta, Georgia, USA.,Division of Physical Therapy, Department of Rehabilitation
Medicine, Emory University School of Medicine, Atlanta, Georgia, USA,Corresponding author Lena H. Ting PhD, Wallace H.
Coulter Department of Biomedical Engineering, Emory University and the Georgia
Institute of Technology, 1760 Haygood Drive, Suite W200, Atlanta, Georgia,
30322, USA,
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11
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Gorst T, Marsden J, Freeman J. Lower Limb Somatosensory Discrimination Is Impaired in People With Parkinson's Disease: Novel Assessment and Associations With Balance, Gait, and Falls. Mov Disord Clin Pract 2019; 6:593-600. [PMID: 31538094 DOI: 10.1002/mdc3.12831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 01/22/2023] Open
Abstract
Background People with Parkinson's disease (PD) have often compromised walking and balance. This may be the result of the impaired lower limb tactile and proprioceptive sensation. Existing clinical measures may not be sufficiently sensitive to uncover these sensory impairments. Objective To determine whether novel measures of lower limb somatosensory discrimination are psychometrically robust and associated with mobility outcomes in people with PD. Methods Lower limb somatosensation was assessed on 2 occasions, 3 to 7 days apart, using the following 3 novel tests: gradient discrimination, roughness discrimination, and step height discrimination. Static and dynamic balance (Brief Balance Evaluations Systems Test), falls incidence, falls confidence (Falls Efficacy Scale), and gait (speed and step length) were also obtained. The participants were 27 people with PD and 27 healthy controls. Results Novel tests showed good to excellent intrarater reliability (intraclass correlation coefficient = 0.72-0.92). Significantly higher gradient and step height discrimination thresholds (P < 0.01) were demonstrated in the participants with PD when compared with the healthy controls, indicating worse position sense at the ankle, knee, and hip. Significant correlations were identified between gradient discrimination and falls incidence (r = 0.55), falls confidence (r = 0.44), and balance (r = 0.63), but not gait (r = 0.21). Step height discrimination was significantly correlated with balance (r = 0.54). Foot roughness discrimination was not significantly different between people with PD and healthy controls and was not significantly correlated with mobility measures (P > .05). Conclusion These novel tests are psychometrically robust and identify impaired lower limb position sense, which was associated with balance and falls in this sample of PD patients. Interventions targeting somatosensory processing in PD may improve aspects of balance and reduce falls risk. Further research is warranted.
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Affiliation(s)
- Terry Gorst
- School of Health Professions, Penninsula Allied Health Centre University of Plymouth Plymouth United Kingdom
| | - Jonathan Marsden
- School of Health Professions, Penninsula Allied Health Centre University of Plymouth Plymouth United Kingdom
| | - Jenny Freeman
- School of Health Professions, Penninsula Allied Health Centre University of Plymouth Plymouth United Kingdom
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12
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Abstract
Parkinson's disease is the second most common neurodegenerative disease with a prevalence rate of 1-2 per 1000 of the population worldwide. Pharmacological management is the mainstay of treatment. Despite optimal medication, motor impairment particularly balance and gait impairment persist leading to various degree of disability and reduced quality-of-life. The present review describes motor impairment including postural impairment, gait dysfunction, reduced muscle strength and aerobic capacity and falls. Physical therapy and complementary exercises have been proven to improve motor performance and functional mobility. Evidence on the efficacy of physical therapy and complementary exercises is presented in this review. These exercises include gait training with cues, gait training with treadmill, Nordic walking, brisk walking, balance training, virtual reality interventions, Tai Chi and dance. All these treatment interventions produce short-term beneficial effects and some interventions demonstrate long-term benefit. Gait training with treadmill enhance walking performance and the effects sustain for 3-6 months. Balance training improves balance, function and reduces fall rate, and these effects carry over to at least 12 months after training ended. Sustained Tai Chi for 6 months, dance therapy for 12 months, progressive resistive training for 24 months alleviates the PD motor symptoms, suggesting that they could slow down PD progression. Based on this evidence, individuals with PD are encouraged to sustain their training in order to improve/maintain their physical ability and to combat the progression of PD.
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Affiliation(s)
- Margaret K Y Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Irene S K Wong-Yu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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13
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Does the M.D. Anderson Dysphagia Inventory correlate with dysphagia-limit and the Unified Parkinson Disease Rating Scale in early-stage Parkinson's disease? J Formos Med Assoc 2019; 119:247-253. [PMID: 31133522 DOI: 10.1016/j.jfma.2019.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/30/2019] [Accepted: 05/07/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Dysphagia is a common and critical condition that occurs in Parkinson's disease (PD), and it may appear in early stages. However, few reliable swallowing-related questionnaires are currently available. Therefore, finding efficient questionnaires for surveying dysphagia during the early stages of PD is necessary. PURPOSE This prospective study aimed to identify the correlations between the M.D. Anderson Dysphagia Inventory (MDADI) with dysphagia limit (DL) and the Unified Parkinson Disease Rating Scale (UPDRS) in early-stage PD. METHODS Forty-two patients with early-stage PD were recruited from a medical center. Data were collected for analysis of swallowing-related quality of life using the MDADI, symptom severity using the UPDRS, and DL using a noninvasive swallowing-respiration assessment system. RESULTS Our results showed that the MDADI, including its composite and subscales, was not correlated with DL. The composite scores of the MDADI were moderately correlated with the total score of the UPDRS (r = -0.504; p < 0.05) as well as with the second and third sections of the UPDRS scores (r = -0.453 to -0.478; p < 0.05). These results indicated that the impaired MDADI score can predict symptom severity (UPDRS), especially in activities of daily life and motor function. CONCLUSION The impaired MDADI for early-stage PD was determined, and decreased DL as a presentation of dysphagia could not be reflected by the MDADI. The MDADI may be used as a quick and convenient questionnaire for predicting the severity of early-stage PD, but not for the screening of early or subclinical dysphagia.
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14
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da Conceição NR, Teixeira-Arroyo C, Vitório R, Orcioli-Silva D, Beretta VS, de Sousa PN, Gobbi LTB. Influence of Parkinson's Disease on Judging Stair Step Height: Exploratory Study. Percept Mot Skills 2018; 126:106-118. [PMID: 30501375 DOI: 10.1177/0031512518814608] [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] [Indexed: 11/16/2022]
Abstract
This study investigated the effects of Parkinson's Disease (PD) on the perceptive judgment of stair step height using both exteroceptive visual and exproprioceptive judgments. We invited 14 individuals with PD and 14 neurologically healthy older adults (OA) to perform perceptual judgment tasks for first step stairway heights of 11 and 20 cm. Initially, participants performed first the exteroceptive visual judgment and then the exproprioceptive judgment in five randomized trials for each stair height. An analysis of variance for the exteroceptive visual judgment revealed no main effects or interaction between PD versus OA groups and height. However, the analysis of variance for exproprioceptive judgment revealed a significant interaction between group and height ( F1,26 = 9.519; p = .005; Pη2 = .268) such that both groups made more errors in exproprioceptive judgment at a height of 11 cm. The OA group made more errors in exproprioceptive judgment for the 20-cm step when compared with the PD group ( p = .016) but the PD group underestimated the step height. We conclude that PD influences exproprioceptive perception of step height and that steps with smaller (vs. larger) heights induce greater exproprioceptive error.
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Affiliation(s)
- Núbia R da Conceição
- 1 Posture and Gait Studies Laboratory, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil.,2 Postgraduate Program in Movement Sciences, Sao Paulo State University - UNESP
| | - Claudia Teixeira-Arroyo
- 1 Posture and Gait Studies Laboratory, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil.,3 UNIFAFIBE-Centro Universitário, Bebedouro, Brazil
| | - Rodrigo Vitório
- 1 Posture and Gait Studies Laboratory, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil.,2 Postgraduate Program in Movement Sciences, Sao Paulo State University - UNESP
| | - Diego Orcioli-Silva
- 1 Posture and Gait Studies Laboratory, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil.,2 Postgraduate Program in Movement Sciences, Sao Paulo State University - UNESP
| | - Victor S Beretta
- 1 Posture and Gait Studies Laboratory, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil.,2 Postgraduate Program in Movement Sciences, Sao Paulo State University - UNESP
| | - Priscila N de Sousa
- 1 Posture and Gait Studies Laboratory, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil.,2 Postgraduate Program in Movement Sciences, Sao Paulo State University - UNESP
| | - Lilian T B Gobbi
- 1 Posture and Gait Studies Laboratory, Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, São Paulo, Brazil.,2 Postgraduate Program in Movement Sciences, Sao Paulo State University - UNESP
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15
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Sidaway B, Aaroe A, Albert M, LePage K, Desrosiers G, Keith M, Laniewski A, Perry J, Morell C, Prada J, Stuart J, Voicechovski R. Visual detection of affordances for aperture negotiation in people with Parkinson disease. Neuropsychologia 2018; 120:59-64. [PMID: 30342073 DOI: 10.1016/j.neuropsychologia.2018.10.010] [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: 03/06/2018] [Revised: 09/19/2018] [Accepted: 10/11/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND An essential requirement for the guidance of action in cluttered environments is that people can accurately perceive what actions are afforded by particular surroundings given the person's action capabilities. Research has shown that healthy young individuals turn their shoulders when walking through a doorway when the aperture is less than a certain percentage of their shoulder width and that they are able to detect this critical width with visual inspection. These findings imply that movements are constrained by perception of the environment in body-scaled unit. OBJECTIVES The present work examined whether the visual affordance of doorway passability is altered in people with Parkinson disease (PD). METHODS People with PD, healthy age-matched controls, and young adults (16 participants per group) walked through a series of apertures scaled to shoulder width. Participants also had to visually judge a series of apertures to determine if they could walk through the gap with their normal gait pattern. Finally, participants had to estimate their eye height. RESULTS Statistical analysis revealed that people with PD initiated shoulder turning to go through the doorway at larger apertures (A) relative to their shoulder (S) width (A/S = 1.61) in comparison to healthy age-matched participants (A/S = 1.41) and young adults (A/S = 1.26). In comparison to healthy participants, People with PD also judged wider apertures as impassable. Individuals with PD were less accurate in their estimation of eye height (Error = 10.1%) than the healthy older (Error = 6.29%) and younger adults (Error = 4.79%). CONCLUSIONS PD significantly impacted the affordances for aperture negotiation. Such altered perceptual affordances may contribute to gait pattern changes in people with PD when walking through doorways. These findings suggest that some of the motor symptoms in PD might have a perceptual underpinning.
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Affiliation(s)
- Ben Sidaway
- School of Physical Therapy, Husson University, Bangor, ME 04401, United States.
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16
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Barbieri FA, Polastri PF, Gobbi LTB, Simieli L, Pereira VIA, Baptista AM, Moretto GF, Fiorelli CM, Imaizumi LFI, Rodrigues ST. Obstacle circumvention and eye coordination during walking to least and most affected side in people with Parkinson's disease. Behav Brain Res 2018; 346:105-114. [PMID: 29180136 DOI: 10.1016/j.bbr.2017.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The mechanisms that contribute to gait asymmetry in people with Parkinson's disease (PD) are unclear, mainly during gait with greater environmental demand, such as when an obstacle is circumvented while walking. OBJECTIVE The aim of this study was to investigate the effects of obstacle circumvention of the least and most affected side on motor and gaze behavior in people with PD under/without the effects of dopaminergic medication. METHODS Fifteen people with PD and 15 matched-control individuals were instructed to walk along a pathway, at a self-selected velocity, and to circumvent an obstacle, avoiding contact with it. Each participant performed five trials for each side. Kinematic parameters, mediolateral and horizontal body clearance to the obstacle, strategy to circumvent the obstacle, and gaze behavior were calculated. Parameters were grouped according to the side that the obstacle was circumvented and compared by three-way ANOVAs. RESULTS Both people with PD and the control group presented asymmetry to circumvent an obstacle during walking, however this was exacerbated in people with PD. Individuals with PD presented safe strategies (largest mediolateral and horizontal body clearance to the obstacle, "lead-out" strategy, and higher number and time of fixations on the obstacle) during obstacle circumvention for the least affected side compared to the most affected side. In addition, positive effects of dopaminergic medication on body clearance, spatial-temporal parameters, and gaze behavior were evidenced only when the obstacle was circumvented to the least affected side. CONCLUSIONS The obstacle circumvention to the most affected side is risky for people with PD.
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Affiliation(s)
- Fabio Augusto Barbieri
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil.
| | - Paula Favaro Polastri
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, SP, Brazil
| | - Lucas Simieli
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Vinicius Ignácio Alota Pereira
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - André Macari Baptista
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Gabriel Felipe Moretto
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Carolina Menezes Fiorelli
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil; Universidade Sagrado Coração, Bauru, SP, Brazil
| | - Luis Felipe Itikawa Imaizumi
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Sérgio Tosi Rodrigues
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
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17
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Absent Audiovisual Integration Elicited by Peripheral Stimuli in Parkinson's Disease. PARKINSONS DISEASE 2018; 2018:1648017. [PMID: 29850014 PMCID: PMC5924975 DOI: 10.1155/2018/1648017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 01/01/2018] [Accepted: 01/29/2018] [Indexed: 01/22/2023]
Abstract
The basal ganglia, which have been shown to be a significant multisensory hub, are disordered in Parkinson's disease (PD). This study was to investigate the audiovisual integration of peripheral stimuli in PD patients with/without sleep disturbances. Thirty-six age-matched normal controls (NC) and 30 PD patients were recruited for an auditory/visual discrimination experiment. The mean response times for each participant were analyzed using repeated measures ANOVA and race model. The results showed that the response to all stimuli was significantly delayed for PD compared to NC (all p < 0.01). The response to audiovisual stimuli was significantly faster than that to unimodal stimuli in both NC and PD (p < 0.001). Additionally, audiovisual integration was absent in PD; however, it did occur in NC. Further analysis showed that there was no significant audiovisual integration in PD with/without cognitive impairment or in PD with/without sleep disturbances. Furthermore, audiovisual facilitation was not associated with Hoehn and Yahr stage, disease duration, or the presence of sleep disturbances (all p > 0.05). The current results showed that audiovisual multisensory integration for peripheral stimuli is absent in PD regardless of sleep disturbances and further suggested the abnormal audiovisual integration might be a potential early manifestation of PD.
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18
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Bekkers EMJ, Dockx K, Devan S, Van Rossom S, Verschueren SMP, Bloem BR, Nieuwboer A. The Impact of Dual-Tasking on Postural Stability in People With Parkinson’s Disease With and Without Freezing of Gait. Neurorehabil Neural Repair 2018; 32:166-174. [DOI: 10.1177/1545968318761121] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Esther M. J. Bekkers
- KU Leuven, Leuven, Belgium
- Radboud University Medical Center, Nijmegen, the Netherlands
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19
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Orcioli-Silva D, Barbieri FA, Simieli L, Vitorio R, Santos PCRD, Beretta VS, Gobbi LTB. Walking behavior over multiple obstacles in people with Parkinson's disease. Gait Posture 2017; 58:510-515. [PMID: 28957776 DOI: 10.1016/j.gaitpost.2017.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 02/02/2023]
Abstract
The presence of a second obstacle changed the planning and adjustments for obstacle avoidance performance, but this context is poorly understood in Parkinson's disease (PD). The aim of this study was to investigate the walking behavior over multiple obstacles in people with PD. Nineteen people with PD and 19 healthy individuals walked across an 8m pathway, performing three trials for following conditions: unobstructed walking, walking with one obstacle avoidance (Single), and walking with two obstacles avoidance (Double). In the Double condition, the analysis was performed only for the first obstacle (First Double). The dependent variables were calculated separately for the approach and crossing phases in the obstacle conditions. The main results show that people with PD decreased single support and increased double support phase in both Single and Double conditions compared to the unobstructed walking. Both groups increased stride duration during approach phase in the Double condition compared to the unobstructed walking and Single conditions. The presence of the second obstacle led to a decrease in trailing toe clearance during obstacle avoidance of the First Double. In conclusion, people with PD use a conservative strategy while approaching obstacles. Both groups need more time to obtain and process environmental information and plan the action in environments with multiple obstacles. The smaller leading toe clearance might be an indicative that the presence of a second obstacle increase the likelihood of tripping during obstacle avoidance in both people with PD and healthy individuals.
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Affiliation(s)
- Diego Orcioli-Silva
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
| | - Fabio Augusto Barbieri
- Universidade Estadual Paulista (Unesp), Faculdade de Ciências, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Lucas Simieli
- Universidade Estadual Paulista (Unesp), Faculdade de Ciências, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Rodrigo Vitorio
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Paulo Cezar Rocha Dos Santos
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Victor Spiandor Beretta
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
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20
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Malik RN, Cote R, Lam T. Sensorimotor integration of vision and proprioception for obstacle crossing in ambulatory individuals with spinal cord injury. J Neurophysiol 2016; 117:36-46. [PMID: 27733593 DOI: 10.1152/jn.00169.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 10/03/2016] [Indexed: 01/02/2023] Open
Abstract
Skilled walking, such as obstacle crossing, is an essential component of functional mobility. Sensorimotor integration of visual and proprioceptive inputs is important for successful obstacle crossing. The objective of this study was to understand how proprioceptive deficits affect obstacle-crossing strategies when controlling for variations in motor deficits in ambulatory individuals with spinal cord injury (SCI). Fifteen ambulatory individuals with SCI and 15 able-bodied controls were asked to step over an obstacle scaled to their motor abilities under full and obstructed vision conditions. An eye tracker was used to determine gaze behaviour and motion capture analysis was used to determine toe kinematics relative to the obstacle. Combined, bilateral hip and knee proprioceptive sense (joint position sense and movement detection sense) was assessed using the Lokomat and customized software controls. Combined, bilateral hip and knee proprioceptive sense in subjects with SCI varied and was significantly different from able-bodied subjects. Subjects with greater proprioceptive deficits stepped higher over the obstacle with their lead and trail limbs in the obstructed vision condition compared with full vision. Subjects with SCI also glanced at the obstacle more frequently and with longer fixation times compared with controls, but this was not related to proprioceptive sense. This study indicates that ambulatory individuals with SCI rely more heavily on vision to cross obstacles and show impairments in key gait parameters required for successful obstacle crossing. Our data suggest that proprioceptive deficits need to be considered in rehabilitation programs aimed at improving functional mobility in ambulatory individuals with SCI. NEW & NOTEWORTHY This work is unique since it examines the contribution of combined, bilateral hip and knee proprioceptive sense on the recovery of skilled walking function, in addition to characterizing gaze behavior during a skilled walking task in people with motor-incomplete spinal cord injury.
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Affiliation(s)
- Raza Naseem Malik
- School of Kinesiology and International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel Cote
- School of Kinesiology and International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tania Lam
- School of Kinesiology and International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
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21
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Pereira MP, Gobbi LT, Almeida QJ. Freezing of gait in Parkinson’s disease: Evidence of sensory rather than attentional mechanisms through muscle vibration. Parkinsonism Relat Disord 2016; 29:78-82. [DOI: 10.1016/j.parkreldis.2016.05.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/05/2016] [Accepted: 05/21/2016] [Indexed: 11/28/2022]
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22
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Impaired interhemispheric synchrony in Parkinson's disease with depression. Sci Rep 2016; 6:27477. [PMID: 27265427 PMCID: PMC4893739 DOI: 10.1038/srep27477] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/19/2016] [Indexed: 01/11/2023] Open
Abstract
The alterations of interhemispheric resting-state functional connectivity (FC) in Parkinson’s disease (PD) with depression remain unclear, so we aimed to explore the differences of interhemispheric FC between PD with and without depression. Twenty-one depressed PD (DPD) patients, 49 non-depressed PD (NDPD) patients and 50 matched healthy controls (HC) participated in this study. Resting-state functional magnetic resonance imaging (fMRI) data were analyzed with the voxel-mirrored homotopic connectivity (VMHC) approach. The DPD patients showed lower VMHC values in the bilateral dorsolateral prefrontal cortex (DLPFC) and calcarine cortex compared to both NDPD and HC groups, and further receiver operating characteristic curves (ROC) analyses revealed that the VMHC in these two brain areas could be used as biomarkers to distinguish DPD from NDPD and from HC. The pooled PD patients (both DPD and NDPD) exhibited decreased VMHC in the bilateral putamen, middle occipital gyrus (MOG), postcentral gyrus (PoCG), paracentral lobule (PCL) and cerebellum posterior lobe when compared with HC. Decreased VMHC values within the DLPFC and calcarine cortex appeared to be unique features for DPD and might be used as potential neuroimaging markers to distinguish DPD patients from NDPD and HC groups. These findings may underlie the neural mechanisms of depression in PD.
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Pieruccini-Faria F, Jones J, Almeida Q. Insight into dopamine-dependent planning deficits in Parkinson’s disease: A sharing of cognitive & sensory resources. Neuroscience 2016; 318:219-29. [DOI: 10.1016/j.neuroscience.2016.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/16/2015] [Accepted: 01/08/2016] [Indexed: 11/15/2022]
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24
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Gerstenberger J, Bauer A, Helmschrodt C, Richter A, Richter F. The novel adaptive rotating beam test unmasks sensorimotor impairments in a transgenic mouse model of Parkinson's disease. Behav Brain Res 2016; 304:102-10. [PMID: 26880341 DOI: 10.1016/j.bbr.2016.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/08/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
Abstract
Development of disease modifying therapeutics for Parkinson's disease (PD), the second most common neurodegenerative disorder, relies on availability of animal models which recapitulate the disease hallmarks. Only few transgenic mouse models, which mimic overexpression of alpha-synuclein, show dopamine loss, behavioral impairments and protein aggregation. Mice overexpressing human wildtype alpha-synuclein under the Thy-1 promotor (Thy1-aSyn) replicate these features. However, female mice do not exhibit a phenotype. This was attributed to a potentially lower transgene expression located on the X chromosome. Here we support that female mice overexpress human wildtype alpha-synuclein only about 1.5 fold in the substantia nigra, compared to about 3 fold in male mice. Since female Thy1-aSyn mice were shown previously to exhibit differences in corticostriatal communication and synaptic plasticity similar to their male counterparts we hypothesized that female mice use compensatory mechanisms and strategies to not show overt motor deficits despite an underlying endophenotype. In order to unmask these deficits we translated recent findings in PD patients that sensory abnormalities can enhance motor dysfunction into a novel behavioral test, the adaptive rotating beam test. We found that under changing sensory input female Thy1-aSyn mice showed an overt phenotype. Our data supports that the integration of sensorimotor information is likely a major contributor to symptoms of movement disorders and that even low levels of overexpression of human wildtype alpha-synuclein has the potential to disrupt processing of these information. The here described adaptive rotating beam test represents a sensitive behavioral test to detect moderate sensorimotor alterations in mouse models.
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Affiliation(s)
- Julia Gerstenberger
- Institute of Pharmacology, Pharmacy and Toxicology, Department of Veterinary Medicine, Leipzig University, An den Tierkliniken 15, 04103 Leipzig, Germany.
| | - Anne Bauer
- Institute of Pharmacology, Pharmacy and Toxicology, Department of Veterinary Medicine, Leipzig University, An den Tierkliniken 15, 04103 Leipzig, Germany.
| | - Christin Helmschrodt
- Institute of Pharmacology, Pharmacy and Toxicology, Department of Veterinary Medicine, Leipzig University, An den Tierkliniken 15, 04103 Leipzig, Germany.
| | - Angelika Richter
- Institute of Pharmacology, Pharmacy and Toxicology, Department of Veterinary Medicine, Leipzig University, An den Tierkliniken 15, 04103 Leipzig, Germany.
| | - Franziska Richter
- Institute of Pharmacology, Pharmacy and Toxicology, Department of Veterinary Medicine, Leipzig University, An den Tierkliniken 15, 04103 Leipzig, Germany.
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Compensatory postural adjustments in Parkinson’s disease assessed via a virtual reality environment. Behav Brain Res 2016; 296:384-392. [DOI: 10.1016/j.bbr.2015.08.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/07/2015] [Accepted: 08/17/2015] [Indexed: 11/23/2022]
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Fearon C, Butler JS, Newman L, Lynch T, Reilly RB. Audiovisual Processing is Abnormal in Parkinson’s Disease and Correlates with Freezing of Gait and Disease Duration. JOURNAL OF PARKINSONS DISEASE 2015; 5:925-36. [DOI: 10.3233/jpd-150655] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Conor Fearon
- Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
- Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
| | - John S. Butler
- Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
- School of Mathematical Sciences, Dublin Institute of Technology, Kevin Street, Dublin, Ireland
| | - Louise Newman
- Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
- Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
| | - Timothy Lynch
- Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
| | - Richard B. Reilly
- Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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Verdonschot RJCG, Baijens L, Vanbelle S, Florie M, Kremer B, Leue C. The relationship between fiberoptic endoscopic evaluation of swallowing outcome and symptoms of anxiety and depression in dysphagic patients. Laryngoscope 2015; 126:E199-207. [PMID: 26451747 DOI: 10.1002/lary.25698] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 08/18/2015] [Accepted: 08/31/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Affective complaints are involved in bothersome oropharyngeal dysphagia (OD). The aim was to determine the relationship between the severity of OD and affective symptoms. STUDY DESIGN Prospective cohort study. METHODS One hundred seven patients underwent a standardized examination protocol including the Hospital Anxiety and Depression Scale and fiberoptic endoscopic evaluation of swallowing (FEES). Two observers independently assessed patient performance on four ordinal FEES-variables (for thin and thick liquid consistency, blindly assessed). The relationship between FEES outcome and the presence of clinically relevant symptoms of anxiety and depression was analyzed using binary logistic regression. RESULTS Significant associations were found between clinically relevant symptoms of anxiety and two variables: piecemeal deglutition (thin liquid consistency only) (P = .026) and postswallow vallecular pooling (thick liquid consistency only) (P = .015). The probability of presenting with anxiety symptoms decreased as the severity of piecemeal deglutition and postswallow vallecular pooling increased. No significant association was found between clinically relevant symptoms of depression and any specific FEES variable. CONCLUSIONS These data revealed few associations between anxiety symptoms and the measured FEES variables. However, the more severe the score on FEES variables, the less important the affective complaints were. Anxiety seems to play a role in OD, but no causal relationship was found, commensurate with a cross-sectional study design. The contribution of affective symptoms to the development and treatment of OD warrants longitudinal research. LEVEL OF EVIDENCE 2b Laryngoscope, 126:E199-E207, 2016.
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Affiliation(s)
- Rob J C G Verdonschot
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Emergency Department, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Laura Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sophie Vanbelle
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Michelle Florie
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Carsten Leue
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
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Malloy JR, Valentin JC, Hands GL, Stevens CA, Langmore SE, Noordzij JP, Stepp CE. Visuomotor control of neck surface electromyography in Parkinson's disease. NeuroRehabilitation 2015; 35:795-803. [PMID: 25318778 DOI: 10.3233/nre-141169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare performance of individuals with Parkinson's disease (PD) and age-matched controls on a visuomotor tracking task controlled via surface electromyography (sEMG). METHODS Twenty-seven adults with PD and twenty-four older controls produced dry swallows and completed a visuomotor tracking task utilizing both static and dynamic targets. sEMG was recorded at the anterior neck and submental surface during both tasks. RESULTS There was no significant difference in visuomotor tracking ability between cohorts. Post hoc analyses indicated that there was no significant difference between participant groups in the strength or duration of swallows as measured by sEMG but that participants with PD showed a trend for decreased swallow durations at the anterior neck (padj = 0.067) whereas controls showed a trend for increased durations at the anterior neck (padj = 0.112), compared to the submental surface. However, there were no significant correlations between swallowing behavior and visuomotor tracking ability. CONCLUSION There were no significant differences in visuomotor tracking performance between individuals with PD and controls. Furthermore, there was no relationship between tracking ability and swallowing behavior. We conclude that sEMG-mediated biofeedback may have limited promise as a tool for treating PD-related dysphagia.
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Affiliation(s)
- Jessica R Malloy
- Speech, Language, and Hearing Sciences, Boston University, Boston, MA, USA
| | - Juliana C Valentin
- Speech, Language, and Hearing Sciences, Boston University, Boston, MA, USA
| | - Gabrielle L Hands
- Speech, Language, and Hearing Sciences, Boston University, Boston, MA, USA
| | | | - Susan E Langmore
- Speech, Language, and Hearing Sciences, Boston University, Boston, MA, USA Otolaryngology - Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - J Pieter Noordzij
- Otolaryngology - Head & Neck Surgery, Boston Medical Center, Boston, MA, USA
| | - Cara E Stepp
- Speech, Language, and Hearing Sciences, Boston University, Boston, MA, USA Biomedical Engineering, Boston University, Boston, MA, USA
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van Hooren MRA, Baijens LWJ, Vos R, Pilz W, Kuijpers LMF, Kremer B, Michou E. Voice- and swallow-related quality of life in idiopathic Parkinson's disease. Laryngoscope 2015; 126:408-14. [DOI: 10.1002/lary.25481] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/12/2015] [Accepted: 06/08/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Michel R. A. van Hooren
- Department of Otorhinolaryngology-Head and Neck Surgery; Maastricht University Medical Center; Maastricht the Netherlands
| | - Laura W. J. Baijens
- Department of Otorhinolaryngology-Head and Neck Surgery; Maastricht University Medical Center; Maastricht the Netherlands
| | - Rein Vos
- Department of Methodology and Statistics; CAPHRI School for Public Health and Primary Care, Maastricht University; Maastricht the Netherlands
| | - Walmari Pilz
- Department of Otorhinolaryngology-Head and Neck Surgery; Maastricht University Medical Center; Maastricht the Netherlands
| | - Laura M. F. Kuijpers
- Department of Clinical Sciences; Institute of Tropical Medicine; Antwerp Belgium
| | - Bernd Kremer
- Department of Otorhinolaryngology-Head and Neck Surgery; Maastricht University Medical Center; Maastricht the Netherlands
| | - Emilia Michou
- Centre for Gastrointestinal Sciences; Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre, Salford Royal Hospital; Salford United Kingdom
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Virtually-induced threat in Parkinson's: Dopaminergic interactions between anxiety and sensory-perceptual processing while walking. Neuropsychologia 2015; 79:322-31. [PMID: 26004056 DOI: 10.1016/j.neuropsychologia.2015.05.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/18/2015] [Accepted: 05/20/2015] [Indexed: 11/20/2022]
Abstract
Research evidence has suggested that anxiety influences gait in PD, with an identified dopa-sensitive gait response in highly anxious PD. It has been well-established that accurate perception of the environment and sensory feedback is essential for gait. Arguably since sensory and perceptual deficits have been noted in PD, anxiety has the potential to exacerbate movement impairments, since one might expect that reducing resources needed to overcome or compensate for sensory-perceptual deficits may lead to even more severe gait impairments. It is possible that anxiety in threatening situations might consume more processing resources, limiting the ability to process information about the environment or one's own movement (sensory feedback) especially in highly anxious PD. Therefore, the current study aimed to (i) evaluate whether processing of threat-related aspects of the environment was influenced by anxiety, (ii) evaluate whether anxiety influences the ability to utilize sensory feedback in PD while walking in threatening situations, and (iii) further understand the role of dopaminergic medication on these processes in threatening situations in PD. Forty-eight participants (24 HC; 12 Low Anxious [LA-PD], 12 Highly Anxious [HA-PD]) completed 20 walking trials in virtual reality across a plank that was (i) located on the ground (GROUND) (ii) located above a deep pit (ELEVATED); while provided with or without visual feedback about their lower limbs (+VF; -VF). After walking across the plank, participants were asked to judge the width of the plank they had just walked across. The plank varied in size from 60-100 cm. Both ON and OFF dopaminergic medication states were evaluated in PD. Gait parameters, judgment error and self-reported anxiety levels were measured. Results showed that HA-PD reported greater levels of anxiety overall (p<0.001) compared to HC and LA-PD, and all participants reported greater anxiety during the ELEVATED condition compared to GROUND (p=0.01). PD had similar judgment error as HC. Additionally, medication state did not significantly influence judgment error in PD. More importantly, HA-PD were the only group that did not adjust their step width when feedback was provided during the GROUND condition. However, medication facilitated a reduction in ST-CV when visual feedback was available only in the HA-PD group. Therefore, the current study provides evidence that anxiety may interfere with information processing, especially utilizing sensory feedback while walking. Dopaminergic medication appears to improve utilization of sensory feedback in stressful situations by reducing anxiety and/or improving resource allocation especially in those with PD who are highly anxious.
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Ehgoetz Martens KA, Ellard CG, Almeida QJ. Does manipulating the speed of visual flow in virtual reality change distance estimation while walking in Parkinson’s disease? Exp Brain Res 2014; 233:787-95. [DOI: 10.1007/s00221-014-4154-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/17/2014] [Indexed: 01/23/2023]
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Vitório R, Lirani-Silva E, Baptista AM, Barbieri FA, dos Santos PCR, Teixeira-Arroyo C, Gobbi LTB. Disease severity affects obstacle crossing in people with Parkinson's disease. Gait Posture 2014; 40:266-9. [PMID: 24671005 DOI: 10.1016/j.gaitpost.2014.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 02/21/2014] [Accepted: 03/03/2014] [Indexed: 02/02/2023]
Abstract
The current study evaluated the effects of disease severity on the control of obstacle crossing in people with idiopathic Parkinson's disease (PD). Forty-five subjects participated in the study, including 15 patients with mild PD (classified as stage 1 to 1.5 of the Hoehn and Yahr Rating Scale), 15 patients with moderate PD (classified as stage 2 to 3 of the Hoehn and Yahr Rating Scale), and 15 neurologically healthy individuals. Groups were matched by sex, age, body mass, and body height. The obstacle crossing task required participants to walk along a pathway and step over an obstacle (half of the knee height, positioned in the middle of the pathway). Patients were tested in a typically medicated state. Kinematic data were recorded using an optoelectronic tridimensional system. The outcome measures included spatiotemporal measures of obstacle avoidance. There were no significant differences between patients with mild PD and healthy individuals. Patients with moderate PD exhibited shorter distances for leading toe clearance and leading foot placement after the obstacle than did healthy individuals. Patients with moderate PD tended to exhibit a lower leading horizontal mean velocity during obstacle crossing than did healthy individuals. We found significant negative relationships between obstacle crossing measures and disease severity (score on the motor section of the Unified Parkinson's Disease Rating Scale). These findings suggest that disease severity affects locomotor behavior during obstacle crossing in PD. Specifically, obstacle avoidance was not affected in the early stages of PD; however, bradykinesia and hypometria influenced obstacle crossing in patients with moderate PD.
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Affiliation(s)
- Rodrigo Vitório
- UNESP, São Paulo State University at Rio Claro, 1515 24-A Avenue, Rio Claro, São Paulo State 13506-900, Brazil.
| | - Ellen Lirani-Silva
- UNESP, São Paulo State University at Rio Claro, 1515 24-A Avenue, Rio Claro, São Paulo State 13506-900, Brazil
| | - André Macari Baptista
- UNESP, São Paulo State University at Rio Claro, 1515 24-A Avenue, Rio Claro, São Paulo State 13506-900, Brazil
| | - Fabio Augusto Barbieri
- UNESP, São Paulo State University at Rio Claro, 1515 24-A Avenue, Rio Claro, São Paulo State 13506-900, Brazil
| | | | - Claudia Teixeira-Arroyo
- UNESP, São Paulo State University at Rio Claro, 1515 24-A Avenue, Rio Claro, São Paulo State 13506-900, Brazil; Centro Universitário UNIFAFIBE, 325 Prof. Orlando França de Carvalho Street, Bebedouro, São Paulo State 14701-070, Brazil
| | - Lilian Teresa Bucken Gobbi
- UNESP, São Paulo State University at Rio Claro, 1515 24-A Avenue, Rio Claro, São Paulo State 13506-900, Brazil
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Li J, Luo C, Chen Y, Chen Q, Huang R, Sun J, Gong Q, Wu X, Qi Z, Liang Z, Li L, Li H, Li P, Wang W, Shang HF. Parkinson׳s disease-related modulation of functional connectivity associated with the striatum in the resting state in a nonhuman primate model. Brain Res 2014; 1555:10-9. [PMID: 24530271 DOI: 10.1016/j.brainres.2014.01.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 01/26/2014] [Accepted: 01/28/2014] [Indexed: 02/07/2023]
Abstract
The goal of this study was to describe Parkinson׳s disease (PD)-related modulation of functional connectivity (FC) associated with the striatum in the resting state in a nonhuman primate model of early-stage PD. Weekly intravenous injections of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) (0.5 mg/kg body weight) were performed until parkinsonian motor symptoms developed in four macaques. After 13 weeks of MPTP treatment, all monkeys displayed parkinsonian symptoms. During the course of the experiment, each animal underwent four magnetic resonance imaging scans and four positron emission tomography (PET) scans with the vesicular monoamine transporter 2 (VMAT2)-selective ligand 9-[(18)F] fluoropropyl-(+)-dihydrotetrabenazine, performed prior to the beginning of MPTP administration as well as after 4, 9, and 13 MPTP injections. The FC profile of the striatum was evaluated using a seed voxel correlation approach and post hoc region of interest analysis on resting-state functional magnetic resonance imaging data. The PET images were subjected to region of interest analysis to examine brain regional reductions in VMAT2 density in the PD model. Significant reductions in the connectivity pattern of the striatal regions were observed: limbic striatum and left hippocampus; caudate nucleus/associative and brain regions, including the right pre-supplementary motor area and bilateral dorsolateral prefrontal cortex; putamen/associative region and left inferior temporal gyrus or right orbital and medial prefrontal cortex; and putamen/motor and cortical structures, including the right superior temporal gyrus and bilateral postcentral gyrus. Subsequent PET studies showed the progressive loss of striatal VMAT2 in the striatum with the presentation of parkinsonism. Significant differences between the specific uptake ratio reductions in each striatal subdivision were not found. By using a long-term, low-dose MPTP-lesioned nonhuman primate model, this study demonstrated PD-related decreased corticostriatal FC in a resting state; moreover, altered sensorimotor integration was also found in early-stage PD.
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Affiliation(s)
- Jianpeng Li
- Department of Neurology, West China Hospital, Sichuan University, China
| | - Chunyan Luo
- Department of Neurology, West China Hospital, Sichuan University, China
| | - Yongping Chen
- Department of Neurology, West China Hospital, Sichuan University, China
| | - Qin Chen
- Department of Neurology, West China Hospital, Sichuan University, China
| | - Rui Huang
- Department of Neurology, West China Hospital, Sichuan University, China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Qiyong Gong
- Department of Radiology, West China Hospital, Sichuan University, China
| | - Xiaoai Wu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, China
| | - Zhongzhi Qi
- Department of Nuclear Medicine, West China Hospital, Sichuan University, China
| | - Zhenglu Liang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, China
| | - Lin Li
- Department of Nuclear Medicine, West China Hospital, Sichuan University, China
| | - Hongxia Li
- National Chengdu Center for Safety Evaluation of Drugs, China
| | - Peng Li
- Department of Neurosurgery, West China Hospital, Sichuan University, China
| | - Wei Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, China
| | - Hui-Fang Shang
- Department of Neurology, West China Hospital, Sichuan University, China.
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Abstract
Movement disorders, which include disorders such as Parkinson's disease, dystonia, Tourette's syndrome, restless legs syndrome, and akathisia, have traditionally been considered to be disorders of impaired motor control resulting predominantly from dysfunction of the basal ganglia. This notion has been revised largely because of increasing recognition of associated behavioural, psychiatric, autonomic, and other non-motor symptoms. The sensory aspects of movement disorders include intrinsic sensory abnormalities and the effects of external sensory input on the underlying motor abnormality. The basal ganglia, cerebellum, thalamus, and their connections, coupled with altered sensory input, seem to play a key part in abnormal sensorimotor integration. However, more investigation into the phenomenology and physiological basis of sensory abnormalities, and about the role of the basal ganglia, cerebellum, and related structures in somatosensory processing, and its effect on motor control, is needed.
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Affiliation(s)
- Neepa Patel
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
| | - Mark Hallett
- Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA
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Sinclair CF, Gurey LE, Brin MF, Stewart C, Blitzer A. Surgical management of airway dysfunction in Parkinson's disease compared with Parkinson-plus syndromes. Ann Otol Rhinol Laryngol 2013; 122:294-8. [PMID: 23815045 DOI: 10.1177/000348941312200502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We sought to compare the laryngeal symptoms of Parkinson's disease (PD) with those of multiple system atrophy (MSA), a Parkinson-plus syndrome; to review the differences in surgical management of upper airway dysfunction between patients with PD and those with MSA; and to present a treatment algorithm for management of upper airway disorders in patients with PD and MSA. METHODS We analyzed the airway manifestations of each disease, including clinical and physiological test results and management outcomes, in a case series of 30 patients (24 with PD and 6 with MSA). RESULTS Vocal fold atrophy causing bowing with a midfold glottic gap was common in patients with PD. One third of patients with PD underwent vocal fold augmentation with noticeable improvement in vocal volume and phonation time. Tracheostomy was required for life-threatening sleep apnea in 50% of the patients with MSA. Systemic medications and speech therapy were integral components of the management regimen. CONCLUSIONS Surgical management of laryngeal disorders in patients with PD should focus on restoring bulk to atrophic vocal folds to minimize glottic gaps, thus improving vocalization efficiency even in the presence of impaired respiratory effort. Conversely, the autonomic dysfunction that characterizes MSA results in upper airway obstruction, and thus surgical management focuses primarily on maintaining an adequate airway, which frequently necessitates tracheostomy.
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Affiliation(s)
- Catherine F Sinclair
- New York Center for Voice and Swallowing Disorders, St Luke's Roosevelt Medical Center, New York, NY 10019, USA
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Pieruccini-Faria F, Vitório R, Almeida QJ, Silveira CRA, Caetano MJD, Stella F, Gobbi S, Gobbi LTB. Evaluating the Acute Contributions of Dopaminergic Replacement to Gait With Obstacles in Parkinson's Disease. J Mot Behav 2013; 45:369-80. [DOI: 10.1080/00222895.2013.810139] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ehgoetz Martens KA, Pieruccini-Faria F, Almeida QJ. Could sensory mechanisms be a core factor that underlies freezing of gait in Parkinson's disease? PLoS One 2013; 8:e62602. [PMID: 23667499 PMCID: PMC3648560 DOI: 10.1371/journal.pone.0062602] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/22/2013] [Indexed: 11/19/2022] Open
Abstract
The main objective of this study was to determine how manipulating the amount of sensory information available about the body and surrounding environment influenced freezing of gait (FOG), while walking through a doorway. It was hypothesized that the more limited the sensory information, the greater the occurrence of freezing of gait. Nineteen patients with Parkinsoǹs disease who experience freezing of gait (PD-FOG) walked through a doorway or into open space in complete darkness. The three doorway conditions included: (i) FRAME (DARK)--walking through the remembered door frame; (ii) FRAME--walking through the door with the door frame illuminated; (iii) FRAME+BODY--walking through the door (both the door and the limbs illuminated). Additionally, two conditions of walking away from the doorway included: (iv) NO FRAME (DARK)--walking into open space; (v) NO FRAME+BODY--walking into open space with the limbs illuminated, to evaluate whether perception (or fear) of the doorway might account for FOG behaviour. Key outcome measures included: the number of freezing of gait episodes recorded, total duration of freezing of gait, and the percentage of time spent frozen. Significantly more freezing of gait episodes occurred when participants walked toward the doorway in complete darkness compared to walking into open space (p<0.05). Similar to previous studies, velocity (p<0.001) and step length (p<0.0001) significantly decreased when walking through the door in complete darkness, compared to all other conditions. Significant increases in step width variability were also identified but only when walking into open space (p<0.005). These results support the notion that sensory deficits may have a profound impact on freezing of gait that need to be carefully considered.
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Affiliation(s)
- Kaylena A. Ehgoetz Martens
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Frederico Pieruccini-Faria
- Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Quincy J. Almeida
- Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
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Nombela C, Rae CL, Grahn JA, Barker RA, Owen AM, Rowe JB. How often does music and rhythm improve patients' perception of motor symptoms in Parkinson's disease? J Neurol 2013; 260:1404-5. [PMID: 23400501 PMCID: PMC3642358 DOI: 10.1007/s00415-013-6860-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 11/25/2022]
Affiliation(s)
- C. Nombela
- Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - C. L. Rae
- MRC-Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge, UK
| | - J. A. Grahn
- Brain and Mind Institute, University of Western Ontario, London, ON Canada
- Department of Psychology, University of Western Ontario, London, ON Canada
| | - R. A. Barker
- Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - A. M. Owen
- Brain and Mind Institute, University of Western Ontario, London, ON Canada
- Department of Psychology, University of Western Ontario, London, ON Canada
| | - J. B. Rowe
- Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
- MRC-Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge, UK
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