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Fortunati M, Febbi M, Negro M, Gennaro F, D’Antona G, Crisafulli O. Lower-Limb Exoskeletons for Gait Training in Parkinson's Disease: The State of the Art and Future Perspectives. Healthcare (Basel) 2024; 12:1636. [PMID: 39201194 PMCID: PMC11353983 DOI: 10.3390/healthcare12161636] [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: 07/08/2024] [Revised: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
Gait dysfunction (GD) is a common impairment of Parkinson's disease (PD), which negatively impacts patients' quality of life. Among the most recent rehabilitation technologies, a lower-limb powered exoskeleton (LLEXO) arises as a useful instrument for gait training in several neurological conditions, including PD. However, some questions relating to methods of use, achievable results, and usefulness compared to traditional rehabilitation methodologies still require clear answers. Therefore, in this review, we aim to summarise and analyse all the studies that have applied an LLEXO to train gait in PD patients. Literature research on PubMed and Scopus retrieved five articles, comprising 46 PD participants stable on medications (age: 71.7 ± 3.7 years, 24 males, Hoehn and Yahr: 2.1 ± 0.6). Compared to traditional rehabilitation, low-profile lower-limb exoskeleton (lp-LLEXO) training brought major improvements towards walking capacity and gait speed, while there are no clear major benefits regarding the dual-task gait cost index and freezing of gait symptoms. Importantly, the results suggest that lp-LLEXO training is more beneficial for patients with an intermediate-to-severe level of disease severity (Hoehn and Yahr > 2.5). This review could provide a novel framework for implementing LLEXO in clinical practise, highlighting its benefits and limitations towards gait training.
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Affiliation(s)
- Matteo Fortunati
- Department of Industrial Engineering, University of Tor Vergata, 00133 Rome, Italy
- CRIAMS-Sport Medicine Centre Voghera, University of Pavia, 27058 Voghera, Italy
| | - Massimiliano Febbi
- Department of Industrial Engineering, University of Tor Vergata, 00133 Rome, Italy
- Laboratory for Rehabilitation, Medicine and Sport (LARM), 00133 Rome, Italy
| | - Massimo Negro
- CRIAMS-Sport Medicine Centre Voghera, University of Pavia, 27058 Voghera, Italy
| | - Federico Gennaro
- Department of Biomedical Sciences, University of Padua, 35131 Padua, Italy
| | - Giuseppe D’Antona
- CRIAMS-Sport Medicine Centre Voghera, University of Pavia, 27058 Voghera, Italy
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Oscar Crisafulli
- CRIAMS-Sport Medicine Centre Voghera, University of Pavia, 27058 Voghera, Italy
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Timed up & go quantification algorithm using IMU and sEMG signal. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sundström N, Rydja J, Virhammar J, Kollén L, Lundin F, Tullberg M. The timed up and go test in idiopathic normal pressure hydrocephalus: a Nationwide Study of 1300 patients. Fluids Barriers CNS 2022; 19:4. [PMID: 35012586 PMCID: PMC8750754 DOI: 10.1186/s12987-021-00298-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to describe the outcome measure timed up and go (TUG) in a large, nationwide cohort of patients with idiopathic normal pressure hydrocephalus (iNPH) pre- and post-operatively. Furthermore, to compare the TUG test to the 10-m walk test (10MWT), the iNPH scale, the modified Rankin scale (mRS) and the Mini Mental State Examination (MMSE), which are commonly applied in clinical assessment of iNPH. METHODS Patients with iNPH (n = 1300), registered in the Swedish Hydrocephalus Quality Registry (SHQR), were included. All data were retrieved from the SHQR except the 10MWT, which was collected from patient medical records. Clinical scales were examined pre- and 3 months post-operatively. Data were dichotomised by sex, age, and preoperative TUG time. RESULTS Preoperative TUG values were 19.0 [14.0-26.0] s (median [IQR]) and 23 [18-30] steps. Post-operatively, significant improvements to 14.0 [11.0-20.0] s and 19 [15-25] steps were seen. TUG time and steps were higher in women compared to men (p < 0.001) but there was no sex difference in improvement rate. Worse preoperative TUG and younger age favoured improvement. TUG was highly correlated to the 10MWT, but correlations of post-operative changes were only low to moderate between all scales (r = 0.22-0.61). CONCLUSIONS This study establishes the distribution of TUG in iNPH patients and shows that the test captures important clinical features that improve after surgery independent of sex and in all age groups, confirming the clinical value of the TUG test. TUG performance is associated with performance on the 10MWT pre- and post-operatively. However, the weak correlations in post-operative change to the 10MWT and other established outcome measures indicate an additional value of TUG when assessing the effects of shunt surgery.
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Affiliation(s)
- Nina Sundström
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden.
| | - Johanna Rydja
- Department of Activity and Health, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johan Virhammar
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Lena Kollén
- Department of Neurology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Fredrik Lundin
- Department of Neurology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mats Tullberg
- Hydrocephalus Research Unit, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Sarasso E, Gardoni A, Piramide N, Volontè MA, Canu E, Tettamanti A, Filippi M, Agosta F. Dual-task clinical and functional MRI correlates in Parkinson's disease with postural instability and gait disorders. Parkinsonism Relat Disord 2021; 91:88-95. [PMID: 34547654 DOI: 10.1016/j.parkreldis.2021.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dual-task is a challenge for Parkinson's disease patients with postural instability and gait disorders (PD-PIGD). OBJECTIVE This study investigated clinical, cognitive and functional brain correlates of dual-task deficits in PD-PIGD patients using quantitative gait analysis, neuropsychological evaluations and functional MRI (fMRI). METHODS Twenty-three PD-PIGD patients performed a clinical assessment of gait/balance abilities. Single and dual-task Timed-Up-and-Go tests were monitored using an optoelectronic system to study turning velocity. Patients underwent executive-attentive function evaluation and two fMRI tasks: motor-task (foot anti-phase movements), and dual-task (foot anti-phase movements while counting backwards by threes starting from 100). Twenty-three healthy subjects underwent neuropsychological and fMRI assessments. RESULTS Dual-task in PD-PIGD patients resulted in worse gait performance, particularly during turning. Performing the dual-task relative to the motor-fMRI task, healthy subjects showed widespread increased recruitment of sensorimotor, cognitive and cerebellar areas and reduced activity of inferior frontal and supramarginal gyri, while PD-PIGD patients showed increased recruitment of inferior frontal gyrus and supplementary motor area and reduced activity of primary motor, supramarginal and caudate areas. Dual-task gait alterations in patients correlated with balance and executive deficits and with altered dual-task fMRI brain activity of frontal areas. CONCLUSIONS This study suggested the correlation between dual-task gait difficulties, postural instability and executive dysfunction in PD-PIGD patients. FMRI results suggest that an optimized recruitment of motor and cognitive networks is associated with a better dual-task performance in PD-PIGD. Future studies should evaluate the effect of specific gait/balance and dual-task trainings to improve gait parameters and optimize brain functional activity during dual-tasks.
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Affiliation(s)
- Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Gardoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Noemi Piramide
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Tettamanti
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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Khalil H, Rehan R, Al-Sharman A, El-Salem K. The clinical correlates of the chair sit to stand performance in people with multiple sclerosis. Physiother Theory Pract 2021; 38:2884-2895. [PMID: 34156901 DOI: 10.1080/09593985.2021.1931590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: This study aimed to evaluate the motor and non-motor factors associated with sit-to-stand performance in people with Multiple Sclerosis (PwMS). Design: Observational cross-sectional study. Subjects: A total of 88 individuals with MS participated in this study. Main Measures: Standing performance was measured using the five-times-sit-to-stand test (FTSTS). The Berg Balance Scale to assess balance, the 10-Meter Walking Test (10-MWT) was used to assess walking speed; the Patient Determined Disease Steps (PDDS) was used to assess disability level. Furthermore, Brief International Cognitive Assessment for MS (BICAMS) was used to assess cognitive status, Hospital Anxiety and Depression scale (HADS) to assess depression and anxiety, and the Modified Fatigue Impact scale (MFIS) to evaluate fatigue. Spearman correlation coefficient was used to determine the relationship between all these variables and the FTSTS. Furthermore, multiple linear regression was conducted to determine predictive factors of the FTSTS. Results: FTSTS score was correlated significantly with BBS, PDDS, BICAMS, 10-MWT and MFIS (r ranged from 0.3 to 0.52; P < .05). However, there was no significant correlation observed between the FTSTS and HADS-depression or HADS-anxiety. Considering the multiple regression analysis, the following factors were significantly predictive of the FTSTS: 10-MWT, MFIS and the BICAMS-z score (R2: 0.433, P < .0001). Conclusion: The study concludes that sit to stand is multifactorial and is potentially associated with walking speed, cognitive function and fatigue. These factors should be considered by healthcare professionals in interpreting the sit-to-stand performance of PwMS and in designing rehabilitation interventions.
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Affiliation(s)
- Hanan Khalil
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Reem Rehan
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Alham Al-Sharman
- Faculty of Applied Medical Sciences, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid El-Salem
- Faculty of Medicine, Department of Neurosciences, Jordan University of Science and Technology, Irbid, Jordan
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Nilsson MH, Tangen GG, Palmqvist S, van Westen D, Mattsson-Carlgren N, Stomrud E, Hansson O. The Effects of Tau, Amyloid, and White Matter Lesions on Mobility, Dual Tasking, and Balance in Older People. J Gerontol A Biol Sci Med Sci 2021; 76:683-691. [PMID: 32506119 PMCID: PMC8011701 DOI: 10.1093/gerona/glaa143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study aimed to investigate whether white matter lesions (WML), β-amyloid-, and tau pathologies are independently associated with mobility, dual tasking, and dynamic balance performance in older nondemented individuals. METHODS We included 299 older people (mean, SD, age: 71.8, 5.6 years) from the Swedish BioFINDER study, whereof 175 were cognitively unimpaired and 124 had mild cognitive impairment (MCI). In multivariable regression analyses, dependent variables included mobility (Timed Up & Go [TUG]), dual tasking (TUG with a simultaneous subtraction task, that is, TUG-Cog, as well as dual task cost), and balance (Figure-of-eight). The analyses were controlled for age, sex, education, diagnosis (ie, MCI), and comorbidity (stroke, diabetes, and ischemic heart disease). Independent variables included WML volume, and measures of β-amyloid (abnormal cerebrospinal fluid [CSF] Aβ42/40 ratio) and tau pathology (CSF phosphorylated tau [p-tau]). RESULTS Multivariable regression analyses showed that an increased WML volume was independently associated with decreased mobility, that is, TUG (standardized β = 0.247; p < .001). Tau pathology was independently associated with dual tasking both when using the raw data of TUG-Cog (β = 0.224; p = .003) and the dual-task cost (β= -0.246; p = .001). Amyloid pathology was associated with decreased balance, that is, Figure-of-eight (β = 0.172; p = .028). The independent effects of WML and tau pathology were mainly observed in those with MCI, which was not the case for the effects of amyloid pathology on balance. CONCLUSIONS Common brain pathologies have different effects where WML are independently associated with mobility, tau pathology has the strongest effect on dual tasking, and amyloid pathology seems to be independently associated with balance. Although these novel findings need to be confirmed in longitudinal studies, they suggest that different brain pathologies have different effects on mobility, balance, and dual-tasking in older nondemented individuals.
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Affiliation(s)
- Maria H Nilsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Sweden
| | - Gro Gujord Tangen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - Sebastian Palmqvist
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Danielle van Westen
- Diagnostic Radiology, Department of Clinical Sciences, Lund University, Sweden
- Image and Function, Skane University Hospital, Lund, Sweden
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Sweden
| | - Erik Stomrud
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Faculty of Medicine, Lund University, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
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Arroyo A, Periáñez JA, Ríos-Lago M, Lubrini G, Andreo J, Benito-León J, Louis ED, Romero JP. Components determining the slowness of information processing in parkinson's disease. Brain Behav 2021; 11:e02031. [PMID: 33452724 PMCID: PMC7994698 DOI: 10.1002/brb3.2031] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/16/2020] [Accepted: 12/25/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Bradyphrenia is a key cognitive feature in Parkinson's disease (PD). There is no consensus on whether information processing speed is impaired or not beyond motor performance. OBJECTIVE This study aims to explore which perceptual, motor, or cognitive components of information processing are involved in the slowdown affecting cognitive performance. METHODS The study included 48 patients with PD (age: 63, 3 ± 8, 18; HY I-III; UPDRS 15,46 ± 7,76) and 53 healthy controls (age: 60,09 ± 12,83). Five reaction time (RT) tasks were administered to all participants. The average RT in each of the tasks and the percentage of correct answers were measured. Patients with PD were in "ON state" at the time of the evaluation. Perceptual, motor, and cognitive components were isolated by means of a series of ANCOVAs. RESULTS As expected, the motor component was slowed down in patients with PD. Moreover, while patients with PD showed slower RT than controls in all tasks, differences between groups did not exponentially increase with the increasing task complexity. ANCOVA analyses also revealed that the perceptual and sustained alert component resulted to be slowed down, with no differences being found in any of the remaining isolated cognitive components (i.e., response strategy-inhibition, decisional, visual search, or interference control). CONCLUSIONS The results revealed that slowness of information processing in PD was mainly associated with an impaired processing speed of the motor and perceptual-alertness components analyzed. The results may help designing new neurorehabilitation strategies, focusing on the improvement of perceptual and alertness mechanisms.
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Affiliation(s)
- Aida Arroyo
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Madrid, Spain
| | - José A Periáñez
- Experimental Psychology Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Marcos Ríos-Lago
- Basic Psychology II Department, UNED, Madrid 28040, Spain; Brain Damage Unit, Hospital Beata María Ana, Madrid, Spain
| | - Genny Lubrini
- Experimental Psychology Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge Andreo
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Madrid, Spain
| | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain; Department of Medicine, Complutense University, Madrid, Spain
| | - Elan D Louis
- Department of Neurology and Neurotherapeutics at UT Southwestern Medical Center
| | - Juan Pablo Romero
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Madrid 28223, Spain; Brain Damage Unit, Hospital Beata María Ana, Madrid, Spain
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Brown KA, Spencer KA. The Relationship Between Speech Characteristics and Motor Subtypes of Parkinson's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:2145-2154. [PMID: 32997516 DOI: 10.1044/2020_ajslp-20-00058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The aim of this study was to examine whether acoustic dysarthria characteristics align with overall motor profile in individuals with Parkinson's disease (PD). Potential speech differences between tremor-dominant and non-tremor-dominant subtypes are theoretically motivated but empirically inconclusive. Method Twenty-seven individuals with dysarthria from PD provided a contextual speech sample. Participants were grouped into non-tremor-dominant (n = 12) and tremor-dominant (n = 15) motor subtypes according to the Unified Parkinson Disease Rating Scale. Dependent speech variables included fundamental frequency range, average pause duration, cepstral peak prominence, stuttering dysfluencies, and maze dysfluencies. Results There were no significant differences between the speech of the tremor-dominant and non-tremor-dominant groups. High within-group variability existed across parameters and motor subtypes. Conclusion Speech characteristics across the areas of phonation, prosody, and fluency did not differ appreciably between PD motor subtypes.
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Affiliation(s)
- Katherine A Brown
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Kristie A Spencer
- Department of Speech and Hearing Sciences, University of Washington, Seattle
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9
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Kalkan AC, Kahraman T, Ugut BO, Donmez Colakoglu B, Genc A. Clinical and laboratory measures of balance and comparison of balance performances according to postural instability and gait disorders in individuals with Parkinson's disease. Somatosens Mot Res 2020; 38:34-40. [PMID: 33115302 DOI: 10.1080/08990220.2020.1840345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE/AIM Primary aim was to investigate the association between laboratory measures of balance and clinical balance tests in individuals with Parkinson's disease (PD). The secondary aim was to compare the balance performances according to postural instability and gait disorders (PIGD). MATERIALS AND METHODS Sixty-four individuals with PD were included in the study. Clinical data were investigated using modified Hoehn and Yahr Scale and Unified Parkinson's Disease Rating Scale (UPDRS). Berg Balance Scale (BBS), Timed Up&Go Test (TUG), Five Times Sit-to-Stand Test (FTSST) were used for clinical measures of balance. Laboratory measures of balance were evaluated by Balance Master System including the modified Clinical Test of Sensory Interaction of Balance (mCTSIB), Limits of Stability Test (LOS), Sit to Stand Test (STS), and Tandem Walk Test (TW). The relationship between clinical and laboratory measures of balance was determined. After participants were divided into two groups based on UPDRS: patients with and without PIGD, their balance performance was compared. RESULTS There were significant correlations between BBS and mCTSIB, LOS-Movement Velocity, and LOS-Endpoint Excursion. FTSST was correlated with STS-Weight Transfer and STS-Rising Index, and TUG was correlated with TW-Speed. Patients with PIGD had worse scores of balance assessments including FTSST, LOS-Movement Velocity, STS-Rising Index. CONCLUSION Laboratory measures are associated with clinical balance tests and they may reflect clinical balance outcome measures. Furthermore, PIGD may negatively affect balance performance in patients with PD.
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Affiliation(s)
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Biron Onur Ugut
- Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | | | - Arzu Genc
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
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Flood MW, O'Callaghan BPF, Diamond P, Liegey J, Hughes G, Lowery MM. Quantitative clinical assessment of motor function during and following LSVT-BIG® therapy. J Neuroeng Rehabil 2020; 17:92. [PMID: 32660495 PMCID: PMC7359464 DOI: 10.1186/s12984-020-00729-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 07/08/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND LSVT-BIG® is an intensively delivered, amplitude-oriented exercise therapy reported to improve mobility in individuals with Parkinson's disease (PD). However, questions remain surrounding the efficacy of LSVT-BIG® when compared with similar exercise therapies. Instrumented clinical tests using body-worn sensors can provide a means to objectively monitor patient progression with therapy by quantifying features of motor function, yet research exploring the feasibility of this approach has been limited to date. The aim of this study was to use accelerometer-instrumented clinical tests to quantify features of gait, balance and fine motor control in individuals with PD, in order to examine motor function during and following LSVT-BIG® therapy. METHODS Twelve individuals with PD undergoing LSVT-BIG® therapy, eight non-exercising PD controls and 14 healthy controls were recruited to participate in the study. Functional mobility was examined using features derived from accelerometry recorded during five instrumented clinical tests: 10 m walk, Timed-Up-and-Go, Sit-to-Stand, quiet stance, and finger tapping. PD subjects undergoing therapy were assessed before, each week during, and up to 13 weeks following LSVT-BIG®. RESULTS Accelerometry data captured significant improvements in 10 m walk and Timed-Up-and-Go times with LSVT-BIG® (p < 0.001), accompanied by increased stride length. Temporal features of the gait cycle were significantly lower following therapy, though no change was observed with measures of asymmetry or stride variance. The total number of Sit-to-Stand transitions significantly increased with LSVT-BIG® (p < 0.001), corresponding to a significant reduction of time spent in each phase of the Sit-to-Stand cycle. No change in measures related to postural or fine motor control was observed with LSVT-BIG®. PD subjects undergoing LSVT-BIG® showed significant improvements in 10 m walk (p < 0.001) and Timed-Up-and-Go times (p = 0.004) over a four-week period when compared to non-exercising PD controls, who showed no week-to-week improvement in any task examined. CONCLUSIONS This study demonstrates the potential for wearable sensors to objectively quantify changes in motor function in response to therapeutic exercise interventions in PD. The observed improvements in accelerometer-derived features provide support for instrumenting gait and sit-to-stand tasks, and demonstrate a rescaling of the speed-amplitude relationship during gait in PD following LSVT-BIG®.
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Affiliation(s)
- Matthew W Flood
- Neuromuscular Systems Lab, School of Electrical & Electronic Engineering, University College Dublin, Belfield, Dublin 4, Ireland.
- Insight Centre for Data Analytics, O'Brien Centre for Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Ben P F O'Callaghan
- Neuromuscular Systems Lab, School of Electrical & Electronic Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - Paul Diamond
- Neuromuscular Systems Lab, School of Electrical & Electronic Engineering, University College Dublin, Belfield, Dublin 4, Ireland
- Occupational Therapy, Day Hospital, Royal Hospital Donnybrook, Bloomfield Avenue, Dublin 4, Ireland
| | - Jérémy Liegey
- Neuromuscular Systems Lab, School of Electrical & Electronic Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - Graham Hughes
- Department of Geriatric Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Madeleine M Lowery
- Neuromuscular Systems Lab, School of Electrical & Electronic Engineering, University College Dublin, Belfield, Dublin 4, Ireland
- Insight Centre for Data Analytics, O'Brien Centre for Science, University College Dublin, Belfield, Dublin 4, Ireland
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11
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Herman T, Dagan M, Shema-Shiratzky S, Reches T, Brozgol M, Giladi N, Manor B, Hausdorff JM. Advantages of timing the duration of a freezing of gait-provoking test in individuals with Parkinson's disease. J Neurol 2020; 267:2582-2588. [PMID: 32383040 DOI: 10.1007/s00415-020-09856-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 12/23/2022]
Abstract
Evaluating freezing of gait (FOG) and quantifying its severity in patients with Parkinson's disease (PD) is challenging; objective assessment is not sufficiently established. We aimed to improve the ability to objectively evaluate FOG severity by investigating the value of measuring the duration of the test and its components. Seventy-one patients with PD and FOG completed a previously validated FOG-provoking test. The test was performed under three conditions: (1) usual, single task; (2) dual task (walking while carrying a tray); and (3) triple task (walking while holding a tray and subtracting 7 s). FOG and festination were scored using standard procedures. We evaluated effect sizes based on both the original scoring and the test duration for the motor-cognitive cost and before and after anti-Parkinsonian medication intake. Additionally, video recording of the test and total time frozen were measured. As expected, the original test score and the test duration increased across the three conditions of the task and were higher in OFF than in the ON-medication state (p < 0.036). For motor-cognitive cost, higher effect sizes were observed for the test duration of each condition, compared to the original scoring in OFF state (0.85 vs. 0.68, respectively). Change in effect size category was more pronounced in the ON state vs. OFF (0.87 vs. 0.55, respectively). Test duration was the only independent predictor for the self-report of FOG severity and the total time frozen during the test. These findings suggest that quantifying the duration of each condition of the FOG-provoking test improves its sensitivity to medications and task complexity. Timing can be used to provide immediate, objective feedback of freezing severity, and a clear interpretation of a patient's performance.
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Affiliation(s)
- Talia Herman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel.
| | - Moria Dagan
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Shirley Shema-Shiratzky
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Tal Reches
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Marina Brozgol
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Nir Giladi
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brad Manor
- Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv, Israel
- Department of Orthopaedic Surgery, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
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12
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Mirelman A, Hillel I, Rochester L, Del Din S, Bloem BR, Avanzino L, Nieuwboer A, Maidan I, Herman T, Thaler A, Gurevich T, Kestenbaum M, Orr‐Urtreger A, Brys M, Cedarbaum JM, Giladi N, Hausdorff JM. Tossing and Turning in Bed: Nocturnal Movements in Parkinson's Disease. Mov Disord 2020; 35:959-968. [DOI: 10.1002/mds.28006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/27/2020] [Accepted: 02/02/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University Tel Aviv Israel
| | - Inbar Hillel
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Lynn Rochester
- Newcastle upon Tyne Hospitals National Health System Foundation TrustUK Institute of Neuroscience, Newcastle University Newcastle upon Tyne UK
| | - Silvia Del Din
- Newcastle upon Tyne Hospitals National Health System Foundation TrustUK Institute of Neuroscience, Newcastle University Newcastle upon Tyne UK
| | - Bastiaan R. Bloem
- Radboud University Medical Center, Donders Institute for BrainCognition and Behavior, Department of Neurology Nijmegen The Netherlands
| | - Laura Avanzino
- Department of NeurosciencesUniversity of Genoa Genoa Italy
- Department of Experimental MedicineUniversity of Genoa Genoa Italy
| | - Alice Nieuwboer
- Department of Rehabilitation SciencesKatholieke Universiteit Leuven Leuven Belgium
| | - Inbal Maidan
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University Tel Aviv Israel
| | - Talia Herman
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Avner Thaler
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University Tel Aviv Israel
| | - Tanya Gurevich
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University Tel Aviv Israel
| | | | - Avi Orr‐Urtreger
- Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University Tel Aviv Israel
- Genetic Institute, Tel Aviv Medical Center Tel Aviv Israel
| | | | | | - Nir Giladi
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University Tel Aviv Israel
| | - Jeffrey M. Hausdorff
- Laboratory for Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition and MobilityNeurological Institute, Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University Tel Aviv Israel
- Department of Physical Therapy, Tel Aviv University Tel Aviv Israel
- Rush Alzheimer's Disease Center, Rush University Medical Center Chicago Illinois USA
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13
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Statistical analysis of the 180 degree walking turn: Common patterns, repeatability and prediction bands of turn signals. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2019.101689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Tchelet K, Stark-Inbar A, Yekutieli Z. Pilot Study of the EncephaLog Smartphone Application for Gait Analysis. SENSORS 2019; 19:s19235179. [PMID: 31779224 PMCID: PMC6929058 DOI: 10.3390/s19235179] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 12/30/2022]
Abstract
Gait disorders and falls are common in elders and in many clinical conditions, yet they are typically infrequently and subjectively evaluated, limiting prevention and intervention. Completion-time of the Timed-Up-and-Go (TUG) test is a well-accepted clinical biomarker for rating mobility and prediction of falls risk. Using smartphones’ integral accelerometers and gyroscopes, we already demonstrated that TUG completion-time can be accurately measured via a smartphone app. Here we present an extended app, EncephaLogTM, which provides gait analysis in much more detail, offering 9 additional gait biomarkers on top of the TUG completion-time. In this pilot, four healthy adults participated in a total of 32 TUG tests; simultaneously recorded by EncephaLog and motion sensor devices used in movement labs: motion capture cameras (MCC), pressure mat; and/or wearable sensors. Results show high agreement between EncephaLog biomarkers and those measured by the other devices. These preliminary results suggest that EncephaLog can provide an accurate, yet simpler, instrumented TUG (iTUG) platform than existing alternatives, offering a solution for clinics that cannot afford the cost or space required for a dedicated motion lab and for monitoring patients at their homes. Further research on a larger study population with pathologies is required to assess full validity.
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15
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The Dual-Tasking Overload on Functional Mobility Is Related to Specific Cognitive Domains in Different Subtypes of Parkinson's Disease. TOPICS IN GERIATRIC REHABILITATION 2019. [DOI: 10.1097/tgr.0000000000000220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Cognitive profile of non-demented Parkinson's disease: Meta-analysis of domain and sex-specific deficits. Parkinsonism Relat Disord 2018; 60:32-42. [PMID: 30361136 DOI: 10.1016/j.parkreldis.2018.10.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 09/24/2018] [Accepted: 10/12/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Better awareness of the cognitive domains affected in non-demented Parkinson's Disease (PD) should improve understanding of cognitive disease mechanisms. A complete understanding of the cognitive areas impaired in non-demented PD is hindered because most studies use small clinical samples without comparison to healthy controls. This meta-analysis examined cumulative evidence across studies to determine if there were impairments in non-demented PD in the three cognitive domains thought to be most widely affected in PD: frontal executive, visuospatial, and verbal memory. Because there are well-documented sex differences in PD, a second objective was to explore sex differences in these findings. METHODS MEDLINE, EMBASE and PsycINFO databases were searched (1988-March 2017). Random effects models were used to compute and compare effect sizes of differences between PD patients and controls within cognitive domains. Sex differences in effect sizes were also examined in these comparisons. Moderating factors including age, disease duration, motor symptom severity, levodopa dosage, and depression were examined through meta-regression. RESULTS PD patients showed deficits of moderate effect sizes in all three cognitive domains relative to controls. Significant sex differences were observed only for frontal executive abilities, with male PD patients showing greater deficits than female PD patients relative to controls. No moderators of effect sizes were identified in the domain specific overall or sex-segregated meta-analyses. CONCLUSIONS Results indicate that non-demented PD patients have deficits of moderate magnitude in frontal executive, verbal memory, and visuospatial abilities. Our findings of greater frontal executive deficits in males warrant further confirmation.
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17
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Tan D, Pua YH, Balakrishnan S, Scully A, Bower KJ, Prakash KM, Tan EK, Chew JS, Poh E, Tan SB, Clark RA. Automated analysis of gait and modified timed up and go using the Microsoft Kinect in people with Parkinson's disease: associations with physical outcome measures. Med Biol Eng Comput 2018; 57:369-377. [PMID: 30123947 DOI: 10.1007/s11517-018-1868-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Abstract
Instrumenting physical assessments in people with Parkinson's disease can provide valuable and sensitive information. This study aimed to investigate whether variables derived from a Kinect-based system can provide incremental value over standard habitual gait speed (HGS) and timed up and go (TUG) variables by evaluating associations with (1) motor and (2) postural instability and gait difficulty (PIGD) subscales of the Unified Parkinson's Disease Rating Scale (UPDRS). Sixty-two individuals with Parkinson's disease (age 66 ± 7 years; 74% male) undertook an instrumented HGS and modified TUG tests, in addition to the UPDRS. Multivariable regression models were used to evaluate the associations of the Kinect measures with UPDRS motor and PIGD scores. First step length during the TUG and average step length and vertical pelvic displacement during the HGS were significantly associated with the PIGD subscale (P < 0.05). The only Kinect-derived variable showing additive benefits over the standard measures for the PIGD association was HGS vertical pelvic displacement. The only standard or Kinect-derived variable significantly associated with the motor subscale was first step length during the TUG (P < 0.01). This study provides preliminary evidence to support the use of a low-cost, non-invasive method of instrumenting gait and TUG tests in people with Parkinson's disease. Graphical abstract ᅟ.
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Affiliation(s)
- Dawn Tan
- Department of Physiotherapy, Singapore General Hospital, National Heart Centre Level 7, 5 Hospital Drive, Singapore, 169609, Republic of Singapore. .,Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Republic of Singapore.
| | - Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, National Heart Centre Level 7, 5 Hospital Drive, Singapore, 169609, Republic of Singapore
| | - Shaminian Balakrishnan
- Department of Physiotherapy, Singapore General Hospital, National Heart Centre Level 7, 5 Hospital Drive, Singapore, 169609, Republic of Singapore
| | - Aileen Scully
- Department of Physiotherapy, Singapore General Hospital, National Heart Centre Level 7, 5 Hospital Drive, Singapore, 169609, Republic of Singapore
| | - Kelly J Bower
- School of Health and Sport Sciences, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD, 4556, Australia
| | - Kumar Manharlal Prakash
- Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Republic of Singapore.,National Neuroscience Institute, Singapore General Hospital, Outram Road, Singapore, 169608, Republic of Singapore
| | - Eng-King Tan
- Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Republic of Singapore.,National Neuroscience Institute, Singapore General Hospital, Outram Road, Singapore, 169608, Republic of Singapore
| | - Jing-Si Chew
- Division of Nursing, Singapore General Hospital, Outram Road, Singapore, 169608, Republic of Singapore
| | - Evelyn Poh
- Division of Nursing, Singapore General Hospital, Outram Road, Singapore, 169608, Republic of Singapore
| | - Siok-Bee Tan
- Division of Nursing, Singapore General Hospital, Outram Road, Singapore, 169608, Republic of Singapore
| | - Ross A Clark
- School of Health and Sport Sciences, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, QLD, 4556, Australia
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18
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Newman MA, Hirsch MA, Peindl RD, Habet NA, Tsai TJ, Runyon MS, Huynh T, Zheng N. Reliability of the sub-components of the instrumented timed up and go test in ambulatory children with traumatic brain injury and typically developed controls. Gait Posture 2018; 63:248-253. [PMID: 29778065 DOI: 10.1016/j.gaitpost.2018.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/03/2018] [Accepted: 05/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies have evaluated the test-re-test reliability of subcomponents of the timed up and-go test in adults by using body-worn inertial sensors. However, studies in children have not been reported in the literature. RESEARCH QUESTION To evaluate the within-session reliability of subcomponents of a newly developed electronically augmented timed 'upand-go' test (EATUG) in ambulatory children with traumatic brain injury (TBI) and children with typical development (TD). METHOD The timed up and go test was administered to twelve consecutive ambulatory children with moderate to severe TBI (6 males and 6 females, age 10.5 ± 1.5 years, range 8-13 years, during inpatient rehabilitation at 27.0 ± 11.8 days following injury) and 10 TD age and sex-matched children (5 males and 5 females, 10.4 ± 1.3 years, range 8-11 years). Participants wore a single chest-mounted inertial measurement sensor package with custom software that measured angular and acceleration velocity and torso flexion and extension angles, while they performed 6 trials of the EATUG test. Measures were derived from the overall time to complete the TUG test, angular velocity and angular displacement data for torso flexion and extension during sit-to-stand and stand-to-sit segments and both mean and peak angular velocities for two turning segments (i.e. turning around a cone and turning-before-sitting). RESULTS Within-session reliability of the subcomponents of the TUG test for children with TBI assessed by the intra-class correlation coefficient was ICC (1,1) = 0.84, (range 0.82-0.96), and for TD children ICC (1,1) = 0.73, (range 0.53-0.89). Scores on Total Time, maximum torso flexion/extension angle and peak flexion angular velocity during sit-tostand, and peak turn angular velocity for both turns around the cone and turns before sitting were lower for children with TBI than for TD children (p ≤ 0.05). SIGNIFICANCE The EATUG test is a reliable measure of physical function in children with TBI who are being discharged from inpatient rehabilitation.
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Affiliation(s)
- Mark A Newman
- Carolinas Medical Center, Carolinas Rehabilitation, Department of Physical Medicine and Rehabilitation, 1100 Blythe Blvd., Charlotte, NC 28203, United States.
| | - Mark A Hirsch
- Carolinas Medical Center, Carolinas Rehabilitation, Department of Physical Medicine and Rehabilitation, 1100 Blythe Blvd., Charlotte, NC 28203, United States
| | - Richard D Peindl
- Atrium Health Musculoskeletal Institute, 1000 Blythe Blvd., Charlotte, NC 28203, United States
| | - Nahir A Habet
- Atrium Health Musculoskeletal Institute, 1000 Blythe Blvd., Charlotte, NC 28203, United States
| | - Tobias J Tsai
- Carolinas Medical Center, Carolinas Rehabilitation, Department of Physical Medicine and Rehabilitation, 1100 Blythe Blvd., Charlotte, NC 28203, United States
| | - Michael S Runyon
- Carolinas Medical Center, Department of Emergency Medicine, 1000 Blythe Blvd., Charlotte, NC 28203, United States
| | - Toan Huynh
- Carolinas Medical Center, Department of Surgery, Division of Acute Care Surgery, 1000 Blythe Blvd., Charlotte, NC 28203, United States
| | - Nigel Zheng
- Center for Biomedical Engineering and Science, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC 28223, United States
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Souza CDO, Voos MC, Barbosa AF, Chen J, Francato DCV, Milosevic M, Popovic M, Fonoff ET, Chien HF, Barbosa ER. Relationship Between Posturography, Clinical Balance and Executive Function in Parkinson´s Disease. J Mot Behav 2018; 51:212-221. [PMID: 29683777 DOI: 10.1080/00222895.2018.1458279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study aimed to evaluate the relationship between posturography, clinical balance, and executive function tests in Parkinson´s disease (PD). Seventy-one people participated in the study. Static posturography evaluated the center of pressure fluctuations in quiet standing and dynamic posturography assessed sit-to-stand, tandem walk, and step over an obstacle. Functional balance was evaluated by Berg Balance Scale, MiniBESTest, and Timed Up and Go test. Executive function was assessed by Trail Making Test (TMT) and semantic verbal fluency test. Step over obstacle measures (percentage of body weight transfer and movement time) were moderately correlated to Timed Up and Go, part B of TMT and semantic verbal fluency (r > 0.40; p < 0.05 in all relationships). Stepping over an obstacle assesses the responses to internal perturbations. Participants with shorter movement times and higher percentage of body weight transfer (higher lift up index) on this task were also faster in Timed Up and Go, part B of TMT, and semantic verbal fluency. All these tasks require executive function (problem solving, sequencing, shifting attention), which is affected by PD and contribute to postural assessment.
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Affiliation(s)
- Carolina de Oliveira Souza
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,b Department of Functional Neurosurgery , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil
| | - Mariana Callil Voos
- c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil.,d Physical Therapy, Occupational Therapy and Speech Therapy Department , University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Alessandra Ferreira Barbosa
- c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil.,d Physical Therapy, Occupational Therapy and Speech Therapy Department , University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Janini Chen
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil
| | - Debora Cristina Valente Francato
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Matija Milosevic
- e Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto , Ontario , Canada.,f Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto , Ontario , Canada
| | - Milos Popovic
- e Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto , Ontario , Canada.,f Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto , Ontario , Canada
| | - Erich Talamoni Fonoff
- b Department of Functional Neurosurgery , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Hsin Fen Chien
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil
| | - Egberto Reis Barbosa
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil
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Clinical subtypes and genetic heterogeneity: of lumping and splitting in Parkinson disease. Curr Opin Neurol 2018; 29:727-734. [PMID: 27749396 DOI: 10.1097/wco.0000000000000384] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Recent studies on clinical, genetic and pathological heterogeneity of Parkinson disease have renewed the old debate whether we should think of Parkinson disease as one disease with variations, or as a group of independent diseases that happen to present with similar phenotypes. Here, we provide an overview of where the debate is coming from, and how recent findings in clinical subtyping, genetics and clinico-pathological correlation have shaped this controversy over the last few years. RECENT FINDINGS New and innovative clinical diagnostic criteria for Parkinson disease have been proposed and await validation. Studies using functional imaging or wearable biosensors, as well as biomarker studies, provide new support for the validity of the traditional clinical subtypes of Parkinson disease (tremor-dominant versus akinetic-rigid or postural instability/gait difficulty). A recent cluster analysis (as unbiased data-driven approach to subtyping) included a wide spectrum of nonmotor variables, and showed correlation of the proposed subtypes with disease progression in a longitudinal analysis. New genetic factors contributing to Parkinson disease susceptibility continue to be identified, including rare mutations causing monogenetic disease, common variants with small effect size and risk factors (like mutations in the gene for glucocerebrosidase) that fall in between the two other categories. Recent studies show some limited correlation between genetic factors and clinical heterogeneity. Despite some variations in patterns of pathology, Lewy bodies are still the hallmark of Parkinson disease, including the vast majority of genetic subgroups. SUMMARY Evidence of clinical, genetic and pathological heterogeneity of Parkinson disease continues to emerge, but clearly defined subtypes that hold up in more than one of these domains remain elusive. For research to identify such subtypes, splitting is likely the way forward; until then, for clinical practice, lumping remains the more pragmatic approach.
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21
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Weiss A, Mirelman A, Giladi N, Barnes LL, Bennett DA, Buchman AS, Hausdorff JM. Transition Between the Timed up and Go Turn to Sit Subtasks: Is Timing Everything? J Am Med Dir Assoc 2017; 17:864.e9-864.e15. [PMID: 27569715 DOI: 10.1016/j.jamda.2016.06.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/24/2016] [Accepted: 06/24/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The Timed Up and Go (TUG), one of the most widely used tests of mobility, has been validated and associated with adverse outcomes in the community, acute care, and nursing home setting. It is composed of several distinct subtasks; however, the temporal relationship when transitioning between subtasks has not been well-studied. We tested the hypothesis that longer transition durations between the final turn to the sitting subtasks are associated with worse motor and cognitive performance in older adults. METHODS A total of 1055 participants (80.33 ± 7.57 years, 76.96% female) performed the TUG while wearing a 3-dimensional inertial sensor on their lower back. We employed a series of linear regressions to examine the association of the duration between the turn and sitting subtasks with clinical characteristics including motor and cognitive functions. RESULTS Participants employed 2 different strategies when they transitioned from turning to sitting. (1) Distinct transition strategy: 816 participants (77.34%) first completed the turn before starting to sit. The average duration between these distinct subtasks (D-interval) was 715 ± 980 ms. (2) Overlapping transition strategy: 239 participants (22.65%) started to sit before completing the turn. The average overlap duration between these tasks (O-interval) was 237 ± 269 ms. Participants who employed the distinct transition strategy were slightly younger than those who employed the overlapping transition strategy (P ≤ .013). Higher D-intervals and O-intervals were associated with worse TUG performance (P ≤ .02), with poorer motor and cognitive function, [ie, worse parkinsonian gait (P ≤ .001), lower level of perceptual speed (P ≤ .03), and with worse mobility disability (P ≤ .001)]. A longer D-interval was associated with worse gait speed and bradykinesia (P ≤ .001), whereas a longer O-interval was associated with increased rigidity (P = .004). CONCLUSIONS Older adults apparently employ 2 different strategies when transitioning from turning to sitting. The instrumented TUG can characterize additional gait and balance aspects that cannot be derived from traditional TUG assessments. These new measures offer novel targets for intervention to decrease the burden of late-life gait impairment.
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Affiliation(s)
- Aner Weiss
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anat Mirelman
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Giladi
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL; Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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22
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Fasano A, Canning CG, Hausdorff JM, Lord S, Rochester L. Falls in Parkinson's disease: A complex and evolving picture. Mov Disord 2017; 32:1524-1536. [PMID: 29067726 DOI: 10.1002/mds.27195] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/10/2017] [Accepted: 09/13/2017] [Indexed: 12/23/2022] Open
Abstract
Falls are a major determinant of poor quality of life, immobilization, and reduced life expectancy in people affected by Parkinson's disease (PD) and in older adults more generally. Although many questions remain, recent research has advanced the understanding of this complex problem. The goal of this review is to condense new knowledge of falls in PD from prodromal to advanced disease, taking into account risk factors, assessment, and classification as well as treatment. The fundamental steps of clinical and research-based approaches to falls are described, namely, the identification of fall risk factors, clinical and instrumental methods to evaluate and classify fall risk, and the latest evidence to reduce or delay falls in PD. We summarize recent developments, the direction in which the field should be heading, and what can be recommended at this stage. We also provide a practical algorithm for clinicians.© 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Jeffrey M Hausdorff
- Center for Study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, US
| | - Sue Lord
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Auckland University of Technology, Auckland, New Zealand
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust, Newcastle upon Tyne, UK
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23
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Cognitive functioning is more closely related to real-life mobility than to laboratory-based mobility parameters. Eur J Ageing 2017. [PMID: 29531515 DOI: 10.1007/s10433-017-0434-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Increasing evidence indicates that mobility depends on cognitive resources, but the exact relationships between various cognitive functions and different mobility parameters still need to be investigated. This study examines the hypothesis that cognitive functioning is more closely related to real-life mobility performance than to mobility capacity as measured with standardized laboratory tests. The final sample used for analysis consisted of 66 older adults (72.3 ± 5.6 years). Cognition was assessed by measures of planning (HOTAP test), spatial working memory (Grid-Span test) and visuospatial attention (Attention Window test). Mobility capacity was assessed by an instrumented version of the Timed Up-and-Go test (iTUG). Mobility performance was assessed with smartphones which collected accelerometer and GPS data over one week to determine the spatial extent and temporal duration of real-life activities. Data analyses involved an exploratory factor analysis and correlation analyses. Mobility measures were reduced to four orthogonal factors: the factor 'real-life mobility' correlated significantly with most cognitive measures (between r = .229 and r = .396); factors representing 'sit-to-stand transition' and 'turn' correlated with fewer cognitive measures (between r = .271 and r = .315 and between r = .210 and r = .316, respectively), and the factor representing straight gait correlated with only one cognitive measure (r = .237). Among the cognitive functions tested, visuospatial attention was associated with most mobility measures, executive functions with fewer and spatial working memory with only one mobility measure. Capacity and real-life performance represent different aspects of mobility. Real-life mobility is more closely associated with cognition than mobility capacity, and in our data this association is most pronounced for visuospatial attention. The close link between real-life mobility and visuospatial attention should be considered by interventions targeting mobility in old age.
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Reinfelder S, Hauer R, Barth J, Klucken J, Eskofier BM. Timed Up-and-Go phase segmentation in Parkinson's disease patients using unobtrusive inertial sensors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:5171-4. [PMID: 26737456 DOI: 10.1109/embc.2015.7319556] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A widely accepted functional motor test for measuring basic mobility capabilities is the `Timed Up-and-Go' (TUG) test. Although several basic mobility tasks are included, only the total time is used as outcome parameter. It has been shown that timings of sub-phases can be used as relevant clinical parameters for the assessment of Parkinson's disease patients. A variety of systems and methods have been proposed for instrumenting the TUG test, but only limited information has been published regarding phase classification. In this paper an automated TUG phase classification methodology is proposed and validated in a study with 16 Parkinson's disease patients. Statistical, signal energy, chronological and gait features were extracted from acceleration and orientation signals of shoe mounted inertial measurement units. The phases `sit to walk', `walking', `first turn', `second turn' and `turn to sit' were segmented in a two stage classifier approach. Strides were used for a separation of the walking phase and classifiers like NaiveBayes, k-Nearest-Neighbor, Support Vector Machine (SVM) and Random Forest for the final phase segmentation. SVM performed best with a mean sensitivity of 81.80% over all phases. Additionally, the impact of UPDRS and Hoehn & Yahr ratings on the phase times was assessed. The proposed methodology could be used to analyze gait parameters of sub-phases like stride length, stride time, foot clearance, heel-strike or toe-off angle for an improved assessment of Parkinson's disease patients.
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Vitale C, Falco F, Trojano L, Erro R, Moccia M, Allocca R, Agosti V, Santangelo F, Barone P, Santangelo G. Neuropsychological correlates of Pisa syndrome in patients with Parkinson's disease. Acta Neurol Scand 2016; 134:101-7. [PMID: 26427765 DOI: 10.1111/ane.12514] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND A complex relationship exists between postural control and cognition in the elderly. Namely, neural mechanisms that are required for the regulation of posture have been variably associated with cognitive dysfunctions. Parkinson's disease (PD) is the second most common neurodegenerative disease among the elderly, and it has been associated with both cognitive and postural abnormalities such as Pisa syndrome (PS). Although its onset has been considered to be multifactorial, the pathophysiological mechanisms underpinning PS are still not fully explained. Until now, no study investigated the possible contribution of cognitive dysfunction to occurrence of PS in PD. PATIENTS AND METHODS Twenty PD patients with PS and 20 PD patients without PS were enrolled. All patients with PD underwent neuropsychological battery to assess behavioural disturbances, memory, attention, frontal/executive and visuospatial functions. RESULTS The two groups did not differ on demographic features, age at PD onset and disease duration, whereas they significantly differed on UPDRS-Part III, and levodopa-equivalent daily dose (LEDD). MANCOVA with above-mentioned clinical variable as covariates revealed significant differences on tasks tapping verbal long-term memory, and attentional and visuoperceptual abilities between groups. The binary logistic regression revealed that higher LEDD and lower performance on visuospatial task (Benton Judgment of Lines Orientation test) significantly predicted occurrence of PS. CONCLUSION Our results revealed a significant association of PS with altered attention and visuoperceptual functions in PD, suggesting that the occurrence of PS may be associated with alteration of both frontal-striatal systems and posterior cortical areas.
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Affiliation(s)
- Carmine Vitale
- University Parthenope; Naples Italy
- IDC-Hermitage-Capodimonte; Naples Italy
| | - Fabrizia Falco
- Department of Psychology; Second University of Naples; Caserta Italy
| | - Luigi Trojano
- Department of Psychology; Second University of Naples; Caserta Italy
- Salvatore Maugeri Foundation; Scientific Institute of Telese; Telese Terme BN Italy
| | - Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders; Institute of Neurology; University College London (UCL); London UK
| | - Marcello Moccia
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences; University of Naples Federico II; Naples Italy
| | - Roberto Allocca
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences; University of Naples Federico II; Naples Italy
| | - Valeria Agosti
- University Parthenope; Naples Italy
- IDC-Hermitage-Capodimonte; Naples Italy
| | - Franco Santangelo
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences; University of Naples Federico II; Naples Italy
| | - Paolo Barone
- Neurodegenerative Diseases Center; Department of Medicine and Surgery; University of Salerno; Salerno Italy
| | - Gabriella Santangelo
- IDC-Hermitage-Capodimonte; Naples Italy
- Department of Psychology; Second University of Naples; Caserta Italy
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Vervoort D, Vuillerme N, Kosse N, Hortobágyi T, Lamoth CJC. Multivariate Analyses and Classification of Inertial Sensor Data to Identify Aging Effects on the Timed-Up-and-Go Test. PLoS One 2016; 11:e0155984. [PMID: 27271994 PMCID: PMC4894562 DOI: 10.1371/journal.pone.0155984] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/06/2016] [Indexed: 11/17/2022] Open
Abstract
Many tests can crudely quantify age-related mobility decrease but instrumented versions of mobility tests could increase their specificity and sensitivity. The Timed-up-and-Go (TUG) test includes several elements that people use in daily life. The test has different transition phases: rise from a chair, walk, 180° turn, walk back, turn, and sit-down on a chair. For this reason the TUG is an often used test to evaluate in a standardized way possible decline in balance and walking ability due to age and or pathology. Using inertial sensors, qualitative information about the performance of the sub-phases can provide more specific information about a decline in balance and walking ability. The first aim of our study was to identify variables extracted from the instrumented timed-up-and-go (iTUG) that most effectively distinguished performance differences across age (age 18-75). Second, we determined the discriminative ability of those identified variables to classify a younger (age 18-45) and older age group (age 46-75). From healthy adults (n = 59), trunk accelerations and angular velocities were recorded during iTUG performance. iTUG phases were detected with wavelet-analysis. Using a Partial Least Square (PLS) model, from the 72-iTUG variables calculated across phases, those that explained most of the covariance between variables and age were extracted. Subsequently, a PLS-discriminant analysis (DA) assessed classification power of the identified iTUG variables to discriminate the age groups. 27 variables, related to turning, walking and the stand-to-sit movement explained 71% of the variation in age. The PLS-DA with these 27 variables showed a sensitivity and specificity of 90% and 85%. Based on this model, the iTUG can accurately distinguish young and older adults. Such data can serve as a reference for pathological aging with respect to a widely used mobility test. Mobility tests like the TUG supplemented with smart technology could be used in clinical practice.
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Affiliation(s)
- Danique Vervoort
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Nicolas Vuillerme
- University Grenoble-Alpes, AGEIS, La Tronche, France.,Institut Universitaire de France, Paris, France
| | - Nienke Kosse
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.,University Grenoble-Alpes, AGEIS, La Tronche, France
| | - Tibor Hortobágyi
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Claudine J C Lamoth
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
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Objective characterization of daily living transitions in patients with Parkinson's disease using a single body-fixed sensor. J Neurol 2016; 263:1544-51. [PMID: 27216626 DOI: 10.1007/s00415-016-8164-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/20/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
Body-fixed sensors (BFS), e.g., accelerometers worn for several days, can be used to augment the traditional clinical assessment. Long-term recordings obtained with BFS have been applied to study tremor, postural control, freezing of gait, turning abilities, motor response fluctuations and fall risk among older adults and patients with Parkinson's disease (PD). We aimed to test whether BFS-derived measures of transitions differ between patients with PD and healthy controls, and to evaluate whether there are differences among patients with mild PD, compared to more severe patients, and to controls. We also explored the added value of the metrics extracted from the sensor as compared to traditional testing in the lab. Ninety-nine patients with PD and 38 healthy older adults (HOA) participated in this study and wore a body-fixed sensor for 3 days. Walk-to-sit (n = 3286) and Sit-to-walk (n = 2858) transitions were analyzed and a machine learning algorithm was applied to distinguish between the groups. Significant differences in transitions were observed between PD patients and HOA, between mild and severe PD, and between mild PD and HOA, both in temporal and distribution features. The machine learning algorithm discriminated patients from HOA (accuracy = 92.3 %), mild from severe patients (accuracy = 89.8 %), and mild patients from HOA (accuracy = 85.9 %). These initial results suggest that body-fixed sensor-derived metrics of everyday transitions can characterize disease severity and differentiate mild PD patients from healthy older adults. Perhaps this approach can help with the integration of BFS into clinical care and the tracking of disease progression and the response to therapy.
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Micó-Amigo ME, Kingma I, Ainsworth E, Walgaard S, Niessen M, van Lummel RC, van Dieën JH. A novel accelerometry-based algorithm for the detection of step durations over short episodes of gait in healthy elderly. J Neuroeng Rehabil 2016; 13:38. [PMID: 27093956 PMCID: PMC4837611 DOI: 10.1186/s12984-016-0145-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 04/03/2016] [Indexed: 11/17/2022] Open
Abstract
Background The assessment of short episodes of gait is clinically relevant and easily implemented, especially given limited space and time requirements. BFS (body-fixed-sensors) are small, lightweight and easy to wear sensors, which allow the assessment of gait at relative low cost and with low interference. Thus, the assessment with BFS of short episodes of gait, extracted from dailylife physical activity or measured in a standardised and supervised setting, may add value in the study of gait quality of the elderly. The aim of this study was to evaluate the accuracy of a novel algorithm based on acceleration signals recorded at different human locations (lower back and heels) for the detection of step durations over short episodes of gait in healthy elderly subjects. Methods Twenty healthy elderly subjects (73.7 ± 7.9 years old) walked twice a distance of 5 m, wearing a BFS on the lower back, and on the outside of each heel. Moreover, an optoelectronic three-dimensional (3D) motion tracking system was used to detect step durations. A novel algorithm is presented for the detection of step durations from low-back and heel acceleration signals separately. The accuracy of the algorithm was assessed by comparing absolute differences in step duration between the three methods: step detection from the optoelectronic 3D motion tracking system, step detection from the application of the novel algorithm to low-back accelerations, and step detection from the application of the novel algorithm to heel accelerations. Results The proposed algorithm successfully detected all the steps, without false positives and without false negatives. Absolute average differences in step duration within trials and across subjects were calculated for each comparison, between low-back accelerations and the optoelectronic system were on average 22.4 ± 7.6 ms (4.0 ± 1.3 % of average step duration), between heel accelerations and the optoelectronic system were on average 20.7 ± 11.8 ms (3.7 ± 1.9 %), and between low-back accelerations and heel accelerations were on average 27.8 ± 15.1 ms (4.9 ± 2.5 % of average step duration). Conclusions This study showed that the presented novel algorithm detects step durations over short episodes of gait in healthy elderly subjects with acceptable accuracy from low-back and heel accelerations, which provides opportunities to extract a range of gait parameters from short episodes of gait.
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Affiliation(s)
- M Encarna Micó-Amigo
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,McRoberts B. V., Raamweg 43, 2596 HN, The Hague, The Netherlands
| | - Idsart Kingma
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Erik Ainsworth
- McRoberts B. V., Raamweg 43, 2596 HN, The Hague, The Netherlands
| | - Stefan Walgaard
- McRoberts B. V., Raamweg 43, 2596 HN, The Hague, The Netherlands
| | - Martijn Niessen
- McRoberts B. V., Raamweg 43, 2596 HN, The Hague, The Netherlands
| | - Rob C van Lummel
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,McRoberts B. V., Raamweg 43, 2596 HN, The Hague, The Netherlands
| | - Jaap H van Dieën
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Yang K, Xiong WX, Liu FT, Sun YM, Luo S, Ding ZT, Wu JJ, Wang J. Objective and quantitative assessment of motor function in Parkinson's disease-from the perspective of practical applications. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:90. [PMID: 27047949 DOI: 10.21037/atm.2016.03.09] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder with high morbidity because of the coming aged society. Currently, disease management and the development of new treatment strategies mainly depend on the clinical information derived from rating scales and patients' diaries, which have various limitations with regard to validity, inter-rater variability and continuous monitoring. Recently the prevalence of mobile medical equipment has made it possible to develop an objective, accurate, remote monitoring system for motor function assessment, playing an important role in disease diagnosis, home-monitoring, and severity evaluation. This review discusses the recent development in sensor technology, which may be a promising replacement of the current rating scales in the assessment of motor function of PD.
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Affiliation(s)
- Ke Yang
- Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Wei-Xi Xiong
- Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Feng-Tao Liu
- Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yi-Min Sun
- Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Susan Luo
- Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zheng-Tong Ding
- Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jian-Jun Wu
- Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jian Wang
- Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
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van Lummel RC, Walgaard S, Hobert MA, Maetzler W, van Dieën JH, Galindo-Garre F, Terwee CB. Intra-Rater, Inter-Rater and Test-Retest Reliability of an Instrumented Timed Up and Go (iTUG) Test in Patients with Parkinson's Disease. PLoS One 2016; 11:e0151881. [PMID: 26999051 PMCID: PMC4801645 DOI: 10.1371/journal.pone.0151881] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/04/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The "Timed Up and Go" (TUG) is a widely used measure of physical functioning in older people and in neurological populations, including Parkinson's Disease. When using an inertial sensor measurement system (instrumented TUG [iTUG]), the individual components of the iTUG and the trunk kinematics can be measured separately, which may provide relevant additional information. OBJECTIVE The aim of this study was to determine intra-rater, inter-rater and test-retest reliability of the iTUG in patients with Parkinson's Disease. METHODS Twenty eight PD patients, aged 50 years or older, were included. For the iTUG the DynaPort Hybrid (McRoberts, The Hague, The Netherlands) was worn at the lower back. The device measured acceleration and angular velocity in three directions at a rate of 100 samples/s. Patients performed the iTUG five times on two consecutive days. Repeated measurements by the same rater on the same day were used to calculate intra-rater reliability. Repeated measurements by different raters on the same day were used to calculate intra-rater and inter-rater reliability. Repeated measurements by the same rater on different days were used to calculate test-retest reliability. RESULTS Nineteen ICC values (15%) were ≥ 0.9 which is considered as excellent reliability. Sixty four ICC values (49%) were ≥ 0.70 and < 0.90 which is considered as good reliability. Thirty one ICC values (24%) were ≥ 0.50 and < 0.70, indicating moderate reliability. Sixteen ICC values (12%) were ≥ 0.30 and < 0.50 indicating poor reliability. Two ICT values (2%) were < 0.30 indicating very poor reliability. CONCLUSIONS In conclusion, in patients with Parkinson's disease the intra-rater, inter-rater, and test-retest reliability of the individual components of the instrumented TUG (iTUG) was excellent to good for total duration and for turning durations, and good to low for the sub durations and for the kinematics of the SiSt and StSi. The results of this fully automated analysis of instrumented TUG movements demonstrate that several reliable TUG parameters can be identified that provide a basis for a more precise, quantitative use of the TUG test, in clinical practice.
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Affiliation(s)
- Rob C. van Lummel
- McRoberts BV, The Hague, The Netherlands
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Markus A. Hobert
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Walter Maetzler
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany
| | - Jaap H. van Dieën
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Francisca Galindo-Garre
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Caroline B. Terwee
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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Bloem BR, Marinus J, Almeida Q, Dibble L, Nieuwboer A, Post B, Ruzicka E, Goetz C, Stebbins G, Martinez-Martin P, Schrag A. Measurement instruments to assess posture, gait, and balance in Parkinson's disease: Critique and recommendations. Mov Disord 2016; 31:1342-55. [PMID: 26945525 DOI: 10.1002/mds.26572] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/14/2016] [Accepted: 01/20/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Disorders of posture, gait, and balance in Parkinson's disease (PD) are common and debilitating. This MDS-commissioned task force assessed clinimetric properties of existing rating scales, questionnaires, and timed tests that assess these features in PD. METHODS A literature review was conducted. Identified instruments were evaluated systematically and classified as "recommended," "suggested," or "listed." Inclusion of rating scales was restricted to those that could be used readily in clinical research and practice. RESULTS One rating scale was classified as "recommended" (UPDRS-derived Postural Instability and Gait Difficulty score) and 2 as "suggested" (Tinetti Balance Scale, Rating Scale for Gait Evaluation). Three scales requiring equipment (Berg Balance Scale, Mini-BESTest, Dynamic Gait Index) also fulfilled criteria for "recommended" and 2 for "suggested" (FOG score, Gait and Balance Scale). Four questionnaires were "recommended" (Freezing of Gait Questionnaire, Activities-specific Balance Confidence Scale, Falls Efficacy Scale, Survey of Activities, and Fear of Falling in the Elderly-Modified). Four tests were classified as "recommended" (6-minute and 10-m walk tests, Timed Up-and-Go, Functional Reach). CONCLUSION We identified several questionnaires that adequately assess freezing of gait and balance confidence in PD and a number of useful clinical tests. However, most clinical rating scales for gait, balance, and posture perform suboptimally or have been evaluated insufficiently. No instrument comprehensively and separately evaluates all relevant PD-specific gait characteristics with good clinimetric properties, and none provides separate balance and gait scores with adequate content validity for PD. We therefore recommend the development of such a PD-specific, easily administered, comprehensive gait and balance scale that separately assesses all relevant constructs. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Dept. of Neurology, Nijmegen, The Netherlands.
| | - Johan Marinus
- Leiden University Medical Center, Department of Neurology, Leiden, The Netherlands
| | - Quincy Almeida
- Sun Life Financial Movement Disorders Research & Rehabilitation Centre; Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Lee Dibble
- University of Utah, Department of Physical Therapy, Salt Lake City, Utah, USA
| | - Alice Nieuwboer
- KU Leuven, University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Bart Post
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Dept. of Neurology, Nijmegen, The Netherlands
| | - Evzen Ruzicka
- 1st Faculty of Medicine and General University Hospital, Dept. of Neurology and Centre of Clinical Neuroscience, Charles University, Prague, Czech Republic
| | - Christopher Goetz
- Department of Neurological Services, Rush University School of Medicine, Chicago, Illinois, USA
| | - Glenn Stebbins
- Department of Neurological Services, Rush University School of Medicine, Chicago, Illinois, USA
| | - Pablo Martinez-Martin
- Alzheimer Center Reina Sofia Foundation and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Anette Schrag
- UCL Institute of Neurology, University College, London, UK
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Bu LL, Yang K, Xiong WX, Liu FT, Anderson B, Wang Y, Wang J. Toward precision medicine in Parkinson's disease. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:26. [PMID: 26889479 DOI: 10.3978/j.issn.2305-5839.2016.01.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Precision medicine refers to an innovative approach selected for disease prevention and health promotion according to the individual characteristics of each patient. The goal of precision medicine is to formulate prevention and treatment strategies based on each individual with novel physiological and pathological insights into a certain disease. A multidimensional data-driven approach is about to upgrade "precision medicine" to a higher level of greater individualization in healthcare, a shift towards the treatment of individual patients rather than treating a certain disease including Parkinson's disease (PD). As one of the most common neurodegenerative diseases, PD is a lifelong chronic disease with clinical and pathophysiologic complexity, currently it is treatable but neither preventable nor curable. At its advanced stage, PD is associated with devastating chronic complications including both motor dysfunction and non-motor symptoms which impose an immense burden on the life quality of patients. Advances in computational approaches provide opportunity to establish the patient's personalized disease data at the multidimensional levels, which finally meeting the need for the current concept of precision medicine via achieving the minimal side effects and maximal benefits individually. Hence, in this review, we focus on highlighting the perspectives of precision medicine in PD based on multi-dimensional information about OMICS, molecular imaging, deep brain stimulation (DBS) and wearable sensors. Precision medicine in PD is expected to integrate the best evidence-based knowledge to individualize optimal management in future health care for those with PD.
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Affiliation(s)
- Lu-Lu Bu
- 1 Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China ; 2 School of Computing, National University of Singapore, Singapore
| | - Ke Yang
- 1 Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China ; 2 School of Computing, National University of Singapore, Singapore
| | - Wei-Xi Xiong
- 1 Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China ; 2 School of Computing, National University of Singapore, Singapore
| | - Feng-Tao Liu
- 1 Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China ; 2 School of Computing, National University of Singapore, Singapore
| | - Boyd Anderson
- 1 Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China ; 2 School of Computing, National University of Singapore, Singapore
| | - Ye Wang
- 1 Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China ; 2 School of Computing, National University of Singapore, Singapore
| | - Jian Wang
- 1 Department & Institute of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China ; 2 School of Computing, National University of Singapore, Singapore
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Parashos SA, Elm J, Boyd JT, Chou KL, Dai L, Mari Z, Morgan JC, Sudarsky L, Wielinski CL. Validation of an ambulatory capacity measure in Parkinson disease: a construct derived from the Unified Parkinson's Disease Rating Scale. JOURNAL OF PARKINSONS DISEASE 2015; 5:67-73. [PMID: 25311202 DOI: 10.3233/jpd-140405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A construct calculated as the sum of items 13-15, 29, 30 of the Unified Parkinson's Disease Rating Scale (UPDRS) has been used as an "Ambulatory Capacity Measure" (ACM) in Parkinson disease (PD). Its construct validity has never been examined. A similar construct, consisting of the mean value of the same UPDRS items has been used under the acronym PIGD as a measure of postural instability and gait disorder in PD. OBJECTIVE To examine the construct validity of the ACM and PIGD in PD. METHODS We analyzed data in an existing database of 340 PD patients, Hoehn and Yahr stages (HYS) 1-5 who participated in a study of falls. Number of falls (NOF) was recorded over 4 weeks, and UPDRS (mental, ADL, and motor subscales), HYS, Activities Based Confidence Scale (ABC), Freezing of Gait Questionnaire (FOG), Five Times Sit-to-Stand (FTSS), Timed Up-and Go (TUG), Gait Velocity (GV), and Berg Balance Scale (BBS) evaluations were performed. Internal consistency was assessed by Cronbach's alpha. Construct validity was assessed through correlations of the ACM and PIGD to these measures and to their summed-ranks. A coefficient of determination was calculated through linear regression. RESULTS Mean age was 71.4, mean age at diagnosis 61.4 years; 46% were women; mean UPDRS subscale scores were: Mental 3.7; ADL 15.7; motor: 27.1; mean ACM was 6.51, and mean PIGD 1.30. Cronbach's alpha was 0.78 for both ACM and PIGD. Spearman correlation coefficients between the ACM/PIGD and ABC, FOG, TUG, GV and BBS were 0.69, 0.72, 0.67, 0.58, and 0.70 respectively. Correlation between the ACM/PIGD and summed-ranks of HYS, NOF, ABC, FOG, FTSS, TUG, GV and BBS was high (Spearman r = 0.823, p < 0.0001); 68% of the variability in the summed-ranks was explained by ACM/PIGD. CONCLUSION The ACM and the PIGD are valid global measures and accurately reflect the combined effects of the various components of ambulatory capacity in PD patients with HY stages 1-4.
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Affiliation(s)
| | - Jordan Elm
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - James T Boyd
- Department of Neurological Sciences, University of Vermont, Burlington, VT, USA
| | - Kelvin L Chou
- Department of Neurology and Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Lin Dai
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Zoltan Mari
- Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - John C Morgan
- Department of Neurology, Georgia Regents University, Augusta, GA, USA
| | - Lewis Sudarsky
- Department of Neurology, Brigham & Women's Hospital, Boston, MA, USA
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Association between Community Ambulation Walking Patterns and Cognitive Function in Patients with Parkinson's Disease: Further Insights into Motor-Cognitive Links. PARKINSONS DISEASE 2015; 2015:547065. [PMID: 26605103 PMCID: PMC4641932 DOI: 10.1155/2015/547065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/10/2015] [Accepted: 10/04/2015] [Indexed: 11/30/2022]
Abstract
Background. Cognitive function is generally evaluated based on testing in the clinic, but this may not always reflect real-life function. We tested whether parameters derived from long-term, continuous monitoring of gait are associated with cognitive function in patients with Parkinson's disease (PD). Methods. 107 patients with PD (age: 64.9 ± 9.3 yrs; UPDRS motor sum “off”: 40.4 ± 13.2; 25.23% women) wore a 3D accelerometer on their lower back for 3 days. Computerized measures of global cognitive function, executive function, attention, and nonverbal memory were assessed. Three-day acceleration derived measures included cadence, variability, bilateral coordination, and dynamic postural control. Associations between the acceleration derived measures and cognitive function were determined. Results. Linear regression showed associations between vertical gait variability and cadence and between global cognitive score, attention, and executive function (p ≤ 0.048). Dynamic postural control was associated with global cognitive score and attention (p ≤ 0.027). Nonverbal memory was not associated with the acceleration-derived measures. Conclusions. These findings suggest that metrics derived from a 3-day worn body-fixed sensor reflect cognitive function, further supporting the idea that the gait pattern may be altered as cognition declines and that gait provides a window into cognitive function in patients with PD.
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Bonnyaud C, Pradon D, Vuillerme N, Bensmail D, Roche N. Spatiotemporal and Kinematic Parameters Relating to Oriented Gait and Turn Performance in Patients with Chronic Stroke. PLoS One 2015; 10:e0129821. [PMID: 26091555 PMCID: PMC4474885 DOI: 10.1371/journal.pone.0129821] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/13/2015] [Indexed: 11/19/2022] Open
Abstract
Background The timed up and go test (TUG) is a functional test which is increasingly used to evaluate patients with stroke. The outcome measured is usually global TUG performance-time. Assessment of spatiotemporal and kinematic parameters during the Oriented gait and Turn sub-tasks of the TUG would provide a better understanding of the mechanisms underlying patients’ performance and therefore may help to guide rehabilitation. The aim of this study was thus to determine the spatiotemporal and kinematic parameters which were most related to the walking and turning sub-tasks of TUG performance in stroke patients. Methods 29 stroke patients carried out the TUG test which was recorded using an optoelectronic system in two conditions: spontaneous and standardized condition (standardized foot position and instructed to turn towards the paretic side). They also underwent a clinical assessment. Stepwise regression was used to determine the parameters most related to Oriented gait and Turn sub-tasks. Relationships between explanatory parameters of Oriented gait and Turn performance and clinical scales were evaluated using Spearman correlations. Results Step length and cadence explained 82% to 95% of the variance for the walking sub-tasks in both conditions. Percentage single support phase and contralateral swing phase (depending on the condition) respectively explained 27% and 56% of the variance during the turning sub-task in the spontaneous and standardized conditions. Discussion and Conclusion Step length, cadence, percentage of paretic single support phase and non-paretic swing phase, as well as dynamic stability were the main parameters related to TUG performance and they should be targeted in rehabilitation.
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Affiliation(s)
- Céline Bonnyaud
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, APHP Service de physiologie et d’exploration fonctionnelle, Hôpital Raymond Poincaré, 92380, Garches, France
- * E-mail:
| | - Didier Pradon
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, APHP Service de physiologie et d’exploration fonctionnelle, Hôpital Raymond Poincaré, 92380, Garches, France
| | - Nicolas Vuillerme
- Univ. Grenoble Alpes Laboratoire AGIM, La Tronche, France
- Institut Universitaire de France, Paris, France
| | - Djamel Bensmail
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, APHP Service de Médecine Physique et Réadaptation, Hôpital R. Poincaré, AP-HP, Garches, France
| | - Nicolas Roche
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, APHP Service de physiologie et d’exploration fonctionnelle, Hôpital Raymond Poincaré, 92380, Garches, France
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Brucki SMD. Timed Up and Go test: a simple test gives important information in elderly. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:185-6. [PMID: 25807121 DOI: 10.1590/0004-282x20140243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 02/18/2015] [Indexed: 11/22/2022]
Affiliation(s)
- Sonia Maria Dozzi Brucki
- Grupo de Neurologia Cognitiva e Comportamental, Universidade de São Paulo, Sao Paulo, SP, Brazil
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Abstract
This perspective article will discuss the potential role of body-worn movement monitors for balance and gait assessment and treatment in rehabilitation. Recent advances in inexpensive, wireless sensor technology and smart devices are resulting in an explosion of miniature, portable sensors that can quickly and accurately quantify body motion. Practical and useful movement monitoring systems are now becoming available. It is critical that therapists understand the potential advantages and limitations of such emerging technology. One important advantage of obtaining objective measures of balance and gait from body-worn sensors is impairment-level metrics characterizing how and why functional performance of balance and gait activities are impaired. Therapy can then be focused on the specific physiological reasons for difficulty in walking or balancing during specific tasks. A second advantage of using technology to measure balance and gait behavior is the increased sensitivity of the balance and gait measures to document mild disability and change with rehabilitation. A third advantage of measuring movement, such as postural sway and gait characteristics, with body-worn sensors is the opportunity for immediate biofeedback provided to patients that can focus attention and enhance performance. In the future, body-worn sensors may allow therapists to perform telerehabilitation to monitor compliance with home exercise programs and the quality of their natural mobility in the community. Therapists need technological systems that are quick to use and provide actionable information and useful reports for their patients and referring physicians. Therapists should look for systems that provide measures that have been validated with respect to gold standard accuracy and to clinically relevant outcomes such as fall risk and severity of disability.
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Cognitive function and other non-motor features in non-demented Parkinson’s disease motor subtypes. J Neural Transm (Vienna) 2014; 122:1115-24. [DOI: 10.1007/s00702-014-1349-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
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Gait and balance in Parkinson’s disease subtypes: objective measures and classification considerations. J Neurol 2014; 261:2401-10. [DOI: 10.1007/s00415-014-7513-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 09/18/2014] [Accepted: 09/18/2014] [Indexed: 10/24/2022]
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