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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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Drechsel TJ, Zippenfennig C, Schmidt D, Milani TL. The Effect of Subliminal Electrical Noise Stimulation on Plantar Vibration Sensitivity in Persons with Diabetes Mellitus. Biomedicines 2022; 10:biomedicines10081880. [PMID: 36009427 PMCID: PMC9405277 DOI: 10.3390/biomedicines10081880] [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: 06/29/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Subliminal electrical noise (SEN) enhances sensitivity in healthy individuals of various ages. Diabetes and its neurodegenerative profile, such as marked decreases in foot sensitivity, highlights the potential benefits of SEN in such populations. Accordingly, this study aimed to investigate the effect of SEN on vibration sensitivity in diabetes. Vibration perception thresholds (VPT) and corresponding VPT variations (coefficient of variation, CoV) of two experimental groups with diabetes mellitus were determined using a customized vibration exciter (30 and 200 Hz). Plantar measurements were taken at the metatarsal area with and without SEN stimulation. Wilcoxon signed-rank and t tests were used to test for differences in VPT and CoV within frequencies, between the conditions with and without SEN. We found no statistically significant effects of SEN on VPT and CoV (p > 0.05). CoV showed descriptively lower mean variations of 4 and 7% for VPT in experiment 1. SEN did not demonstrate improvements in VPT in diabetic individuals. Interestingly, taking into account the most severely affected (neuropathy severity) individuals, SEN seems to positively influence vibratory perception. However, the descriptively reduced variations in experiment 1 indicate that participants felt more consistently. It is possible that the effect of SEN on thick, myelinated Aβ-fibers is only marginally present.
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Affiliation(s)
- Tina J. Drechsel
- Department of Human Locomotion, Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Chemnitz University of Technology, 09107 Chemnitz, Germany
- Correspondence: ; Tel.: +49-371-531-30022
| | - Claudio Zippenfennig
- Department of Human Locomotion, Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Chemnitz University of Technology, 09107 Chemnitz, Germany
| | - Daniel Schmidt
- Motor Control, Cognition and Neurophysiology, Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Chemnitz University of Technology, 09107 Chemnitz, Germany
| | - Thomas L. Milani
- Department of Human Locomotion, Faculty of Behavioral and Social Sciences, Institute of Human Movement Science and Health, Chemnitz University of Technology, 09107 Chemnitz, Germany
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Topkara B, Aydin T, Corum M, Karaoglu A, Ekici Zincirci D, S Bugdayci D, Ones K, Paker N, Kesiktas N, Karacan I, Türker KS. A new method to determine stretch reflex latency. Muscle Nerve 2021; 64:726-733. [PMID: 34617302 DOI: 10.1002/mus.27434] [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: 05/01/2020] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION/AIMS Motion artifact signals (MASs) created by the relative movement of intramuscular wire electrodes are an indicator of the mechanical stimulus arrival time to the muscle belly. This study proposes a method that uses wire electrodes as an intramuscular mechanosensor to determine the stretch reflex (SR) latency without lag time. METHODS Gastrocnemius SR was induced by tendon tap, heel tap, and forefoot tap. The MASs recorded by intramuscular wire electrodes were extracted from background electromyographic activity using the spike-triggered averaging technique. Simultaneous recordings were obtained from multiple sites to validate the MAS technique. RESULTS Using intramuscular wire electrodes, the MASs were successfully determined and extracted for all stimulus sites. In the records from the rectus femoris, MASs were also successfully extracted; thus, the reflex latency could be calculated. DISCUSSION Wire electrodes can be used as an intramuscular mechanosensor to determine the mechanical stimulus arrival time to the muscle belly.
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Affiliation(s)
- Betilay Topkara
- Faculty of Dentistry, Physiology Dept., Istanbul Gelişim University, Istanbul, Turkey
| | - Tugba Aydin
- Istanbul Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Corum
- Istanbul Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Ayse Karaoglu
- Faculty of Engineering and Architecture, Electrical Electronics Engineer Dept., Istanbul Gelişim University, Istanbul, Turkey
| | - Dilara Ekici Zincirci
- Istanbul Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Derya S Bugdayci
- Istanbul Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Kadriye Ones
- Istanbul Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Nurdan Paker
- Istanbul Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Nur Kesiktas
- Istanbul Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Ilhan Karacan
- Istanbul Physical Therapy Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Kemal S Türker
- Faculty of Dentistry, Physiology Dept., Istanbul Gelişim University, Istanbul, Turkey
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Schmidt D, Carpes FP, Milani TL, Germano AMC. Different visual manipulations have similar effects on quasi-static and dynamic balance responses of young and older people. PeerJ 2021; 9:e11221. [PMID: 34026347 PMCID: PMC8121054 DOI: 10.7717/peerj.11221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background Studies demonstrated that the older adults can be more susceptible to balance instability after acute visual manipulation. There are different manipulation approaches used to investigate the importance of visual inputs on balance, e.g., eyes closed and blackout glasses. However, there is evidence that eyes open versus eyes closed results in a different organization of human brain functional networks. It is, however, unclear how different visual manipulations affect balance, and whether such effects differ between young and elderly persons. Therefore, this study aimed to determine whether different visual manipulation approaches affect quasi-static and dynamic balance responses differently, and to investigate whether balance responses of young and older adults are affected differently by these various visual conditions. Methods Thirty-six healthy participants (20 young and 16 older adults) performed balance tests (quasi-static and unexpected perturbations) under four visual conditions: Eyes Open, Eyes Closed, Blackout Glasses, and Dark Room. Center of pressure (CoP) and muscle activation (EMG) were quantified. Results As expected, visual deprivation resulted in larger CoP excursions and higher muscle activations during balance tests for all participants. Surprisingly, the visual manipulation approach did not influence balance control in either group. Furthermore, quasi-static and dynamic balance control did not differ between young or older adults. The visual system plays an important role in balance control, however, similarly for both young and older adults. Different visual deprivation approaches did not influence balance results, meaning our results are comparable between participants of different ages. Further studies should investigate whether a critical illumination level may elicit different postural responses between young and older adults.
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Affiliation(s)
- Daniel Schmidt
- Department of Human Locomotion, Institute of Human Movement Science & Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Felipe P Carpes
- Applied Neuromechanics Research Group, Federal University of Pampa, Uruguaiana, Brazil
| | - Thomas L Milani
- Department of Human Locomotion, Institute of Human Movement Science & Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Andresa M C Germano
- Department of Human Locomotion, Institute of Human Movement Science & Health, Chemnitz University of Technology, Chemnitz, Germany
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Heß T, Milani TL, Meixensberger J, Krause M. Postural performance and plantar cutaneous vibration perception in patients with idiopathic normal pressure hydrocephalus. Heliyon 2021; 7:e05811. [PMID: 33458441 PMCID: PMC7797513 DOI: 10.1016/j.heliyon.2020.e05811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/22/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate whether impaired plantar cutaneous vibration perception contributes to postural disturbance in idiopathic normal pressure hydrocephalus (iNPH). Methods Three different groups were tested: iNPH-patients (iNPH), iNPH-patients after surgical shunt therapy (iNPH shunt), and healthy subjects (HS). Postural performance was quantified during quiescent stance on a pressure distribution platform. Vibration perception threshold (VPT) was measured using a modified vibration exciter to apply stimuli to the plantar foot. Results Regarding postural performance, iNPH showed significantly higher values for all investigated center of pressure (COP)-parameters compared to HS, which suggests impaired postural control. Shunted patients presented a tendency towards better postural control in contrast to non-shunted patients. VPTs did not differ significantly between all investigated groups, which suggests comparable plantar cutaneous vibration perception. Conclusion Patients with iNPH suffer from poor postural stability, whereas shunting tends to affect postural performance positively. Plantar cutaneous vibration perception seems to be comparable between all investigated study groups. Consequently, postural disturbance in iNPH cannot clearly be ascribed to defective plantar cutaneous input.
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Affiliation(s)
- Tobias Heß
- Chemnitz University of Technology, Department of Human Locomotion, Chemnitz, Germany
| | - Thomas L Milani
- Chemnitz University of Technology, Department of Human Locomotion, Chemnitz, Germany
| | | | - Matthias Krause
- University Hospital, Department of Neurosurgery, Leipzig, Germany
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Müller K, Fröhlich S, Germano AMC, Kondragunta J, Agoitia Hurtado MFDC, Rudisch J, Schmidt D, Hirtz G, Stollmann P, Voelcker-Rehage C. Sensor-based systems for early detection of dementia (SENDA): a study protocol for a prospective cohort sequential study. BMC Neurol 2020; 20:84. [PMID: 32145744 PMCID: PMC7060588 DOI: 10.1186/s12883-020-01666-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/28/2020] [Indexed: 02/06/2023] Open
Abstract
Background Dementia and cognitive decline are serious social and economic burdens. An increase in the population of older people, as well as longer lifespans mean that numbers of dementia cases are exponentially rising. Neuropathological changes associated with dementia are thought to appear before the clinical manifestation of cognitive symptoms, i.e., memory impairments. Further, some older adults (OA) experience cognitive decline before it can be objectively diagnosed. For optimal care of these patients, it is necessary to detect cognitive decline and dementia at an early stage. In this vein, motor, sensory, and neurophysiological declines could be promising factors if found to be present before the onset of cognitive impairment. Hence, the objective of the SENDA study is to develop a multi-dimensional sensor-based instrument that allows early detection of cognitive decline or dementia in OA with the help of cognitive, sensory, motor, and neurophysiological parameters before its clinical manifestation. Methods/design In the cohort sequential study, participants are assigned to one of three study groups depending on their cognitive status: 1. cognitively healthy individuals (CHI), 2. subjectively cognitively impaired persons (SCI), or 3. (possible) mildly cognitively impaired persons (pMCI, MCI). All groups take part in the same cognitive (e.g., executive function tests), motor (e.g., gait analyses, balance tests), sensory (e.g., vibration perception threshold test, proprioception tests), and neurophysiological (e.g., electroencephalograms) measurements. Depending on the time at which participants are included into the study, all measurements are repeated up to four times in intervals of 8 months within 3 years to identify associations with cognitive changes over time. Discussion This study aims to detect possible motor, sensory, neurophysiological, and cognitive predictors to develop an early screening tool for dementia and its pre-stages in OA. Thus, affected persons could receive optimal health care at an earlier time point to maintain their health resources. Trial status The study is ongoing. The recruitment of participants will be continued until May 2020.
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Affiliation(s)
- Katrin Müller
- Department of Sports Psychology (with focus on prevention and rehabilitation), Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Thüringer Weg 11, 09126, Chemnitz, Germany.
| | - Stephanie Fröhlich
- Department of Sports Psychology (with focus on prevention and rehabilitation), Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Thüringer Weg 11, 09126, Chemnitz, Germany
| | - Andresa M C Germano
- Department of Human Locomotion, Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany
| | - Jyothsna Kondragunta
- Department of Digital Signal Processing and Circuit Technology, Faculty of Electrical Engineering and Information Technology, Chemnitz University of Technology, Chemnitz, Germany
| | | | - Julian Rudisch
- Department of Sports Psychology (with focus on prevention and rehabilitation), Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Thüringer Weg 11, 09126, Chemnitz, Germany.,Department of Neuromotor Behavior and Exercise, University of Münster, Münster, Germany
| | - Daniel Schmidt
- Department of Human Locomotion, Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany
| | - Gangolf Hirtz
- Department of Digital Signal Processing and Circuit Technology, Faculty of Electrical Engineering and Information Technology, Chemnitz University of Technology, Chemnitz, Germany
| | - Peter Stollmann
- Department of Analysis, Faculty of Mathematics, Chemnitz University of Technology, Chemnitz, Germany
| | - Claudia Voelcker-Rehage
- Department of Sports Psychology (with focus on prevention and rehabilitation), Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Thüringer Weg 11, 09126, Chemnitz, Germany.,Department of Neuromotor Behavior and Exercise, University of Münster, Münster, Germany
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Germano AMC, Schmidt D, Milani TL. Effects of hypothermically reduced plantar skin inputs on anticipatory and compensatory balance responses. BMC Neurosci 2016; 17:41. [PMID: 27357844 PMCID: PMC4928340 DOI: 10.1186/s12868-016-0279-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/21/2016] [Indexed: 12/28/2022] Open
Abstract
Background Anticipatory and compensatory balance responses are used by the central nervous system (CNS) to preserve balance, hence they significantly contribute to the understanding of physiological mechanisms of postural control. It is well established that various sensory systems contribute to the regulation of balance. However, it is still unclear which role each individual sensory system (e.g. plantar mechanoreceptors) plays in balance regulation. This becomes also evident in various patient populations, for instance in diabetics with reduced plantar sensitivity. To investigate these sensory mechanisms, approaches like hypothermia to deliberately reduce plantar afferent input have been applied. But there are some limitations regarding hypothermic procedures in previous studies: Not only plantar aspects of the feet might be affected and maintaining the hypothermic effect during data collection. Therefore, the aim of the present study was to induce a permanent and controlled plantar hypothermia and to examine its effects on anticipatory and compensatory balance responses. We hypothesized deteriorations in anticipatory and compensatory balance responses as increased center of pressure excursions (COP) and electromyographic activity (EMG) in response to the hypothermic plantar procedure. 52 healthy and young subjects (23.6 ± 3.0 years) performed balance tests (unexpected perturbations). Subjects’ foot soles were exposed to three temperatures while standing upright: 25, 12 and 0 °C. COP and EMG were analyzed during two intervals of anticipatory and one interval of compensatory balance responses (intervals 0, 1 and 2, respectively). Results Similar plantar temperatures confirmed the successful implementation of the thermal platform. No significant COP and EMG differences were found for the anticipatory responses (intervals 0 and 1) under the hyperthermia procedure. Parameters in interval 2 showed generally decreased values in response to cooling. Conclusion No changes in anticipatory responses were found possibly due to sensory compensation processes of other intact afferents. Decreased compensatory responses may be interpreted as the additional balance threat, creating a more cautious behavior causing the CNS to generate a kind of over-compensatory behavior. Contrary to the expectations, there were different anticipatory and compensatory responses after reduced plantar inputs, thereby, revealing alterations in the organization of CNS inputs and outputs according to different task difficulties.
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Affiliation(s)
- Andresa M C Germano
- Department of Human Locomotion, Institute of Human Movement Science and Health, Chemnitz University of Technology, Reichenhainer Straße 29a, 09126, Chemnitz, Germany.
| | - Daniel Schmidt
- Department of Human Locomotion, Institute of Human Movement Science and Health, Chemnitz University of Technology, Reichenhainer Straße 29a, 09126, Chemnitz, Germany
| | - Thomas L Milani
- Department of Human Locomotion, Institute of Human Movement Science and Health, Chemnitz University of Technology, Reichenhainer Straße 29a, 09126, Chemnitz, Germany
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