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Araújo-Silva F, Santinelli FB, Felipe I Imaizumi L, Silveira APB, Vieira LHP, Alcock L, Barbieri FA. Temporal dynamics of cortical activity and postural control in response to the first levodopa dose of the day in people with Parkinson's disease. Brain Res 2021; 1775:147727. [PMID: 34788638 DOI: 10.1016/j.brainres.2021.147727] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Our understanding of how balance control responds to levodopa over the course of a single day in people with Parkinson's disease (PD) is limited with the majority of studies focused on isolated comparisons of ON vs. OFF levodopa medication. OBJECTIVE To evaluate the temporal dynamics of postural control following the first levodopa dose of the day during a challenging standing task in a group of people with PD. METHODS Changes in postural control were evaluated by monitoring cortical activity (covering frontal, motor, parietal and occipital areas), body sway parameters (force platform), and lower limb muscle activity (tibialis anterior and gastrocnemius medialis) in 15 individuals with PD during a semi-tandem standing task. Participants were assessed during two 60 second trials every 30 minutes (ON-30 ON-60 etc.) for 3 hours after the first matinal dose (ON-180). RESULTS Compared to when tested OFF-medication, cortical activity was increased across all four regions from ON-60 to ON-120 with early increases in alpha and beta band activity observed at ON-30. Levodopa was associated with increased gastrocnemius medialis activity (ON-30 to ON-120) and ankle co-contraction (ON-60 to ON-120). Changes in body sway outcomes (particularly in the anterior-posterior direction) were evident from ON-60 to ON-120. CONCLUSIONS Our results reveal a 60-minute window within which postural control outcomes may be obtained that are different compared to OFF-state and remain stable (from 60-minutes to 120-minutes after levodopa intake). Identifying a window of opportunity for measurement when individuals are optimally medicated is important for observations in a clinical and research setting.
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Affiliation(s)
- Fabiana Araújo-Silva
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Felipe B Santinelli
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Luis Felipe I Imaizumi
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Aline P B Silveira
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Luiz H P Vieira
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne, UK
| | - Fabio A Barbieri
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil.
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2
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Ávila de Oliveira J, Bazán PR, de Oliveira CEN, Treza RDC, Hondo SM, Los Angeles E, Bernardo C, de Oliveira LDS, Carvalho MDJ, de Lima-Pardini AC, Coelho DB. The effects of levodopa in the spatiotemporal gait parameters are mediated by self-selected gait speed in Parkinson's disease. Eur J Neurosci 2021; 54:8020-8028. [PMID: 34755397 DOI: 10.1111/ejn.15522] [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: 07/26/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/27/2022]
Abstract
In individuals with Parkinson's disease (PD), the medication induces different and inconsistent results in the spatiotemporal parameters of gait, making it difficult to understand its effects on gait. As spatiotemporal gait parameters have been reported to be affected by gait speed, it is essential to consider the gait speed when studying walking biomechanics to interpret the results better when comparing the gait pattern of different conditions. Since the medication alters the self-selected gait speed of individuals with PD, this study analysed whether the change in gait speed can explain the selective effects of l-DOPA on the spatiotemporal parameters of gait in individuals with PD. We analysed the spatiotemporal gait parameters at the self-selected speed of 22 individuals with PD under ON and OFF states of l-DOPA medication. Bayesian mediation analysis evaluated which gait variables were affected by the medication state and checked if those effects were mediated by speed changes induced by medication. The gait speed was significantly higher among ON compared with OFF medication. All the spatiotemporal parameters of the gait were mediated by speed, with proportions of mediation close to 1 (effect entirely explained by speed changes). Our results show that a change in gait speed better explains the changes in the spatiotemporal gait parameters than the ON-OFF phenomenon. As an implication for rehabilitation, our results suggest that it is possible to assess the effect of l-DOPA on improving motor symptoms related to gait disorders by measuring gait speed.
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Affiliation(s)
- Júlia Ávila de Oliveira
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | | | - Renata de Castro Treza
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Sandy Mikie Hondo
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Emanuele Los Angeles
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Claudionor Bernardo
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, Brazil
| | | | | | - Andrea C de Lima-Pardini
- Laboratory of Integrative Motor Behaviour, Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Daniel Boari Coelho
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.,Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil.,Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, Brazil
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3
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Wang J, Gong D, Luo H, Zhang W, Zhang L, Zhang H, Zhou J, Wang S. Measurement of Step Angle for Quantifying the Gait Impairment of Parkinson's Disease by Wearable Sensors: Controlled Study. JMIR Mhealth Uhealth 2020; 8:e16650. [PMID: 32196458 PMCID: PMC7125438 DOI: 10.2196/16650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/29/2019] [Accepted: 02/07/2020] [Indexed: 12/20/2022] Open
Abstract
Background Gait impairments including shuffling gait and hesitation are common in people with Parkinson’s disease (PD), and have been linked to increased fall risk and freezing of gait. Nowadays the gait metrics mostly focus on the spatiotemporal characteristics of gait, but less is known of the angular characteristics of the gait, which may provide helpful information pertaining to the functional status and effects of the treatment in PD. Objective This study aimed to quantify the angles of steps during walking, and explore if this novel step angle metric is associated with the severity of PD and the effects of the treatment including the acute levodopa challenge test (ALCT) and deep brain stimulation (DBS). Methods A total of 18 participants with PD completed the walking test before and after the ALCT, and 25 participants with PD completed the test with the DBS on and off. The walking test was implemented under two conditions: walking normally at a preferred speed (single task) and walking while performing a cognitive serial subtraction task (dual task). A total of 17 age-matched participants without PD also completed this walking test. The angular velocity was measured using wearable sensors on each ankle, and three gait angular metrics were obtained, that is mean step angle, initial step angle, and last step angle. The conventional gait metrics (ie, step time and step number) were also calculated. Results The results showed that compared to the control, the following three step angle metrics were significantly smaller in those with PD: mean step angle (F1,48=69.75, P<.001, partial eta-square=0.59), initial step angle (F1,48=15.56, P<.001, partial eta-square=0.25), and last step angle (F1,48=61.99, P<.001, partial eta-square=0.56). Within the PD cohort, both the ALCT and DBS induced greater mean step angles (ACLT: F1,38=5.77, P=.02, partial eta-square=0.13; DBS: F1,52=8.53, P=.005, partial eta-square=0.14) and last step angles (ACLT: F1,38=10, P=.003, partial eta-square=0.21; DBS: F1,52=4.96, P=.003, partial eta-square=0.09), but no significant changes were observed in step time and number after the treatments. Additionally, these step angles were correlated with the Unified Parkinson's Disease Rating Scale, Part III score: mean step angle (single task: r=–0.60, P<.001; dual task: r=–0.52, P<.001), initial step angle (single task: r=–0.35, P=.006; dual task: r=–0.35, P=.01), and last step angle (single task: r=–0.43, P=.001; dual task: r=–0.41, P=.002). Conclusions This pilot study demonstrated that the gait angular characteristics, as quantified by the step angles, were sensitive to the disease severity of PD and, more importantly, can capture the effects of treatments on the gait, while the traditional metrics cannot. This indicates that these metrics may serve as novel markers to help the assessment of gait in those with PD as well as the rehabilitation of this vulnerable cohort.
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Affiliation(s)
- Jingying Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
| | - Dawei Gong
- Department of Neurosurgery, The Second Hospital of Nanjing, Nanjing, China
| | - Huichun Luo
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Wenbin Zhang
- Department of Neurosurgery, Nanjing Brain Hospital, Nanjing, China
| | - Lei Zhang
- Department of Computer Science, Virginia Tech, Falls Church, VA, United States
| | - Han Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Roslindale, MA, United States
| | - Shouyan Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.,Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
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Gilmore G, Gouelle A, Adamson MB, Pieterman M, Jog M. Forward and backward walking in Parkinson disease: A factor analysis. Gait Posture 2019; 74:14-19. [PMID: 31437733 DOI: 10.1016/j.gaitpost.2019.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/09/2019] [Accepted: 08/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Forward and backward walking are both impaired in Parkinson disease (PD). In this study, an exploratory factor analysis was performed to investigate the relationship between forward and backward walking in PD. RESEARCH QUESTION Given the difference in levodopa response between forward and backward walking, what is the additive value of testing backwards walking in a clinical setting. METHODS Sixty-two patients with PD (65.29 ± 7.17 yrs, UPDRS OFF = 29.68 ± 9.88, UPDRS ON = 16.40 ± 8.21) and eleven healthy age-matched controls (63.09 ± 8.09 yrs) were recruited. PD participants completed forward (F) and backward (B) walking tasks on a 6.1 m instrumented walkway (OFF and ON levodopa). Factor analysis was used to derive models for both walking tasks/medication states. RESULTS In both OFF and ON, four factors were identified: Variability (OFF: F = 30.0%, B = 17.8%, ON: F = 21.6%, B = 25.0%), Rhythm (OFF: F = 14.5%, B = 17.0%, ON: F = 17.4%, B = 19.0%), Asymmetry (OFF: F = 13.7%, B = 14.3%, ON: F = 16.1%, B = 15.2%), and Pace (OFF: F = 12.2%, B = 17.0%, ON: F = 13.9%, B = 8.7%). In the ON state, a fifth factor was identified: Posture (ON: F = 3.8%, B = 7.7%). SIGNIFICANCE This study demonstrates the similarity in gait domain factors in both forward and backward walking. While domains of gait are similar in both walking tasks, levodopa response is reduced in backward walking. This could be a result of the increased complexity of backward walking. This study provides a normative dataset that can be used when assessing forward and backward walking in individuals with PD.
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Affiliation(s)
- Greydon Gilmore
- School of Biomedical Engineering, Western University, London, Canada; Department of Clinical Neurological Sciences, University Hospital, London, Canada.
| | - Arnaud Gouelle
- Gait and Balance Academy, ProtoKinetics, Havertown, PA, United States; Laboratory Performance, Sante, Metrologie, Societe (PSMS), UFR STAPS, Reims, France
| | - Mitchell B Adamson
- Department of Clinical Neurological Sciences, University Hospital, London, Canada
| | - Marcus Pieterman
- Department of Clinical Neurological Sciences, University Hospital, London, Canada
| | - Mandar Jog
- School of Biomedical Engineering, Western University, London, Canada; Department of Clinical Neurological Sciences, University Hospital, London, Canada
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5
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Di Giovanni G, Chagraoui A, Puginier E, Galati S, De Deurwaerdère P. Reciprocal interaction between monoaminergic systems and the pedunculopontine nucleus: Implication in the mechanism of L-DOPA. Neurobiol Dis 2018; 128:9-18. [PMID: 30149181 DOI: 10.1016/j.nbd.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/19/2018] [Accepted: 08/23/2018] [Indexed: 01/31/2023] Open
Abstract
The pedunculopontine nucleus (PPN) is part of the mesencephalic locomotor region (MLR) and has been involved in the control of gait, posture, locomotion, sleep, and arousal. It likely participates in some motor and non-motor symptoms of Parkinson's disease and is regularly proposed as a surgical target to ameliorate gait, posture and sleep disorders in Parkinsonian patients. The PPN overlaps with the monoaminergic systems including dopamine, serotonin and noradrenaline in the modulation of the above-mentioned functions. All these systems are involved in Parkinson's disease and the mechanism of the anti-Parkinsonian agents, mostly L-DOPA. This suggests that PPN interacts with monoaminergic neurons and vice versa. Some evidence indicates that the PPN sends cholinergic, glutamatergic and even gabaergic inputs to mesencephalic dopaminergic cells, with the data regarding serotonergic or noradrenergic cells being less well known. Similarly, the control exerted by the PPN on dopaminergic neurons, is multiple and complex, and more extensively explored than the other monoaminergic systems. The data on the influence of monoaminergic systems on PPN neuron activity are rather scarce. While there is evidence that the PPN influences the therapeutic response of L-DOPA, it is still difficult to discerne the reciprocal action of the PPN and monoaminergic systems in this action. Additional data are required to better understand the functional organization of monoaminergic inputs to the MLR including the PPN to get a clearer picture of their interaction.
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Affiliation(s)
- Giuseppe Di Giovanni
- Department of Physiology & Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta; Neuroscience Division, School of Biosciences, Cardiff University, Cardiff, UK.
| | - Abdeslam Chagraoui
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France; Department of Medical Biochemistry, Rouen University Hospital, Rouen, France
| | - Emilie Puginier
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France; Department of Medical Biochemistry, Rouen University Hospital, Rouen, France
| | - Salvatore Galati
- Parkinson and movement Disorders Center Neurocenter of Southern Switzerland, Ospedale Civico di Lugano, Lugano, Switzerland
| | - Philippe De Deurwaerdère
- Centre National de la Recherche Scientifique (Unité Mixte de Recherche 5287), 146 rue Léo Saignat, B.P.281, F-33000 Bordeaux Cedex, France.
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6
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Ryczko D, Dubuc R. Dopamine and the Brainstem Locomotor Networks: From Lamprey to Human. Front Neurosci 2017; 11:295. [PMID: 28603482 PMCID: PMC5445171 DOI: 10.3389/fnins.2017.00295] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/11/2017] [Indexed: 11/13/2022] Open
Abstract
In vertebrates, dopamine neurons are classically known to modulate locomotion via their ascending projections to the basal ganglia that project to brainstem locomotor networks. An increased dopaminergic tone is associated with increase in locomotor activity. In pathological conditions where dopamine cells are lost, such as in Parkinson's disease, locomotor deficits are traditionally associated with the reduced ascending dopaminergic input to the basal ganglia. However, a descending dopaminergic pathway originating from the substantia nigra pars compacta was recently discovered. It innervates the mesencephalic locomotor region (MLR) from basal vertebrates to mammals. This pathway was shown to increase locomotor output in lampreys, and could very well play an important role in mammals. Here, we provide a detailed account on the newly found dopaminergic pathway in lamprey, salamander, rat, monkey, and human. In lampreys and salamanders, dopamine release in the MLR is associated with the activation of reticulospinal neurons that carry the locomotor command to the spinal cord. Dopamine release in the MLR potentiates locomotor movements through a D1-receptor mechanism in lampreys. In rats, stimulation of the substantia nigra pars compacta elicited dopamine release in the pedunculopontine nucleus, a known part of the MLR. In a monkey model of Parkinson's disease, a reduced dopaminergic innervation of the brainstem locomotor networks was reported. Dopaminergic fibers are also present in human pedunculopontine nucleus. We discuss the conserved locomotor role of this pathway from lamprey to mammals, and the hypothesis that this pathway could play a role in the locomotor deficits reported in Parkinson's disease.
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Affiliation(s)
- Dimitri Ryczko
- Groupe de Recherche sur le Système Nerveux Central, Département de Neurosciences, Université de MontréalMontréal, QC, Canada
| | - Réjean Dubuc
- Groupe de Recherche sur le Système Nerveux Central, Département de Neurosciences, Université de MontréalMontréal, QC, Canada.,Groupe de Recherche en Activité Physique Adaptée, Département des Sciences de l'Activité Physique, Université du Québec à MontréalMontréal, QC, Canada
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7
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Pistacchi M, Gioulis M, Sanson F, De Giovannini E, Filippi G, Rossetto F, Zambito Marsala S. Gait analysis and clinical correlations in early Parkinson's disease. FUNCTIONAL NEUROLOGY 2017; 32:28-34. [PMID: 28380321 DOI: 10.11138/fneur/2017.32.1.028] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of our study was to identify and quantify spatiotemporal and kinematic gait parameters obtained by 3D gait analysis (GA) in a group of Parkinson's disease (PD) patients compared with healthy subjects in order to investigate whether early PD patients could present an abnormal gait pattern. Forty-four patients affected by early-stage PD compared with a control group were analyzed. All participants were evaluated with 3D GA in the gait laboratory. The greatest significance in temporal parameters was found in cadence (102.46 ± 13.17 steps/min in parkinsonian patients vs 113.84 ± 4.30 steps/min in control subjects), followed by stride duration (1.19 ± 0.18 seconds right limb and 1.19 ± 0.19 seconds left limb in PD patients vs 0.426 ± 0.16 seconds right limb and 0.429 ± 0.23 seconds left limb in normal subjects) and stance duration. Marked differences were also found in the swing phase and in swing duration (p<0.05), while the stance phase was not significantly different in patients compared with healthy subjects. A statistically different velocity in PD patients (0.082 ± 0.29 m/s) vs healthy subjects (1.33 ± 0.06 m/s) was shown by spatial parameter analysis. Step width, stride length and swing velocity were highly significant parameters, as was average velocity. Our study highlighted some distinguishing characteristics of gait in early PD. Ambulation disorders may be present in the early stage of PD and their detection allows for early medical treatment and possible rehabilitation.
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8
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Defining the clinically meaningful difference in gait speed in persons with Parkinson disease. J Neurol Phys Ther 2015; 38:233-8. [PMID: 25198866 DOI: 10.1097/npt.0000000000000055] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Gait dysfunction is a common target for pharmacological, behavioral, and surgical interventions in persons with Parkinson disease. However, the responsiveness of gait speed, that is, clinically important difference, is not well described in the literature for this population. The purpose of this study was to determine the magnitude of meaningful difference in gait speed using multiple methods of assessment and utilizing a large sample of participants inclusive of various stages of disease severity. METHODS Gait speed was measured using an instrumented walkway in 324 ambulatory persons with idiopathic Parkinson disease. Cross-sectional analysis of the clinically important difference for gait speed was performed using distribution- and anchor-based approaches: disability (Schwab and England Activities of Daily Living Scale), disease stage (Modified Hoehn and Yahr Scale), and severity (Unified Parkinson's Disease Rating Scale). RESULTS Using distribution-based analyses and effect size metrics, the small important difference in gait speed was 0.06 m/s, moderate was 0.14 m/s, and large was 0.22 m/s. Applying previously established cut-points for small, moderate, and large change in the motor scale score, the associated changes in gait speed that might be expected are 0.02, 0.06, and 0.10 m/s. DISCUSSION AND CONCLUSIONS Our data revealed that the clinically important difference in gait speed among persons with Parkinson disease on medication ranged from 0.05 m/s to 0.22 m/s by distribution-based analysis and ranged from 0.02 m/s to 0.18 m/s per level within the anchor-based metrics. These data will aid in evaluating the effectiveness of interventions to improve gait speed in persons with Parkinson disease.Video Abstract available. See video (Supplemental Digital Content 1, http://links.lww.com/JNPT/A77) for more insights from the authors.
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Hobert MA, Maetzler W, Aminian K, Chiari L. Technical and clinical view on ambulatory assessment in Parkinson's disease. Acta Neurol Scand 2014; 130:139-47. [PMID: 24689772 DOI: 10.1111/ane.12248] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 11/29/2022]
Abstract
With the progress of technologies of recent years, methods have become available that use wearable sensors and ambulatory systems to measure aspects of--particular axial--motor function. As Parkinson's disease (PD) can be considered a model disorder for motor impairment, a significant number of studies have already been performed with these patients using such techniques. In general, motion sensors such as accelerometers and gyroscopes are used, in combination with lightweight electronics that do not interfere with normal human motion. A fundamental advantage in comparison with usual clinical assessment is that these sensors allow a more quantitative, objective, and reliable evaluation of symptoms; they have also significant advantages compared to in-lab technologies (e.g., optoelectronic motion capture) as they allow long-term monitoring under real-life conditions. In addition, based on recent findings particularly from studies using functional imaging, we learned that non-motor symptoms, specifically cognitive aspects, may be at least indirectly assessable. It is hypothesized that ambulatory quantitative assessment strategies will allow users, clinicians, and scientists in the future to gain more quantitative, unobtrusive, and everyday relevant data out of their clinical evaluation and can also be designed as pervasive (everywhere) and intensive (anytime) tools for ambulatory assessment and even rehabilitation of motor and (partly) non-motor symptoms in PD.
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Affiliation(s)
- M. A. Hobert
- Center for Neurology and Hertie Institute for Clinical Brain Research; Department of Neurodegenerative Diseases; University of Tübingen; Tübingen Germany
- DZNE; German Center for Neurodegenerative Diseases; Tübingen Germany
| | - W. Maetzler
- Center for Neurology and Hertie Institute for Clinical Brain Research; Department of Neurodegenerative Diseases; University of Tübingen; Tübingen Germany
- DZNE; German Center for Neurodegenerative Diseases; Tübingen Germany
| | - K. Aminian
- Ecole Polytechnique Fédérale de Lausanne; Laboratory of Movement Analysis and Measurement; Lausanne Switzerland
| | - L. Chiari
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”; University of Bologna; Bologna Italy
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10
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Djurić-Jovicić MD, Jovicić NS, Radovanović SM, Stanković ID, Popović MB, Kostić VS. Automatic Identification and Classification of Freezing of Gait Episodes in Parkinson's Disease Patients. IEEE Trans Neural Syst Rehabil Eng 2014; 22:685-94. [PMID: 24235277 DOI: 10.1109/tnsre.2013.2287241] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Khoo HM, Kishima H, Hosomi K, Maruo T, Tani N, Oshino S, Shimokawa T, Yokoe M, Mochizuki H, Saitoh Y, Yoshimine T. Low-frequency subthalamic nucleus stimulation in Parkinson's disease: A randomized clinical trial. Mov Disord 2014; 29:270-4. [DOI: 10.1002/mds.25810] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 12/18/2013] [Accepted: 12/18/2013] [Indexed: 11/08/2022] Open
Affiliation(s)
- Hui Ming Khoo
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Osaka Japan
| | - Haruhiko Kishima
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Osaka Japan
| | - Koichi Hosomi
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Osaka Japan
- Department of Neuromodulation and Neurosurgery; Osaka University Office for University-Industry Collaboration; Osaka Japan
| | - Tomoyuki Maruo
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Osaka Japan
- Department of Neuromodulation and Neurosurgery; Osaka University Office for University-Industry Collaboration; Osaka Japan
| | - Naoki Tani
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Osaka Japan
- Department of Neurosurgery; Otemae Hospital; Osaka Japan
| | - Satoru Oshino
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Osaka Japan
| | - Toshio Shimokawa
- Department of Ecosocial System Engineering; Graduate School of Medicine and Engineering; University of Yamanashi; Yamanashi Japan
| | - Masaru Yokoe
- Department of Neurology; Osaka University Graduate School of Medicine; Osaka Japan
- Department of Neuromodulation and Neurosurgery; Osaka University Office for University-Industry Collaboration; Osaka Japan
| | - Hideki Mochizuki
- Department of Neurology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Youichi Saitoh
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Osaka Japan
- Department of Neuromodulation and Neurosurgery; Osaka University Office for University-Industry Collaboration; Osaka Japan
| | - Toshiki Yoshimine
- Department of Neurosurgery; Osaka University Graduate School of Medicine; Osaka Japan
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12
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Maetzler W, Domingos J, Srulijes K, Ferreira JJ, Bloem BR. Quantitative wearable sensors for objective assessment of Parkinson's disease. Mov Disord 2013; 28:1628-37. [PMID: 24030855 DOI: 10.1002/mds.25628] [Citation(s) in RCA: 207] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 05/26/2013] [Accepted: 07/01/2013] [Indexed: 12/20/2022] Open
Abstract
There is a rapidly growing interest in the quantitative assessment of Parkinson's disease (PD)-associated signs and disability using wearable technology. Both persons with PD and their clinicians see advantages in such developments. Specifically, quantitative assessments using wearable technology may allow for continuous, unobtrusive, objective, and ecologically valid data collection. Also, this approach may improve patient-doctor interaction, influence therapeutic decisions, and ultimately ameliorate patients' global health status. In addition, such measures have the potential to be used as outcome parameters in clinical trials, allowing for frequent assessments; eg, in the home setting. This review discusses promising wearable technology, addresses which parameters should be prioritized in such assessment strategies, and reports about studies that have already investigated daily life issues in PD using this new technology.
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Affiliation(s)
- Walter Maetzler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tuebingen, Germany
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Terayama K, Sakakibara R, Ogawa A, Haruta H, Akiba T, Nagao T, Takahashi O, Sugiyama M, Tateno A, Tateno F, Yano M, Kishi M, Tsuyusaki Y, Uchiyama T, Yamamoto T. Weak detrusor contractility correlates with motor disorders in Parkinson's disease. Mov Disord 2012; 27:1775-80. [DOI: 10.1002/mds.25225] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 08/12/2012] [Accepted: 08/20/2012] [Indexed: 12/14/2022] Open
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Amboni M, Barone P, Iuppariello L, Lista I, Tranfaglia R, Fasano A, Picillo M, Vitale C, Santangelo G, Agosti V, Iavarone A, Sorrentino G. Gait patterns in parkinsonian patients with or without mild cognitive impairment. Mov Disord 2012; 27:1536-43. [DOI: 10.1002/mds.25165] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 07/23/2012] [Accepted: 07/27/2012] [Indexed: 11/08/2022] Open
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Bryant MS, Rintala DH, Hou JG, Lai EC, Protas EJ. Effects of levodopa on forward and backward gait patterns in persons with Parkinson's disease. NeuroRehabilitation 2012; 29:247-52. [PMID: 22142758 DOI: 10.3233/nre-2011-0700] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Backward walking is difficult for persons with Parkinson's disease (PD). It is unknown how levodopa influences backward gait patterns, especially when compared to forward gait patterns. PURPOSE Investigate the effects of levodopa on forward and backward gait patterns in individuals with PD. DESIGN A repeated measures design was used. METHODS The sample consisted of 21 individuals with PD (15 males, 6 females). Their mean age was 70.24 ± 8.69 yr. The average time since diagnosis was 11.81 ± 5.49 years. The median of the Hoehn and Yahr stage while 'ON' medication was 2.57. Gait patterns during forward and backward walking at a self-selected comfortable speed were recorded before and after taking levodopa on the same day. RESULTS Levodopa significantly increased gait speed and stride length and decreased the percent of the gait cycle (%GC) spent in double support. Gait speed and stride length were greater and the %GC spent in double support was less during forward walking compared with backward walking. Cadence was not changed by levodopa or walking direction. CONCLUSIONS Levodopa improved gait characteristics during backward walking in a manner similar to that during forward walking in persons with PD.
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Affiliation(s)
- M S Bryant
- School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA.
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Moore ST, Dilda V, Hakim B, Macdougall HG. Validation of 24-hour ambulatory gait assessment in Parkinson's disease with simultaneous video observation. Biomed Eng Online 2011; 10:82. [PMID: 21936884 PMCID: PMC3184280 DOI: 10.1186/1475-925x-10-82] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 09/21/2011] [Indexed: 11/30/2022] Open
Abstract
Background Parkinson's disease (PD) is a neurodegenerative disorder resulting in motor disturbances that can impact normal gait. Although PD initially responds well to pharmacological treatment, as the disease progresses efficacy often fluctuates over the course of the day, and clinical management would benefit from long-term objective measures of gait. We have previously described a small device worn on the shank that uses acceleration and angular velocity sensors to calculate stride length and identify freezing of gait in PD patients. In this study we extend validation of the gait monitor to 24-h using simultaneous video observation of PD patients. Methods A sleep laboratory was adapted to perform 24-hr video monitoring of patients while wearing the device. Continuous video monitoring of a sleep lab, hallway, kitchen and conference room was performed using a 4-camera security system and recorded to hard disk. Subjects (3) wore the gait monitor on the left shank (just above the ankle) for a 24-h period beginning around 5 pm in the evening. Accuracy of stride length measures were assessed at the beginning and end of the 24-h epoch. Two independent observers rated the video logs to identify when subjects were walking or lying down. Results The mean error in stride length at the start of recording was 0.05 m (SD 0) and at the conclusion of the 24 h epoch was 0.06 m (SD 0.026). There was full agreement between observer coding of the video logs and the output from the gait monitor software; that is, for every video observation of the subject walking there was a corresponding pulse in the monitor data that indicated gait. Conclusions The accuracy of ambulatory stride length measurement was maintained over the 24-h period, and there was 100% agreement between the autonomous detection of locomotion by the gait monitor and video observation.
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Affiliation(s)
- Steven T Moore
- Human Aerospace Laboratory, Department of Neurology, Mount Sinai School of Medicine, New York NY 10029, USA.
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Ondo WG, Shinawi L, Moore S. Comparison of orally dissolving carbidopa/levodopa (Parcopa) to conventional oral carbidopa/levodopa: A single-dose, double-blind, double-dummy, placebo-controlled, crossover trial. Mov Disord 2011; 25:2724-7. [PMID: 20925074 DOI: 10.1002/mds.23158] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Levodopa use in fluctuating Parkinson's disease (PD) is complicated by an inconsistent and prolonged onset to clinical improvement. An orally dissolved carbidopa/levodopa (OD C/L) preparation (Parcopa UCB Pharma) is available in the United States. This offers potential advantages to shorten the duration from ingestion to clinical improvement. Surprisingly, this has never been clinically assessed. We tested 20 patients with fluctuating PD and a Unified Parkinson's Disease Rating Scale (UPDRS) "off" motor score of ≥ 25 in a 2-day, single-dose, double-blind, double-dummy, crossover study. Patients arrived in the morning in the practically defined "off" state and were randomly assigned to receive identical doses of either oral C/L and OD placebo or OD C/L and oral C/L placebo on 1st day and the reverse combination on a 2nd day. After training, patients underwent bilateral hand tapping at baseline and every 5 minutes for 60 minutes after dose ingestion. Stride length (SL) was recorded at 5-minute intervals with an ambulatory gait monitor. Patients identified their subjective latency to "on" and noted drug preferences and adverse events. They also underwent a UPDRS motor examination at baseline and 60 minutes after dose. Twenty subjects [15 male, age 68.7 (9.7), PD duration 13.4 (6.8)] completed. There were no significant group differences in tapping speed, subjective time to "on," latency of increased SL, or overall preference. However, all trends did favor OD C/L. Adverse events were similar. This small pilot study did not show significant group differences favoring OD C/L; however, larger studies may be justified, and individual patients may benefit.
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Affiliation(s)
- William G Ondo
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
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Lim I, van Wegen E, Jones D, Rochester L, Nieuwboer A, Willems AM, Baker K, Hetherington V, Kwakkel G. Does Cueing Training Improve Physical Activity in Patients With Parkinson’s Disease? Neurorehabil Neural Repair 2010; 24:469-77. [DOI: 10.1177/1545968309356294] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Patients with Parkinson’s disease (PD) are encouraged to stay active to maintain their mobility. Ambulatory activity monitoring (AM) provides an objective way to determine type and amount of gait-related daily activities. Objective . To investigate the effects of a home cueing training program on functional walking activity in PD. Methods. In a single-blind, randomized crossover trial, PD patients allocated to early intervention received cueing training for 3 weeks, whereas the late intervention group received training in the following 3 weeks. Training was applied at home, using a prototype cueing device. AM was applied at baseline, 3, 6, and 12 weeks in the patient’s home, to record body movements. Postures and motions were classified as percentage of total time spent on ( a) static activity, further specified as % sitting and % standing, and ( b) % dynamic activity, further specified as % walking, % walking periods exceeding 5 seconds (W>" xbd="1983" xhg="1960" ybd="1440" yhg="1401"/>5s) and 10 seconds (W>10s). Random coefficient analysis was applied. Results. A total of 153 patients participated in this trial. Significant improvements were found for dynamic activity (β= 4.46; P < .01), static activity (β=-3.34; P < .01), walking (β= 4.23; P < .01), W>5s (β = 2.63; P < .05), and W>10s (β = 2.90; P < .01). All intervention effects declined significantly at 6 weeks follow-up. Conclusion. Cueing training in PD patients’ own home significantly improves the amount of walking as recorded by AM. Treatment effects reduced after the intervention period, pointing to the need for permanent cueing devices and follow-up cueing training.
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Affiliation(s)
- Inge Lim
- VU University Medical Center, Amsterdam, the Netherlands
| | | | - Diana Jones
- Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Northumbria University, Newcastle upon Tyne, United Kingdom, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | | | | | | | - Gert Kwakkel
- VU University Medical Center, Amsterdam, the Netherlands
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Kurz MJ, Hou JG. Levodopa influences the regularity of the ankle joint kinematics in individuals with Parkinson’s disease. J Comput Neurosci 2009; 28:131-6. [DOI: 10.1007/s10827-009-0192-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 07/01/2009] [Accepted: 09/30/2009] [Indexed: 11/28/2022]
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