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Hinchliffe C, Rehman RZU, Pinaud C, Branco D, Jackson D, Ahmaniemi T, Guerreiro T, Chatterjee M, Manyakov NV, Pandis I, Davies K, Macrae V, Aufenberg S, Paulides E, Hildesheim H, Kudelka J, Emmert K, Van Gassen G, Rochester L, van der Woude CJ, Reilmann R, Maetzler W, Ng WF, Del Din S. Evaluation of walking activity and gait to identify physical and mental fatigue in neurodegenerative and immune disorders: preliminary insights from the IDEA-FAST feasibility study. J Neuroeng Rehabil 2024; 21:94. [PMID: 38840208 PMCID: PMC11151484 DOI: 10.1186/s12984-024-01390-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/21/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Many individuals with neurodegenerative (NDD) and immune-mediated inflammatory disorders (IMID) experience debilitating fatigue. Currently, assessments of fatigue rely on patient reported outcomes (PROs), which are subjective and prone to recall biases. Wearable devices, however, provide objective and reliable estimates of gait, an essential component of health, and may present objective evidence of fatigue. This study explored the relationships between gait characteristics derived from an inertial measurement unit (IMU) and patient-reported fatigue in the IDEA-FAST feasibility study. METHODS Participants with IMIDs and NDDs (Parkinson's disease (PD), Huntington's disease (HD), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), primary Sjogren's syndrome (PSS), and inflammatory bowel disease (IBD)) wore a lower-back IMU continuously for up to 10 days at home. Concurrently, participants completed PROs (physical fatigue (PF) and mental fatigue (MF)) up to four times a day. Macro (volume, variability, pattern, and acceleration vector magnitude) and micro (pace, rhythm, variability, asymmetry, and postural control) gait characteristics were extracted from the accelerometer data. The associations of these measures with the PROs were evaluated using a generalised linear mixed-effects model (GLMM) and binary classification with machine learning. RESULTS Data were recorded from 72 participants: PD = 13, HD = 9, RA = 12, SLE = 9, PSS = 14, IBD = 15. For the GLMM, the variability of the non-walking bouts length (in seconds) with PF returned the highest conditional R2, 0.165, and with MF the highest marginal R2, 0.0018. For the machine learning classifiers, the highest accuracy of the current analysis was returned by the micro gait characteristics with an intrasubject cross validation method and MF as 56.90% (precision = 43.9%, recall = 51.4%). Overall, the acceleration vector magnitude, bout length variation, postural control, and gait rhythm were the most interesting characteristics for future analysis. CONCLUSIONS Counterintuitively, the outcomes indicate that there is a weak relationship between typical gait measures and abnormal fatigue. However, factors such as the COVID-19 pandemic may have impacted gait behaviours. Therefore, further investigations with a larger cohort are required to fully understand the relationship between gait and abnormal fatigue.
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Affiliation(s)
- Chloe Hinchliffe
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, The Catalyst, 3 Science Square, Room 3.27, Newcastle Upon Tyne, NE4 5TG, UK
| | | | | | - Diogo Branco
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Dan Jackson
- Open Lab, School of Computing, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Tiago Guerreiro
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | | | | | | | - Kristen Davies
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, The Catalyst, 3 Science Square, Room 3.27, Newcastle Upon Tyne, NE4 5TG, UK
| | - Victoria Macrae
- NIHR Newcastle Clinical Research Facility, Newcastle Upon Tyne, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Emma Paulides
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Hanna Hildesheim
- Department of Neurology, University Medical Center Schleswig-Holstein Campus, Kiel, Germany
| | - Jennifer Kudelka
- Department of Neurology, University Medical Center Schleswig-Holstein Campus, Kiel, Germany
| | - Kirsten Emmert
- Department of Neurology, University Medical Center Schleswig-Holstein Campus, Kiel, Germany
| | | | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, The Catalyst, 3 Science Square, Room 3.27, Newcastle Upon Tyne, NE4 5TG, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - C Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | | | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein Campus, Kiel, Germany
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, The Catalyst, 3 Science Square, Room 3.27, Newcastle Upon Tyne, NE4 5TG, UK
- NIHR Newcastle Clinical Research Facility, Newcastle Upon Tyne, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, The Catalyst, 3 Science Square, Room 3.27, Newcastle Upon Tyne, NE4 5TG, UK.
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
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Kamble N, Pal PK. Frequency of Stimulation: The Most Important DBS Parameter in Improvement of Freezing of Gait in Parkinson's Disease. Ann Indian Acad Neurol 2024; 27:120-121. [PMID: 38751920 PMCID: PMC11093155 DOI: 10.4103/aian.aian_580_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 05/18/2024] Open
Affiliation(s)
- Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pramod K. Pal
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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Lheureux A, Lejeune T, Doncev I, Jeanne A, Stoquart G. Comparison of the effects of rhythmic vibrotactile stimulations and rhythmic auditory stimulations on Parkinson's disease patients' gait variability: a pilot study. Acta Neurol Belg 2024; 124:161-168. [PMID: 37597161 DOI: 10.1007/s13760-023-02360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Parkinson's disease patients' gait is characterized by shorter step length, reduced gait velocity and deterioration of temporal organization of stride duration variability (modified Long Range Autocorrelations). The objective of this study was to compare effects of rhythmic auditory stimulations (RAS) and Rhythmic Vibrotactile Stimulations (RVS) on Parkinson's disease patients' gait. METHODS Ten Parkinson's disease patients performed three walking conditions lasting 5-7 min each: control condition (CC), RAS condition and RVS condition. Inertial measurement units were used to assess spatiotemporal gait parameters. Stride duration variability was assessed in terms of magnitude using coefficient of variation and in terms of temporal organization (i.e., Long Range Autocorrelations computation) using the evenly spaced averaged Detrended Fluctuation Analysis (α-DFA exponent). RESULTS Gait velocity was significantly higher during RAS condition than during CC (Cohen's d = 0.52) and similar to RVS condition (Cohen's d = 0.17). Cadence was significantly higher during RAS (Cohen's d = 0.77) and RVS (Cohens' d = 0.56) conditions than during CC. Concerning variability, no difference was found either for mean coefficient of variation or mean α-DFA between conditions. However, a great variability of individual results between the RAS and the RVS conditions is to be noted concerning α-DFA. CONCLUSIONS RAS and RVS improved similarly PD patients' spatiotemporal gait parameters, without modifying stride duration variability in terms of magnitude and temporal organization at group level. Future studies should evaluate the relevant parameters for administering the right cueing type for the right patient. TRIAL REGISTRATION ClinicalTrial.gov registration number NCT05790759, date of registration: 16/03/2023, retrospectively registered.
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Affiliation(s)
- Alexis Lheureux
- Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- Université Catholique de Louvain, Louvain-La-Neuve, Belgium.
| | - Thierry Lejeune
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Ivan Doncev
- Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Alix Jeanne
- Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Gaëtan Stoquart
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Université Catholique de Louvain, Louvain-La-Neuve, Belgium
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Hodgson P, Jordan A, Sinani C, Charura D, Orange ST. The relationship between physical function and psychological symptoms in Parkinson's disease: A systematic review and meta-regression analysis. CNS Neurosci Ther 2024; 30:e14562. [PMID: 38334239 PMCID: PMC10853949 DOI: 10.1111/cns.14562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/21/2023] [Accepted: 12/01/2023] [Indexed: 02/10/2024] Open
Abstract
AIMS This systematic review and meta-regression aimed to examine available literature reporting measures of physical function, anxiety, and/or depression and whether any relationships exist between these measures in individuals with Parkinson's disease. METHODS MEDLINE, CINAHL, AMED, and APA PsychInfo databases were systematically searched. Screening, quality assessment, and data extraction were completed alongside meta-regression analysis. RESULTS Of 1175 studies retrieved, 40 were selected for analysis with only one study assessing the relationship between physical and psychological outcomes within their cohort. A total of 27 studies were also eligible for meta-regression analysis-a total sample of 1211 participants. Meta-regressions of five combinations of paired physical and psychological outcomes showed a significant moderating effect of symptoms of depression (Beck Depression Inventory) on mobility (Timed-Up-and-Go test; coefficient = 0.37, 95% CI 0.09 to 0.65, p = 0.012) and balance (Berg Balance Score) scores (coefficient = -1.25, 95% CI -1.77 to -0.73, p < 0.001). CONCLUSION Although physical and psychological outcomes of interest were used in all included studies, only one examined their relationship. Our analysis suggests that symptoms of depression may influence measures of mobility and balance. Specifically, as the severity of symptoms of depression increases, performance on measures of mobility and balance worsens.
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Affiliation(s)
- Philip Hodgson
- Tees, Esk and Wear Valleys NHS Foundation TrustYork St John UniversityYorkUK
- York St John UniversityYorkUK
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Ghani HA, Alghwiri AA, Hisham H, Manaf H. Lower Limb Muscle Fatigue Alters Spatiotemporal Gait Parameters and Turning Difficulty Characteristics in Parkinson's Disease. Ann Rehabil Med 2023; 47:282-290. [PMID: 37558204 PMCID: PMC10475814 DOI: 10.5535/arm.23067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To determine the effects of lower limb muscle fatigue on spatiotemporal gait parameters and turning difficulty characteristics during the extended Timed Up and Go (extended TUG) test in individuals with different severity stages of Parkinson's disease (PD). METHODS Forty individuals with PD, classified as Hoehn and Yahr (H&Y) stages 2 and 3 participated in this pre- and post-experimental study design. The participants performed a continuous sit-to-stand task from a chair based on 30 cycles/min set-up to induce lower limb muscle fatigue. They performed extended TUG test immediately before and after completing the fatigue protocol. Spatiotemporal gait parameters and turning difficulty characteristics were recorded using two GoPro® Hero 4 Silver cameras. Data were subjected to a repeated-measure ANOVA. RESULTS Individuals with PD experience significant changes in spatiotemporal gait parameters, specifically stride velocity and length, under conditions of lower limb muscle fatigue (p=0.001). These changes were more pronounced in individuals with PD in the H&Y stage 3 group. Additionally, both PD groups exhibited difficulty with turning, requiring more than five steps to complete a 180° turn and taking more than 3 seconds to accomplish it. CONCLUSION These findings highlight the impact of muscle fatigue on gait performance in PD and suggest that individuals in later stages of the disease may be particularly affected. Further research is needed to explore interventions that can mitigate these gait impairments and improve mobility in individuals with PD.
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Affiliation(s)
- Halimatul Abd Ghani
- Physiotherapy Program, Institut Latihan Kementerian Kesihatan Malaysia, Johor, Malaysia
| | - Alia A. Alghwiri
- Department of Physiotherapy, Faculty of Allied Medical Sciences, Applied Science Private University, Amman, Jordan
| | - Hafifi Hisham
- Physiotherapy Program, Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Haidzir Manaf
- Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, Puncak Alam, Malaysia
- Integrative Pharmacogenomics Institute, Universiti Teknologi MARA, Puncak Alam Campus, Puncak Alam, Malaysia
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Wang H, Hu B, Huang J, Chen L, Yuan M, Tian X, Shi T, Zhao J, Huang W. Predicting the fatigue in Parkinson's disease using inertial sensor gait data and clinical characteristics. Front Neurol 2023; 14:1172320. [PMID: 37388552 PMCID: PMC10303817 DOI: 10.3389/fneur.2023.1172320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/23/2023] [Indexed: 07/01/2023] Open
Abstract
Objectives The study aimed to analyze the clinical features and gait characteristics of patients with Parkinson's disease (PD) who also suffer from fatigue and to develop a model that can help identify fatigue states in the early stages of PD. Methodology A total of 81 PD patients have been enrolled for the Parkinson's Fatigue Scale (PFS-16) assessment and divided into two groups: patients with or without fatigue. Neuropsychological assessments of the two groups, including motor and non-motor symptoms, were collected. The patient's gait characteristics were collected using a wearable inertial sensor device. Results PD patients who experienced fatigue had a more significant impairment of motor symptoms than those who did not, and the experience of fatigue became more pronounced as the disease progressed. Patients with fatigue had more significant mood disorders and sleep disturbances, which can lead to a poorer quality of life. PD patients with fatigue had shorter step lengths, lower velocity, and stride length and increased stride length variability. As for kinematic parameters, PD patients with fatigue had lower shank-forward swing max, trunk-max sagittal angular velocity, and lumbar-max coronal angular velocity than PD patients without fatigue. The binary logistic analysis found that Movement Disorder Society-Unified Parkinson's Disease Rating Scale-I (MDS-UPDRS-I) scores, Hamilton Depression Scale (HAMD) scores, and stride length variability independently predicted fatigue in PD patients. The area under the curve (AUC) of these selected factors in the receiver operating characteristic (ROC) analysis was 0.900. Moreover, HAMD might completely mediate the association between Hamilton Anxiety Scale (HAMA) scores and fatigue (indirect effect: β = 0.032, 95% confidence interval: 0.001-0.062), with a percentage of mediation of 55.46%. Conclusion Combining clinical characteristics and gait cycle parameters, including MDS-UPDRS-I scores, HAMD scores, and stride length variability, can identify PD patients with a high fatigue risk.
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Affiliation(s)
- Hui Wang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Binbin Hu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Juan Huang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lin Chen
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Min Yuan
- Department of Neurology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Xingfu Tian
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ting Shi
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiahao Zhao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Huang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Castiglia SF, Trabassi D, Conte C, Ranavolo A, Coppola G, Sebastianelli G, Abagnale C, Barone F, Bighiani F, De Icco R, Tassorelli C, Serrao M. Multiscale Entropy Algorithms to Analyze Complexity and Variability of Trunk Accelerations Time Series in Subjects with Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2023; 23:4983. [PMID: 37430896 DOI: 10.3390/s23104983] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/14/2023] [Accepted: 05/16/2023] [Indexed: 07/12/2023]
Abstract
The aim of this study was to assess the ability of multiscale sample entropy (MSE), refined composite multiscale entropy (RCMSE), and complexity index (CI) to characterize gait complexity through trunk acceleration patterns in subjects with Parkinson's disease (swPD) and healthy subjects, regardless of age or gait speed. The trunk acceleration patterns of 51 swPD and 50 healthy subjects (HS) were acquired using a lumbar-mounted magneto-inertial measurement unit during their walking. MSE, RCMSE, and CI were calculated on 2000 data points, using scale factors (τ) 1-6. Differences between swPD and HS were calculated at each τ, and the area under the receiver operating characteristics, optimal cutoff points, post-test probabilities, and diagnostic odds ratios were calculated. MSE, RCMSE, and CIs showed to differentiate swPD from HS. MSE in the anteroposterior direction at τ4 and τ5, and MSE in the ML direction at τ4 showed to characterize the gait disorders of swPD with the best trade-off between positive and negative posttest probabilities and correlated with the motor disability, pelvic kinematics, and stance phase. Using a time series of 2000 data points, a scale factor of 4 or 5 in the MSE procedure can yield the best trade-off in terms of post-test probabilities when compared to other scale factors for detecting gait variability and complexity in swPD.
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Affiliation(s)
- Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, 00078 Monte Porzio Catone, Italy
| | - Dante Trabassi
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Carmela Conte
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Alberto Ranavolo
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Gianluca Coppola
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Gabriele Sebastianelli
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Chiara Abagnale
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Francesca Barone
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Federico Bighiani
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCSS Mondino Foundation, 27100 Pavia, Italy
| | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCSS Mondino Foundation, 27100 Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCSS Mondino Foundation, 27100 Pavia, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
- Movement Analysis Laboratory, Policlinico Italia, 00162 Rome, Italy
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The Executive-Function-Related Cognitive-Motor Dual Task Walking Performance and Task Prioritizing Effect on People with Parkinson's Disease. Healthcare (Basel) 2023; 11:healthcare11040567. [PMID: 36833101 PMCID: PMC9956339 DOI: 10.3390/healthcare11040567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023] Open
Abstract
To safely walk in a community environment requires dual cognitive-walking ambulation ability for people with Parkinson's disease (PD). A past study showed inconsistent results on cognitive-walking performance for PD patients, possibly due to the various cognitive tasks used and task priority assignment. This study designed cognitive-walking tests that used executive-related cognitive tasks to evaluate patients with early-stage Parkinson's disease who did not have obvious cognitive deficits. The effect of assigning task prioritization was also evaluated. Sixteen individuals with PD (PD group) and 16 individuals without PD (control group) underwent single cognitive tests, single walking tests, dual walking tests, and prioritizing task tests. Three types of cognitive, spatial memory, Stroops, and calculation tasks were employed. The cognitive performance was evaluated by response time, accuracy, and speed-accuracy trade off composite score. The walking performance was evaluated by the temporal spatial gait characteristics and variation in gait. The results showed that the walking performance of the PD group was significantly worse than the control group in both single and dual walking conditions. The group difference in cognitive performance was shown in composite score under the dual calculation walking task but not under the single task. While assigning priority to walking, no group difference in walking was observed but the response accuracy rate of PD groups declined. This study concluded that the dual task walking test could sharpen the cognitive deficits for early-stage PD patients. The task priority assignment might not be recommended while testing gait deficits since it decreased the ability to discriminate group differences.
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Geritz J, Welzel J, Hansen C, Maetzler C, Hobert MA, Elshehabi M, Knacke H, Aleknonytė-Resch M, Kudelka J, Bunzeck N, Maetzler W. Cognitive parameters can predict change of walking performance in advanced Parkinson's disease - Chances and limits of early rehabilitation. Front Aging Neurosci 2022; 14:1070093. [PMID: 36620765 PMCID: PMC9813446 DOI: 10.3389/fnagi.2022.1070093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Links between cognition and walking performance in patients with Parkinson's disease (PD), which both decline with disease progression, are well known. There is lack of knowledge regarding the predictive value of cognition for changes in walking performance after individualized therapy. The aim of this study is to identify relevant predictive cognitive and affective parameters, measurable in daily clinical routines, for change in quantitative walking performance after early geriatric rehabilitation. Methods Forty-seven acutely hospitalized patients with advanced PD were assessed at baseline (T1) and at the end (T2) of a 2-week early rehabilitative geriatric complex treatment (ERGCT). Global cognitive performance (Montreal Cognitive Assessment, MoCA), EF and divided attention (Trail Making Test B minus A, delta TMT), depressive symptoms, and fear of falling were assessed at T1. Change in walking performance was determined by the difference in quantitative walking parameters extracted from a sensor-based movement analysis over 20 m straight walking in single (ST, fast and normal pace) and dual task (DT, with secondary cognitive, respectively, motor task) conditions between T1 and T2. Bayesian regression (using Bayes Factor BF10) and multiple linear regression models were used to determine the association of non-motor characteristics for change in walking performance. Results Under ST, there was moderate evidence (BF10 = 7.8, respectively, BF10 = 4.4) that lower performance in the ∆TMT at baseline is associated with lower reduction of step time asymmetry after treatment (R 2 adj = 0.26, p ≤ 0.008, respectively, R 2 adj = 0.18, p ≤ 0.009). Under DT walking-cognitive, there was strong evidence (BF10 = 29.9, respectively, BF10 = 27.9) that lower performance in the ∆TMT is associated with more reduced stride time and double limb support (R 2 adj = 0.62, p ≤ 0.002, respectively, R 2 adj = 0.51, p ≤ 0.009). There was moderate evidence (BF10 = 5.1) that a higher MoCA total score was associated with increased gait speed after treatment (R 2 adj = 0.30, p ≤ 0.02). Discussion Our results indicate that the effect of ERGT on change in walking performance is limited for patients with deficits in EF and divided attention. However, these patients also seem to walk more cautiously after treatment in walking situations with additional cognitive demand. Therefore, future development of individualized treatment algorithms is required, which address individual needs of these vulnerable patients.
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Affiliation(s)
- Johanna Geritz
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany,Department of Psychology, University of Lübeck, Lübeck, Germany,*Correspondence: Johanna Geritz,
| | - Julius Welzel
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Markus A. Hobert
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Morad Elshehabi
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Henrike Knacke
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Jennifer Kudelka
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nico Bunzeck
- Department of Psychology, University of Lübeck, Lübeck, Germany,Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
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Profiles of Motor-Cognitive Interference in Parkinson's Disease-The Trail-Walking-Test to Discriminate between Motor Phenotypes. Brain Sci 2022; 12:brainsci12091217. [PMID: 36138953 PMCID: PMC9497145 DOI: 10.3390/brainsci12091217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Aims. Most research on Parkinson’s disease (PD) focuses on describing symptoms and movement characteristics. Studies rarely focus on the early detection of PD and the search for suitable markers of a prodromal stage. Early detection is important, so treatments that may potentially change the course of the disease can be attempted early on. While gait disturbances are less pronounced in the early stages of the disease, the prevalence, and severity increase with disease progression. Therefore, postural instability and gait difficulties could be identified as sensitive biomarkers. The aim was to evaluate the discriminatory power of the Trail-Walking Test (TWT; Schott, 2015) as a potential diagnostic instrument to improve the predictive power of the clinical evaluation concerning the severity of the disease and record the different aspects of walking. Methods. A total of 20 older healthy (M = 72.4 years, SD = 5.53) adults and 43 older adults with PD and the motor phenotypes postural instability/gait difficulty (PIGD; M = 69.7 years, SD = 8.68) and tremor dominant (TD; M = 68.2 years, SD = 8.94) participated in the study. The participants performed a motor-cognitive dual task (DT) of increasing cognitive difficulty in which they had to walk a given path (condition 1), walk to numbers in ascending order (condition 2), and walk to numbers and letters alternately and in ascending order (condition 3). Results. With an increase in the cognitive load, the time to complete the tasks (seconds) became longer in all groups, F(1.23, 73.5) = 121, p < 0.001, ɳ2p = 0.670. PIGD showed the longest times in all conditions of the TWT, F(2, 60) = 8.15, p < 0.001, ɳ2p = 0.214. Mutual interferences in the cognitive and motor domain can be observed. However, clear group-specific patterns cannot be identified. A differentiation between the motor phenotypes of PD is especially feasible with the purely motor condition (TWT-M; AUC = 0.685, p = 0.44). Conclusions. PD patients with PIGD must be identified by valid, well-evaluated clinical tests that allow for a precise assessment of the disease’s individual fall risk, the severity of the disease, and the prognosis of progression. The TWT covers various aspects of mobility, examines the relationship between cognitive functions and walking, and enables differentiation of the motor phenotypes of PD.
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Geritz J, Welzel J, Hansen C, Maetzler C, Hobert MA, Elshehabi M, Sobczak A, Kudelka J, Stiel C, Hieke J, Alpes A, Bunzeck N, Maetzler W. Does Executive Function Influence Walking in Acutely Hospitalized Patients With Advanced Parkinson's Disease: A Quantitative Analysis. Front Neurol 2022; 13:852725. [PMID: 35928127 PMCID: PMC9344922 DOI: 10.3389/fneur.2022.852725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionIt is well-known that, in Parkinson's disease (PD), executive function (EF) and motor deficits lead to reduced walking performance. As previous studies investigated mainly patients during the compensated phases of the disease, the aim of this study was to investigate the above associations in acutely hospitalized patients with PD.MethodsA total of seventy-four acutely hospitalized patients with PD were assessed with the delta Trail Making Test (ΔTMT, TMT-B minus TMT-A) and the Movement Disorder Society-revised version of the motor part of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS III). Walking performance was assessed with wearable sensors under single (ST; fast and normal pace) and dual-task (DT; walking and checking boxes as the motor secondary task and walking and subtracting seven consecutively from a given three-digit number as the cognitive secondary task) conditions over 20 m. Multiple linear regression and Bayes factor BF10 were performed for each walking parameter and their dual-task costs while walking (DTC) as dependent variables and also included ΔTMT, MDS-UPDRS III, age, and gender.ResultsUnder ST, significant negative effects of the use of a walking aid and MDS-UPDRS III on gait speed and at a fast pace on the number of steps were observed. Moreover, depending on the pace, the use of a walking aid, age, and gender affected step time variability. Under walking-cognitive DT, a resolved variance of 23% was observed in the overall model for step time variability DTC, driven mainly by age (β = 0.26, p = 0.09). Under DT, no other significant effects could be observed. ΔTMT showed no significant associations with any of the walking conditions.DiscussionThe results of this study suggest that, in acutely hospitalized patients with PD, reduced walking performance is mainly explained by the use of a walking aid, motor symptoms, age, and gender, and EF deficits surprisingly do not seem to play a significant role. However, these patients with PD should avoid walking-cognitive DT situations, as under this condition, especially step time variability, a parameter associated with the risk of falling in PD worsens.
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Affiliation(s)
- Johanna Geritz
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Psychology and Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- *Correspondence: Johanna Geritz
| | - Julius Welzel
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Markus A. Hobert
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Morad Elshehabi
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Alexandra Sobczak
- Department of Psychology and Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Jennifer Kudelka
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christopher Stiel
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Johanne Hieke
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Annekathrin Alpes
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nico Bunzeck
- Department of Psychology and Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
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12
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Elshehabi M, Del Din S, Hobert MA, Warmerdam E, Sünkel U, Schmitz-Hübsch T, Behncke LM, Heinzel S, Brockmann K, Metzger FG, Schlenstedt C, Rochester L, Hansen C, Berg D, Maetzler W. Walking parameters of older adults from a lower back inertial measurement unit, a 6-year longitudinal observational study. Front Aging Neurosci 2022; 14:789220. [PMID: 36172482 PMCID: PMC9511986 DOI: 10.3389/fnagi.2022.789220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
Gait changes during aging and differs between sexes. Inertial measurement units (IMUs) enable accurate quantitative evaluations of gait in ambulatory environments and in large populations. This study aims to provide IMU-based gait parameters' values derived from a large longitudinal cohort study in older adults. We measured gait parameters, such as velocity, step length, time, variability, and asymmetry, from straight, self-paced 20-m walks in older adults (four visits: 715/1102/1017/957 participants) every second year over 6 years using an IMU at the lower back. Moreover, we calculated the associations of gait parameters with sex and age. Women showed lower gait speed, step length, step time, stride time, swing time, and stance time, compared to men. Longitudinal analyses suggest that these parameters are at least partly deteriorating within the assessment period of 2 years, especially in men and at an older age. Variability and asymmetry parameters show a less clear sex- and age-associated pattern. Altogether, our large longitudinal dataset provides the first sex-specific information on which parameters are particularly promising for the detection of age-related gait changes that can be extracted from an IMU on the lower back. This information may be helpful for future observational and treatment studies investigating sex and age-related effects on gait, as well as for studies investigating age-related diseases.
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Affiliation(s)
- Morad Elshehabi
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Markus A Hobert
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Elke Warmerdam
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Ulrike Sünkel
- German Center for Neurodegenerative Diseases DZNE, Tübingen, Germany.,Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, a cooperation of Max-Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Kathrin Brockmann
- German Center for Neurodegenerative Diseases DZNE, Tübingen, Germany.,Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany
| | - Florian G Metzger
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Geriatric Center, University of Tübingen, Tübingen, Germany
| | | | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Clint Hansen
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany.,Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tübingen, Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
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13
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Greene BR, Premoli I, McManus K, McGrath D, Caulfield B. Predicting Fall Counts Using Wearable Sensors: A Novel Digital Biomarker for Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2021; 22:54. [PMID: 35009599 PMCID: PMC8747473 DOI: 10.3390/s22010054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
People with Parkinson's disease (PD) experience significant impairments to gait and balance; as a result, the rate of falls in people with Parkinson's disease is much greater than that of the general population. Falls can have a catastrophic impact on quality of life, often resulting in serious injury and even death. The number (or rate) of falls is often used as a primary outcome in clinical trials on PD. However, falls data can be unreliable, expensive and time-consuming to collect. We sought to validate and test a novel digital biomarker for PD that uses wearable sensor data obtained during the Timed Up and Go (TUG) test to predict the number of falls that will be experienced by a person with PD. Three datasets, containing a total of 1057 (671 female) participants, including 71 previously diagnosed with PD, were included in the analysis. Two statistical approaches were considered in predicting falls counts: the first based on a previously reported falls risk assessment algorithm, and the second based on elastic net and ensemble regression models. A predictive model for falls counts in PD showed a mean R2 value of 0.43, mean error of 0.42 and a mean correlation of 30% when the results were averaged across two independent sets of PD data. The results also suggest a strong association between falls counts and a previously reported inertial sensor-based falls risk estimate. In addition, significant associations were observed between falls counts and a number of individual gait and mobility parameters. Our preliminary research suggests that the falls counts predicted from the inertial sensor data obtained during a simple walking task have the potential to be developed as a novel digital biomarker for PD, and this deserves further validation in the targeted clinical population.
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Affiliation(s)
| | - Isabella Premoli
- Biomarker Department, Division of Experimental Medicine, H. Lundbeck A/S, 2500 Copenhagen, Denmark;
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King′s College London, London SE5 9RX, UK
| | - Killian McManus
- Kinesis Health Technologies Ltd., D04 V2N9 Dublin, Ireland;
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland;
| | - Denise McGrath
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland;
| | - Brian Caulfield
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland;
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland;
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14
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Sheng W, Guo T, Zhou C, Wu J, Gao T, Pu J, Zhang B, Zhang M, Yang Y, Guan X, Xu X. Altered Cortical Cholinergic Network in Parkinson's Disease at Different Stage: A Resting-State fMRI Study. Front Aging Neurosci 2021; 13:723948. [PMID: 34566625 PMCID: PMC8461333 DOI: 10.3389/fnagi.2021.723948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
The cholinergic system is critical in Parkinson’s disease (PD) pathology, which accounts for various clinical symptoms in PD patients. The substantia innominata (SI) provides the main source of cortical cholinergic innervation. Previous studies revealed cholinergic-related dysfunction in PD pathology at early stage. Since PD is a progressive disorder, alterations of cholinergic system function along with the PD progression have yet to be elucidated. Seventy-nine PD patients, including thirty-five early-stage PD patients (PD-E) and forty-four middle-to-late stage PD patients (PD-M), and sixty-four healthy controls (HC) underwent brain magnetic resonance imaging and clinical assessments. We employed seed-based resting-state functional connectivity analysis to explore the cholinergic-related functional alterations. Correlation analysis was used to investigate the relationship between altered functional connectivity and the severity of motor symptoms in PD patients. Results showed that both PD-E and PD-M groups exhibited decreased functional connectivity between left SI and left frontal inferior opercularis areas and increased functional connectivity between left SI and left cingulum middle area as well as right primary motor and sensory areas when comparing with HC. At advanced stages of PD, functional connectivity in the right primary motor and sensory areas was further increased. These altered functional connectivity were also significantly correlated with the Unified Parkinson’s Disease Rating Scale motor scores. In conclusion, this study illustrated that altered cholinergic function plays an important role in the motor disruptions in PD patients both in early stage as well as during the progression of the disease.
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Affiliation(s)
- Wenshuang Sheng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ting Gao
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiali Pu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Xu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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15
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Sigurdsson HP, Raw R, Hunter H, Baker MR, Taylor JP, Rochester L, Yarnall AJ. Noninvasive vagus nerve stimulation in Parkinson's disease: current status and future prospects. Expert Rev Med Devices 2021; 18:971-984. [PMID: 34461787 DOI: 10.1080/17434440.2021.1969913] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is a common progressive neurodegenerative disorder with multifactorial etiology. While dopaminergic medication is the standard therapy in PD, it provides limited symptomatic treatment and non-pharmacological interventions are currently being trialed. AREAS COVERED Recent pathophysiological theories of Parkinson's suggest that aggregated α-synuclein form in the gut and spread to nuclei in the brainstem via autonomic connections. In this paper, we review the novel hypothesis that noninvasive vagus nerve stimulation (nVNS), targeting efferent and afferent vagal projections, is a promising therapeutic tool to improve gait and cognitive control and ameliorate non-motor symptoms in people with Parkinson's. We conducted an unstructured search of the literature for any studies employing nVNS in PD as well as for studies examining the efficacy of nVNS on improving cognitive function and where nVNS has been applied to co-occurring conditions in PD. EXPERT OPINION Evidence of nVNS as a novel therapeutic to improve gait in PD is preliminary, but early signs indicate the possibility that nVNS may be useful to target dopa-resistant gait characteristics in early PD. The evidence for nVNS as a therapeutic tool is, however, limited and further studies are needed in both brain health and disease.
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Affiliation(s)
- Hilmar P Sigurdsson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Rachael Raw
- Department of General Internal Medicine, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Heather Hunter
- Department of Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mark R Baker
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Clinical Neurophysiology, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Neurosciences, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Older People's Medicine, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
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16
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Vitorio R, Hasegawa N, Carlson-Kuhta P, Nutt JG, Horak FB, Mancini M, Shah VV. Dual-Task Costs of Quantitative Gait Parameters While Walking and Turning in People with Parkinson's Disease: Beyond Gait Speed. JOURNAL OF PARKINSONS DISEASE 2021; 11:653-664. [PMID: 33386812 DOI: 10.3233/jpd-202289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is a lack of recommendations for selecting the most appropriate gait measures of Parkinson's disease (PD)-specific dual-task costs to use in clinical practice and research. OBJECTIVE We aimed to identify measures of dual-task costs of gait and turning that best discriminate performance in people with PD from healthy individuals. We also investigated the relationship between the most discriminative measures of dual-task costs of gait and turning with disease severity and disease duration. METHODS People with mild-to-moderate PD (n = 144) and age-matched healthy individuals (n = 79) wore 8 inertial sensors while walking under single and dual-task (reciting every other letter of the alphabet) conditions. Outcome measures included 26 objective measures within four gait domains (upper/lower body, turning and variability). The area under the curve (AUC) from the receiver-operator characteristic plot was calculated to compare discriminative ability of dual-task costs on gait across outcome measures. RESULTS PD-specific, dual-task interference was identified for arm range of motion, foot strike angle, turn velocity and turn duration. Arm range of motion (AUC = 0.73) and foot strike angle (AUC = 0.68) had the largest AUCs across dual-task costs measures and they were associated with disease severity and/or disease duration. In contrast, the most commonly used dual-task gait measure, gait speed, showed an AUC of only 0.54. CONCLUSION Findings suggest that people with PD rely more than healthy individuals on executive-attentional resources to control arm swing, foot strike, and turning, but not gait speed. The dual-task costs of arm range of motion best discriminated people with PD from healthy individuals.
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Affiliation(s)
- Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Naoya Hasegawa
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | | | - John G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
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17
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Chheng C, Wilson D. Abnormal Gait Detection Using Wearable Hall-Effect Sensors. SENSORS 2021; 21:s21041206. [PMID: 33572170 PMCID: PMC7915068 DOI: 10.3390/s21041206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 01/07/2023]
Abstract
Abnormalities and irregularities in walking (gait) are predictors and indicators of both disease and injury. Gait has traditionally been monitored and analyzed in clinical settings using complex video (camera-based) systems, pressure mats, or a combination thereof. Wearable gait sensors offer the opportunity to collect data in natural settings and to complement data collected in clinical settings, thereby offering the potential to improve quality of care and diagnosis for those whose gait varies from healthy patterns of movement. This paper presents a gait monitoring system designed to be worn on the inner knee or upper thigh. It consists of low-power Hall-effect sensors positioned on one leg and a compact magnet positioned on the opposite leg. Wireless data collected from the sensor system were used to analyze stride width, stride width variability, cadence, and cadence variability for four different individuals engaged in normal gait, two types of abnormal gait, and two types of irregular gait. Using leg gap variability as a proxy for stride width variability, 81% of abnormal or irregular strides were accurately identified as different from normal stride. Cadence was surprisingly 100% accurate in identifying strides which strayed from normal, but variability in cadence provided no useful information. This highly sensitive, non-contact Hall-effect sensing method for gait monitoring offers the possibility for detecting visually imperceptible gait variability in natural settings. These nuanced changes in gait are valuable for predicting early stages of disease and also for indicating progress in recovering from injury.
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Affiliation(s)
- Courtney Chheng
- Department of Electrical Engineering, University of Washington Bothell, Bothell, WA 98011, USA
- Correspondence: ; Tel.: +1-425-280-2564
| | - Denise Wilson
- Department of Electrical and Computer Engineering, University of Washington Seattle, Seattle, WA 98195, USA;
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Yun SJ, Lee HH, Lee WH, Lee SH, Oh BM, Seo HG. Effect of robot-assisted gait training on gait automaticity in Parkinson disease: A prospective, open-label, single-arm, pilot study. Medicine (Baltimore) 2021; 100:e24348. [PMID: 33592882 PMCID: PMC7870221 DOI: 10.1097/md.0000000000024348] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/17/2020] [Accepted: 12/27/2020] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Gait automaticity is reduced in patients with Parkinson disease (PD) due to impaired habitual control. The aim of this study was to investigate the effect of robot-assisted gait training (RAGT) on gait automaticity as well as gait speed and balance in patients with PD.This study was a prospective, open-label, single-arm, pilot study. We planned to recruit 12 patients with idiopathic PD. Participants received 12 sessions of RAGT using exoskeleton-type robotic device. Sessions were 45-minute each, 3 days a week, for 4 consecutive weeks using an exoskeleton-type gait robot. The primary outcome was the percentage of dual-task interference measured by the 10-Meter Walk Test (10MWT) under single and dual-task (cognitive and physical) conditions. Secondary outcomes were the Berg Balance Scale and Korean version of the Falls Efficacy Scale-International. All measures were evaluated before treatment (T0), after treatment (T1), and 1-month post-treatment (T2).Twelve patients were enrolled and 1 dropped out. Finally, 11 patients with idiopathic PD were analyzed. The mean age of 11 patients (5 males) was 66.46 ± 5.66 years, and disease duration was 112.91 ± 50.19 months. The Hoehn and Yahr stages were 2.5 in 8 patients and 3 in 3 patients. Linear mixed-effect model analysis showed a significant change over time only in single-task gait speed of the 10MWT (P = .007), but not in dual-task gait speed, dual-task interferences, and Korean version of the Falls Efficacy Scale-International. Cognitive dual-task interference significantly increased (P = .026) at T1, but not at T2 (P = .203). No significant changes were observed for physical dual-task interference at T1 and T2. Single-task gait speed of the 10MWT was significantly increased at T1 (P = .041), but not at T2 (P = .445). There were no significant changes in the dual-task gait speed of 10MWT. A significant improvement was observed in Berg Balance Scale score at T1 and T2 (P = .004 and P = .024, respectively).In this pilot study, despite improvement in walking speed and balance, gait automaticity in patients with PD was not improved by RAGT using an exoskeleton-type robot. Additional therapeutic components may be needed to improve gait automaticity using RAGT in patients with PD.
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Affiliation(s)
- Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital
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19
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Marquez JS, Hasan SMS, Siddiquee MR, Luca CC, Mishra VR, Mari Z, Bai O. Neural Correlates of Freezing of Gait in Parkinson's Disease: An Electrophysiology Mini-Review. Front Neurol 2020; 11:571086. [PMID: 33240199 PMCID: PMC7683766 DOI: 10.3389/fneur.2020.571086] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022] Open
Abstract
Freezing of gait (FoG) is a disabling symptom characterized as a brief inability to step or by short steps, which occurs when initiating gait or while turning, affecting over half the population with advanced Parkinson's disease (PD). Several non-competing hypotheses have been proposed to explain the pathophysiology and mechanism behind FoG. Yet, due to the complexity of FoG and the lack of a complete understanding of its mechanism, no clear consensus has been reached on the best treatment options. Moreover, most studies that aim to explore neural biomarkers of FoG have been limited to semi-static or imagined paradigms. One of the biggest unmet needs in the field is the identification of reliable biomarkers that can be construed from real walking scenarios to guide better treatments and validate medical and therapeutic interventions. Advances in neural electrophysiology exploration, including EEG and DBS, will allow for pathophysiology research on more real-to-life scenarios for better FoG biomarker identification and validation. The major aim of this review is to highlight the most up-to-date studies that explain the mechanisms underlying FoG through electrophysiology explorations. The latest methodological approaches used in the neurophysiological study of FoG are summarized, and potential future research directions are discussed.
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Affiliation(s)
- J. Sebastian Marquez
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, United States
| | - S. M. Shafiul Hasan
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, United States
| | - Masudur R. Siddiquee
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, United States
| | - Corneliu C. Luca
- Department of Neurology, University of Miami Hospital, Miami, FL, United States
| | - Virendra R. Mishra
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, United States
| | - Zoltan Mari
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, United States
| | - Ou Bai
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL, United States
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20
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Onder H, Ozyurek O. The impact of distinct cognitive dual-tasks on gait in Parkinson's disease and the associations with the clinical features of Parkinson's disease. Neurol Sci 2020; 42:2775-2783. [PMID: 33150515 DOI: 10.1007/s10072-020-04874-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
AIMS To investigate the impact of distinct cognitive dual-task abilities in patients with Parkinson's disease (PD) and compare the impact of these dual-tasks in association with the severity of PD and its clinical features. MATERIALS AND METHODS Modified Hoehn and Yahr Scale, UPDRS, and Standardized Mini-Mental State Examination (SMMSE) were evaluated in all PD patients. The subtype of PD and the presence of freezing of gait (FOG) were also evaluated. The Timed Up and Go (TUG) test was applied under single- and dual-task conditions including the digit span-forwards, digit span-backwards, delayed recall memory, counting down the days, counting backwards from 20, and animal fluency tests. RESULTS Most of the cognitive dual-tasks resulted in deterioration in gait performance in our PD subjects. Remarkably, the completion time of TUG duration under single- and dual-task of counting down days was higher in the FOG (+) PD subjects (p = 0.008, p = 0.050, respectively). Besides, the TUG duration under the dual-task of counting down days was found to be positively correlated with the UPDRS-motor scores and FOG scores. CONCLUSION We think that the concurrent execution of the dual-task of counting down days, which requires complex attentional skills, may disturb gait via a mechanism of overloading of the attentional reserves proceeding gait which is already defective in PD subjects. The neural correlate of this domain and its significance in performing dual-tasks in PD should be investigated in future large-scale studies. The results of these studies may provide substantial perspectives regarding the pathophysiology of gait disturbance in PD.
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Affiliation(s)
- Halil Onder
- Department of Neurology, Yozgat City Hospital, Yozgat, Turkey.
| | - Ozge Ozyurek
- Department of Psychology, Yozgat City Hospital, Yozgat, Turkey
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21
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Wilson J, Alcock L, Yarnall AJ, Lord S, Lawson RA, Morris R, Taylor JP, Burn DJ, Rochester L, Galna B. Gait Progression Over 6 Years in Parkinson's Disease: Effects of Age, Medication, and Pathology. Front Aging Neurosci 2020; 12:577435. [PMID: 33192470 PMCID: PMC7593770 DOI: 10.3389/fnagi.2020.577435] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/09/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Gait disturbance is an early, cardinal feature of Parkinson's disease (PD) associated with falls and reduced physical activity. Progression of gait impairment in Parkinson's disease is not well characterized and a better understanding is imperative to mitigate impairment. Subtle gait impairments progress in early disease despite optimal dopaminergic medication. Evaluating gait disturbances over longer periods, accounting for typical aging and dopaminergic medication changes, will enable a better understanding of gait changes and inform targeted therapies for early disease. This study aimed to describe gait progression over the first 6 years of PD by delineating changes associated with aging, medication, and pathology. Methods: One-hundred and nine newly diagnosed PD participants and 130 controls completed at least two gait assessments. Gait was assessed at 18-month intervals for up to 6 years using an instrumented walkway to measure sixteen spatiotemporal gait characteristics. Linear mixed-effects models assessed progression. Results: Ten gait characteristics significantly progressed in PD, with changes in four of these characteristics attributable to disease progression. Age-related changes also contributed to gait progression; changes in another two characteristics reflected both aging and disease progression. Gait impairment progressed irrespective of dopaminergic medication change for all characteristics except step width variability. Conclusions: Discrete gait impairments continue to progress in PD over 6 years, reflecting a combination of, and potential interaction between, disease-specific progression and age-related change. Gait changes were mostly unrelated to dopaminergic medication adjustments, highlighting limitations of current dopaminergic therapy and the need to improve interventions targeting gait decline.
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Affiliation(s)
- Joanna Wilson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sue Lord
- Auckland University of Technology, Auckland, New Zealand
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rosie Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - David J Burn
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Brook Galna
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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22
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Gait variability is linked to the atrophy of the Nucleus Basalis of Meynert and is resistant to STN DBS in Parkinson's disease. Neurobiol Dis 2020; 146:105134. [PMID: 33045357 PMCID: PMC7711311 DOI: 10.1016/j.nbd.2020.105134] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/26/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022] Open
Abstract
Parkinson’s disease (PD) is a systemic brain disorder where the cortical cholinergic network begins to degenerate early in the disease process. Readily accessible, quantitative, and specific behavioral markers of the cortical cholinergic network are lacking. Although degeneration of the dopaminergic network may be responsible for deficits in cardinal motor signs, the control of gait is a complex process and control of higher-order aspects of gait, such as gait variability, may be influenced by cognitive processes attributed to cholinergic networks. We investigated whether swing time variability, a metric of gait variability that is independent from gait speed, was a quantitative behavioral marker of cortical cholinergic network integrity in PD. Twenty-two individuals with PD and subthalamic nucleus (STN) deep brain stimulation (PD-DBS cohort) and twenty-nine age-matched controls performed a validated stepping-in-place (SIP) task to assess swing time variability off all therapy. The PD-DBS cohort underwent structural MRI scans to measure gray matter volume of the Nucleus Basalis of Meynert (NBM), the key node in the cortical cholinergic network. In order to determine the role of the dopaminergic system on swing time variability, it was measured ON and OFF STN DBS in the PD-DBS cohort, and on and off dopaminergic medication in a second PD cohort of thirty-two individuals (PD-med). A subset of eleven individuals in the PD-DBS cohort completed the SIP task again off all therapy after three years of continuous DBS to assess progression of gait impairment. Swing time variability was significantly greater (i.e., worse) in PD compared to controls and greater swing time variability was related to greater atrophy of the NBM, as was gait speed. STN DBS significantly improved cardinal motor signs and gait speed but did not improve swing time variability, which was replicated in the second cohort using dopaminergic medication. Swing time variability continued to worsen in PD, off therapy, after three years of continuous STN DBS, and NBM atrophy showed a trend for predicting the degree of increase. In contrast, cardinal motor signs did not progress. These results demonstrate that swing time variability is a reliable marker of cortical cholinergic health, and support a framework in which higher-order aspects of gait control in PD are reliant on the cortical cholinergic system, in contrast to other motor aspects of PD that rely on the dopaminergic network.
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23
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Otte K, Ellermeyer T, Vater TS, Voigt M, Kroneberg D, Rasche L, Krüger T, Röhling HM, Kayser B, Mansow-Model S, Klostermann F, Brandt AU, Paul F, Lipp A, Schmitz-Hübsch T. Instrumental Assessment of Stepping in Place Captures Clinically Relevant Motor Symptoms of Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5465. [PMID: 32977647 PMCID: PMC7582555 DOI: 10.3390/s20195465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/10/2020] [Accepted: 09/21/2020] [Indexed: 12/13/2022]
Abstract
Fluctuations of motor symptoms make clinical assessment in Parkinson's disease a complex task. New technologies aim to quantify motor symptoms, and their remote application holds potential for a closer monitoring of treatment effects. The focus of this study was to explore the potential of a stepping in place task using RGB-Depth (RGBD) camera technology to assess motor symptoms of people with Parkinson's disease. In total, 25 persons performed a 40 s stepping in place task in front of a single RGBD camera (Kinect for Xbox One) in up to two different therapeutic states. Eight kinematic parameters were derived from knee movements to describe features of hypokinesia, asymmetry, and arrhythmicity of stepping. To explore their potential clinical utility, these parameters were analyzed for their Spearman's Rho rank correlation to clinical ratings, and for intraindividual changes between treatment conditions using standard response mean and paired t-test. Test performance not only differed between ON and OFF treatment conditions, but showed moderate correlations to clinical ratings, specifically ratings of postural instability (pull test). Furthermore, the test elicited freezing in some subjects. Results suggest that this single standardized motor task is a promising candidate to assess an array of relevant motor symptoms of Parkinson's disease. The simple technical test setup would allow future use by patients themselves.
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Affiliation(s)
- Karen Otte
- NeuroCure Clinical Research Center, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (T.K.); (H.M.R.); (A.U.B.); (F.P.)
- Motognosis GmbH, 10119 Berlin, Germany; (B.K.); (S.M.-M.)
| | - Tobias Ellermeyer
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (T.E.); (T.-S.V.); (M.V.); (D.K.); (F.K.); (A.L.)
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, 12157 Berlin, Germany
| | - Tim-Sebastian Vater
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (T.E.); (T.-S.V.); (M.V.); (D.K.); (F.K.); (A.L.)
| | - Marlen Voigt
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (T.E.); (T.-S.V.); (M.V.); (D.K.); (F.K.); (A.L.)
| | - Daniel Kroneberg
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (T.E.); (T.-S.V.); (M.V.); (D.K.); (F.K.); (A.L.)
| | - Ludwig Rasche
- Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and Max Delbrück Center for Molecular Medicine, 13125 Berlin, Germany;
- Department of Neurology, Park-Klinik Weißensee, 13086 Berlin, Germany
| | - Theresa Krüger
- NeuroCure Clinical Research Center, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (T.K.); (H.M.R.); (A.U.B.); (F.P.)
| | - Hanna Maria Röhling
- NeuroCure Clinical Research Center, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (T.K.); (H.M.R.); (A.U.B.); (F.P.)
- Motognosis GmbH, 10119 Berlin, Germany; (B.K.); (S.M.-M.)
| | - Bastian Kayser
- Motognosis GmbH, 10119 Berlin, Germany; (B.K.); (S.M.-M.)
| | | | - Fabian Klostermann
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (T.E.); (T.-S.V.); (M.V.); (D.K.); (F.K.); (A.L.)
| | - Alexander Ulrich Brandt
- NeuroCure Clinical Research Center, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (T.K.); (H.M.R.); (A.U.B.); (F.P.)
- Department of Neurology, University of California, Irvine, CA 92868, USA
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (T.K.); (H.M.R.); (A.U.B.); (F.P.)
- Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and Max Delbrück Center for Molecular Medicine, 13125 Berlin, Germany;
- Einstein Center for Neuroscience, 10117 Berlin, Germany
| | - Axel Lipp
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (T.E.); (T.-S.V.); (M.V.); (D.K.); (F.K.); (A.L.)
- Department of Neurology, Park-Klinik Weißensee, 13086 Berlin, Germany
| | - Tanja Schmitz-Hübsch
- NeuroCure Clinical Research Center, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (T.K.); (H.M.R.); (A.U.B.); (F.P.)
- Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health and Max Delbrück Center for Molecular Medicine, 13125 Berlin, Germany;
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24
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Cao SS, Yuan XZ, Wang SH, Taximaimaiti R, Wang XP. Transverse Strips Instead of Wearable Laser Lights Alleviate the Sequence Effect Toward a Destination in Parkinson's Disease Patients With Freezing of Gait. Front Neurol 2020; 11:838. [PMID: 32903360 PMCID: PMC7434927 DOI: 10.3389/fneur.2020.00838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/06/2020] [Indexed: 12/22/2022] Open
Abstract
Background: The sequence effect (SE), referring to step-to-step reduction in amplitude, is considered to lead to freezing of gait (FOG) in Parkinson's disease (PD). Visual cues may alleviate SE and help reduce freezing episodes. FOG patients show significant SE prior to turning or toward a doorway, but the SE toward a destination has not been clearly studied. Objectives: To examine the SE when approaching a destination in PD patients with FOG, and to further explore the effects of different types of visual cues on destination SE. Methods: Thirty-five PD patients were divided into a freezing (PD+FOG, n = 15) group and a non-freezing (PD-FOG, n = 20) group. Walking trials were tested under three conditions, including without cues (no-cue condition), with wearable laser lights (laser condition), and with transverse strips placed on the floor (strip condition). Kinematic data was recorded by a portable Inertial Measurement Unit (IMU) system. The destination SE and some key gait parameters were evaluated. Results: The PD+FOG group showed greater destination SE in the no-cue and laser conditions when compared to the PD-FOG group. There were no significant differences in the strip condition when comparing destination SE of the two groups. The destination SE was alleviated only by using the transverse strips on the floor. In contrast, transverse strips and wearable laser lights could increase the step length. Conclusions: The significant destination SE may explain why FOG patients are prone to freezing when heading toward their destination. Visual cues using transverse strips on the floor may be a more effective strategy for FOG rehabilitation in PD patients.
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Affiliation(s)
- Shan-Shan Cao
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang-Zhen Yuan
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu-Hong Wang
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Reyisha Taximaimaiti
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Ping Wang
- Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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25
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Carvalho LP, Mate KKV, Cinar E, Abou-Sharkh A, Lafontaine AL, Mayo NE. A new approach toward gait training in patients with Parkinson's Disease. Gait Posture 2020; 81:14-20. [PMID: 32650238 DOI: 10.1016/j.gaitpost.2020.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Typically, people with Parkinson's Disease (PD) progress to develop a gait pattern that is characterized by quick, short and shuffling steps. Gait cycle is altered and lacks definition and fluidity. Gait training combined with a variety of feedback modalities for PD are usually based on non-immediate and externally-based cues but none of these provide real-time feedback on gait quality and acquired gains tend to abate shortly after rehabilitation. Based on principals of motor learning, our team has developed the Heel2Toe sensor to provide real-time auditory feedback during gait training. RESEARCH QUESTION Is a short-term training using the Heel2Toe sensor feasible and efficient to improve gait in people with PD? Our objectives are to identify the extent of the immediate response to the feedback within the same session and the carry-over response to training and; 2) to identify patients' perceived effects, pleasures and challenges of using the Heel2Toe. METHODS Single-arm, proof-of-concept study. Six people received five sessions of gait training over a 2-3-week period using the Heel2Toe augmented with mobility exercises as an adjunct to gait training. The main outcomes were technically assessed gait parameters collected over a 2-minute walk test, without and with feedback. Heel2Toe signals were analyzed to extract angular velocity(AV), percentage of good steps, average cadence, and AV coefficient of variation(CV). RESULTS An immediate response to the Heel2Toe use and a carry-over response to the short-term training with the sensor were observed: an increase in AV with a reduction in CV (better heel strike and gait regularity); an increase in %good steps; and a near-optimal and homogeneous cadence (∼100 steps/min), which is equivalent to a moderate-intensity walking. SIGNIFICANCE Gait training using the Heel2Toe sensor is feasible and potentially effective for improving gait quality in people with PD. A definitive trial is a logical next step.
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Affiliation(s)
- Livia P Carvalho
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
| | - Kedar K V Mate
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
| | - Eda Cinar
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
| | - Ahmed Abou-Sharkh
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
| | | | - Nancy E Mayo
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
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Orcioli-Silva D, Vitório R, Nóbrega-Sousa P, da Conceição NR, Beretta VS, Lirani-Silva E, Gobbi LTB. Levodopa Facilitates Prefrontal Cortex Activation During Dual Task Walking in Parkinson Disease. Neurorehabil Neural Repair 2020; 34:589-599. [DOI: 10.1177/1545968320924430] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background. Although dopaminergic medication improves dual task walking in people with Parkinson disease (PD), the underlying neural mechanisms are not yet fully understood. As prefrontal cognitive resources are involved in dual task walking, evaluation of the prefrontal cortex (PFC) is required. Objective. To investigate the effect of dopaminergic medication on PFC activity and gait parameters during dual task walking in people with PD. Methods. A total of 20 individuals with PD (69.8 ± 5.9 years) and 30 healthy older people (68.0 ± 5.6 years) performed 2 walking conditions: single and dual task (walking while performing a digit vigilance task). A mobile functional near infrared spectroscopy system and an electronic sensor carpet were used to analyze PFC activation and gait parameters, respectively. Relative concentrations of oxygenated hemoglobin (HbO2) from the left and right PFC were measured. Results. People with PD in the off state did not present changes in HbO2 level in the left PFC across walking conditions. In contrast, in the on state, they presented increased HbO2 levels during dual task compared with single task. Regardless of medication state, people with PD presented increased HbO2 levels in the right PFC during dual task walking compared with single task. The control group demonstrated increased PFC activity in both hemispheres during dual task compared with single task. People with PD showed increases in both step length and velocity in the on state compared with the off state. Conclusions. PD limits the activation of the left PFC during dual task walking, and dopaminergic medication facilitates its recruitment.
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Affiliation(s)
- Diego Orcioli-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Rodrigo Vitório
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Priscila Nóbrega-Sousa
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Núbia Ribeiro da Conceição
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Victor Spiandor Beretta
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Ellen Lirani-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
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27
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The Effects of Dog Walking on Gait and Mobility in People with Parkinson Disease: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051549. [PMID: 32121195 PMCID: PMC7084601 DOI: 10.3390/ijerph17051549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 11/16/2022]
Abstract
The objective of this study was to assess the effects of dog walking on gait and mobility in people with Parkinson disease (PD). This single-group, single-session, observational pilot study included nineteen participants with PD in Hoehn and Yahr stages II (n = 9) and III (n = 10). Primary measures were a gait analysis and the Timed Up and Go (TUG). Three trials of two conditions (walking with and without a dog) were completed. Walking with a dog resulted in slower gait velocity (mean difference = 0.11 m/s, p = 0.003, d = 0.77), shorter step length (left: mean difference = 7.11 cm, p = 0.000; right: mean difference = 3.05, p = 0.01), and stride length (left: mean difference = 7.52, p = 0.003; right: mean difference = 8.74, p = 0.001). The base of support was more narrowed (Z = -2.13, p = 0.03), with increased double limb stance time (left: Z = -2.89, p = 0.004; right: Z = -2.59, p = 0.01). Walking with a dog caused slower TUG times (mean difference = -1.67, p = 0.000) and increased number of steps (Z = -3.73, p = 0.000). No significant change shown in step time (left: mean difference = -0.001, p = 0.81; right: mean difference = 0.002, p = 0.77) or cadence (Z = -1.67, p = 0.10). In conclusion, there was an overall decline of gait parameters in people with PD when walking with a dog.
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Pickett KA, Schultz-Darken N, Bradfield AF, Malicki K, Pape B, Ausderau KK, Emborg ME. Spatiotemporal quantification of gait in common marmosets. J Neurosci Methods 2019; 330:108517. [PMID: 31730871 DOI: 10.1016/j.jneumeth.2019.108517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Objective gait evaluation in humans is used as a predictive disability outcome measure as well as an indicator for intervention effectiveness. Parallel methods of gait analysis in nonhuman primate models are essential for clinical translation. The goal of this study was to first assess whether marmosets' gait data could be reliably collected in a Noldus CatWalk XT10.6 and second, establish a testing protocol to assess gait and the intraindividual variability during repeated testing. NEW METHOD The CatWalk, originally developed for rodents, was modified and used to assess gait in eight adult common marmoset monkeys across multiple days and trials. Data was first analyzed to identify valid runs. Repeated measures ANOVA was completed for the following gait measures: mean base of support, average stride length, average swing time, and average stance time. RESULTS Raters had a high level of concurrence of usable data across all trials with successful trials including four consecutive hindfoot footfalls, during a continuous, uninterrupted segment of walking. A significant main effect of time (p < 0.000) but not rater (p = 0.98) was present with significant interactions for time by subject (p < 0.000), but not rater per subject (p = 0.538), time (p = 0.186), or three-way interaction (p = 0.297). COMPARISON WITH EXISTING METHOD(S) Gait has been assessed using force-plate and video data. The CatWalk allowed reproducible, automated and translational locomotor data to be collected at multiple time points with detailed analyses that identified a diagonal gait pattern. CONCLUSIONS The CatWalk system, similar to those used in humans, can be effectively used to quantify spatiotemporal characteristics of gait in the common marmoset.
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Affiliation(s)
- Kristen A Pickett
- Department of Kinesiology, University of Wisconsin - Madison, Madison, WI, USA; Program in Occupational Therapy, University of Wisconsin - Madison, Madison, WI, USA; Department of Biomedical Engineering, University of Wisconsin - Madison, Madison, WI, USA
| | - Nancy Schultz-Darken
- Wisconsin National Primate Research Center, University of Wisconsin - Madison, Madison, WI, USA
| | - Abigail F Bradfield
- Department of Kinesiology, University of Wisconsin - Madison, Madison, WI, USA; Program in Occupational Therapy, University of Wisconsin - Madison, Madison, WI, USA
| | - Kerri Malicki
- Wisconsin National Primate Research Center, University of Wisconsin - Madison, Madison, WI, USA
| | - Bruce Pape
- Wisconsin National Primate Research Center, University of Wisconsin - Madison, Madison, WI, USA
| | - Karla K Ausderau
- Department of Kinesiology, University of Wisconsin - Madison, Madison, WI, USA; Program in Occupational Therapy, University of Wisconsin - Madison, Madison, WI, USA; Waisman Center, University of Wisconsin - Madison, Madison, WI, USA
| | - Marina E Emborg
- Wisconsin National Primate Research Center, University of Wisconsin - Madison, Madison, WI, USA; Department of Medical Physics, University of Wisconsin - Madison, Madison, WI, USA.
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29
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Ricciardi C, Amboni M, De Santis C, Improta G, Volpe G, Iuppariello L, Ricciardelli G, D'Addio G, Vitale C, Barone P, Cesarelli M. Using gait analysis' parameters to classify Parkinsonism: A data mining approach. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2019; 180:105033. [PMID: 31445485 DOI: 10.1016/j.cmpb.2019.105033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/08/2019] [Accepted: 08/11/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Parkinson's disease (PD) is the second most common neurodegenerative disorder in the world, while Progressive Supranuclear Palsy (PSP) is an atypical Parkinsonism resembling PD, especially in early stage. Assumed that gait dysfunctions represent a major motor symptom for both pathologies, gait analysis can provide clinicians with subclinical information reflecting subtle differences between these diseases. In this scenario, data mining can be exploited in order to differentiate PD patients at different stages of the disease course and PSP using all the variables acquired through gait analysis. METHODS A cohort of 46 subjects (divided into three groups) affected by PD patients at different stages and PSP patients was acquired through gait analysis and spatial and temporal parameters were analysed. Synthetic Minority Over-sampling Technique was used to balance our imbalanced dataset and cross-validation was applied to provide different training and testing sets. Then, Random Forests and Gradient Boosted Trees were implemented. RESULTS Accuracy, error, precision, recall, specificity and sensitivity were computed for each group and for both algorithms, including 16 features. Random Forests obtained the highest accuracy (86.4%) but also specificity and sensitivity were particularly high, overcoming the 90% for PSP group. CONCLUSION The novelty of the study is the use of a data mining approach on the spatial and temporal parameters of gait analysis in order to classify patients affected by typical (PD) and atypical Parkinsonism (PSP) based on gait patterns. This application would be helpful for clinicians to distinguish PSP from PD at early stage, when the differential diagnosis is particularly challenging.
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Affiliation(s)
- Carlo Ricciardi
- Department of Advanced Biomedical Sciences, University Hospital of Naples 'Federico II', Via S. Pansini, 5, Naples 80131, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Via bagni vecchi, 1, Telese Terme (BN), Italy
| | - Marianna Amboni
- Center for Neurodegenerative Diseases, Department of Medicine and Surgery, University of Salerno, Via San Leonardo, Salerno 84131, Italy; Istituto di Diagnosi e Cura Hermitage-Capodimonte, Naples, Italy
| | - Chiara De Santis
- Center for Neurodegenerative Diseases, Department of Medicine and Surgery, University of Salerno, Via San Leonardo, Salerno 84131, Italy
| | - Giovanni Improta
- Department of Public Health, University Hospital of Naples 'Federico II', Via S. Pansini, 5, Naples 80131, Italy
| | - Giampiero Volpe
- Azienda Ospedaliera Universitaria OO.RR. San Giovanni di Dio Ruggi d'Aragona - Scuola Medica Salernitana, Via San Leonardo, Salerno 84131, Italy
| | - Luigi Iuppariello
- Department of Electrical Engineering and Information Technology, University of Naples 'Federico II', Via Claudio, 21, Naples, Italy; Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Gianluca Ricciardelli
- Azienda Ospedaliera Universitaria OO.RR. San Giovanni di Dio Ruggi d'Aragona - Scuola Medica Salernitana, Via San Leonardo, Salerno 84131, Italy
| | - Giovanni D'Addio
- Istituti Clinici Scientifici Maugeri IRCCS, Via bagni vecchi, 1, Telese Terme (BN), Italy
| | - Carmine Vitale
- Department of Motor Sciences and Wellness, University of Naples Parthenope, Via Ammiraglio Ferdinando Acton, 38, Naples 80133, Italy
| | - Paolo Barone
- Center for Neurodegenerative Diseases, Department of Medicine and Surgery, University of Salerno, Via San Leonardo, Salerno 84131, Italy
| | - Mario Cesarelli
- Istituti Clinici Scientifici Maugeri IRCCS, Via bagni vecchi, 1, Telese Terme (BN), Italy; Department of Electrical Engineering and Information Technology, University of Naples 'Federico II', Via Claudio, 21, Naples, Italy.
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30
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Del Din S, Elshehabi M, Galna B, Hobert MA, Warmerdam E, Suenkel U, Brockmann K, Metzger F, Hansen C, Berg D, Rochester L, Maetzler W. Gait analysis with wearables predicts conversion to parkinson disease. Ann Neurol 2019; 86:357-367. [PMID: 31294853 PMCID: PMC6899833 DOI: 10.1002/ana.25548] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 12/17/2022]
Abstract
Objective Quantification of gait with wearable technology is promising; recent cross‐sectional studies showed that gait characteristics are potential prodromal markers for Parkinson disease (PD). The aim of this longitudinal prospective observational study was to establish gait impairments and trajectories in the prodromal phase of PD, identifying which gait characteristics are potentially early diagnostic markers of PD. Methods The 696 healthy controls (mean age = 63 ± 7 years) recruited in the Tubingen Evaluation of Risk Factors for Early Detection of Neurodegeneration study were included. Assessments were performed longitudinally 4 times at 2‐year intervals, and people who converted to PD were identified. Participants were asked to walk at different speeds under single and dual tasking, with a wearable device placed on the lower back; 14 validated clinically relevant gait characteristics were quantified. Cox regression was used to examine whether gait at first visit could predict time to PD conversion after controlling for age and sex. Random effects linear mixed models (RELMs) were used to establish longitudinal trajectories of gait and model the latency between impaired gait and PD diagnosis. Results Sixteen participants were diagnosed with PD on average 4.5 years after first visit (converters; PDC). Higher step time variability and asymmetry of all gait characteristics were associated with a shorter time to PD diagnosis. RELMs indicated that gait (lower pace) deviates from that of non‐PDC approximately 4 years prior to diagnosis. Interpretation Together with other prodromal markers, quantitative gait characteristics can play an important role in identifying prodromal PD and progression within this phase. ANN NEUROL 2019;86:357–367
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Affiliation(s)
- Silvia Del Din
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Morad Elshehabi
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University Hospital Tübingen, and Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Brook Galna
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Markus A Hobert
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University Hospital Tübingen, and Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Elke Warmerdam
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ulrike Suenkel
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University Hospital Tübingen, and Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Kathrin Brockmann
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University Hospital Tübingen, and Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Florian Metzger
- Geriatric Center and the Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Clint Hansen
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Daniela Berg
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University Hospital Tübingen, and Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Lynn Rochester
- Institute of Neuroscience/Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne University Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Walter Maetzler
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University Hospital Tübingen, and Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
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31
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Kroneberg D, Elshehabi M, Meyer AC, Otte K, Doss S, Paul F, Nussbaum S, Berg D, Kühn AA, Maetzler W, Schmitz-Hübsch T. Less Is More - Estimation of the Number of Strides Required to Assess Gait Variability in Spatially Confined Settings. Front Aging Neurosci 2019; 10:435. [PMID: 30719002 PMCID: PMC6348278 DOI: 10.3389/fnagi.2018.00435] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 12/20/2018] [Indexed: 12/19/2022] Open
Abstract
Background: Gait variability is an established marker of gait function that can be assessed using sensor-based approaches. In clinical settings, spatial constraints and patient condition impede the execution of longer distance walks for the recording of gait parameters. Turning paradigms are often used to overcome these constraints and commercial gait analysis systems algorithmically exclude turns for gait parameters calculations. We investigated the effect of turns in sensor-based assessment of gait variability. Methods: Continuous recordings from 31 patients with movement disorders (ataxia, essential tremor and Parkinson’s disease) and 162 healthy elderly (HE) performing level walks including 180° turns were obtained using an inertial sensor system. Accuracy of the manufacturer’s algorithm of turn-detection was verified by plotting stride time series. Strides before and after turn events were extracted and compared to respective average of all strides. Coefficient of variation (CoV) of stride length and stride time was calculated for entire set of strides, segments between turns and as cumulative values. Their variance and congruency was used to estimate the number of strides required to reliably assess the magnitude of stride variability. Results: Non-detection of turns in 5.8% of HE lead to falsely increased CoV for these individuals. Even after exclusion of these, strides before/after turns tended to be spatially shorter and temporally longer in all groups, contributing to an increase of CoV at group level and widening of confidence margins with increasing numbers of strides. This could be attenuated by a more generous turn excision as an alternative approach. Correlation analyses revealed excellent consistency for CoVs after at most 20 strides in all groups. Respective stride counts were even lower in patients using a more generous turn excision. Conclusion: Including turns to increase continuous walking distance in spatially confined settings does not necessarily improve the validity and reliability of gait variability measures. Specifically with gait pathology, perturbations of stride characteristics before/after algorithmically excised turns were observed that may increase gait variability with this paradigm. We conclude that shorter distance walks of around 15 strides suffice for reliable and valid recordings of gait variability in the groups studied here.
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Affiliation(s)
- Daniel Kroneberg
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany
| | - Morad Elshehabi
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Department of Neurodegenerative Diseases, Center for Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Anne-Christiane Meyer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany
| | - Karen Otte
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, Berlin, Germany
| | - Sarah Doss
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany
| | - Friedemann Paul
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Nussbaum
- Department of Neurodegenerative Diseases, Center for Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Department of Neurodegenerative Diseases, Center for Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Andrea A Kühn
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Walter Maetzler
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Department of Neurodegenerative Diseases, Center for Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Tanja Schmitz-Hübsch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
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32
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Kang MG, Yun SJ, Shin HI, Kim E, Lee HH, Oh BM, Seo HG. Effects of robot-assisted gait training in patients with Parkinson's disease: study protocol for a randomized controlled trial. Trials 2019; 20:15. [PMID: 30616685 PMCID: PMC6322303 DOI: 10.1186/s13063-018-3123-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Robot-assisted gait training (RAGT) was developed to restore gait function by promoting neuroplasticity through repetitive locomotor training and has been utilized in gait training. However, contradictory outcomes of RAGT have been reported for patients with Parkinson's disease (PD). In addition, the mechanism of the RAGT treatment effect is still unknown. This study aims to investigate the effects of RAGT on gait velocity in patients with PD and to unveil the mechanisms of these effects. METHODS This is a prospective, single-blind, single-center, randomized controlled trial. Eligible participants will be randomly allocated to: 1) a Walkbot-S™ RAGT group or 2) a treadmill training group. The participants will receive three 45-min sessions of each intervention per week for 4 weeks. Gait speed during RAGT will be targeted to the maximal speed depending on the participant's height; the same principle will be applied to the treadmill training group to match the training intensity. The primary outcome measure is gait speed measured by the 10-Meter Walk Test at a comfortable pace under single-task conditions. Secondary outcomes include dual-task interference, the Berg Balance Scale, Timed Up and Go test, the Korean version of the Falls Efficacy Scale-International, New Freezing of Gait Questionnaire, Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale, and functional connectivity measured by resting-state functional magnetic resonance imaging. Baseline assessments (T0) will be conducted to acquire clinical characteristics and outcome measure values before the intervention. Postintervention assessments (T1) will compare immediate efficacies within 3 days after the intervention. Follow-up assessments (T2) will be conducted 1 month after the intervention. Considering an alpha of 0.05 and a power of 80%, the total number of participants to be recruited is 44. DISCUSSION This study will reveal the effect of RAGT using an exoskeletal robot, not only on gait speed, but also on gait automaticity, balance function, fall risk, quality of life, and disease severity. In addition, the study will shed new light on the mechanism of the RAGT effect by evaluating changes in gait automaticity and brain functional networks. TRIAL REGISTRATION ClinicalTrials.gov, NCT03490578 . Registered on 21 March 2018.
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Affiliation(s)
- Min-Gu Kang
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Hyun Iee Shin
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Eunkyung Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
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Pantall A, Suresparan P, Kapa L, Morris R, Yarnall A, Del Din S, Rochester L. Postural Dynamics Are Associated With Cognitive Decline in Parkinson's Disease. Front Neurol 2018; 9:1044. [PMID: 30568629 PMCID: PMC6290334 DOI: 10.3389/fneur.2018.01044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 11/19/2018] [Indexed: 11/25/2022] Open
Abstract
Early features of Parkinson's disease (PD) include both motor and cognitive changes, suggesting shared common pathways. A common motor dysfunction is postural instability, a known predictor of falls, which have a major impact on quality of life. Understanding mechanisms of postural dynamics in PD and specifically how they relate to cognitive changes is essential for developing effective interventions. The aims of this study were to examine the changes that occur in postural metrics over time and explore the relationship between postural and cognitive dysfunction. The study group consisted of 35 people (66 ± 8years, 12 female, UPDRS III: 22.5 ± 9.6) diagnosed with PD who were recruited as part of the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation—PD Gait (ICICLE-GAIT) study. Postural and cognitive assessments were performed at 18, 36, and 54 months after enrolment. Participants stood still for 120 s, eyes open and arms by their side. Postural dynamics were measured using metrics derived from a single tri-axial accelerometer (Axivity AX3, York, UK) on the lower back. Accelerometry metrics included jerk (derivative of acceleration), root mean square, frequency, and ellipsis (acceleration area). Cognition was evaluated by neuropsychological tests including the Montreal Cognitive Assessment (MoCA) and digit span. There was a significant decrease in accelerometry parameters, greater in the anteroposterior direction, and a decline in cognitive function over time. Accelerometry metrics were positively correlated with lower cognitive function and increased geriatric depression score and negatively associated with a qualitative measure of balance confidence. In conclusion, people with PD showed reduced postural dynamics that may represent a postural safety strategy. Associations with cognitive function and depression, both symptoms that may pre-empt motor symptoms, suggest shared neural pathways. Further studies, involving neuroimaging, may determine how these postural parameters relate to underlying neural and clinical correlates.
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Affiliation(s)
- Annette Pantall
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom
| | - Piriya Suresparan
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom
| | - Leanne Kapa
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom
| | - Rosie Morris
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom.,Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Alison Yarnall
- The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Silvia Del Din
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom.,The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Ehm G, Lee WW, Jin Jung Y, Kim HJ, Jeon B. Clinical differences in patients with Parkinson's disease according to tandem gait performance. J Clin Neurosci 2018; 60:93-95. [PMID: 30309805 DOI: 10.1016/j.jocn.2018.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
Some of patients with Parkinson's disease (PD) have abnormal tandem gait (TG) performance without any symptoms and signs of cerebellar dysfunction. Clinical difference between patients with good and poor TG performance has not yet been studied. We report the relationship between tandem gait performance and clinical characteristics including 37 patients with PD who had no evidence of cerebellar dysfunction. Using tandem gait test, the patients were divided into two groups (good-TG and poor-TG). We evaluated the two groups with Montreal Cognitive Assessment (MoCA), Mini Mental Status Examination (MMSE), Frontal Assessment Batter (FAB), Beck Depression Index (BDI-II), REM Sleep Behavior Disorder Single-Question Screen (RBD1Q), MDS-UPDRS items related to axial disability and freezing. Fifteen participants were classified as good-TG group and 22 were as poor-TG group. Participants in good-TG group had higher MoCA score and lower BDI-II score. The proportion of participants who answered "yes" to RBD1Q was lower in good-TG group (27%, 4 of 15) than that in poor-TG group (55%, 12 of 22). All participants in good-TG group marked "0" for the MDS-UPDRS item 2.13 which addresses freezing event over the past week, whereas 18% (4 of 22) of participants in poor-TG group marked "1". In conclusion, tandem gait performance may be related to various clinical characteristics including cognitive function, mood, RBD, and freezing in patients with PD.
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Affiliation(s)
- Gwanhee Ehm
- Department of Neurology, National Medical Center, Seoul, South Korea
| | - Woong-Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Yu Jin Jung
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, South Korea
| | - Han-Joon Kim
- Department of Neurology and Movement Disorder Center, Parkinson Study Group and Neuroscience Research Institute, College of Medicine, Seoul National University, Seoul, South Korea
| | - Beomseok Jeon
- Department of Neurology and Movement Disorder Center, Parkinson Study Group and Neuroscience Research Institute, College of Medicine, Seoul National University, Seoul, South Korea.
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Zirek E, Ersoz Huseyinsinoglu B, Tufekcioglu Z, Bilgic B, Hanagasi H. Which cognitive dual-task walking causes most interference on the Timed Up and Go test in Parkinson’s disease: a controlled study. Neurol Sci 2018; 39:2151-2157. [DOI: 10.1007/s10072-018-3564-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/07/2018] [Indexed: 12/23/2022]
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36
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Avanzino L, Lagravinese G, Abbruzzese G, Pelosin E. Relationships between gait and emotion in Parkinson's disease: A narrative review. Gait Posture 2018; 65:57-64. [PMID: 30558947 DOI: 10.1016/j.gaitpost.2018.06.171] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Disturbance of gait is a key feature of Parkinson's disease (PD) and has a negative impact on quality of life. Deficits in cognition and sensorimotor processing impair the ability of people with PD to walk quickly, efficiently and safely. Recent evidence suggests that emotional disturbances may also affect gait in PD. RESEARCH QUESTION We explored if there were relationships between walking ability, emotion and cognitive impairment in people with PD. METHODS The literature was firstly reviewed for unimpaired individuals. The recent experimental evidence for the influence of emotion on gait in people with PD was then explored. The contribution of affective disorders to continuous gait disorders was investigated, particularly for bradykinetic and hypokinetic gait. In addition, we investigated the influence of emotional processing on episodic gait disturbances, such as freezing of gait. Potential effects of pharmacological, surgical and physical therapy interventions were also considered. RESULTS Emerging evidence showed that emotional disturbances arising from affective disorders such as anxiety and depression, in addition to cognitive impairment, could contribute to gait disorders in some people with PD. An analysis of the literature indicated mixed evidence that improvements in affective disorders induced by physical therapy, pharmacological management or surgery improve locomotion in PD. SIGNIFICANCE When assessing and treating gait disorders in people with PD, it is important to take into the account non-motor symptoms such as anxiety, depression and cognitive impairment, in addition to the motor sequalae of this progressive neurological condition.
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Affiliation(s)
- Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Giovanna Lagravinese
- Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy
| | - Giovanni Abbruzzese
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Unit, University of Genoa, Italy
| | - Elisa Pelosin
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Unit, University of Genoa, Italy.
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37
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Caramia C, Torricelli D, Schmid M, Munoz-Gonzalez A, Gonzalez-Vargas J, Grandas F, Pons JL. IMU-Based Classification of Parkinson's Disease From Gait: A Sensitivity Analysis on Sensor Location and Feature Selection. IEEE J Biomed Health Inform 2018; 22:1765-1774. [PMID: 30106745 DOI: 10.1109/jbhi.2018.2865218] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Inertial measurement units (IMUs) have a long-lasting popularity in a variety of industrial applications from navigation systems to guidance and robotics. Their use in clinical practice is now becoming more common, thanks to miniaturization and the ability to integrate on-board computational and decision-support features. IMU-based gait analysis is a paradigm of this evolving process, and in this study its use for the assessment of Parkinson's disease (PD) is comprehensively analyzed. Data coming from 25 individuals with different levels of PD symptoms severity and an equal number of age-matched healthy individuals were included into a set of 6 different machine learning (ML) techniques, processing 18 different configurations of gait parameters taken from 8 IMU sensors. Classification accuracy was calculated for each configuration and ML technique, adding two meta-classifiers based on the results obtained from all individual techniques through majority of voting, with two different weighting schemes. Average classification accuracy ranged between 63% and 80% among classifiers and increased up to 96% for one meta-classifier configuration. Configurations based on a statistical preselection process showed the highest average classification accuracy. When reducing the number of sensors, features based on the joint range of motion were more accurate than those based on spatio-temporal parameters. In particular, best results were obtained with the knee range of motion, calculated with four IMUs, placed bilaterally. The obtained findings provide data-driven evidence on which combination of sensor configurations and classification methods to be used during IMU-based gait analysis to grade the severity level of PD.
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Marmelat V, Reynolds NR, Hellman A. Gait Dynamics in Parkinson's Disease: Short Gait Trials "Stitched" Together Provide Different Fractal Fluctuations Compared to Longer Trials. Front Physiol 2018; 9:861. [PMID: 30038582 PMCID: PMC6047485 DOI: 10.3389/fphys.2018.00861] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
The fractal analysis of stride-to-stride fluctuations in walking has become an integral part of human gait research. Fractal analysis of stride time intervals can provide insights into locomotor function and dysfunction, but its application requires a large number of strides, which can be difficult to collect from people with movement disorders such as Parkinson's disease. It has recently been suggested that "stitching" together short gait trials to create a longer time series could be a solution. The objective of this study was to determine if scaling exponents from "stitched" stride time series were similar to those from continuous, longer stride time series. Fifteen young adults, fourteen older adults, and thirteen people with Parkinson's disease walked around an indoor track in three blocks: one time 15 min, five times 3 min, and thirty times 30 s. Stride time intervals were determined from gait events recorded with instrumented insoles, and the detrended fluctuation analysis was applied to each stride time series of 512 strides. There was no statistically significant difference between scaling exponents in the three blocks, but intra-class correlation revealed very low between-blocks reliability of scaling exponents. This result challenges the premise that the stitching procedure could provide reliable information about gait dynamics, as it suggests that fractal analysis of stitched time series does not capture the same dynamics as gait recorded continuously. The stitching procedure cannot be considered as a valid alternative to the collection of continuous, long trials. Further studies are recommended to determine if the application of fractal analysis is limited by its own methodological considerations (i.e., long time series), or if other solutions exists to obtain reliable scaling exponents in populations with movement disorders.
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Affiliation(s)
- Vivien Marmelat
- Center for Research in Human Movement Variability, Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, United States
| | - Nicholas R Reynolds
- Center for Research in Human Movement Variability, Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, United States
| | - Amy Hellman
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
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Turcato AM, Godi M, Giardini M, Arcolin I, Nardone A, Giordano A, Schieppati M. Abnormal gait pattern emerges during curved trajectories in high-functioning Parkinsonian patients walking in line at normal speed. PLoS One 2018; 13:e0197264. [PMID: 29750815 PMCID: PMC5947908 DOI: 10.1371/journal.pone.0197264] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/30/2018] [Indexed: 12/22/2022] Open
Abstract
Background Several patients with Parkinson´s disease (PD) can walk normally along straight trajectories, and impairment in their stride length and cadence may not be easily discernible. Do obvious abnormalities occur in these high-functioning patients when more challenging trajectories are travelled, such as circular paths, which normally implicate a graded modulation in the duration of the interlimb gait cycle phases? Methods We compared a cohort of well-treated mildly to moderately affected PD patients to a group of age-matched healthy subjects (HS), by deliberately including HS spontaneously walking at the same speed of the patients with PD. All participants performed, in random order: linear and circular walking (clockwise and counter-clockwise) at self-selected speed. By means of pressure-sensitive insoles, we recorded walking speed, cadence, duration of single support, double support, swing phase, and stride time. Stride length-cadence relationships were built for linear and curved walking. Stride-to-stride variability of temporal gait parameters was also estimated. Results Walking speed, cadence or stride length were not different between PD and HS during linear walking. Speed, cadence and stride length diminished during curved walking in both groups, stride length more in PD than HS. In PD compared to HS, the stride length-cadence relationship was altered during curved walking. Duration of the double-support phase was also increased during curved walking, as was variability of the single support, swing phase and double support phase. Conclusion The spatio-temporal gait pattern and variability are significantly modified in well-treated, high-functioning patients with PD walking along circular trajectories, even when they exhibit no changes in speed in straight-line walking. The increased variability of the gait phases during curved walking is an identifying characteristic of PD. We discuss our findings in term of interplay between control of balance and of locomotor progression: the former is challenged by curved trajectories even in high-functioning patients, while the latter may not be critically affected.
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Affiliation(s)
- Anna Maria Turcato
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Marco Godi
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
- * E-mail:
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Antonio Nardone
- Centro Studi Attività Motorie, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Neurorehabilitation and Spinal Units, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Giordano
- Unit of Bioengineering, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Marco Schieppati
- Department of Exercise & Sports Science, International University of Health, Exercise and Sports, LUNEX University, Differdange, Luxembourg
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Baillieul S, Wuyam B, Pépin JL, Marillier M, Tamisier R, Pérennou D, Verges S. Continuous positive airway pressure improves gait control in severe obstructive sleep apnoea: A prospective study. PLoS One 2018; 13:e0192442. [PMID: 29474363 PMCID: PMC5825012 DOI: 10.1371/journal.pone.0192442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 01/11/2018] [Indexed: 01/10/2023] Open
Abstract
Study aim Severe obstructive sleep apnoea (OSA) can lead to neurocognitive alterations, including gait impairments. The beneficial effects of continuous positive airway pressure (CPAP) on improving excessive daytime sleepiness and daily functioning have been documented. However, a demonstration of CPAP treatment efficacy on gait control is still lacking. This study aims to test the hypothesis that CPAP improves gait control in severe OSA patients. Material and methods In this prospective controlled study, twelve severe OSA patients (age = 57.2±8.9 years, body mass index = 27.4±3.1 kg·m-2, apnoea-hypopnoea index = 46.3±11.7 events·h-1) and 10 healthy matched subjects were included. Overground gait parameters were recorded at spontaneous speed and stride time variability, a clinical marker of gait control, was calculated. To assess the role of executive functions in gait and postural control, a dual-task paradigm was applied using a Stroop test as secondary cognitive task. All assessments were performed before and after 8 weeks of CPAP treatment. Results Before CPAP treatment, OSA patients had significantly larger stride time variability (3.1±1.1% vs 2.1±0.5%) and lower cognitive performances under dual task compared to controls. After CPAP treatment, stride time variability was significantly improved and no longer different compared to controls. Cognitive performance under dual task also improved after CPAP treatment. Conclusion Eight weeks of CPAP treatment improves gait control of severe OSA patients, suggesting morphological and functional cerebral improvements. Our data provide a rationale for further mechanistic studies and the use of gait as a biomarker of OSA brain consequences.
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Affiliation(s)
- Sébastien Baillieul
- HP2 laboratory, Grenoble Alpes University, Grenoble, France
- U1042, INSERM, Grenoble, France
- Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
- * E-mail:
| | - Bernard Wuyam
- HP2 laboratory, Grenoble Alpes University, Grenoble, France
- U1042, INSERM, Grenoble, France
- Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- HP2 laboratory, Grenoble Alpes University, Grenoble, France
- U1042, INSERM, Grenoble, France
- Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Mathieu Marillier
- HP2 laboratory, Grenoble Alpes University, Grenoble, France
- U1042, INSERM, Grenoble, France
| | - Renaud Tamisier
- HP2 laboratory, Grenoble Alpes University, Grenoble, France
- U1042, INSERM, Grenoble, France
- Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Dominic Pérennou
- LPNC laboratory (UMPR CNRS 5105), Grenoble Alpes University, Grenoble, France
- MPR Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Samuel Verges
- HP2 laboratory, Grenoble Alpes University, Grenoble, France
- U1042, INSERM, Grenoble, France
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Beck EN, Intzandt BN, Almeida QJ. Can Dual Task Walking Improve in Parkinson's Disease After External Focus of Attention Exercise? A Single Blind Randomized Controlled Trial. Neurorehabil Neural Repair 2017; 32:18-33. [PMID: 29262749 DOI: 10.1177/1545968317746782] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND It may be possible to use attention-based exercise to decrease demands associated with walking in Parkinson's disease (PD), and thus improve dual task walking ability. For example, an external focus of attention (focusing on the effect of an action on the environment) may recruit automatic control processes degenerated in PD, whereas an internal focus (limb movement) may recruit conscious (nonautomatic) control processes. Thus, we aimed to investigate how externally and internally focused exercise influences dual task walking and symptom severity in PD. METHODS Forty-seven participants with PD were randomized to either an Externally (n = 24) or Internally (n = 23) focused group and completed 33 one-hour attention-based exercise sessions over 11 weeks. In addition, 16 participants were part of a control group. Before, after, and 8 weeks following the program (pre/post/washout), gait patterns were measured during single and dual task walking (digit-monitoring task, ie, walking while counting numbers announced by an audio-track), and symptom severity (UPDRS-III) was assessed ON and OFF dopamine replacement. Pairwise comparisons (95% confidence intervals [CIs]) and repeated-measures analyses of variance were conducted. RESULTS Pre to post: Dual task step time decreased in the external group (Δ = 0.02 seconds, CI 0.01-0.04). Dual task step length (Δ = 2.3 cm, CI 0.86-3.75) and velocity (Δ = 4.5 cm/s, CI 0.59-8.48) decreased (became worse) in the internal group. UPDRS-III scores (ON and OFF) decreased (improved) in only the External group. Pre to washout: Dual task step time ( P = .005) and percentage in double support ( P = .014) significantly decreased (improved) in both exercise groups, although only the internal group increased error on the secondary counting task (ie, more errors monitoring numbers). UPDRS-III scores in both exercise groups significantly decreased ( P = .001). CONCLUSIONS Since dual task walking improvements were found immediately, and 8 weeks after the cessation of an externally focused exercise program, we conclude that externally focused exercise may improve on functioning of automatic control networks in PD. Internally focused exercise hindered dual tasking ability. Overall, externally focused exercise led to greater rehabilitation benefits in dual tasking and motor symptoms compared with internally focused exercise.
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Affiliation(s)
- Eric N Beck
- 1 Wilfrid Laurier University, Waterloo, Ontario, Canada
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Cazalets JR, Bestaven E, Doat E, Baudier MP, Gallot C, Amestoy A, Bouvard M, Guillaud E, Guillain I, Grech E, Van-gils J, Fergelot P, Fraisse S, Taupiac E, Arveiler B, Lacombe D. Evaluation of Motor Skills in Children with Rubinstein–Taybi Syndrome. J Autism Dev Disord 2017; 47:3321-3332. [DOI: 10.1007/s10803-017-3259-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Gilat M, Bell PT, Ehgoetz Martens KA, Georgiades MJ, Hall JM, Walton CC, Lewis SJG, Shine JM. Dopamine depletion impairs gait automaticity by altering cortico-striatal and cerebellar processing in Parkinson's disease. Neuroimage 2017; 152:207-220. [PMID: 28263926 DOI: 10.1016/j.neuroimage.2017.02.073] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 12/11/2022] Open
Abstract
Impairments in motor automaticity cause patients with Parkinson's disease to rely on attentional resources during gait, resulting in greater motor variability and a higher risk of falls. Although dopaminergic circuitry is known to play an important role in motor automaticity, little evidence exists on the neural mechanisms underlying the breakdown of locomotor automaticity in Parkinson's disease. This impedes clinical management and is in great part due to mobility restrictions that accompany the neuroimaging of gait. This study therefore utilized a virtual reality gait paradigm in conjunction with functional MRI to investigate the role of dopaminergic medication on lower limb motor automaticity in 23 patients with Parkinson's disease that were measured both on and off dopaminergic medication. Participants either operated foot pedals to navigate a corridor ('walk' condition) or watched the screen while a researcher operated the paradigm from outside the scanner ('watch' condition), a setting that controlled for the non-motor aspects of the task. Step time variability during walk was used as a surrogate measure for motor automaticity (where higher variability equates to reduced automaticity), and patients demonstrated a predicted increase in step time variability during the dopaminergic "off" state. During the "off" state, subjects showed an increased blood oxygen level-dependent response in the bilateral orbitofrontal cortices (walk>watch). To estimate step time variability, a parametric modulator was designed that allowed for the examination of brain regions associated with periods of decreased automaticity. This analysis showed that patients on dopaminergic medication recruited the cerebellum during periods of increasing variability, whereas patients off medication instead relied upon cortical regions implicated in cognitive control. Finally, a task-based functional connectivity analysis was conducted to examine the manner in which dopamine modulates large-scale network interactions during gait. A main effect of medication was found for functional connectivity within an attentional motor network and a significant condition by medication interaction for functional connectivity was found within the striatum. Furthermore, functional connectivity within the striatum correlated strongly with increasing step time variability during walk in the off state (r=0.616, p=0.002), but not in the on state (r=-0.233, p=0.284). Post-hoc analyses revealed that functional connectivity in the dopamine depleted state within an orbitofrontal-striatal limbic circuit was correlated with worse step time variability (r=0.653, p<0.001). Overall, this study demonstrates that dopamine ameliorates gait automaticity in Parkinson's disease by altering striatal, limbic and cerebellar processing, thereby informing future therapeutic avenues for gait and falls prevention.
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Affiliation(s)
- Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
| | - Peter T Bell
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Kaylena A Ehgoetz Martens
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Matthew J Georgiades
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Julie M Hall
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Courtney C Walton
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - James M Shine
- Department of Psychology, Stanford University, Stanford, CA, United States of America; Neuroscience Research Australia, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
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Warlop T, Detrembleur C, Buxes Lopez M, Stoquart G, Lejeune T, Jeanjean A. Does Nordic Walking restore the temporal organization of gait variability in Parkinson's disease? J Neuroeng Rehabil 2017; 14:17. [PMID: 28222810 PMCID: PMC5320697 DOI: 10.1186/s12984-017-0226-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 02/14/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Gait disorders of Parkinson's disease (PD) are characterized by the breakdown of the temporal organization of stride duration variability that was tightly associated to dynamic instability in PD. Activating the upper body during walking, Nordic Walking (NW) may be used as an external cueing to improve spatiotemporal parameters of gait, such as stride length or gait variability, in PD. The aim of this study was to evaluate the beneficial effects of NW on temporal organization of gait variability and spatiotemporal gait variables in PD. METHODS Fourteen mild to moderate PD participants and ten age-matched healthy subjects performed 2 × 12 min overground walking sessions (with and without pole in a randomized order) at a comfortable speed. Gait speed, cadence, step length and temporal organization (i.e. long-range autocorrelations; LRA) of stride duration variability were studied on 512 consecutive gait cycles using a unidimensional accelerometer placed on the malleola of the most affected side in PD patients and of the dominant side in healthy controls. The presence of LRA was determined using the Rescaled Range Analysis (Hurst exponent) and the Power Spectral Density (α exponent). To assess NW and disease influences on gait, paired t-tests, Z-score and a two-way (pathological condition x walking condition) ANOVA repeated measure were used. RESULTS Leading to significant improvement of LRA, NW enhances step length and reduces gait cadence without any change in gait speed in PD. Interestingly, LRA and step length collected from the NW session are similar to that of the healthy population. CONCLUSION This cross-sectional controlled study demonstrates that NW may constitute a powerful way to struggle against the randomness of PD gait and the typical gait hypokinesia. Involving a voluntary intersegmental coordination, such improvement could also be due to the upper body rhythmic movements acting as rhythmical external cue to bypass their defective basal ganglia circuitries. ETHICS COMMITTEE'S REFERENCE NUMBER B403201318916 TRIAL REGISTRATION: NCT02419768.
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Affiliation(s)
- Thibault Warlop
- Physical and Rehabilitation Medicine Department, Cliniques universitaires Saint-Luc, Avenue Hippocrate n°10, 1200, Brussels, Belgium. .,Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (IREC/NMSK), Université catholique de Louvain, Brussels, Belgium. .,Louvain Bionics, Université catholique de Louvain, Brussels, Belgium.
| | - Christine Detrembleur
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (IREC/NMSK), Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, Université catholique de Louvain, Brussels, Belgium
| | | | - Gaëtan Stoquart
- Physical and Rehabilitation Medicine Department, Cliniques universitaires Saint-Luc, Avenue Hippocrate n°10, 1200, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (IREC/NMSK), Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, Université catholique de Louvain, Brussels, Belgium
| | - Thierry Lejeune
- Physical and Rehabilitation Medicine Department, Cliniques universitaires Saint-Luc, Avenue Hippocrate n°10, 1200, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (IREC/NMSK), Université catholique de Louvain, Brussels, Belgium.,Louvain Bionics, Université catholique de Louvain, Brussels, Belgium
| | - Anne Jeanjean
- Institute of Neurosciences (IoNS), Université catholique de Louvain, Brussels, Belgium.,Neurology Department, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Wu Y, Chen P, Luo X, Wu M, Liao L, Yang S, Rangayyan RM. Measuring signal fluctuations in gait rhythm time series of patients with Parkinson's disease using entropy parameters. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2016.08.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Custodio N, Lira D, Herrera-Perez E, Montesinos R, Castro-Suarez S, Cuenca-Alfaro J, Cortijo P. Predictive model for falling in Parkinson disease patients. eNeurologicalSci 2016; 5:20-24. [PMID: 29430553 PMCID: PMC5803085 DOI: 10.1016/j.ensci.2016.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 10/05/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022] Open
Abstract
Background/aims Falls are a common complication of advancing Parkinson's disease (PD). Although numerous risk factors are known, reliable predictors of future falls are still lacking. The aim of this study was to develop a multivariate model to predict falling in PD patients. Methods Prospective cohort with forty-nine PD patients. The area under the receiver-operating characteristic curve (AUC) was calculated to evaluate predictive performance of the purposed multivariate model. Results The median of PD duration and UPDRS-III score in the cohort was 6 years and 24 points, respectively. Falls occurred in 18 PD patients (30%). Predictive factors for falling identified by univariate analysis were age, PD duration, physical activity, and scores of UPDRS motor, FOG, ACE, IFS, PFAQ and GDS (p-value < 0.001), as well as fear of falling score (p-value = 0.04). The final multivariate model (PD duration, FOG, ACE, and physical activity) showed an AUC = 0.9282 (correctly classified = 89.83%; sensitivity = 92.68%; specificity = 83.33%). Conclusions This study showed that our multivariate model have a high performance to predict falling in a sample of PD patients. In PD patients the fall rates doubles the reported rates in community welling older people without neurological disease, ranging from 35% to 90%. Falls have a negative psychosocial impact creating a spiral of increased fear of falling and reduced physical activity, and increased likelihood of nursing home admission. A multivariate model (PD duration, freezing of gait, Addenbrook's Cognitive Examination, and physical activity) to predict falling in our sample of PD patients showed a high performance.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Corresponding author at: Instituto Peruano de Neurociencias, – Bartolomé Herrera 161, Lima, Peru.Instituto Peruano de NeurocienciasBartolomé Herrera 161LimaPeru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Desarrollo de Investigación, Tecnologías y Docencia, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
- Centro de Investigación para el Desarrollo Integral y Sostenible (CIDIS), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Medicina Física y Rehabilitación, Clínica Internacional, Lima, Peru
| | - Sheila Castro-Suarez
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neurología de la Conducta, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Jose Cuenca-Alfaro
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Patricia Cortijo
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
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König N, Singh NB, Baumann CR, Taylor WR. Can Gait Signatures Provide Quantitative Measures for Aiding Clinical Decision-Making? A Systematic Meta-Analysis of Gait Variability Behavior in Patients with Parkinson's Disease. Front Hum Neurosci 2016; 10:319. [PMID: 27445759 PMCID: PMC4927578 DOI: 10.3389/fnhum.2016.00319] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/13/2016] [Indexed: 12/16/2022] Open
Abstract
A disturbed, inconsistent walking pattern is a common feature of patients with Parkinson's disease (PwPD). Such extreme variability in both temporal and spatial parameters of gait has been associated with unstable walking and an elevated prevalence of falls. However, despite their ability to discretise healthy from pathological function, normative variability values for key gait parameters are still missing. Furthermore, an understanding of each parameter's response to pathology, as well as the inter-parameter relationships, has received little attention. The aim of this systematic literature review and meta-analysis was therefore to define threshold levels for pathological gait variability as well as to investigate whether all gait parameters are equally perturbed in PwPD. Based on a broader systematic literature search that included 13′195 titles, 34 studies addressed Parkinson's disease, presenting 800 PwPD and 854 healthy subjects. Eight gait parameters were compared, of which six showed increased levels of variability during walking in PwPD. The most commonly reported parameter, coefficient of variation of stride time, revealed an upper threshold of 2.4% to discriminate the two groups. Variability of step width, however, was consistently lower in PwPD compared to healthy subjects, and therefore suggests an explicit sensory motor system control mechanism to prioritize balance during walking. The results provide a clear functional threshold for monitoring treatment efficacy in patients with Parkinson's disease. More importantly, however, quantification of specific functional deficits could well provide a basis for locating the source and extent of the neurological damage, and therefore aid clinical decision-making for individualizing therapies.
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Affiliation(s)
- Niklas König
- Department of Health Sciences and Technology, Institute for Biomechanics, Swiss Federal Institute of Technology in Zurich (ETHZ) Zürich, Switzerland
| | - Navrag B Singh
- Department of Health Sciences and Technology, Institute for Biomechanics, Swiss Federal Institute of Technology in Zurich (ETHZ) Zürich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zürich, University of Zürich Zürich, Switzerland
| | - William R Taylor
- Department of Health Sciences and Technology, Institute for Biomechanics, Swiss Federal Institute of Technology in Zurich (ETHZ) Zürich, Switzerland
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48
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Rodger MWM, Craig CM. Beyond the Metronome: Auditory Events and Music May Afford More than Just Interval Durations as Gait Cues in Parkinson's Disease. Front Neurosci 2016; 10:272. [PMID: 27378841 PMCID: PMC4906221 DOI: 10.3389/fnins.2016.00272] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/31/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Cathy M Craig
- School of Psychology, Queen's University Belfast Belfast, UK
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49
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Maetzler W, Klucken J, Horne M. A clinical view on the development of technology-based tools in managing Parkinson's disease. Mov Disord 2016; 31:1263-71. [PMID: 27273651 DOI: 10.1002/mds.26673] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/04/2016] [Accepted: 04/14/2016] [Indexed: 12/22/2022] Open
Abstract
Recently, quantitative, objective, and easy-to-use technology-based tools that can assess PD features over long time periods have been developed and generate clinically relevant and comparable patient information. Herein, we present a clinician's view on technological developments that have the potential to revolutionize clinical management concepts in PD. According to prominent examples in clinical medicine (e.g., blood glycosylated hemoglobin and blood pressure), we argue that the consideration of technology-based assessment in the clinical management of PD must be based on specific assumptions: (1) It provides a valid and accurate parameter of a clinically relevant feature of the disease; (2) there is confirmed evidence that the parameter has an ecologically relevant effect on the specific clinical application; (3) a target range can be defined wherein the parameter reflects the adequate treatment response; and (4) implementation is simple to allow repetitive use. Currently, there are no technology-based tools available that fulfil all these assumptions; however, assessments of akinesia, dyskinesia, motor fluctuations, physical inactivity, gait impairment, and postural instability seem relatively close to the specifications described. An iterative process of integration is recommended to bring technology-based tools into clinical practice. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Walter Maetzler
- Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, Center of Neurology, University of Tuebingen, Tuebingen, Germany.
- DZNE, German Center for Neurodegenerative Diseases, Tuebingen, Germany.
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Malcolm Horne
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- St. Vincent's, Neurology Department, Fitzroy, Victoria, Australia
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50
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Lauretani F, Galuppo L, Costantino C, Ticinesi A, Ceda G, Ruffini L, Nardelli A, Maggio M. Parkinson's disease (PD) with dementia and falls is improved by AChEI? A preliminary study report. Aging Clin Exp Res 2016; 28:551-5. [PMID: 26294137 DOI: 10.1007/s40520-015-0437-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 07/31/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVE Advanced PD is often associated with cognitive impairment and frequent falls. We describe a suggestive case report of PD associated with mild cognitive impairment (MCI) and falls. The aim of our study was to test alteration in balance potentially related to use of acetylcholinesterase inhibitor (AchEI). We address this hypothesis after keeping the patient in stable dosage of dopamine agonist. METHODS/MEASUREMENTS We describe an initial pharmacological management in a 78-year-old man affected by Parkinson disease (PD) associated with mild cognitive impairment (MCI) and history of falls. The diagnosis of PD was also confirmed by SPECT with DATSCAN, after CT-brain exclusion of potential other causes of the symptoms. Cognitive and motor performances of the patient were initially evaluated by Mini Mental Examination State Examination (MMSE), Short Physical Performance Battery (SPPB) and Romberg test. We also recorded gait parameters using an accelerometer, while balance and stability were assessed by stabilometric platform with open and closed eyes. We repeated cognitive and motor tests and gait and balance evaluation after stable dosage of dopamine agonist before and after introduction of AchEI. RESULTS After starting dopamine agonist therapy, there was a significant improvement in gait parameters (speed, stride/min, stride length, swing duration, and decrease in gait cycle duration and rolling duration). When stable dosage of dopamine agonist was reached, AchEI was introduced obtaining not only a significant improvement of cognitive performance, but also a significant positive change in balance. CONCLUSION AND RELEVANCE We hypothesize that AchEI could improve stability, balance and postural instability in addition to cognitive performance in PD with MCI and balance deficits.
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Affiliation(s)
- Fulvio Lauretani
- Geriatric Unit, Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy.
- Learning Center for Health Systems and Health Services Organization, University of Parma, Parma, Italy.
| | - Laura Galuppo
- Rehabilitation Medicine, Department of Clinical and Experimental Medicine, Parma University Hospital, Parma, Italy
| | - Cosimo Costantino
- Rehabilitation Medicine, Department of Clinical and Experimental Medicine, Parma University Hospital, Parma, Italy
| | - Andrea Ticinesi
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Gianpaolo Ceda
- Geriatric Unit, Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy
- Learning Center for Health Systems and Health Services Organization, University of Parma, Parma, Italy
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Livio Ruffini
- Nuclear Medicine Unit, Department of Radiology, Academic Hospital of Parma, Parma, Italy
| | - Anna Nardelli
- Geriatric Unit, Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Marcello Maggio
- Geriatric Unit, Geriatric Rehabilitation Department, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy
- Learning Center for Health Systems and Health Services Organization, University of Parma, Parma, Italy
- Section of Geriatrics, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
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