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Borhanazad M, van Wijk BC, Buizer AI, Kerkman JN, Bekius A, Dominici N, Daffertshofer A. Lateralized modulation of cortical beta power during human gait is related to arm swing. iScience 2024; 27:110301. [PMID: 39055930 PMCID: PMC11269954 DOI: 10.1016/j.isci.2024.110301] [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: 11/20/2023] [Revised: 05/15/2024] [Accepted: 06/14/2024] [Indexed: 07/28/2024] Open
Abstract
Human gait is a complex behavior requiring dynamic control of upper and lower extremities that is accompanied by cortical activity in multiple brain areas. We investigated the contribution of beta (15-30 Hz) and gamma (30-50 Hz) band electroencephalography (EEG) activity during specific phases of the gait cycle, comparing treadmill walking with and without arm swing. Modulations of spectral power in the beta band during early double support and swing phases source-localized to the sensorimotor cortex ipsilateral, but not contralateral, to the leading leg. The lateralization disappeared in the condition with constrained arms, together with an increase of activity in bilateral supplementary motor areas. By contrast, gamma band modulations that localized to the presumed leg area of sensorimotor cortex around the heel-strike events were unaffected by arm movement. Our findings demonstrate that arm swing is accompanied by considerable cortical activation that should not be neglected in gait-related neuroimaging studies.
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Affiliation(s)
- Marzieh Borhanazad
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, the Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
- Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Bernadette C.M. van Wijk
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, the Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
- Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Neurology, Amsterdam UMC Location University of Amsterdam, Amsterdam 1105 AZ, the Netherlands
| | - Annemieke I. Buizer
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam 1081 HZ, the Netherlands
| | - Jennifer N. Kerkman
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, the Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
- Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Annike Bekius
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, the Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
- Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Centre, Utrecht University, Utrecht 3584 CG, the Netherlands
| | - Nadia Dominici
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, the Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
- Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Andreas Daffertshofer
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam 1081 BT, the Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
- Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Borin G, Sato SD, Spencer RMC, Choi JT. Sleep benefits perceptual but not movement-based learning of locomotor sequences. Sci Rep 2024; 14:15868. [PMID: 38982186 PMCID: PMC11233676 DOI: 10.1038/s41598-024-66177-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024] Open
Abstract
Practicing complex locomotor skills, such as those involving a step sequence engages distinct perceptual and motor mechanisms that support the recall of learning under new conditions (i.e., skill transfer). While sleep has been shown to enhance learning of sequences of fine movements (i.e., sleep-dependent consolidation), here we examined whether this benefit extends to learning of a locomotor pattern. Specifically, we tested the perceptual and motor learning of a locomotor sequence following sleep compared to wake. We hypothesized that post-practice sleep would increase locomotor sequence learning in the perceptual, but not in the motor domain. In this study, healthy young adult participants (n = 48; 18-33 years) practiced a step length sequence on a treadmill cued by visual stimuli displayed on a screen during training. Participants were then tested in a perceptual condition (backward walking with the same visual stimuli), or a motor condition (forward walking but with an inverted screen). Skill was assessed immediately, and again after a 12-h delay following overnight sleep or daytime wake (n = 12 for each interval/condition). Off-line learning improved following sleep compared to wake, but only for the perceptual condition. Our results suggest that perceptual and motor sequence learning are processed separately after locomotor training, and further points to a benefit of sleep that is rooted in the perceptual as opposed to the motor aspects of motor learning.
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Affiliation(s)
- Gabriela Borin
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
| | - Sumire D Sato
- Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118205, Gainesville, FL, 32611, USA
- Neuroscience & Behavior Program, University of Massachusetts Amherst, Amherst, MA, USA
| | - Rebecca M C Spencer
- Neuroscience & Behavior Program, University of Massachusetts Amherst, Amherst, MA, USA
- Department of Psychological & Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
- Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Julia T Choi
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA.
- Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118205, Gainesville, FL, 32611, USA.
- Neuroscience & Behavior Program, University of Massachusetts Amherst, Amherst, MA, USA.
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Wang Y, Yu L, Mao H, Chen X, Hu P, Ge Y, Liu Y, Zhang J, Cheng H. Deep Brain Stimulation Modulates the Visual Pathway to Improve Freezing of Gait in Parkinson's Disease Patients. World Neurosurg 2024; 187:e148-e155. [PMID: 38636635 DOI: 10.1016/j.wneu.2024.04.055] [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: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To investigate the involvement of the visual cortex in improving freezing of gait (FoG) after subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) patients using whole-brain seed-based functional connectivity. METHODS A total of 66 PD patients with FoG who underwent bilateral STN-DBS were included in our study. Patients were divided into a FoG responder group and an FoG nonresponder group according to whether FoG improved 1 year after DBS. We compared the differences in clinical characteristics, brain structural imaging, and seed-based functional connectivity between the 2 groups. The locations of active contacts were further analyzed. RESULTS All PD patients benefited from STN-DBS. No significant differences in the baseline characteristics or brain structures were found between the 2 groups. Seed-based functional connectivity analysis revealed that better connectivity in bilateral primary visual areas was associated with better clinical improvement in FoG (P < 0.05 familywise error corrected). Further analysis revealed that this disparity was associated with the location of the active contacts within the rostral region of the sensorimotor subregion in the FoG responder group, in contrast to the findings in the FoG nonresponder group. CONCLUSIONS This study suggested that DBS in the rostral region of the STN sensorimotor subregion may alleviate FoG by strengthening functional connectivity in primary visual areas, which has significant implications for guiding surgical strategies for FoG in the future.
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Affiliation(s)
- Yi Wang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Liangchen Yu
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Hongliang Mao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Xianwen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yue Ge
- Department of Rehabilitation, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yue Liu
- First Clinical Medical College, Anhui Medical University, Hefei, P.R. China
| | - Jiarui Zhang
- First Clinical Medical College, Anhui Medical University, Hefei, P.R. China
| | - Hongwei Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China.
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Zhang Z, Su J, Tang J, Chung L, Page JC, Winter CC, Liu Y, Kegeles E, Conti S, Zhang Y, Biundo J, Chalif JI, Hua CY, Yang Z, Yao X, Yang Y, Chen S, Schwab JM, Wang KH, Chen C, Prerau MJ, He Z. Spinal projecting neurons in rostral ventromedial medulla co-regulate motor and sympathetic tone. Cell 2024; 187:3427-3444.e21. [PMID: 38733990 PMCID: PMC11193620 DOI: 10.1016/j.cell.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/27/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
Many behaviors require the coordinated actions of somatic and autonomic functions. However, the underlying mechanisms remain elusive. By opto-stimulating different populations of descending spinal projecting neurons (SPNs) in anesthetized mice, we show that stimulation of excitatory SPNs in the rostral ventromedial medulla (rVMM) resulted in a simultaneous increase in somatomotor and sympathetic activities. Conversely, opto-stimulation of rVMM inhibitory SPNs decreased both activities. Anatomically, these SPNs innervate both sympathetic preganglionic neurons and motor-related regions in the spinal cord. Fiber-photometry recording indicated that the activities of rVMM SPNs correlate with different levels of muscle and sympathetic tone during distinct arousal states. Inhibiting rVMM excitatory SPNs reduced basal muscle and sympathetic tone, impairing locomotion initiation and high-speed performance. In contrast, silencing the inhibitory population abolished muscle atonia and sympathetic hypoactivity during rapid eye movement (REM) sleep. Together, these results identify rVMM SPNs as descending spinal projecting pathways controlling the tone of both the somatomotor and sympathetic systems.
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Affiliation(s)
- Zicong Zhang
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Junfeng Su
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jing Tang
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Leeyup Chung
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jessica C Page
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Carla C Winter
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard/MIT MD-PhD Program, Harvard Medical School, Boston, MA, USA
| | - Yuchu Liu
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Evgenii Kegeles
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA; PhD Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA, USA
| | - Sara Conti
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Yu Zhang
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jason Biundo
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Joshua I Chalif
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Charles Y Hua
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Zhiyun Yang
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Xue Yao
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Yang Yang
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Shuqiang Chen
- Graduate Program for Neuroscience, Boston University, Boston, MA, USA
| | - Jan M Schwab
- Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH, USA; Departments of Neurology and Neuroscience, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kuan Hong Wang
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
| | - Chinfei Chen
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Michael J Prerau
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Zhigang He
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA; Department of Neurology and Ophthalmology, Harvard Medical School, Boston, MA, USA.
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Lu Y, Lin Z, Li M, Zhuang Y, Nie B, Lei J, Zhao Y, Zhao H. Three-phase Enriched Environment Improves Post-stroke Gait Dysfunction via Facilitating Neuronal Plasticity in the Bilateral Sensorimotor Cortex: A Multimodal MRI/PET Analysis in Rats. Neurosci Bull 2024; 40:719-731. [PMID: 38055107 PMCID: PMC11178725 DOI: 10.1007/s12264-023-01155-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/22/2023] [Indexed: 12/07/2023] Open
Abstract
The three-phase Enriched Environment (EE) paradigm has been shown to promote post-stroke functional improvement, but the neuronal mechanisms are still unclear. In this study, we applied a multimodal neuroimaging protocol combining magnetic resonance imaging (MRI) and positron emission tomography (PET) to examine the effects of post-ischemic EE treatment on structural and functional neuroplasticity in the bilateral sensorimotor cortex. Rats were subjected to permanent middle cerebral artery occlusion. The motor function of the rats was examined using the DigiGait test. MRI was applied to investigate the EE-induced structural modifications of the bilateral sensorimotor cortex. [18F]-fluorodeoxyglucose PET was used to detect glucose metabolism. Blood oxygen level-dependent (BOLD)-functional MRI (fMRI) was used to identify the regional brain activity and functional connectivity (FC). In addition, the expression of neuroplasticity-related signaling pathways including neurotrophic factors (BDNF/CREB), axonal guidance proteins (Robo1/Slit2), and axonal growth-inhibitory proteins (NogoA/NgR) as well as downstream proteins (RhoA/ROCK) in the bilateral sensorimotor cortex were measured by Western blots. Our results showed the three-phase EE improved the walking ability. Structural T2 mapping imaging and diffusion tensor imaging demonstrated that EE benefited structure integrity in the bilateral sensorimotor cortex. PET-MRI fused images showed improved glucose metabolism in the corresponding regions after EE intervention. Specifically, the BOLD-based amplitude of low-frequency fluctuations showed that EE increased spontaneous activity in the bilateral motor cortex and ipsilateral sensory cortex. In addition, FC results showed increased sensorimotor connectivity in the ipsilateral hemisphere and increased interhemispheric motor cortical connectivity and motor cortical-thalamic connectivity following EE intervention. In addition, a strong correlation was found between increased functional connectivity and improved motor performance of limbs. Specifically, EE regulated the expression of neuroplasticity-related signaling, involving BDNF/CREB, Slit2/Robo1, as well as the axonal growth-inhibitory pathways Nogo-A/Nogo receptor and RhoA/ROCK in the bilateral sensorimotor cortex. Our results indicated that the three-phase enriched environment paradigm enhances neuronal plasticity of the bilateral sensorimotor cortex and consequently ameliorates post-stroke gait deficits. These findings might provide some new clues for the development of EE and thus facilitate the clinical translation of EE.
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Affiliation(s)
- Yun Lu
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
- Beijing Key Lab of TCM Collateral Disease Theory Research, Beijing, 100069, China
| | - Ziyue Lin
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
- Beijing Key Lab of TCM Collateral Disease Theory Research, Beijing, 100069, China
| | - Mingcong Li
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
- Beijing Key Lab of TCM Collateral Disease Theory Research, Beijing, 100069, China
| | - Yuming Zhuang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
- Beijing Key Lab of TCM Collateral Disease Theory Research, Beijing, 100069, China
| | - Binbin Nie
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100049, China
| | - Jianfeng Lei
- Medical Imaging Laboratory of Core Facility Center, Capital Medical University, Beijing, 100069, China
| | - Yuanyuan Zhao
- Medical Imaging Laboratory of Core Facility Center, Capital Medical University, Beijing, 100069, China
| | - Hui Zhao
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China.
- Beijing Key Lab of TCM Collateral Disease Theory Research, Beijing, 100069, China.
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Gibson E, Douglas G, Jeffries K, Delaurier J, Chestnut T, Charlton JM. Foot orientation and trajectory variability in locomotion: Effects of real-world terrain. PLoS One 2024; 19:e0293691. [PMID: 38753603 PMCID: PMC11098422 DOI: 10.1371/journal.pone.0293691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Abstract
Capturing human locomotion in nearly any environment or context is becoming increasingly feasible with wearable sensors, giving access to commonly encountered walking conditions. While important in expanding our understanding of locomotor biomechanics, these more variable environments present challenges to identify changes in data due to person-level factors among the varying environment-level factors. Our study examined foot-specific biomechanics while walking on terrain commonly encountered with the goal of understanding the extent to which these variables change due to terrain. We recruited healthy adults to walk at self-selected speeds on stairs, flat ground, and both shallow and steep sloped terrain. A pair of inertial measurement units were embedded in both shoes to capture foot biomechanics while walking. Foot orientation was calculated using a strapdown procedure and foot trajectory was determined by double integrating the linear acceleration. Stance time, swing time, cadence, sagittal and frontal orientations, stride length and width were extracted as discrete variables. These data were compared within-participant and across terrain conditions. The physical constraints of the stairs resulted in shorter stride lengths, less time spent in swing, toe-first foot contact, and higher variability during stair ascent specifically (p<0.05). Stride lengths increased when ascending compared to descending slopes, and the sagittal foot angle at initial contact was greatest in the steep slope descent condition (p<0.05). No differences were found between conditions for horizontal foot angle in midstance (p≥0.067). Our results show that walking on slopes creates differential changes in foot biomechanics depending on whether one is descending or ascending, and stairs require different biomechanics and gait timing than slopes or flat ground. This may be an important factor to consider when making comparisons of real-world walking bouts, as greater proportions of one terrain feature in a data set could create bias in the outcomes. Classifying terrain in unsupervised walking datasets would be helpful to avoid comparing metrics from different walking terrain scenarios.
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Affiliation(s)
- Emma Gibson
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Greg Douglas
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Katelyn Jeffries
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Julianne Delaurier
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Taylor Chestnut
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Jesse M. Charlton
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
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Xie H, Zhang N, Xia C, Ding Y, Zhao H, Huang Y. The clinical characteristics of cerebral small vessel disease patients with motoric cognitive risk syndrome during single- and dual-task walking. Heliyon 2024; 10:e30007. [PMID: 38742083 PMCID: PMC11089308 DOI: 10.1016/j.heliyon.2024.e30007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
Objective We aimed to (1) identify neuroimaging biomarkers of distinguishing motoric cognitive risk syndrome (MCRS) risk among older Chinese adults with cerebral small vessel disease (CSVD) and (2) detect differences in gait parameters and neuroimaging biomarkers between CSVD individual with and without MCRS, especially during dual-task walking (DTW). Methods We enrolled 126 inpatients with CSVD who were divided into two groups according to MCRS status. Data on basic parameters, variability, asymmetry, and coordination were collected during single-task walking (STW) and DTW. Neuroimaging features (white matter hyperintensities, lacunes, and microbleeds) and total disease burden were calculated. Analysis of variance and logistic regression analyses were applied to assess the role of STW, DTW, and neuroimaging biomarkers in MCRS. Results In total, 126 consecutive inpatients with CSVD were included (84 and 42 patients were classified as MCRS-negative and MCRS-positive, respectively). The MCRS-positive group showed poorer performance for nearly all gait parameters compared with the MCRS-negative group during cognitive DTW. Meanwhile, all gait parameters except asymmetry were assessed in participants with MCRS for significant deterioration during cognitive DTW compared with that during STW. However, only basic parameters differed between STW and cognitive DTW in participants without MCRS. A significant independent association between total CSVD scores and MCRS was also detected. Conclusions For CSVD patients, with higher total CSVD burden rather than any single neuroimaging marker, was linked to a greater risk of MCRS. In addition, CSVD individuals with MCRS had higher variability and phase coordination index (PCI), especially in cognitive DTW. Thus, they should concentrate more on their gait variability or coordination and reduce secondary task loads while walking in daily life, especially in cognitive secondary tasks.
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Affiliation(s)
- Hongyang Xie
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Nan Zhang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Cuiqiao Xia
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Yu Ding
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Hongyi Zhao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
- Department of Neurology, Number 984 Hospital of the PLA, Beijing, China
| | - Yonghua Huang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Jahromi MM, Vlček P, Kvašňák E, Lippertová MG. Posture enhancement with cerebellum transcranial electrical stimulation: a systematic review of current methods and findings. Exp Brain Res 2024; 242:991-1009. [PMID: 38546838 DOI: 10.1007/s00221-024-06808-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/13/2024] [Indexed: 07/13/2024]
Abstract
Recently, transcranial electrical stimulation (tES) has gained increasing popularity among researchers, especially for recovery and improvement, but interpretation of these results is difficult due to variations in study methods and outcome measurements. The main goal of this study was to better understand the postural and balance indicators affected by cerebellar tES, as the cerebellum is the main brain region responsible for controlling balance. For this systematic literature review, three databases were searched for articles where the cerebellum was stimulated by any type of tES in either healthy participants or those with neurologic disorders. Postural, dynamic, and/or static stability measurements were recorded, and risk of bias was assessed on the PEDro scale. A total of 21 studies were included in the analysis. 17 studies reported improvements after application of tES. 14 studies stimulated the cerebellum unilaterally and 15 used this modality for 20 min. Moreover, all studies exclusively used transcranial direct current as the type of stimulation. Evaluation of PEDro results showed that studies included in the analysis utilized good methodology. Although there were some inconsistencies in study results, overall, it was demonstrated that tES can improve balance and postural index under both healthy and neurological conditions. Further research of bilateral cerebellar stimulation or the use of transcranial alternating current stimulation, transcranial random noise stimulation, and transcranial pulsed current stimulation is needed for a more comprehensive assessment of the potential positive effects of cerebellar tES on the balance system.
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Affiliation(s)
| | - Přemysl Vlček
- Third Faculty of Medicine, Charles University, Prague, Czech Republic.
- Applied Brain Electroencephalography, National Institute of Mental Health, Topolova 748, 25067, Klecany, Czech Republic.
| | - Eugen Kvašňák
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Bonassi G, Zhao M, Samogin J, Mantini D, Marchese R, Contrino L, Tognetti P, Putzolu M, Botta A, Pelosin E, Avanzino L. Brain Networks Modulation during Simple and Complex Gait: A "Mobile Brain/Body Imaging" Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:2875. [PMID: 38732980 PMCID: PMC11086305 DOI: 10.3390/s24092875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
Walking encompasses a complex interplay of neuromuscular coordination and cognitive processes. Disruptions in gait can impact personal independence and quality of life, especially among the elderly and neurodegenerative patients. While traditional biomechanical analyses and neuroimaging techniques have contributed to understanding gait control, they often lack the temporal resolution needed for rapid neural dynamics. This study employs a mobile brain/body imaging (MoBI) platform with high-density electroencephalography (hd-EEG) to explore event-related desynchronization and synchronization (ERD/ERS) during overground walking. Simultaneous to hdEEG, we recorded gait spatiotemporal parameters. Participants were asked to walk under usual walking and dual-task walking conditions. For data analysis, we extracted ERD/ERS in α, β, and γ bands from 17 selected regions of interest encompassing not only the sensorimotor cerebral network but also the cognitive and affective networks. A correlation analysis was performed between gait parameters and ERD/ERS intensities in different networks in the different phases of gait. Results showed that ERD/ERS modulations across gait phases in the α and β bands extended beyond the sensorimotor network, over the cognitive and limbic networks, and were more prominent in all networks during dual tasks with respect to usual walking. Correlation analyses showed that a stronger α ERS in the initial double-support phases correlates with shorter step length, emphasizing the role of attention in motor control. Additionally, β ERD/ERS in affective and cognitive networks during dual-task walking correlated with dual-task gait performance, suggesting compensatory mechanisms in complex tasks. This study advances our understanding of neural dynamics during overground walking, emphasizing the multidimensional nature of gait control involving cognitive and affective networks.
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Affiliation(s)
- Gaia Bonassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy;
| | - Mingqi Zhao
- Research Center for Motor Control and Neuroplasticity, KU Leuven, 3001 Leuven, Belgium; (M.Z.); (J.S.); (D.M.)
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou 730000, China
| | - Jessica Samogin
- Research Center for Motor Control and Neuroplasticity, KU Leuven, 3001 Leuven, Belgium; (M.Z.); (J.S.); (D.M.)
| | - Dante Mantini
- Research Center for Motor Control and Neuroplasticity, KU Leuven, 3001 Leuven, Belgium; (M.Z.); (J.S.); (D.M.)
| | - Roberta Marchese
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
| | - Luciano Contrino
- S.C. Medicina Fisica e Riabilitazione Ospedaliera, Azienda Sanitaria Locale Chiavarese, 16043 Chiavari, Italy; (L.C.); (P.T.)
| | - Paola Tognetti
- S.C. Medicina Fisica e Riabilitazione Ospedaliera, Azienda Sanitaria Locale Chiavarese, 16043 Chiavari, Italy; (L.C.); (P.T.)
| | - Martina Putzolu
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Viale Benedetto XV 3, 16132 Genoa, Italy;
| | - Alessandro Botta
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy;
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
| | - Laura Avanzino
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (R.M.); (A.B.); (L.A.)
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Viale Benedetto XV 3, 16132 Genoa, Italy;
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10
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Langer A, Hansen C, Roth D, Santer A, Flotz A, Gruber J, Wizany L, Hasenauer S, Pokan R, Dabnichki P, Treven M, Zimmel S, Schmoeger M, Willinger U, Gassner L, Brücke C, Maetzler W, Zach H. Vertical locomotion improves horizontal locomotion: effects of climbing on gait and other mobility aspects in Parkinson's disease. A secondary analysis from a randomized controlled trial. J Neuroeng Rehabil 2024; 21:63. [PMID: 38678241 PMCID: PMC11055236 DOI: 10.1186/s12984-024-01363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND In the Climb Up! Head Up! trial, we showed that sport climbing reduces bradykinesia, tremor, and rigidity in mildly to moderately affected participants with Parkinson's disease. This secondary analysis aimed to evaluate the effects of sport climbing on gait and functional mobility in this cohort. METHODS Climb Up! Head Up! was a 1:1 randomized controlled trial. Forty-eight PD participants (Hoehn and Yahr stage 2-3) either participated in a 12-week, 90-min-per-week sport climbing course (intervention group) or were engaged in regular unsupervised physical activity (control group). Relevant outcome measures for this analysis were extracted from six inertial measurement units placed on the extremities, chest, and lower back, that were worn during supervised gait and functional mobility assessments before and after the intervention. Assessments included normal and fast walking, dual-tasking walking, Timed Up and Go test, Instrumented Stand and Walk test, and Five Times Sit to Stand test. RESULTS Compared to baseline, climbing improved gait speed during normal walking by 0.09 m/s (p = 0.005) and during fast walking by 0.1 m/s. Climbing also reduced the time spent in the stance phase during fast walking by 0.03 s. Climbing improved the walking speed in the 7-m- Timed Up and Go test by 0.1 m/s (p < 0.001) and the turning speed by 0.39 s (p = 0.052), the speed in the Instrumented Stand and Walk test by 0.1 m/s (p < 0.001), and the speed in the Five Times Sit to Stand test by 2.5 s (p = 0.014). There was no effect of sport climbing on gait speed or gait variables during dual-task walking. CONCLUSIONS Sport climbing improves gait speed during normal and fast walking, as well as functional mobility in people with Parkinson's disease. Trial registration This study was registered within the U.S. National Library of Medicine (No: NCT04569981, date of registration September 30th, 2020).
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Affiliation(s)
- Agnes Langer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, 24105, Kiel, Germany
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, 1090, Vienna, Austria
| | - Agnes Santer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Anna Flotz
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Jakob Gruber
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Laurenz Wizany
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Sebastian Hasenauer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Rochus Pokan
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, 1090, Vienna, Austria
| | - Peter Dabnichki
- School of Engineering, RMIT University, 3000, Melbourne, VIC, Australia
| | - Marco Treven
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Sarah Zimmel
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Michaela Schmoeger
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Ulrike Willinger
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Lucia Gassner
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, 1090, Vienna, Austria
- School of Engineering, RMIT University, 3000, Melbourne, VIC, Australia
| | - Christof Brücke
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, 24105, Kiel, Germany
| | - Heidemarie Zach
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria.
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11
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Valero-Cuevas FJ, Finley J, Orsborn A, Fung N, Hicks JL, Huang HH, Reinkensmeyer D, Schweighofer N, Weber D, Steele KM. NSF DARE-Transforming modeling in neurorehabilitation: Four threads for catalyzing progress. J Neuroeng Rehabil 2024; 21:46. [PMID: 38570842 PMCID: PMC10988973 DOI: 10.1186/s12984-024-01324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/09/2024] [Indexed: 04/05/2024] Open
Abstract
We present an overview of the Conference on Transformative Opportunities for Modeling in Neurorehabilitation held in March 2023. It was supported by the Disability and Rehabilitation Engineering (DARE) program from the National Science Foundation's Engineering Biology and Health Cluster. The conference brought together experts and trainees from around the world to discuss critical questions, challenges, and opportunities at the intersection of computational modeling and neurorehabilitation to understand, optimize, and improve clinical translation of neurorehabilitation. We organized the conference around four key, relevant, and promising Focus Areas for modeling: Adaptation & Plasticity, Personalization, Human-Device Interactions, and Modeling 'In-the-Wild'. We identified four common threads across the Focus Areas that, if addressed, can catalyze progress in the short, medium, and long terms. These were: (i) the need to capture and curate appropriate and useful data necessary to develop, validate, and deploy useful computational models (ii) the need to create multi-scale models that span the personalization spectrum from individuals to populations, and from cellular to behavioral levels (iii) the need for algorithms that extract as much information from available data, while requiring as little data as possible from each client (iv) the insistence on leveraging readily available sensors and data systems to push model-driven treatments from the lab, and into the clinic, home, workplace, and community. The conference archive can be found at (dare2023.usc.edu). These topics are also extended by three perspective papers prepared by trainees and junior faculty, clinician researchers, and federal funding agency representatives who attended the conference.
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Affiliation(s)
- Francisco J Valero-Cuevas
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, 90089, CA, USA.
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St 155, Los Angeles, 90033, CA, USA.
- Thomas Lord Department of Computer Science, University of Southern California, 941 Bloom Walk, Los Angeles, 90089, CA, USA.
| | - James Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St 155, Los Angeles, 90033, CA, USA
| | - Amy Orsborn
- Department of Electrical and Computer Engineering, University of Washington, 185 W Stevens Way NE, Box 352500, Seattle, 98195, WA, USA
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, 98195, WA, USA
- Washington National Primate Research Center, University of Washington, 3018 Western Ave, Seattle, 98121, WA, USA
| | - Natalie Fung
- Thomas Lord Department of Computer Science, University of Southern California, 941 Bloom Walk, Los Angeles, 90089, CA, USA
| | - Jennifer L Hicks
- Department of Bioengineering, Stanford University, 443 Via Ortega, Stanford, 94305, CA, USA
| | - He Helen Huang
- Joint Department of Biomedical Engineering, North Carolina State University, 1840 Entrepreneur Dr Suite 4130, Raleigh, 27606, NC, USA
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, 333 S Columbia St, Chapel Hill, 27514, NC, USA
| | - David Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, UCI Samueli School of Engineering, 3225 Engineering Gateway, Irvine, 92697, CA, USA
| | - Nicolas Schweighofer
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, 90089, CA, USA
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St 155, Los Angeles, 90033, CA, USA
| | - Douglas Weber
- Department of Mechanical Engineering and the Neuroscience Institute, Carnegie Mellon University, 5000 Forbes Avenue, B12 Scaife Hall, Pittsburgh, 15213, PA, USA
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, 3900 E Stevens Way NE, Box 352600, Seattle, 98195, WA, USA
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12
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Li Z, Liu J, Miao X, Ge S, Shen J, Jin S, Gu Z, Jia Y, Zhang K, Wang J, Wang M. Reorganization of structural brain networks in Parkinson's disease with postural instability/gait difficulty. Neurosci Lett 2024; 827:137736. [PMID: 38513936 DOI: 10.1016/j.neulet.2024.137736] [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: 10/14/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
The Postural Instability/Gait Difficulty (PIGD) subtype of Parkinson's disease (PD) has a faster disease progression, a higher risk of cognitive and motor decline, yet the alterations of structural topological organization remain unknown. Diffusion Tensor Imaging (DTI) and 3D-TI scanning were conducted on 31 PD patients with PIGD (PD-PIGD), 30 PD patients without PIGD (PD-non-PIGD) and 35 Healthy Controls (HCs). Structural networks were constructed using DTI brain white matter fiber tractography. A graph theory approach was applied to characterize the topological properties of complex structural networks, and the relationships between significantly different network metrics and motor deficits were analyzed within the PD-PIGD group. PD-PIGD patients exhibited increased shortest path length compared with PD-non-PIGD and HCs (P < 0.05, respectively). Additionally, PD-PIGD patients exhibited decreased nodal properties, mainly in the cerebellar vermis, prefrontal cortex, paracentral lobule, and visual regions. Notably, the degree centrality of the cerebellar vermis was negatively correlated with the PIGD score (r = -0.390; P = 0.030) and Unified Parkinson's Disease Rating Scale Part III score (r = -0.436; P = 0.014) in PD-PIGD patients. Furthermore, network-based statistical analysis revealed decreased structural connectivity between the prefrontal lobe, putamen, supplementary motor area, insula, and cingulate gyrus in PD-PIGD patients. Our findings demonstrated that PD-PIGD patients existed abnormal structural connectomes in the cerebellar vermis, frontal-parietal cortex and visual regions. These topological differences can provide a topological perspective for understanding the potential pathophysiological mechanisms of PIGD in PD.
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Affiliation(s)
- Zihan Li
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinxin Miao
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shaoyun Ge
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Shen
- Department of Radiology, Taizhou Fourth People's Hospital, Taizhou, China
| | - Shaohua Jin
- Department of Radiology, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China
| | - Zhengxue Gu
- Department of Radiology, Nanjing Central Hospital, Nanjing, China
| | - Yongfeng Jia
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kezhong Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jianwei Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Min Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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13
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Yang L, Singla D, Wu AK, Cross KA, Masmanidis SC. Dopamine lesions alter the striatal encoding of single-limb gait. eLife 2024; 12:RP92821. [PMID: 38526916 PMCID: PMC10963031 DOI: 10.7554/elife.92821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
The striatum serves an important role in motor control, and neurons in this area encode the body's initiation, cessation, and speed of locomotion. However, it remains unclear whether the same neurons also encode the step-by-step rhythmic motor patterns of individual limbs that characterize gait. By combining high-speed video tracking, electrophysiology, and optogenetic tagging, we found that a sizable population of both D1 and D2 receptor expressing medium spiny projection neurons (MSNs) were phase-locked to the gait cycle of individual limbs in mice. Healthy animals showed balanced limb phase-locking between D1 and D2 MSNs, while dopamine depletion led to stronger phase-locking in D2 MSNs. These findings indicate that striatal neurons represent gait on a single-limb and step basis, and suggest that elevated limb phase-locking of D2 MSNs may underlie some of the gait impairments associated with dopamine loss.
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Affiliation(s)
- Long Yang
- Department of Neurobiology, University of California Los AngelesLos AngelesUnited States
| | - Deepak Singla
- Department of Bioengineering, University of California Los AngelesLos AngelesUnited States
| | - Alexander K Wu
- Department of Neurobiology, University of California Los AngelesLos AngelesUnited States
| | - Katy A Cross
- Department of Neurology, University of California Los AngelesLos AngelesUnited States
| | - Sotiris C Masmanidis
- Department of Neurobiology, University of California Los AngelesLos AngelesUnited States
- California Nanosystems Institute, University of California Los AngelesLos AngelesUnited States
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14
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Calvano A, Kleinholdermann U, Heun AS, Bopp MHA, Nimsky C, Timmermann L, Pedrosa DJ. Structural connectivity of low-frequency subthalamic stimulation for improving stride length in Parkinson's disease. Neuroimage Clin 2024; 42:103591. [PMID: 38507954 PMCID: PMC10965492 DOI: 10.1016/j.nicl.2024.103591] [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: 01/19/2024] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND A reduction in stride length is considered a key characteristic of gait kinematics in Parkinson's disease (PD) and has been identified as a predictor of falls. Although low-frequency stimulation (LFS) has been suggested as a method to improve gait characteristics, the underlying structural network is not well understood. OBJECTIVE This study aims to investigate the structural correlates of changes in stride length during LFS (85 Hz). METHODS Objective gait performance was retrospectively evaluated in 19 PD patients who underwent deep brain stimulation (DBS) at 85 Hz and 130 Hz. Individual DBS contacts and volumes of activated tissue (VAT) were computed using preoperative magnetic resonance imaging (MRI) and postoperative computed tomography (CT) scans. Structural connectivity profiles to predetermined cortical and mesencephalic areas were estimated using a normative connectome. RESULTS LFS led to a significant improvement in stride length compared to 130 Hz stimulation. The intersection between VAT and the associative subregion of the subthalamic nucleus (STN) was associated with an improvement in stride length and had structural connections to the supplementary motor area, prefrontal cortex, and pedunculopontine nucleus. Conversely, we found that a lack of improvement was linked to stimulation volumes connected to cortico-diencephalic fibers bypassing the STN dorsolaterally. The robustness of the connectivity model was verified through leave-one-patient-out, 5-, and 10-fold cross cross-validation paradigms. CONCLUSION These findings offer new insights into the structural connectivity that underlies gait changes following LFS. Targeting the non-motor subregion of the STN with LFS on an individual level may present a potential therapeutic approach for PD patients with gait disorders.
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Affiliation(s)
- Alexander Calvano
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Urs Kleinholdermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany
| | | | - Miriam H A Bopp
- Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany; Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Christopher Nimsky
- Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany; Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany
| | - David J Pedrosa
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany.
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15
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Roeder L, Breakspear M, Kerr GK, Boonstra TW. Dynamics of brain-muscle networks reveal effects of age and somatosensory function on gait. iScience 2024; 27:109162. [PMID: 38414847 PMCID: PMC10897916 DOI: 10.1016/j.isci.2024.109162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/16/2023] [Accepted: 02/05/2024] [Indexed: 02/29/2024] Open
Abstract
Walking is a complex motor activity that requires coordinated interactions between the sensory and motor systems. We used mobile EEG and EMG to investigate the brain-muscle networks involved in gait control during overground walking in young people, older people, and individuals with Parkinson's disease. Dynamic interactions between the sensorimotor cortices and eight leg muscles within a gait cycle were assessed using multivariate analysis. We identified three distinct brain-muscle networks during a gait cycle. These networks include a bilateral network, a left-lateralized network activated during the left swing phase, and a right-lateralized network active during the right swing. The trajectories of these networks are contracted in older adults, indicating a reduction in neuromuscular connectivity with age. Individuals with the impaired tactile sensitivity of the foot showed a selective enhancement of the bilateral network, possibly reflecting a compensation strategy to maintain gait stability. These findings provide a parsimonious description of interindividual differences in neuromuscular connectivity during gait.
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Affiliation(s)
- Luisa Roeder
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, QLD, Australia
- Chair of Human Movement Science, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Michael Breakspear
- College of Engineering Science and Environment, College of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Graham K Kerr
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Tjeerd W Boonstra
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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16
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Silva-Batista C, Lira J, Coelho DB, de Lima-Pardini AC, Nucci MP, Mattos ECT, Magalhaes FH, Barbosa ER, Teixeira LA, Amaro Junior E, Ugrinowitsch C, Horak FB. Mesencephalic Locomotor Region and Presynaptic Inhibition during Anticipatory Postural Adjustments in People with Parkinson's Disease. Brain Sci 2024; 14:178. [PMID: 38391752 PMCID: PMC10887111 DOI: 10.3390/brainsci14020178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
Individuals with Parkinson's disease (PD) and freezing of gait (FOG) have a loss of presynaptic inhibition (PSI) during anticipatory postural adjustments (APAs) for step initiation. The mesencephalic locomotor region (MLR) has connections to the reticulospinal tract that mediates inhibitory interneurons responsible for modulating PSI and APAs. Here, we hypothesized that MLR activity during step initiation would explain the loss of PSI during APAs for step initiation in FOG (freezers). Freezers (n = 34) were assessed in the ON-medication state. We assessed the beta of blood oxygenation level-dependent signal change of areas known to initiate and pace gait (e.g., MLR) during a functional magnetic resonance imaging protocol of an APA task. In addition, we assessed the PSI of the soleus muscle during APA for step initiation, and clinical (e.g., disease duration) and behavioral (e.g., FOG severity and APA amplitude for step initiation) variables. A linear multiple regression model showed that MLR activity (R2 = 0.32, p = 0.0006) and APA amplitude (R2 = 0.13, p = 0.0097) explained together 45% of the loss of PSI during step initiation in freezers. Decreased MLR activity during a simulated APA task is related to a higher loss of PSI during APA for step initiation. Deficits in central and spinal inhibitions during APA may be related to FOG pathophysiology.
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Affiliation(s)
- Carla Silva-Batista
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo 05508-070, Brazil
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
| | - Jumes Lira
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo 05508-070, Brazil
- School of Arts, Sciences and Humanities, University of São Paulo, São Paulo 03828-000, Brazil
- School of Physical Education and Sport, University of São Paulo, São Paulo 05508-030, Brazil
| | - Daniel Boari Coelho
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo 09210-170, Brazil
| | | | | | | | | | - Egberto Reis Barbosa
- Movement Disorders Clinic, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05508-070, Brazil
| | - Luis Augusto Teixeira
- School of Physical Education and Sport, University of São Paulo, São Paulo 05508-030, Brazil
| | - Edson Amaro Junior
- Department of Radiology, University of São Paulo, São Paulo 05508-090, Brazil
| | - Carlos Ugrinowitsch
- School of Physical Education and Sport, University of São Paulo, São Paulo 05508-030, Brazil
| | - Fay B Horak
- Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA
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Yang L, Singla D, Wu AK, Cross KA, Masmanidis SC. Dopamine lesions alter the striatal encoding of single-limb gait. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.10.06.561216. [PMID: 37873374 PMCID: PMC10592622 DOI: 10.1101/2023.10.06.561216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
The striatum serves an important role in motor control, and neurons in this area encode the body's initiation, cessation, and speed of locomotion. However, it remains unclear whether the same neurons also encode the step-by-step rhythmic motor patterns of individual limbs that characterize gait. By combining high-speed video tracking, electrophysiology, and optogenetic tagging, we found that a sizable population of both D1 and D2 receptor expressing medium spiny projection neurons (MSNs) were phase-locked to the gait cycle of individual limbs in mice. Healthy animals showed balanced limb phase-locking between D1 and D2 MSNs, while dopamine depletion led to stronger phase-locking in D2 MSNs. These findings indicate that striatal neurons represent gait on a single-limb and step basis, and suggest that elevated limb phase-locking of D2 MSNs may underlie some of the gait impairments associated with dopamine loss.
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Affiliation(s)
- Long Yang
- Department of Neurobiology, University of California Los Angeles, Los Angeles, California 90095, USA
| | - Deepak Singla
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California 90095, USA
| | - Alexander K. Wu
- Department of Neurobiology, University of California Los Angeles, Los Angeles, California 90095, USA
| | - Katy A. Cross
- Department of Neurology, University of California Los Angeles, Los Angeles, California 90095, USA
| | - Sotiris C. Masmanidis
- Department of Neurobiology, University of California Los Angeles, Los Angeles, California 90095, USA
- California Nanosystems Institute, University of California Los Angeles, Los Angeles, California 90095, USA
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18
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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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Jiang X, Zhou J, Chen Q, Xu Q, Wang S, Yuan L, Zhang D, Bi H, Li H. Effect of robot-assisted gait training on motor dysfunction in Parkinson's patients:A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2024; 37:253-268. [PMID: 37955075 DOI: 10.3233/bmr-220395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Robot-assisted gait training (RAGT) has been reported to treat motor dysfunction in patients with Parkinson's disease (PD) in the last few years. However, the benefits of RAGT for treating motor dysfunction in PD are still unclear. OBJECTIVES To investigate the efficacy of RAGT for motor dysfunction in PD patients. METHODS We searched PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang, Chinese Biomedical Literature Database (CBM), and Chinese VIP Database for randomized controlled trials investigating RAGT to improve motor dysfunction in PD from the databases' inception dates until September 1, 2022. The following outcome indexes were employed to evaluate motor dysfunction: the Berg Balance Scale (BBS), Activities-specific Balance Confidence Scale (ABC), 10-Meter Walk Test gait speed (10-MWT), gait speed, stride length, cadence Unified Parkinson Disease Rating Scale Part III (UPDRS III), 6-Minute Walk Test (6MWT), and the Timed Up and Go test (TUG). The meta-analysis was performed using the proper randomeffect model or fixed-effect model to evaluate the difference in efficacy between the RAGT and the control groups. The Cochrane Risk of Bias Tool was used for the included studies and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to interpret the certainty of the results. RESULTS The results consisted of 17 studies comprising a total of 670 participants. Six hundred and seven PD patients with motor dysfunction were included: 335 in the RAGT group and 335 in the control group. This meta-analysis results established that when compared with the control group, robot-assisted gait training improved the BBS results of PD patients (MD: 2.80, 95%CI: 2.11-3.49, P< 0.00001), ABC score (MD: 7.30, 95%CI: 5.08-9.52, P< 0.00001), 10-MWT (MD: 0.06, 95%CI: 0.03-0.10, P= 0.0009), gait speed (MD: 3.67, 95%CI: 2.58-4.76, P< 0.00001), stride length (MD: 5.53, 95%CI: 3.64-7.42, P< 0.00001), cadence (MD: 4.52, 95%CI: 0.94-8.10, P= 0.01), UPDRS III (MD: -2.16, 95%CI: -2.48--1.83, P< 0.00001), 6MWT (MD: 13.87, 95%CI: 11.92-15.82, P< 0.00001). However, RAGT did not significantly improve the TUG test result of patients with PD (MD =-0.56, 95% CI: -1.12-0.00, P= 0.05). No safety concerns or adverse reactions among robot-assisted gait training patients were observed. CONCLUSION Even though RAGT can improve balance function, walking function, and gait performance and has demonstrated positive results in several studies, there is currently insufficient compelling evidence to suggest that it can improve all aspects of lower motor function.
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Affiliation(s)
- Xiaoyu Jiang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jianpeng Zhou
- Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, Shandong, China
| | - Qiang Chen
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Qiling Xu
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Shuting Wang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Lin Yuan
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Deqi Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Hongyan Bi
- Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, Shandong, China
| | - Haixia Li
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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20
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Sarcher A, Carcreff L, Moissenet F, Hug F, Deschamps T. Consistency of muscle activation signatures across different walking speeds. Gait Posture 2024; 107:155-161. [PMID: 37781901 DOI: 10.1016/j.gaitpost.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Using a machine learning algorithm, individuals can be accurately identified from their muscle activation patterns during gait, leading to the concept of individual muscle activation signatures. RESEARCH QUESTION Are muscle activation signatures robust across different walking speeds? METHODS We used an open dataset containing electromyographic (EMG) signals from 8 lower limb muscles in 50 asymptomatic adults walking at 5 speeds (extremely slow, very slow, slow, spontaneous, and fast). A machine learning approach classified the EMG profiles based on similar (intra-speed classification) or different (inter-speed classification) walking speeds as training and testing conditions. RESULTS Intra-speed median classification rates of muscle activation profiles increased with walking speed, from 92 % for extremely slow, to 100 % for self-selected fast walking conditions. Inter-speed median classification rates increased when the speed of the training condition was closer to that of the testing condition. Higher median classification rates were found across slow, spontaneous, and fast walking speed conditions, from 56 % to 96 %, compared with classification rates involving extremely and very slow walking speed conditions, from 6 % to 62 %. SIGNIFICANCE Our findings reveal that i) muscle activation signatures are detectable for a large range of walking speeds, even those involving different gait strategies (intra-speed median classification rates from 92 % to 100 %), and ii) muscle activation signatures observed during very low walking speeds are not consistent with those observed at higher speeds, suggesting a difference in motor control strategy. Caution should therefore be exercised when assessing gait deviations of a slow walking patient against a normative database obtained at higher speed. Identifying the robustness of individual muscle activation signatures across different movements could help in detecting changes in motor control, otherwise difficult to detect on classical time-varying EMG patterns.
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Affiliation(s)
- Aurélie Sarcher
- Nantes Université, Movement - Interactions - Performance, MIP, UR4334, F-44000 Nantes, France.
| | - Lena Carcreff
- Nantes Université, Movement - Interactions - Performance, MIP, UR4334, F-44000 Nantes, France
| | - Florent Moissenet
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - François Hug
- Nantes Université, Movement - Interactions - Performance, MIP, UR4334, F-44000 Nantes, France; Université Côte d'Azur, LAMHESS, Nice, France; Institut Universitaire de France (IUF), Paris, France
| | - Thibault Deschamps
- Nantes Université, Movement - Interactions - Performance, MIP, UR4334, F-44000 Nantes, France
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21
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Baruzzi V, Lodi M, Storace M. Optimization strategies to obtain smooth gait transitions through biologically plausible central pattern generators. Phys Rev E 2024; 109:014404. [PMID: 38366407 DOI: 10.1103/physreve.109.014404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/07/2023] [Indexed: 02/18/2024]
Abstract
Central pattern generators are small networks that contribute to generating animal locomotion. The models used to study gait generation and gait transition mechanisms often require biologically accurate neuron and synapse models, with high dimensionality and complex dynamics. Tuning the parameters of these models to elicit network dynamics compatible with gait features is not a trivial task, due to the impossibility of inferring a priori the effects of each parameter on the nonlinear system's emergent dynamics. In this paper we explore the use of global optimization strategies for parameter optimization in multigait central pattern generator (CPG) models with complex cell dynamics and minimal topology. We first consider an existing quadruped CPG model as a test bed for the objective function formulation, then proceed to optimize the parameters of a newly proposed multigait, interlimb hexapod CPG model. We successfully obtain hexapod gaits and prompt gait transitions by varying only control currents, while all CPG parameters, once optimized, are kept fixed. This mechanism of gait transitions is compatible with short-term synaptic plasticity.
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Affiliation(s)
- V Baruzzi
- Department of Electrical, Electronics and Telecommunication Engineering and Naval Architecture, University of Genoa, 16145 Genoa, Italy
| | - M Lodi
- Department of Electrical, Electronics and Telecommunication Engineering and Naval Architecture, University of Genoa, 16145 Genoa, Italy
| | - M Storace
- Department of Electrical, Electronics and Telecommunication Engineering and Naval Architecture, University of Genoa, 16145 Genoa, Italy
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22
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Tomita T, Yuminaga H, Takashima H, Masuda T, Mano T. Image Findings as Predictors of Fall Risk in Patients with Cerebrovascular Disease. Brain Sci 2023; 13:1690. [PMID: 38137138 PMCID: PMC10742017 DOI: 10.3390/brainsci13121690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
This study examined computed tomography findings in patients with cerebrovascular disease and determined predictors for falls. Images of the head were divided into 13 regions, and the relationships between computed tomography findings and the presence or absence of falls were investigated. A total of 138 patients with cerebrovascular disease (66% men, aged 73.8 ± 9.6 years) were included. A comparison between the fall and non-fall groups revealed a significant difference in the total functional independence measure scores and imaging findings at admission. Logistic regression analysis showed that the thalamus (p < 0.001), periventricular lucency (p < 0.001), lateral hemisphere room enlargement (p < 0.05), and age (p < 0.05) were related to the presence or absence of falls. For the 42 patients with cerebral hemorrhage, the thalamus (p < 0.01), periventricular lucency (p < 0.05), lateral ventricle vicinity (p < 0.05), and posterior limb of the internal capsule (p < 0.05) were extracted as factors related to the presence or absence of falls. For the 96 patients with cerebral infarction, the thalamus (p < 0.001), periventricular lucency (p < 0.01), and anterior limb of the internal capsule (p < 0.05) were extracted as factors related to the presence or absence of falls. This study found a relationship between the thalamus, lateral ventricle enlargement, periventricular lucency, and falls. Fall prognosis can potentially be predicted from computed tomography findings at admission.
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Affiliation(s)
- Tatsuya Tomita
- Department of Rehabilitation, Nara Prefectural General Medical Center, Nara 630-8054, Japan; (T.T.); (H.T.); (T.M.)
| | - Hisanori Yuminaga
- Department of Physical Therapy, Kansai Vocational College of Medicine, Osaka 558-0011, Japan;
| | - Hideki Takashima
- Department of Rehabilitation, Nara Prefectural General Medical Center, Nara 630-8054, Japan; (T.T.); (H.T.); (T.M.)
| | - Takashi Masuda
- Department of Rehabilitation, Nara Prefectural General Medical Center, Nara 630-8054, Japan; (T.T.); (H.T.); (T.M.)
| | - Tomoo Mano
- Department of Rehabilitation, Nara Prefectural General Medical Center, Nara 630-8054, Japan; (T.T.); (H.T.); (T.M.)
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23
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Artoni F, Cometa A, Dalise S, Azzollini V, Micera S, Chisari C. Cortico-muscular connectivity is modulated by passive and active Lokomat-assisted Gait. Sci Rep 2023; 13:21618. [PMID: 38062035 PMCID: PMC10703891 DOI: 10.1038/s41598-023-48072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
The effects of robotic-assisted gait (RAG) training, besides conventional therapy, on neuroplasticity mechanisms and cortical integration in locomotion are still uncertain. To advance our knowledge on the matter, we determined the involvement of motor cortical areas in the control of muscle activity in healthy subjects, during RAG with Lokomat, both with maximal guidance force (100 GF-passive RAG) and without guidance force (0 GF-active RAG) as customary in rehabilitation treatments. We applied a novel cortico-muscular connectivity estimation procedure, based on Partial Directed Coherence, to jointly study source localized EEG and EMG activity during rest (standing) and active/passive RAG. We found greater cortico-cortical connectivity, with higher path length and tendency toward segregation during rest than in both RAG conditions, for all frequency bands except for delta. We also found higher cortico-muscular connectivity in distal muscles during swing (0 GF), and stance (100 GF), highlighting the importance of direct supraspinal control to maintain balance, even when gait is supported by a robotic exoskeleton. Source-localized connectivity shows that this control is driven mainly by the parietal and frontal lobes. The involvement of many cortical areas also in passive RAG (100 GF) justifies the use of the 100 GF RAG training for neurorehabilitation, with the aim of enhancing cortical-muscle connections and driving neural plasticity in neurological patients.
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Affiliation(s)
- Fiorenzo Artoni
- Department of Clinical Neurosciences, University of Genève, Faculty of Medicine, 1211, Geneva, Switzerland.
- Ago Neurotechnologies Sàrl, 1201, Geneva, Switzerland.
| | - Andrea Cometa
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera, Italy
- University School for Advanced Studies IUSS Pavia, 27100, Pavia, Italy
| | - Stefania Dalise
- Unit of Neurorehabilitation, Pisa University Hospital, Pisa, Italy
| | - Valentina Azzollini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Silvestro Micera
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera, Italy
- Translational Neural Engineering Laboratory (TNE), École Polytechnique Fédérale de Lausanne, Campus Biotech, Geneva, Switzerland
| | - Carmelo Chisari
- Unit of Neurorehabilitation, Pisa University Hospital, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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24
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Heß T, Themann P, Oehlwein C, Milani TL. Does Impaired Plantar Cutaneous Vibration Perception Contribute to Axial Motor Symptoms in Parkinson's Disease? Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation. Brain Sci 2023; 13:1681. [PMID: 38137129 PMCID: PMC10742284 DOI: 10.3390/brainsci13121681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To investigate whether impaired plantar cutaneous vibration perception contributes to axial motor symptoms in Parkinson's disease (PD) and whether anti-parkinsonian medication and subthalamic nucleus deep brain stimulation (STN-DBS) show different effects. METHODS Three groups were evaluated: PD patients in the medication "on" state (PD-MED), PD patients in the medication "on" state and additionally "on" STN-DBS (PD-MED-DBS), as well as healthy subjects (HS) as reference. Motor performance was analyzed using a pressure distribution platform. Plantar cutaneous vibration perception thresholds (VPT) were investigated using a customized vibration exciter at 30 Hz. RESULTS Motor performance of PD-MED and PD-MED-DBS was characterized by greater postural sway, smaller limits of stability ranges, and slower gait due to shorter strides, fewer steps per minute, and broader stride widths compared to HS. Comparing patient groups, PD-MED-DBS showed better overall motor performance than PD-MED, particularly for the functional limits of stability and gait. VPTs were significantly higher for PD-MED compared to those of HS, which suggests impaired plantar cutaneous vibration perception in PD. However, PD-MED-DBS showed less impaired cutaneous vibration perception than PD-MED. CONCLUSIONS PD patients suffer from poor motor performance compared to healthy subjects. Anti-parkinsonian medication in tandem with STN-DBS seems to be superior for normalizing axial motor symptoms compared to medication alone. Plantar cutaneous vibration perception is impaired in PD patients, whereas anti-parkinsonian medication together with STN-DBS is superior for normalizing tactile cutaneous perception compared to medication alone. Consequently, based on our results and the findings of the literature, impaired plantar cutaneous vibration perception might contribute to axial motor symptoms in PD.
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Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Peter Themann
- Department of Neurology and Parkinson, Clinic at Tharandter Forest, 09633 Halsbruecke, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L. Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
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25
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Frank Y, Levy T, Lozano R, Friedman K, Underwood S, Kostic A, Walker H, Kolevzon A. Gait Abnormalities in Children with Phelan-McDermid Syndrome. J Child Neurol 2023; 38:665-671. [PMID: 37849292 DOI: 10.1177/08830738231204395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Background: Phelan-McDermid syndrome is a genetic disorder caused by haploinsufficiency of the SHANK3 gene on chromosome 22q13.3 and is characterized by autism spectrum disorder, intellectual disability, speech and language abnormalities, hypotonia, and mild dysmorphic features. Early literature in Phelan-McDermid syndrome did not include gait abnormalities as part of the syndrome although recent prospective studies report that the prevalence of gait abnormalities ranges from 55% to 94%. We compared gait abnormalities in individuals with Phelan-McDermid syndrome, idiopathic autism spectrum disorder, and typically developing controls, and explored associations between gait abnormalities, autism spectrum disorder, and intellectual functioning. Method: The study cohort consists of 67 participants between the ages of 3 and 18 years, divided into 3 groups: Phelan-McDermid syndrome (n = 46), idiopathic autism spectrum disorder (n = 11), and typically developing controls (n = 10). Gait was recorded using a video camera and scored across 26 gait features using a "Gait Clinical Observations scale" designed specifically for this study. Results: Gait abnormalities were significantly higher in the Phelan-McDermid syndrome group as compared to idiopathic autism spectrum disorder or typically developing controls. The number of gait abnormalities across groups was also significantly correlated with Intellectual Quotient/Developmental Quotient (IQ/DQ). In analysis of covariance including IQ/DQ, the effect of group was not significant, but the effect of IQ/DQ was significant. Conclusions: Overall differences in gait abnormalities were determined by the degree of intellectual disability, which was significantly higher in Phelan-McDermid syndrome.
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Affiliation(s)
- Yitzchak Frank
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tess Levy
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reymundo Lozano
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kate Friedman
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Slayton Underwood
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ana Kostic
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah Walker
- Health and Behavior Sciences at Teachers College, Columbia University, New York, NY, USA
| | - Alexander Kolevzon
- Department of Psychiatry, Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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26
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Bao T, Gao J, Wang J, Chen Y, Xu F, Qiao G, Li F. A global bibliometric and visualized analysis of gait analysis and artificial intelligence research from 1992 to 2022. Front Robot AI 2023; 10:1265543. [PMID: 38047061 PMCID: PMC10691112 DOI: 10.3389/frobt.2023.1265543] [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: 08/11/2023] [Accepted: 10/06/2023] [Indexed: 12/05/2023] Open
Abstract
Gait is an important basic function of human beings and an integral part of life. Many mental and physical abnormalities can cause noticeable differences in a person's gait. Abnormal gait can lead to serious consequences such as falls, limited mobility and reduced life satisfaction. Gait analysis, which includes joint kinematics, kinetics, and dynamic Electromyography (EMG) data, is now recognized as a clinically useful tool that can provide both quantifiable and qualitative information on performance to aid in treatment planning and evaluate its outcome. With the assistance of new artificial intelligence (AI) technology, the traditional medical environment has undergone great changes. AI has the potential to reshape medicine, making gait analysis more accurate, efficient and accessible. In this study, we analyzed basic information about gait analysis and AI articles that met inclusion criteria in the WoS Core Collection database from 1992-2022, and the VosViewer software was used for web visualization and keyword analysis. Through bibliometric and visual analysis, this article systematically introduces the research status of gait analysis and AI. We introduce the application of artificial intelligence in clinical gait analysis, which affects the identification and management of gait abnormalities found in various diseases. Machine learning (ML) and artificial neural networks (ANNs) are the most often utilized AI methods in gait analysis. By comparing the predictive capability of different AI algorithms in published studies, we evaluate their potential for gait analysis in different situations. Furthermore, the current challenges and future directions of gait analysis and AI research are discussed, which will also provide valuable reference information for investors in this field.
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Affiliation(s)
- Tong Bao
- School of Medicine, Tsinghua University, Beijing, China
- Institute for Precision Medicine, Tsinghua University, Beijing, China
- Orthopedics Department of the First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Jiasi Gao
- Institute for AI Industry Research, Tsinghua University, Beijing, China
| | - Jinyi Wang
- School of Medicine, Tsinghua University, Beijing, China
- Orthopedics Department of the First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Yang Chen
- Orthopedics Department of the First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Feng Xu
- Orthopedics Department of the First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Guanzhong Qiao
- Orthopedics Department of the First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Fei Li
- Institute for Precision Medicine, Tsinghua University, Beijing, China
- Orthopedics Department of the First Affiliated Hospital of Tsinghua University, Beijing, China
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27
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Awosika OO, Garver A, Drury C, Sucharew HJ, Boyne P, Schwab SM, Wasik E, Earnest M, Dunning K, Bhattacharya A, Khatri P, Kissela BM. Insufficiencies in sensory systems reweighting is associated with walking impairment severity in chronic stroke: an observational cohort study. Front Neurol 2023; 14:1244657. [PMID: 38020645 PMCID: PMC10656616 DOI: 10.3389/fneur.2023.1244657] [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: 06/22/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Walking and balance impairment are common sequelae of stroke and significantly impact functional independence, morbidity, and mortality. Adequate postural stability is needed for walking, which requires sufficient integration of sensory information between the visual, somatosensory, and vestibular centers. "Sensory reweighting" describes the normal physiologic response needed to maintain postural stability in the absence of sufficient visual or somatosensory information and is believed to play a critical role in preserving postural stability after stroke. However, the extent to which sensory reweighting successfully maintains postural stability in the chronic stages of stroke and its potential impact on walking function remains understudied. Methods In this cross-sectional study, fifty-eight community-dwelling ambulatory chronic stroke survivors underwent baseline postural stability testing during quiet stance using the modified Clinical test of Sensory Interaction in Balance (mCTSIB) and assessment of spatiotemporal gait parameters. Results Seventy-six percent (45/58) of participants showed sufficient sensory reweighting with visual and somatosensory deprivation for maintaining postural stability, albeit with greater postural sway velocity indices than normative data. In contrast, survivors with insufficient reweighting demonstrated markedly slower overground walking speeds, greater spatiotemporal asymmetry, and limited acceleration potential. Conclusion Adequate sensory system reweighting is essential for chronic stroke survivors' postural stability and walking independence. Greater emphasis should be placed on rehabilitation strategies incorporating multisensory system integration testing and strengthening as part of walking rehabilitation protocols. Given its potential impact on outcomes, walking rehabilitation trials may benefit from incorporating formal postural stability testing in design and group stratification.
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Affiliation(s)
- Oluwole O. Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Amanda Garver
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Colin Drury
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Heidi J. Sucharew
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Sarah M. Schwab
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Emily Wasik
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Melinda Earnest
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Amit Bhattacharya
- EDDI Lab—Early Detection of Degenerative Disorders and Innovative Solutions, Department of Environmental Health, University of Cincinnati, Cincinnati, OH, United States
| | - Pooja Khatri
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Brett M. Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
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Ferreira-Sánchez MDR, Moreno-Verdú M, Poliakoff E, Sánchez Milá Z, Rodríguez Sanz D, Frutos Llanes R, Barragán Casas JM, Velázquez Saornil J. Differences in Motor Imagery Ability between People with Parkinson's Disease and Healthy Controls, and Its Relationship with Functionality, Independence and Quality of Life. Healthcare (Basel) 2023; 11:2898. [PMID: 37958042 PMCID: PMC10650523 DOI: 10.3390/healthcare11212898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/24/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Motor imagery (MI) has been shown to be effective for the acquisition of motor skills; however, it is still unknown whether similar benefits can be achieved in neurological patients. Previous findings of differences in MI ability between people with Parkinson's disease (PwPD) and healthy controls (HCs) are mixed. This study examined differences in the ability to both create and maintain MI as well as investigating the relationship between the ability to create and maintain MI and motor function, independence and quality of life (QoL). A case-control study was conducted (31 PwPD and 31 HCs), collecting gender, age, dominance, socio-demographic data, duration and impact of the disease. MI intensity (MIQ-RS and KVIQ-34) and temporal accuracy of MI (imagined box and block test [iBBT], imagined timed stand and walk test [iTUG]) were assessed. Functional and clinical assessments included upper limb motor function, balance, gait, independence in activities of daily living and quality of life measures. Statistically significant differences in temporal accuracy were observed and partial and weak relationships were revealed between MI measures and functioning, independence and QoL. PwPD retain the ability to create MI, indicating the suitability of MI in this population. Temporal accuracy might be altered as a reflection of bradykinesia on the mentally simulated actions.
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Affiliation(s)
- María del Rosario Ferreira-Sánchez
- NEUMUSK Group, Facultad de Ciencias de la Salud, Universidad Católica de Ávila, C/Canteros s/n, 05005 Ávila, Spain; (M.d.R.F.-S.); (R.F.L.); (J.M.B.C.); (J.V.S.)
| | - Marcos Moreno-Verdú
- Brain, Action and Skill Laboratory, Institute of Neuroscience (Cognition and Systems Division), UC Louvain, 1348 Ottignies-Louvain-la-Neuve, Belgium;
| | - Ellen Poliakoff
- Body Eyes and Movement (BEAM) Laboratory, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Zacarías Sánchez Milá
- NEUMUSK Group, Facultad de Ciencias de la Salud, Universidad Católica de Ávila, C/Canteros s/n, 05005 Ávila, Spain; (M.d.R.F.-S.); (R.F.L.); (J.M.B.C.); (J.V.S.)
| | - David Rodríguez Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain;
| | - Raúl Frutos Llanes
- NEUMUSK Group, Facultad de Ciencias de la Salud, Universidad Católica de Ávila, C/Canteros s/n, 05005 Ávila, Spain; (M.d.R.F.-S.); (R.F.L.); (J.M.B.C.); (J.V.S.)
| | - José Manuel Barragán Casas
- NEUMUSK Group, Facultad de Ciencias de la Salud, Universidad Católica de Ávila, C/Canteros s/n, 05005 Ávila, Spain; (M.d.R.F.-S.); (R.F.L.); (J.M.B.C.); (J.V.S.)
| | - Jorge Velázquez Saornil
- NEUMUSK Group, Facultad de Ciencias de la Salud, Universidad Católica de Ávila, C/Canteros s/n, 05005 Ávila, Spain; (M.d.R.F.-S.); (R.F.L.); (J.M.B.C.); (J.V.S.)
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Trevarrow MP, Dukkipati SS, Baker SE, Wilson TW, Kurz MJ. Reduced brainstem volume is associated with mobility impairments in youth with cerebral palsy. J Clin Neurosci 2023; 117:114-119. [PMID: 37801875 PMCID: PMC10841759 DOI: 10.1016/j.jocn.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/09/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Persons with cerebral palsy (CP) have impaired mobility that has been attributed to changes in structure and function within the nervous system. The brainstem is a region that plays a critical role in mobility by connecting the cortex and cerebellum to the spinal cord, yet this region has been largely unstudied in persons with CP. RESEARCH QUESTION We used high-resolution structural MRI and biomechanical analyses to examine whether the volume of the whole brainstem and its constituent elements are altered in CP and if these alterations relate to the mobility impairments within this population. METHODS A cohort study was conducted to assess the volume of the whole brainstem, pons, midbrain, medulla, and superior cerebellar peduncle in a cohort of persons with CP (N = 26; Age = 16.3 ± 1.0 years; GMFCS levels I-IV, Females = 12) and a cohort of neurotypical (NT) controls (N = 38; Age = 14.3 ± 0.4 years, Females = 14) using structural MR imaging of the brainstem. Outside the scanner, a digital mat was used to quantify the spatiotemporal gait biomechanics of these individuals. RESULTS We found a significant decrease in volume of the total brainstem, midbrain, and pons in persons with CP in comparison to the NT controls. Furthermore, we found that the altered volumes were related to reduced gait velocity and step length. SIGNIFICANCE The structural changes in the brainstems of persons with CP may contribute to the mobility impairments that are ubiquitous within this population.
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Affiliation(s)
- Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA
| | - Saihari S Dukkipati
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA
| | - Sarah E Baker
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA; Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA; Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA.
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Divandari N, Bird ML, Vakili M, Jaberzadeh S. The Association Between Cognitive Domains and Postural Balance among Healthy Older Adults: A Systematic Review of Literature and Meta-Analysis. Curr Neurol Neurosci Rep 2023; 23:681-693. [PMID: 37856048 PMCID: PMC10673728 DOI: 10.1007/s11910-023-01305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE OF REVIEW This review aims to explore which cognitive domain is more closely associated with which type of balance (static or dynamic). RESENT FINDING Based on recent reviews, inhibitory control, a part of cognition, plays a crucial role in balance performance. Previous reviews report significant links between cognition, mobility, and physical function in older adults. However, evidence regarding the relationship between cognition and balance scores remains inconclusive. The strength of association between cognition and balance appears to be domain-specific and task-specific. Executive function exhibits the strongest correlation with balance, while episodic memory shows a small link with dynamic balance. Processing speed and global cognition demonstrate moderate correlations. Additionally, there is a slight association between cognitive domains and static balance. Further research is needed to elucidate the underlying mechanisms and develop targeted interventions for managing balance-related concerns that are domain-specific and task-specific.
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Affiliation(s)
- Nahid Divandari
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Melbourne, Frankston, VIC, 3199, Australia.
| | - Marie-Louise Bird
- School of Health Sciences, University of Tasmania, Newnham Tasmania 7248, Launceston, Australia
| | - Mahdi Vakili
- Mowbray Medical Clinic, Invermay, TAS, Australia
| | - Shapour Jaberzadeh
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Melbourne, Frankston, VIC, 3199, Australia
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Kamada H, Takeuchi N. Transcranial Direct Current Stimulation over the Temporoparietal Junction Modulates Posture Control in Unfamiliar Environments. Brain Sci 2023; 13:1514. [PMID: 38002475 PMCID: PMC10669516 DOI: 10.3390/brainsci13111514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
The temporoparietal junction (TPJ), which integrates visual, somatosensory, and vestibular information to form body schema, is involved in human postural control. We evaluated whether or not the transcranial direct current stimulation (tDCS) of the TPJ can modulate postural control on an unstable surface with eyes closed, during which the updating of body schema is needed to maintain balance. Sixteen healthy subjects participated in this study. The order of the three types of tDCS (anodal, cathodal, and sham) over the right TPJ was counterbalanced across the participants. We evaluated dynamic posture control while the participants were standing on a stable surface with eyes open and an unstable surface with eyes closed. Anodal tDCS enhanced postural control on an unstable surface with eyes closed during and after stimulation, but cathodal tDCS deteriorated postural control during stimulation. Neither anodal nor cathodal tDCS altered postural control while the participants were on a stable surface with eyes open. Anodal tDCS may enhance postural control with non-vision and altered tactile perception by activating the TPJ, which integrates multisensory inputs to update the body schema, whereas cathodal tDCS has the opposite effect. tDCS over the TPJ may facilitate the updating of body schemas to accommodate changes in sensory inputs and help develop novel approaches to prevent falls.
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Affiliation(s)
- Hiroshi Kamada
- Department of Rehabilitation, Onoba Hospital, Seikan-kai Healthcare Corporation, Akita 010-1424, Japan;
| | - Naoyuki Takeuchi
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita 010-8543, Japan
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Wall A, Palmcrantz S, Borg J, Gutierrez-Farewik EM. Gait pattern after electromechanically-assisted gait training with the Hybrid Assistive Limb and conventional gait training in sub-acute stroke rehabilitation-A subsample from a randomized controlled trial. Front Neurol 2023; 14:1244287. [PMID: 37885482 PMCID: PMC10598624 DOI: 10.3389/fneur.2023.1244287] [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: 06/22/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction Electromechanically-assisted gait training has been introduced in stroke rehabilitation as a means to enable gait training with a large number of reproducible and symmetrical task repetitions, i.e. steps. However, few studies have evaluated its impact on gait pattern functions. This study includes persons with no independent ambulation function at the start of a 4-week neurorehabilitation period in the sub-acute phase after stroke. The primary aim of the study was to evaluate whether the addition of electromechanically-assisted gait training to conventional training resulted in better gait pattern function than conventional training alone. The secondary aim was to identify correlations between overall gait quality and standardized clinical assessments. Participants and methods Seventeen patients with no independent ambulation function who participated in a Prospective Randomized Open Blinded End-point study in the sub-acute phase after stroke were randomized into two groups; one group (n = 7) to undergo conventional training only (CONV group) and the other group (n = 10) to undergo conventional training with additional electromechanically-assisted gait training (HAL group). All patients were assessed with 3D gait analysis and clinical assessments after the 4-week intervention period. Overall gait quality as per the Gait Profile Score (GPS), as well as kinematic, and kinetic and other spatiotemporal metrics were collected and compared between intervention groups. Correlations between biomechanical and clinical outcomes were evaluated. Results Both the CONV and HAL groups exhibited similar gait patterns with no significant differences between groups in any kinematic, kinetic parameters or other spatiotemporal metrics. The GPS for the paretic limb had a median (IQR) of 12.9° (7.8°) and 13.4° (4.3°) for the CONV and HAL groups, respectively (p = 0.887). Overall gait quality was correlated with independence in walking, walking speed, movement function and balance. We found no added benefit in gait pattern function from the electromechanically-assisted gait training compared to the conventional training alone. Discussion This finding raises new questions about how to best design effective and optimal post-stroke rehabilitation programs in patients with moderate to severe gait impairments to achieve both independent walking and optimal gait pattern function, and about which patients should be in focus in further studies on the efficacy of electromechanically-assisted gait training. Clinical trial registration The study was retrospectively registered at ClinicalTrials.gov, identifier (NCT02410915) on April 2015.
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Affiliation(s)
- Anneli Wall
- Department of Rehabilitation Medicine Stockholm, Danderyd Hospital, Stockholm, Sweden
| | - Susanne Palmcrantz
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jörgen Borg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Elena M. Gutierrez-Farewik
- KTH MoveAbility Lab, Department of Engineering Mechanics, Royal Institute of Technology, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Yoo M, Chun MH, Hong GR, Lee C, Lee JK, Lee A. Effects of Training with a Powered Exoskeleton on Cortical Activity Modulation in Hemiparetic Chronic Stroke Patients: A Randomized Controlled Pilot Trial. Arch Phys Med Rehabil 2023; 104:1620-1629. [PMID: 37295705 DOI: 10.1016/j.apmr.2023.05.012] [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: 05/02/2022] [Revised: 04/26/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate the effects of exoskeleton-assisted gait training in stroke patients. DESIGN Prospective randomized controlled trial. SETTING Rehabilitation department in a single tertiary hospital. PARTICIPANTS Thirty (N=30) chronic stroke patients with Functional Ambulatory Category scale (FAC) between 2 and 4. INTERVENTION Patients were randomly assigned to 1 of 2 groups: training with Healbot G, a wearable powered exoskeleton (Healbot G group; n=15), or treadmill training (control group; n=15). All participants received 30 minutes of training, 10 times per week, for 4 weeks. OUTCOME MEASUREMENTS The primary outcome was oxyhemoglobin level changes, representing cortical activity in both motor cortices using functional near-infrared spectroscopy. The secondary outcomes included FAC, Berg Balance Scale, Motricity Index for the lower extremities (MI-Lower), 10-meter walk test, and gait symmetry ratio (spatial step and temporal symmetry ratio). RESULTS Compared to the control group, during the entire training session, the pre-training and post-training mean cortical activity, and the amount of increment between pre- and post-training were significantly higher in the Healbot G group (∆mean ± SD; pre-training, 0.245±0.119, post-training, 0.697±0.429, between pre- and post-training, 0.471±0.401μmol, P<.001). There was no significant difference in cortical activity between affected- and unaffected hemispheres after Healbot G training. FAC (∆mean ± SD; 0.35 ± 0.50, P=.012), MI-Lower (∆mean ± SD; 7.01 ± 0.14, P=.001), and spatial step gait symmetry ratio (∆mean ± SD; -0.32 ± 0.25, P=.049) were improved significantly in the Healbot G group. CONCLUSION Exoskeleton-assisted gait training induces cortical modulation effect in both motor cortices, a balanced cortical activation pattern with improvements in spatial step symmetry ratio, walking ability, and voluntary strength.
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Affiliation(s)
- Miran Yoo
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Ga Ram Hong
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Changmin Lee
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
| | - June Kyoung Lee
- Department of Rehabilitation Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Anna Lee
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Ciocca M, Seemungal BM, Tai YF. Spinal Cord Stimulation for Gait Disorders in Parkinson's Disease and Atypical Parkinsonism: A Systematic Review of Preclinical and Clinical Data. Neuromodulation 2023; 26:1339-1361. [PMID: 37452800 DOI: 10.1016/j.neurom.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/15/2023] [Accepted: 06/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Falls in extrapyramidal disorders, particularly Parkinson's disease (PD), multisystem atrophy (MSA), and progressive supranuclear palsy (PSP), are key milestones affecting patients' quality of life, incurring increased morbidity/mortality and high healthcare costs. Unfortunately, gait and balance in parkinsonisms respond poorly to currently available treatments. A serendipitous observation of improved gait and balance in patients with PD receiving spinal cord stimulation (SCS) for back pain kindled an interest in using SCS to treat gait disorders in parkinsonisms. OBJECTIVES We reviewed preclinical and clinical studies of SCS to treat gait dysfunction in parkinsonisms, covering its putative mechanisms and efficacies. MATERIALS AND METHODS Preclinical studies in animal models of PD and clinical studies in patients with PD, PSP, and MSA who received SCS for gait disorders were included. The main outcome assessed was clinical improvement in gait, together with outcome measures used and possible mechanism of actions. RESULTS We identified 500 references, and 45 met the selection criteria and have been included in this study for analysis. Despite positive results in animal models, the outcomes in human studies are inconsistent. CONCLUSIONS The lack of blind and statistically powered studies, the heterogeneity in patient selection and study outcomes, and the poor understanding of the underlying mechanisms of action of SCS are some of the limiting factors in the field. Addressing these limitations will allow us to draw more reliable conclusions on the effects of SCS on gait and balance in extrapyramidal disorders.
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Affiliation(s)
- Matteo Ciocca
- Department of Brain Sciences, Imperial College London, London, UK
| | | | - Yen F Tai
- Department of Brain Sciences, Imperial College London, London, UK.
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Sousani M, Rojas RF, Preston E, Ghahramani M. Toward a Multi-Modal Brain-Body Assessment in Parkinson's Disease: A Systematic Review in fNIRS. IEEE J Biomed Health Inform 2023; 27:4840-4853. [PMID: 37639416 DOI: 10.1109/jbhi.2023.3308901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Parkinson's disease (PD) causes impairments in cortical structures leading to motor and cognitive symptoms. While common disease management and treatment strategies mainly depend on the subjective assessment of clinical scales and patients' diaries, research in recent years has focused on advances in automatic and objective tools to help with diagnosing PD and determining its severity. Due to the link between brain structure deficits and physical symptoms in PD, objective brain activity and body motion assessment of patients have been studied in the literature. This study aimed to explore the relationship between brain activity and body motion measures of people with PD to look at the feasibility of diagnosis or assessment of PD using these measures. In this study, we summarised the findings of 24 selected papers from the complete literature review using the Scopus database. Selected studies used both brain activity recording using functional near-infrared spectroscopy (fNIRS) and motion assessment using sensors for people with PD in their experiments. Results include 1) the most common study protocol is a combination of single tasks. 2) Prefrontal cortex is mostly studied region of interest in the literature. 3) Oxygenated haemoglobin (HbO 2) concentration is the predominant metric utilised in fNIRS, compared to deoxygenated haemoglobin (HHb). 4) Motion assessment in people with PD is mostly done with inertial measurement units (IMUs) and electronic walkway. 5) The relationship between brain activity and body motion measures is an important factor that has been neglected in the literature.
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Liu Z, Wang X, Wu Z, Yin G, Chu H, Zhao P. HBOT has a better cognitive outcome than NBH for patients with mild traumatic brain injury: A randomized controlled clinical trial. Medicine (Baltimore) 2023; 102:e35215. [PMID: 37713814 PMCID: PMC10508512 DOI: 10.1097/md.0000000000035215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Normobaric hyperoxia (NBH) and hyperbaric oxygen therapy (HBOT) are effective treatment plan for traumatic brain injury (TBI). The aim of this study was to compare cognitive outcome after mild TBI between NBH and HBOT so as to provide a more suitable treatment strategy for patients with mild TBI. METHODS A prospective research was conducted between October 2017 and March 2023, enrolling patients with mild TBI (Glasgow coma scale score: 13-15 points) within 24 hours of injury in Cangzhou Central Hospital. Patients were randomized into 3 groups: group control (C), group NBH and group HBOT. The patients in HBOT group received hyperbaric oxygen therapy in high pressure oxygen chamber and patients in NBH group received hyperbaric oxygen therapy. at 0 minute before NBH or HBOT (T1), 0 minute after NBH or HBOT (T2) and 30 days after NBH or HBOT (T3), level of S100β, NSE, GFAP, HIF-1α, and MDA were determined by ELISA. At the same time, the detection was performed for MoCA and MMSE scores, along with rSO2. RESULTS The results showed both NBH and HBOT could improve the score of MoCA and MMSE, as well as the decrease the level of S100β, NSE, GFAP, HIF-1α, MDA, and rSO2 compared with group C. Furthermore, the patients in group HBOT have higher score of MoCA and MMSE and lower level of S100β, NSE, GFAP, HIF-1α, MDA, and rSO2. CONCLUSION Both NBH and HBOT can effectively improve cognitive outcome for patients with mild TBI by improving cerebral hypoxia and alleviating brain injury, while HBOT exert better effect than NBH.
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Affiliation(s)
- Zhiguo Liu
- The Third Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, China
| | - Xirui Wang
- The Third Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, China
| | - Zhiyou Wu
- The Third Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, China
| | - Gangfeng Yin
- The Third Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, China
| | - Haibin Chu
- The Third Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, China
| | - Pengyue Zhao
- The Third Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, China
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Potvin-Desrochers A, Martinez-Moreno A, Clouette J, Parent-L'Ecuyer F, Lajeunesse H, Paquette C. Upregulation of the parietal cortex improves freezing of gait in Parkinson's disease. J Neurol Sci 2023; 452:120770. [PMID: 37633012 DOI: 10.1016/j.jns.2023.120770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The posterior parietal cortex (PPC) is a key brain area for visuospatial processing and locomotion. It has been repetitively shown to be involved in the neural correlates of freezing of gait (FOG), a common symptom of Parkinson's disease (PD). However, current neuroimaging modalities do not allow to precisely determine the role of the PPC during real FOG episodes. OBJECTIVES The purpose of this study was to modulate the PPC cortical excitability using repetitive transcranial magnetic stimulation (rTMS) to determine whether the PPC contributes to FOG or compensates for dysfunctional neural networks to reduce FOG. METHODS Fourteen participants with PD who experience freezing took part in a proof of principle study consisting of three experimental sessions targeting the PPC with inhibitory, excitatory, and sham rTMS. Objective FOG outcomes and cortical excitability measurements were acquired before and after each stimulation protocol. RESULTS Increasing PPC excitability resulted in significantly fewer freezing episodes and percent time frozen during a FOG-provoking task. This reduction in FOG most likely emerged from the trend in PPC inhibiting the lower leg motor cortex excitability. CONCLUSION Our results suggest that the recruitment of the PPC is linked to less FOG, providing support for the beneficial role of the PPC upregulation in preventing FOG. This could potentially be linked to a reduction of the cortical input burden on the basal ganglia prior to FOG. Excitatory rTMS interventions targeting the PPC may have the potential to reduce FOG.
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Affiliation(s)
- Alexandra Potvin-Desrochers
- McGill University, Department of Kinesiology and Physical Education Montréal, Québec, Canada; McGill University, Integrated Program in Neuroscience, McGill University, Montréal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec, Canada
| | - Alejandra Martinez-Moreno
- McGill University, Department of Kinesiology and Physical Education Montréal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec, Canada
| | - Julien Clouette
- McGill University, Department of Kinesiology and Physical Education Montréal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec, Canada
| | - Frédérike Parent-L'Ecuyer
- McGill University, Department of Kinesiology and Physical Education Montréal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec, Canada
| | - Henri Lajeunesse
- McGill University, Department of Kinesiology and Physical Education Montréal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec, Canada
| | - Caroline Paquette
- McGill University, Department of Kinesiology and Physical Education Montréal, Québec, Canada; McGill University, Integrated Program in Neuroscience, McGill University, Montréal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montréal, Québec, Canada.
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Homagain A, Ehgoetz Martens KA. Emotional states affect steady state walking performance. PLoS One 2023; 18:e0284308. [PMID: 37708145 PMCID: PMC10501668 DOI: 10.1371/journal.pone.0284308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
Gait is a large component and indicator of health. Many factors affect gait including age, disease, and even mood disorders. Few studies have looked at the influence of emotional states on gait. This study aimed to investigate the influence of emotional states on walking performance to understand whether an emotional state may be an important factor to consider when evaluating gait. Thirty-six young adults were recruited (23F, 13M) and performed a neutral baseline condition of walking which included six passes of walking across an 8m walkway (a total of 48m of walking). Participants then completed 6 pseudo-randomized emotional state induction conditions while immersive 360-degree videos were used to induce the following emotional conditions: happiness, excitement, sadness, fear, and anger. Participants viewed the emotion elicitation videos using a virtual reality head-mounted display (HMD), then rated their emotional state using self-assessment manikins and walked (without the HMD) over a pressure sensor walkway. One-way repeated measures ANOVA and pairwise comparisons were used to examine differences in gait parameters across the emotional conditions. Participants walked with significantly reduced step length and speed during the sadness condition compared to the other emotional conditions and the neutral condition. Furthermore, participants adjusted the timing of their walking during the sadness condition and walked with significantly increased step, stance, and swing times compared to other emotional conditions, but not the neutral condition. Step time was significantly reduced during the conditions of excitement and fear compared to the neutral condition. Emotions may impact variety of gait parameters involving pace and rhythm, however have little influence on gait variability and postural control. These results indicate that perhaps the emotions of sadness and excitement should be taken into account as potential confounds for future gait analysis.
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Affiliation(s)
- Abhishesh Homagain
- Faculty of Health, Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Kaylena A. Ehgoetz Martens
- Faculty of Health, Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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39
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Jacobsen NA, Ferris DP. Electrocortical activity correlated with locomotor adaptation during split-belt treadmill walking. J Physiol 2023; 601:3921-3944. [PMID: 37522890 PMCID: PMC10528133 DOI: 10.1113/jp284505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
Locomotor adaptation is crucial for daily gait adjustments to changing environmental demands and obstacle avoidance. Mobile brain imaging with high-density electroencephalography (EEG) now permits quantification of electrocortical dynamics during human locomotion. To determine the brain areas involved in human locomotor adaptation, we recorded high-density EEG from healthy, young adults during split-belt treadmill walking. We incorporated a dual-electrode EEG system and neck electromyography to decrease motion and muscle artefacts. Voluntary movement preparation and execution have been linked to alpha (8-13 Hz) and beta band (13-30 Hz) desynchronizations in the sensorimotor and posterior parietal cortices, whereas theta band (4-7 Hz) modulations in the anterior cingulate have been correlated with movement error monitoring. We hypothesized that relative to normal walking, split-belt walking would elicit: (1) decreases in alpha and beta band power in sensorimotor and posterior parietal cortices, reflecting enhanced motor flexibility; and (2) increases in theta band power in anterior cingulate cortex, reflecting instability and balance errors that will diminish with practice. We found electrocortical activity in multiple regions that was associated with stages of gait adaptation. Data indicated that sensorimotor and posterior parietal cortices had decreased alpha and beta band spectral power during early adaptation to split-belt treadmill walking that gradually returned to pre-adaptation levels by the end of the adaptation period. Our findings emphasize that multiple brain areas are involved in adjusting gait under changing environmental demands during human walking. Future studies could use these findings on healthy, young participants to identify dysfunctional supraspinal mechanisms that may be impairing gait adaptation. KEY POINTS: Identifying the location and time course of electrical changes in the brain correlating with gait adaptation increases our understanding of brain function and provides targets for brain stimulation interventions. Using high-density EEG in combination with 3D biomechanics, we found changes in neural oscillations localized near the sensorimotor, posterior parietal and cingulate cortices during split-belt treadmill adaptation. These findings suggest that multiple cortical mechanisms may be associated with locomotor adaptation, and their temporal dynamics can be quantified using mobile EEG. Results from this study can serve as a reference model to examine brain dynamics in individuals with movement disorders that cause gait asymmetry and reduced gait adaptation.
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Affiliation(s)
- Noelle A Jacobsen
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Daniel P Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
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40
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Hall KJ, Van Ooteghem K, McIlroy WE. Emotional state as a modulator of autonomic and somatic nervous system activity in postural control: a review. Front Neurol 2023; 14:1188799. [PMID: 37719760 PMCID: PMC10500443 DOI: 10.3389/fneur.2023.1188799] [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: 03/17/2023] [Accepted: 08/07/2023] [Indexed: 09/19/2023] Open
Abstract
Advances in our understanding of postural control have highlighted the need to examine the influence of higher brain centers in the modulation of this complex function. There is strong evidence of a link between emotional state, autonomic nervous system (ANS) activity and somatic nervous system (somatic NS) activity in postural control. For example, relationships have been demonstrated between postural threat, anxiety, fear of falling, balance confidence, and physiological arousal. Behaviorally, increased arousal has been associated with changes in velocity and amplitude of postural sway during quiet standing. The potential links between ANS and somatic NS, observed in control of posture, are associated with shared neuroanatomical connections within the central nervous system (CNS). The influence of emotional state on postural control likely reflects the important influence the limbic system has on these ANS/somatic NS control networks. This narrative review will highlight several examples of behaviors which routinely require coordination between the ANS and somatic NS, highlighting the importance of the neurofunctional link between these systems. Furthermore, we will extend beyond the more historical focus on threat models and examine how disordered/altered emotional state and ANS processing may influence postural control and assessment. Finally, this paper will discuss studies that have been important in uncovering the modulatory effect of emotional state on postural control including links that may inform our understanding of disordered control, such as that observed in individuals living with Parkinson's disease and discuss methodological tools that have the potential to advance understanding of this complex relationship.
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Affiliation(s)
- Karlee J. Hall
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
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41
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Tosserams A, Bloem BR, Nonnekes J. Compensation Strategies for Gait Impairments in Parkinson's Disease: From Underlying Mechanisms to Daily Clinical Practice. Mov Disord Clin Pract 2023; 10:S56-S62. [PMID: 37637990 PMCID: PMC10448134 DOI: 10.1002/mdc3.13616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/22/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anouk Tosserams
- Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
| | - Jorik Nonnekes
- Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
- Department of RehabilitationSint MaartenskliniekNijmegenThe Netherlands
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42
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Costanzo M, Cutrona C, Leodori G, De Bartolo MI, Fabbrini A, Vivacqua G, Conte A, Fabbrini G, Berardelli A, Belvisi D. Distal Upper Limb Tremor during Walking in Parkinson's Disease. Mov Disord Clin Pract 2023; 10:1198-1202. [PMID: 37635779 PMCID: PMC10450241 DOI: 10.1002/mdc3.13814] [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: 01/23/2023] [Revised: 05/13/2023] [Accepted: 05/29/2023] [Indexed: 08/29/2023] Open
Abstract
Background Distal upper limb tremor during walking (TW) is frequently observed in Parkinson's disease (PD) but its clinical features are unknown. Objective To characterize the occurrence and the clinical features of TW in comparison to the other types of tremors in PD. Methods Fifty-one PD patients with rest tremor were evaluated off- and on-treatment. Occurrence, body distribution, severity and latency of TW and of other tremor types were assessed. Results TW was present in 78% of the PD patients examined. TW body distribution and severity were similar to those of rest and re-emergent tremor but different from the postural tremor presented by the same patients. TW latency, observed in 85% of patients, was on average 5.8 s. Dopaminergic treatment significantly improved TW, rest, and re-emergent tremor severity but left TW latency unaffected. Conclusions TW is a frequent motor sign in PD and is likely a clinical variant of rest tremor.
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Affiliation(s)
| | | | - Giorgio Leodori
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | | | - Andrea Fabbrini
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Giorgio Vivacqua
- Department of Experimental Morphology and Microscopy – Integrated Research Center (PRAAB) – Campus Biomedico University of RomeRomeItaly
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics SciencesSapienza University of RomeRomeItaly
| | - Antonella Conte
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Giovanni Fabbrini
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Alfredo Berardelli
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
| | - Daniele Belvisi
- IRCCS NeuromedPozzilliItaly
- Department of Human NeurosciencesSapienza University of RomeRomeItaly
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43
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Lynch DG, Shah KA, Powell K, Wadolowski S, Tambo W, Strohl JJ, Unadkat P, Eidelberg D, Huerta PT, Li C. Neurobehavioral Impairments Predict Specific Cerebral Damage in Rat Model of Subarachnoid Hemorrhage. Transl Stroke Res 2023:10.1007/s12975-023-01180-2. [PMID: 37493939 DOI: 10.1007/s12975-023-01180-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
Subarachnoid hemorrhage (SAH) is a severe form of stroke that can cause unpredictable and diffuse cerebral damage, which is difficult to detect until it becomes irreversible. Therefore, there is a need for a reliable method to identify dysfunctional regions and initiate treatment before permanent damage occurs. Neurobehavioral assessments have been suggested as a possible tool to detect and approximately localize dysfunctional cerebral regions. In this study, we hypothesized that a neurobehavioral assessment battery could be a sensitive and specific method for detecting damage in discrete cerebral regions following SAH. To test this hypothesis, a behavioral battery was employed at multiple time points after SAH induced via an endovascular perforation, and brain damage was confirmed via postmortem histopathological analysis. Our results demonstrate that impairment of sensorimotor function accurately predict damage in the cerebral cortex (AUC 0.905; sensitivity 81.8%; specificity 90.9%) and striatum (AUC 0.913; sensitivity 90.1%; specificity 100%), while impaired novel object recognition is a more accurate indicator of damage to the hippocampus (AUC 0.902; sensitivity 74.1%; specificity 83.3%) than impaired reference memory (AUC 0.746; sensitivity 72.2%; specificity 58.0%). Tests for anxiety-like and depression-like behaviors predict damage to the amygdala (AUC 0.900; sensitivity 77.0%; specificity 81.7%) and thalamus (AUC 0.963; sensitivity 86.3%; specificity 87.8%), respectively. This study suggests that recurring behavioral testing can accurately predict damage in specific brain regions, which could be developed into a clinical battery for early detection of SAH damage in humans, potentially improving early treatment and outcomes.
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Affiliation(s)
- Daniel G Lynch
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kevin A Shah
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Department of Neurosurgery, North Shore University Hospital, Manhasset, NY, USA
| | - Keren Powell
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Steven Wadolowski
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Willians Tambo
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
| | - Joshua J Strohl
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Laboratory of Immune and Neural Networks, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Prashin Unadkat
- Department of Neurosurgery, North Shore University Hospital, Manhasset, NY, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
- Center for Neurosciences, Lab for Behavioral and Molecular Neuroimaging, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - David Eidelberg
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
- Center for Neurosciences, Lab for Behavioral and Molecular Neuroimaging, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Patricio T Huerta
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
- Laboratory of Immune and Neural Networks, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Chunyan Li
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, Manhasset, NY, USA.
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Department of Neurosurgery, North Shore University Hospital, Manhasset, NY, USA.
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA.
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44
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Choi JY, Ha SW, Jeong DE, Lee J, Kim D, Min JY, Min KB. Association Between the Loss of Gait Harmony and Cognitive Impairment: Cross-Sectional Study. JMIR Public Health Surveill 2023; 9:e46264. [PMID: 37428538 PMCID: PMC10366667 DOI: 10.2196/46264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/20/2023] [Accepted: 06/15/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Functional limitations and disabilities have been associated with a decrease in cognitive function due to increasing age. Gait performance and cognitive function have been associated with gait variability in executive function, the phase domain in memory, and gait abnormalities in cognitive decline. OBJECTIVE Our study aimed to investigate whether gait harmony was associated with cognitive function in the older adult population. Moreover, we aimed to investigate whether gait harmony was associated with cognitive function and explore each cognitive function in a specific harmonic state. METHODS The study population included 510 adults aged ≥60 years who visited the Department of Neurology at the Veterans Health Service Medical Center, Seoul, South Korea. Gait data were collected using a 3D motion capture device with a wireless inertial measurement unit system. For cognitive function assessments, we used the Seoul Neuropsychological Screening Battery-Core test, which evaluates the level of cognitive function or impairment in 5 cognitive domains. RESULTS In general, the association between the Seoul Neuropsychological Screening Battery-Core tests and the stance-to-swing ratio in the >1.63 ratio group yielded lower β coefficients than those in the 1.50-1.63 ratio group. After adjustment for confounders, the odds ratio (OR) for the Digit Symbol Coding test (adjusted OR 0.42, 95% CI 0.20-0.88) and the Korean version of the Color Word Stroop Test: 60 seconds (adjusted OR 0.51, 95% CI 0.29-0.89) for frontal and executive function were significantly lower for the >1.63 ratio group than the reference group. CONCLUSIONS Our findings suggest that the gait phase ratio is a valuable indicator of walking deficits and may also be associated with cognitive impairment in older adults.
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Affiliation(s)
- Ju-Young Choi
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Sang-Won Ha
- Department of Neurology, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Da-Eun Jeong
- Department of Neurology, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Jaeho Lee
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Donghoon Kim
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Republic of Korea
| | - Jin-Young Min
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Kyoung-Bok Min
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Republic of Korea
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Republic of Korea
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45
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Wu H, Wu C, Qin J, Zhou C, Tan S, DuanMu X, Guan X, Bai X, Guo T, Wu J, Chen J, Wen J, Cao Z, Gao T, Gu L, Huang P, Zhang B, Xu X, Zhang M. Functional connectome predicting individual gait function and its relationship with molecular architecture in Parkinson's disease. Neurobiol Dis 2023:106216. [PMID: 37385459 DOI: 10.1016/j.nbd.2023.106216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023] Open
Abstract
Gait impairment is a common symptom of Parkinson's disease (PD), but its neural signature remains unclear due to the interindividual variability of gait performance. Identifying a robust gait-brain correlation at the individual level would provide insight into a generalizable neural basis of gait impairment. In this context, this study aimed to detect connectome that can predict individual gait function of PD, and follow-up analyses assess the molecular architecture underlying the connectome by relating it to the neurotransmitter-receptor/transporter density maps. Resting-state functional magnetic resonance imaging was used to detect the functional connectome, and gait function was assessed via a 10 m-walking test. The functional connectome was first detected within drug-naive patients (N = 48) by using connectome-based predictive modeling following cross-validation and then successfully validated within drug-managed patients (N = 30). The results showed that the motor, subcortical, and visual networks played an important role in predicting gait function. The connectome generated from patients failed to predict the gait function of 33 normal controls (NCs) and had distinct connection patterns compared to NCs. The negative connections (connection negatively correlated with 10 m-walking-time) pattern of the PD connectome was associated with the density of the D2 receptor and VAChT transporter. These findings suggested that gait-associated functional alteration induced by PD pathology differed from that induced by aging degeneration. The brain dysfunction related to gait impairment was more commonly found in regions expressing more dopaminergic and cholinergic neurotransmitters, which may aid in developing targeted treatments.
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Affiliation(s)
- Haoting Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Chenqing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jianmei Qin
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Sijia Tan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xiaojie DuanMu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xueqin Bai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jingwen Chen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Jiaqi Wen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Zhengye Cao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Ting Gao
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Luyan Gu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310009 Hangzhou, China.
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46
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Yu X, Wang HJ, Zhen QX, Zhang QR, Yan HJ, Zhen Y, An X, Xi JN, Qie SY, Fang BY. Added forearm weights for gait pattern normalization in patients with Parkinson's disease. J Clin Neurosci 2023; 114:17-24. [PMID: 37276741 DOI: 10.1016/j.jocn.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/11/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
Patients with Parkinson's Disease presented gait impairment. Applying additional weights to enhancing sensory input may improve gait impairment. We assumed that gait impairment could be improved when patients walked with additional forearm weights, and the gait improvement was associated with clinical characteristic of Parkinson's Disease. Thirty patients with Parkinson's Disease and 30 age-sex matched controls were recruited. Spatiotemporal and joint kinematics parameters were evaluated by a three-dimensional motion capture system in normal walking and walking with sandbags, respectively. The comparisons of spatiotemporal parameters were analyzed using t-test or nonparametric tests. The comparison of joint kinematic data was analyzed using statistical parametric mapping. The correlation between motor symptom and gait parameters changes was analyzed using Pearson's correlation analysis. During normal walking, patients showed deteriorated gait compared with controls. After applying weights to forearms patients increased cadence (p = 0.004), speed (p < 0.001) and step length (p = 0.048), and decreased stride time (p = 0.003). The hip angles significantly increased during 5%-23% and 87%-100% of gait cycle, while knee angles during 9%-25% and 88%-98% of the gait cycle, and ankle angles in 92%-100% of gait cycle. The gait parameters of patients with forearm-loading showed no significant difference compared with healthy subjects walking normally. The change of gait parameters correlated positively with the axial and tremor severity while correlated negatively with the rigidity sub-score. Patients with tremor dominant subtype also showed greater improvement of speed and step time compared with patients with postural instability/gait difficulty subtype. Applying added weights bilaterally to the forearms of patients can normalize gait patterns. Notably, patients with higher scores on axial and tremor and lower rigidity scores gained more benefits.
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Affiliation(s)
- Xin Yu
- Beijing Rehabilitation Medical College, Capital Medical University, Beijing, China
| | - Hu-Jun Wang
- Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Qiao-Xia Zhen
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Qiao-Rong Zhang
- Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Hong-Jiao Yan
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yi Zhen
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Xia An
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jia-Ning Xi
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Shu-Yan Qie
- Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China.
| | - Bo-Yan Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China.
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47
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Lynch DG, Shah KA, Powell K, Wadolowski S, Ayol WT, Strohl JJ, Unadkat P, Eidelberg D, Huerta PT, Li C. Neurobehavioral impairments predict specific cerebral damage in rat model of subarachnoid hemorrhage. RESEARCH SQUARE 2023:rs.3.rs-2943917. [PMID: 37292945 PMCID: PMC10246236 DOI: 10.21203/rs.3.rs-2943917/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Subarachnoid hemorrhage (SAH) is a severe form of stroke that can cause unpredictable and diffuse cerebral damage, which is difficult to detect until it becomes irreversible. Therefore, there is a need for a reliable method to identify dysfunctional regions and initiate treatment before permanent damage occurs. Neurobehavioral assessments have been suggested as a possible tool to detect and approximately localize dysfunctional cerebral regions. In this study, we hypothesized that a neurobehavioral assessment battery could be a sensitive and specific early warning for damage in discrete cerebral regions following SAH. To test this hypothesis, a behavioral battery was employed at multiple time points after SAH induced via an endovascular perforation, and brain damage was confirmed via postmortem histopathological analysis. Our results demonstrate that impairment of sensorimotor function accurately predict damage in the cerebral cortex (AUC: 0.905; sensitivity: 81.8%; specificity: 90.9%) and striatum (AUC: 0.913; sensitivity: 90.1%; specificity: 100%), while impaired novel object recognition is a more accurate indicator of damage to the hippocampus (AUC: 0.902; sensitivity: 74.1%; specificity: 83.3%) than impaired reference memory (AUC: 0.746; sensitivity: 72.2%; specificity: 58.0%). Tests for anxiety-like and depression-like behaviors predict damage to the amygdala (AUC: 0.900; sensitivity: 77.0%; specificity: 81.7%) and thalamus (AUC: 0.963; sensitivity: 86.3%; specificity: 87.8%), respectively. This study suggests that recurring behavioral testing can accurately predict damage in specific brain regions, which could be developed into a clinical battery for early detection of SAH damage in humans, potentially improving early treatment and outcomes.
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48
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La Rosa G, Avola M, Di Gregorio T, Calabrò RS, Onesta MP. Gait Recovery in Spinal Cord Injury: A Systematic Review with Metanalysis Involving New Rehabilitative Technologies. Brain Sci 2023; 13:brainsci13050703. [PMID: 37239175 DOI: 10.3390/brainsci13050703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
Gait recovery is a fundamental goal in patients with spinal cord injury to attain greater autonomy and quality of life. Robotics is becoming a valid tool in improving motor, balance, and gait function in this patient population. Moreover, other innovative approaches are leading to promising results. The aim of this study was to investigate new rehabilitative methods for gait recovery in people who have suffered spinal cord injuries. A systematic review of the last 10 years of the literature was performed in three databases (PubMed, PEDro, andCochrane). We followed this PICO of the review: P: adults with non-progressive spinal cord injury; I: new rehabilitative methods; C: new methods vs. conventional methods; and O: improvement of gait parameters. When feasible, a comparison through ES forest plots was performed. A total of 18 RCTs of the 599 results obtained were included. The studies investigated robotic rehabilitation (n = 10), intermittent hypoxia (N = 3) and external stimulation (N = 5). Six studies of the first group (robotic rehabilitation) were compared using a forest plot for 10MWT, LEMS, WISCI-II, and SCIM-3. The other clinical trials were analyzed through a narrative review of the results. We found weak evidence for the claim that robotic devices lead to better outcomes in gait independence compared to conventional rehabilitation methods. External stimulation and intermittent hypoxia seem to improve gait parameters associated with other rehabilitation methods. Research investigating the role of innovative technologies in improving gait and balance is needed since walking ability is a fundamental issue in patients with SCI.
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Affiliation(s)
| | - Marianna Avola
- Consorzio Siciliano di Riabilitazione, 95100 Catania, Italy
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Lacroix-Ouellette P, Dubuc R. Brainstem neural mechanisms controlling locomotion with special reference to basal vertebrates. Front Neural Circuits 2023; 17:910207. [PMID: 37063386 PMCID: PMC10098025 DOI: 10.3389/fncir.2023.910207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
Over the last 60 years, the basic neural circuitry responsible for the supraspinal control of locomotion has progressively been uncovered. Initially, significant progress was made in identifying the different supraspinal structures controlling locomotion in mammals as well as some of the underlying mechanisms. It became clear, however, that the complexity of the mammalian central nervous system (CNS) prevented researchers from characterizing the detailed cellular mechanisms involved and that animal models with a simpler nervous system were needed. Basal vertebrate species such as lampreys, xenopus embryos, and zebrafish became models of choice. More recently, optogenetic approaches have considerably revived interest in mammalian models. The mesencephalic locomotor region (MLR) is an important brainstem region known to control locomotion in all vertebrate species examined to date. It controls locomotion through intermediary cells in the hindbrain, the reticulospinal neurons (RSNs). The MLR comprises populations of cholinergic and glutamatergic neurons and their specific contribution to the control of locomotion is not fully resolved yet. Moreover, the downward projections from the MLR to RSNs is still not fully understood. Reporting on discoveries made in different animal models, this review article focuses on the MLR, its projections to RSNs, and the contribution of these neural elements to the control of locomotion. Excellent and detailed reviews on the brainstem control of locomotion have been recently published with emphasis on mammalian species. The present review article focuses on findings made in basal vertebrates such as the lamprey, to help direct new research in mammals, including humans.
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Affiliation(s)
| | - Réjean Dubuc
- Department of Neurosciences, Université de Montréal, Montréal, QC, Canada
- Department of Physical Activity Sciences, Université du Québec à Montréal, Montréal, QC, Canada
- Research Group for Adapted Physical Activity, Université du Québec à Montréal, Montréal, QC, Canada
- *Correspondence: Réjean Dubuc,
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Tosserams A, Bloem BR, Ehgoetz Martens KA, Helmich RC, Kessels RPC, Shine JM, Taylor NL, Wainstein G, Lewis SJG, Nonnekes J. Modulating arousal to overcome gait impairments in Parkinson's disease: how the noradrenergic system may act as a double-edged sword. Transl Neurodegener 2023; 12:15. [PMID: 36967402 PMCID: PMC10040128 DOI: 10.1186/s40035-023-00347-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/28/2023] [Indexed: 03/28/2023] Open
Abstract
In stressful or anxiety-provoking situations, most people with Parkinson's disease (PD) experience a general worsening of motor symptoms, including their gait impairments. However, a proportion of patients actually report benefits from experiencing-or even purposely inducing-stressful or high-arousal situations. Using data from a large-scale international survey study among 4324 people with PD and gait impairments within the online Fox Insight (USA) and ParkinsonNEXT (NL) cohorts, we demonstrate that individuals with PD deploy an array of mental state alteration strategies to cope with their gait impairment. Crucially, these strategies differ along an axis of arousal-some act to heighten, whereas others diminish, overall sympathetic tone. Together, our observations suggest that arousal may act as a double-edged sword for gait control in PD. We propose a theoretical, neurobiological framework to explain why heightened arousal can have detrimental effects on the occurrence and severity of gait impairments in some individuals, while alleviating them in others. Specifically, we postulate that this seemingly contradictory phenomenon is explained by the inherent features of the ascending arousal system: namely, that arousal is related to task performance by an inverted u-shaped curve (the so-called Yerkes and Dodson relationship). We propose that the noradrenergic locus coeruleus plays an important role in modulating PD symptom severity and expression, by regulating arousal and by mediating network-level functional integration across the brain. The ability of the locus coeruleus to facilitate dynamic 'cross-talk' between distinct, otherwise largely segregated brain regions may facilitate the necessary cerebral compensation for gait impairments in PD. In the presence of suboptimal arousal, compensatory networks may be too segregated to allow for adequate compensation. Conversely, with supraoptimal arousal, increased cross-talk between competing inputs of these complementary networks may emerge and become dysfunctional. Because the locus coeruleus degenerates with disease progression, finetuning of this delicate balance becomes increasingly difficult, heightening the need for mental strategies to self-modulate arousal and facilitate shifting from a sub- or supraoptimal state of arousal to improve gait performance. Recognition of this underlying mechanism emphasises the importance of PD-specific rehabilitation strategies to alleviate gait disability.
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Affiliation(s)
- Anouk Tosserams
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Rehabilitation, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | | | - Rick C Helmich
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Roy P C Kessels
- Department of Neuropsychology and Rehabilitation Psychology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Medical Psychology and Radboudumc Alzheimer Center, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Vincent Van Gogh Institute for Psychiatry, Venray, The Netherlands
- Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
| | - James M Shine
- Brain and Mind Centre, Parkinson's Disease Research Clinic, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
- Centre for Complex Systems, The University of Sydney, Camperdown, NSW, Australia
| | - Natasha L Taylor
- Brain and Mind Centre, Parkinson's Disease Research Clinic, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Gabriel Wainstein
- Brain and Mind Centre, Parkinson's Disease Research Clinic, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Simon J G Lewis
- Brain and Mind Centre, Parkinson's Disease Research Clinic, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Jorik Nonnekes
- Department of Rehabilitation, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.
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