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Ilg W, Milne S, Schmitz-Hübsch T, Alcock L, Beichert L, Bertini E, Mohamed Ibrahim N, Dawes H, Gomez CM, Hanagasi H, Kinnunen KM, Minnerop M, Németh AH, Newman J, Ng YS, Rentz C, Samanci B, Shah VV, Summa S, Vasco G, McNames J, Horak FB. Quantitative Gait and Balance Outcomes for Ataxia Trials: Consensus Recommendations by the Ataxia Global Initiative Working Group on Digital-Motor Biomarkers. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1566-1592. [PMID: 37955812 PMCID: PMC11269489 DOI: 10.1007/s12311-023-01625-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
With disease-modifying drugs on the horizon for degenerative ataxias, ecologically valid, finely granulated, digital health measures are highly warranted to augment clinical and patient-reported outcome measures. Gait and balance disturbances most often present as the first signs of degenerative cerebellar ataxia and are the most reported disabling features in disease progression. Thus, digital gait and balance measures constitute promising and relevant performance outcomes for clinical trials.This narrative review with embedded consensus will describe evidence for the sensitivity of digital gait and balance measures for evaluating ataxia severity and progression, propose a consensus protocol for establishing gait and balance metrics in natural history studies and clinical trials, and discuss relevant issues for their use as performance outcomes.
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Affiliation(s)
- Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, Otfried-Müller-Straße 25, 72076, Tübingen, Germany.
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany.
| | - Sarah Milne
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Melbourne University, Melbourne, VIC, Australia
- Physiotherapy Department, Monash Health, Clayton, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, a cooperation of Max-Delbrueck Center for Molecular Medicine and Charité, Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Lukas Beichert
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Enrico Bertini
- Research Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesu' Children's Research Hospital, IRCCS, Rome, Italy
| | | | - Helen Dawes
- NIHR Exeter BRC, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Hasmet Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Martina Minnerop
- Institute of Neuroscience and Medicine (INM-1)), Research Centre Juelich, Juelich, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Andrea H Németh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jane Newman
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK
| | - Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK
| | - Clara Rentz
- Institute of Neuroscience and Medicine (INM-1)), Research Centre Juelich, Juelich, Germany
| | - Bedia Samanci
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- APDM Precision Motion, Clario, Portland, OR, USA
| | - Susanna Summa
- Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Unit, Neurological Science and Neurorehabilitation Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Gessica Vasco
- Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Unit, Neurological Science and Neurorehabilitation Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - James McNames
- APDM Precision Motion, Clario, Portland, OR, USA
- Department of Electrical and Computer Engineering, Portland State University, Portland, OR, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- APDM Precision Motion, Clario, Portland, OR, USA
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L'Italien GJ, Oikonomou EK, Khera R, Potashman MH, Beiner MW, Maclaine GDH, Schmahmann JD, Perlman S, Coric V. Video-Based Kinematic Analysis of Movement Quality in a Phase 3 Clinical Trial of Troriluzole in Adults with Spinocerebellar Ataxia: A Post Hoc Analysis. Neurol Ther 2024; 13:1287-1301. [PMID: 38814532 PMCID: PMC11263303 DOI: 10.1007/s40120-024-00625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/24/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Traditional methods for assessing movement quality rely on subjective standardized scales and clinical expertise. This limitation creates challenges for assessing patients with spinocerebellar ataxia (SCA), in whom changes in mobility can be subtle and varied. We hypothesized that a machine learning analytic system might complement traditional clinician-rated measures of gait. Our objective was to use a video-based assessment of gait dispersion to compare the effects of troriluzole with placebo on gait quality in adults with SCA. METHODS Participants with SCA underwent gait assessment in a phase 3, double-blind, placebo-controlled trial of troriluzole (NCT03701399). Videos were processed through a deep learning pose extraction algorithm, followed by the estimation of a novel gait stability measure, the Pose Dispersion Index, quantifying the frame-by-frame symmetry, balance, and stability during natural and tandem walk tasks. The effects of troriluzole treatment were assessed in mixed linear models, participant-level grouping, and treatment group-by-visit week interaction adjusted for age, sex, baseline modified Functional Scale for the Assessment and Rating of Ataxia (f-SARA), and time since diagnosis. RESULTS From 218 randomized participants, 67 and 56 participants had interpretable videos of a tandem and natural walk attempt, respectively. At Week 48, individuals assigned to troriluzole exhibited significant (p = 0.010) improvement in tandem walk Pose Dispersion Index versus placebo {adjusted interaction coefficient: 0.584 [95% confidence interval (CI) 0.137 to 1.031]}. A similar, nonsignificant trend was observed in the natural walk assessment [coefficient: 1.198 (95% CI - 1.067 to 3.462)]. Further, lower baseline Pose Dispersion Index during the natural walk was significantly (p = 0.041) associated with a higher risk of subsequent falls [adjusted Poisson coefficient: - 0.356 [95% CI - 0.697 to - 0.014)]. CONCLUSION Using this novel approach, troriluzole-treated subjects demonstrated improvement in gait as compared to placebo for the tandem walk. Machine learning applied to video-captured gait parameters can complement clinician-reported motor assessment in adults with SCA. The Pose Dispersion Index may enhance assessment in future research. TRIAL REGISTRATION-CLINICALTRIALS. GOV IDENTIFIER NCT03701399.
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Affiliation(s)
- Gilbert J L'Italien
- Biohaven Pharmaceuticals, Inc., 215 Church Street, New Haven, CT, 06510, USA
| | | | | | - Michele H Potashman
- Biohaven Pharmaceuticals, Inc., 215 Church Street, New Haven, CT, 06510, USA.
| | - Melissa W Beiner
- Biohaven Pharmaceuticals, Inc., 215 Church Street, New Haven, CT, 06510, USA
| | | | - Jeremy D Schmahmann
- Ataxia Center, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Susan Perlman
- Department of Neurology, UCLA School of Medicine, Los Angeles, CA, USA
| | - Vladimir Coric
- Biohaven Pharmaceuticals, Inc., 215 Church Street, New Haven, CT, 06510, USA
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Barcellos I, Hansen C, Strobel GK, Geritz J, Munhoz RP, Moscovich M, Maetzler W, Teive HAG. Spatiotemporal Gait Analysis of Patients with Spinocerebellar Ataxia Types 3 and 10 Using Inertial Measurement Units: A Comparative Study. CEREBELLUM (LONDON, ENGLAND) 2024:10.1007/s12311-024-01709-7. [PMID: 38869768 DOI: 10.1007/s12311-024-01709-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
Given the high morbidity related to the progression of gait deficits in spinocerebellar ataxias (SCA), there is a growing interest in identifying biomarkers that can guide early diagnosis and rehabilitation. Spatiotemporal parameter (STP) gait analysis using inertial measurement units (IMUs) has been increasingly studied in this context. This study evaluated STP profiles in SCA types 3 and 10, compared them to controls, and correlated them with clinical scales. IMU portable sensors were used to measure STPs under four gait conditions: self-selected pace (SSP), fast pace (FP), fast pace checking-boxes (FPCB), and fast pace with serial seven subtractions (FPS7). Compared to healthy subjects, both SCA groups had higher values for step time, variability, and swing time, with lower values for gait speed, cadence, and step length. We also found a reduction in speed gain capacity in both SCA groups compared to controls and an increase in speed dual-task cost in the SCA10 group. However, there were no significant differences between the SCA groups. Swing time, mean speed, and step length were correlated with disease severity, risk of falling and functionality in both clinical groups. In the SCA3 group, fear of falling was correlated with cadence. In the SCA10 group, results of the Montreal cognitive assessment test were correlated with step time, mean speed, and step length. These results show that individuals with SCA3 and SCA10 present a highly variable, short-stepped, slow gait pattern compared to healthy subjects, and their gait quality worsened with a fast pace and dual-task involvement.
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Affiliation(s)
- Igor Barcellos
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil.
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Giovanna Klüppel Strobel
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Johanna Geritz
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Renato P Munhoz
- Gloria and Morton Shulman Movement Disorders Centre, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Mariana Moscovich
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Hélio Afonso Ghizoni Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
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Kroneberg D, Nümann A, Minnerop M, Rönnefarth M, Endres M, Kühn AA, Paul F, Doss S, Solbrig S, Elshehabi M, Maetzler W, Schmitz-Hübsch T. Gait Variability as a Potential Motor Marker of Cerebellar Disease-Relationship between Variability of Stride, Arm Swing and Trunk Movements, and Walking Speed. SENSORS (BASEL, SWITZERLAND) 2024; 24:3476. [PMID: 38894268 PMCID: PMC11174553 DOI: 10.3390/s24113476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024]
Abstract
Excessive stride variability is a characteristic feature of cerebellar ataxias, even in pre-ataxic or prodromal disease stages. This study explores the relation of variability of arm swing and trunk deflection in relationship to stride length and gait speed in previously described cohorts of cerebellar disease and healthy elderly: we examined 10 patients with spinocerebellar ataxia type 14 (SCA), 12 patients with essential tremor (ET), and 67 healthy elderly (HE). Using inertial sensors, recordings of gait performance were conducted at different subjective walking speeds to delineate gait parameters and respective coefficients of variability (CoV). Comparisons across cohorts and walking speed categories revealed slower stride velocities in SCA and ET patients compared to HE, which was paralleled by reduced arm swing range of motion (RoM), peak velocity, and increased CoV of stride length, while no group differences were found for trunk deflections and their variability. Larger arm swing RoM, peak velocity, and stride length were predicted by higher gait velocity in all cohorts. Lower gait velocity predicted higher CoV values of trunk sagittal and horizontal deflections, as well as arm swing and stride length in ET and SCA patients, but not in HE. These findings highlight the role of arm movements in ataxic gait and the impact of gait velocity on variability, which are essential for defining disease manifestation and disease-related changes in longitudinal observations.
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Affiliation(s)
- Daniel Kroneberg
- Department of Neurology with Experimental Neurology, Charité–Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Astrid Nümann
- Department of Neurology with Experimental Neurology, Charité–Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Experimental and Clinical Research Center, a cooperation of Max-Delbrueck Center of Molecular Medicine and Charité–Universitätsmedizin Berlin, Lindenberger Weg 80, 13125 Berlin, Germany;
| | - Martina Minnerop
- Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, 52425 Jülich, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Center for Movement Disorders and Neuromodulation, Department of Neurology, Medical Faculty & University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Maria Rönnefarth
- Department of Neurology with Experimental Neurology, Charité–Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Endres
- Department of Neurology with Experimental Neurology, Charité–Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Center for Stroke Research Berlin, Charitéplatz 1, 10117 Berlin, Germany
- NeuroCure Cluster of Excellence, Charité–University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Charitéplatz 1, 10117 Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 10117 Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site Berlin, 10117 Berlin, Germany
| | - Andrea A. Kühn
- Department of Neurology with Experimental Neurology, Charité–Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- NeuroCure Cluster of Excellence, Charité–University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Friedemann Paul
- Department of Neurology with Experimental Neurology, Charité–Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Experimental and Clinical Research Center, a cooperation of Max-Delbrueck Center of Molecular Medicine and Charité–Universitätsmedizin Berlin, Lindenberger Weg 80, 13125 Berlin, Germany;
- NCRC-Neuroscience Clinical Research Center, Charité–Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sarah Doss
- Department of Neurology with Experimental Neurology, Charité–Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Susanne Solbrig
- Department of Neurodegenerative Diseases, Center for Neurology, Hertie Institute, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Morad Elshehabi
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Walter Maetzler
- Department of Neurodegenerative Diseases, Center for Neurology, Hertie Institute, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, a cooperation of Max-Delbrueck Center of Molecular Medicine and Charité–Universitätsmedizin Berlin, Lindenberger Weg 80, 13125 Berlin, Germany;
- NCRC-Neuroscience Clinical Research Center, Charité–Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Seemann J, Daghsen L, Cazier M, Lamy JC, Welter ML, Giese MA, Synofzik M, Durr A, Ilg W, Coarelli G. Digital Gait Measures Capture 1-Year Progression in Early-Stage Spinocerebellar Ataxia Type 2. Mov Disord 2024; 39:788-797. [PMID: 38419144 DOI: 10.1002/mds.29757] [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: 10/12/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND With disease-modifying drugs in reach for cerebellar ataxias, fine-grained digital health measures are highly warranted to complement clinical and patient-reported outcome measures in upcoming treatment trials and treatment monitoring. These measures need to demonstrate sensitivity to capture change, in particular in the early stages of the disease. OBJECTIVE Our aim is to unravel gait measures sensitive to longitudinal change in the-particularly trial-relevant-early stage of spinocerebellar ataxia type 2 (SCA2). METHODS We performed a multicenter longitudinal study with combined cross-sectional and 1-year interval longitudinal analysis in early-stage SCA2 participants (n = 23, including nine pre-ataxic expansion carriers; median, ATXN2 CAG repeat expansion 38 ± 2; median, Scale for the Assessment and Rating of Ataxia [SARA] score 4.8 ± 4.3). Gait was assessed using three wearable motion sensors during a 2-minute walk, with analyses focused on gait measures of spatio-temporal variability that have shown sensitivity to ataxia severity (eg, lateral step deviation). RESULTS We found significant changes for gait measures between baseline and 1-year follow-up with large effect sizes (lateral step deviation P = 0.0001, effect size rprb = 0.78), whereas the SARA score showed no change (P = 0.67). Sample size estimation indicates a required cohort size of n = 43 to detect a 50% reduction in natural progression. Test-retest reliability and minimal detectable change analysis confirm the accuracy of detecting 50% of the identified 1-year change. CONCLUSIONS Gait measures assessed by wearable sensors can capture natural progression in early-stage SCA2 within just 1 year-in contrast to a clinical ataxia outcome. Lateral step deviation represents a promising outcome measure for upcoming multicenter interventional trials, particularly in the early stages of cerebellar ataxia. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jens Seemann
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany
| | - Lina Daghsen
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Matthieu Cazier
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Jean-Charles Lamy
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Marie-Laure Welter
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Martin A Giese
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany
| | - Matthis Synofzik
- Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
| | - Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany
| | - Giulia Coarelli
- Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Paris, France
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Libri I, Cantoni V, Benussi A, Rivolta J, Ferrari C, Fancellu R, Synofzik M, Alberici A, Padovani A, Borroni B. Comparing Cerebellar tDCS and Cerebellar tACS in Neurodegenerative Ataxias Using Wearable Sensors: A Randomized, Double-Blind, Sham-Controlled, Triple-Crossover Trial. CEREBELLUM (LONDON, ENGLAND) 2024; 23:570-578. [PMID: 37349632 PMCID: PMC10951038 DOI: 10.1007/s12311-023-01578-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Abstract
Cerebellar transcranial direct current stimulation (tDCS) represents a promising therapeutic approach for both motor and cognitive symptoms in neurodegenerative ataxias. Recently, transcranial alternating current stimulation (tACS) was also demonstrated to modulate cerebellar excitability by neuronal entrainment. To compare the effectiveness of cerebellar tDCS vs. cerebellar tACS in patients with neurodegenerative ataxia, we performed a double-blind, randomized, sham controlled, triple cross-over trial with cerebellar tDCS, cerebellar tACS or sham stimulation in twenty-six participants with neurodegenerative ataxia. Before entering the study, each participant underwent motor assessment with wearable sensors considering gait cadence (steps/minute), turn velocity (degrees/second) and turn duration (seconds), and a clinical evaluation with the scale for the Assessment and Rating of Ataxia (SARA) and the International Cooperative Ataxia Rating Scale (ICARS). After each intervention, participants underwent the same clinical assessment along with cerebellar inhibition (CBI) measurement, a marker of cerebellar activity. The gait cadence, turn velocity, SARA, and ICARS significantly improved after both tDCS and tACS, compared to sham stimulation (all p<0.010). Comparable effects were observed for CBI (p<0.001). Overall, tDCS significantly outperformed tACS on clinical scales and CBI (p<0.01). A significant correlation between changes of wearable sensors parameters from baseline and changes of clinical scales and CBI scores was detected. Cerebellar tDCS and cerebellar tACS are effective in ameliorating symptoms of neurodegenerative ataxias, with the former being more beneficial than the latter. Wearable sensors may serve as rater-unbiased outcome measures in future clinical trials. ClinicalTrial.gov Identifier: NCT05621200.
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Affiliation(s)
- Ilenia Libri
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Valentina Cantoni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - Jasmine Rivolta
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - Camilla Ferrari
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Roberto Fancellu
- UO Neurologia, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany
- German Research Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Antonella Alberici
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy.
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Netukova S, Horakova L, Szabo Z, Krupicka R. Beyond timing and step counting in 360° turning-in-place assessment: a scoping review. Biomed Eng Online 2024; 23:13. [PMID: 38297359 PMCID: PMC10832107 DOI: 10.1186/s12938-024-01208-0] [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: 10/20/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Turning in place is a challenging motor task and is used as a brief assessment test of lower limb function and dynamic balance. This review aims to examine how research of instrumented analysis of turning in place is implemented. In addition to reporting the studied population, we covered acquisition systems, turn detection methods, quantitative parameters, and how these parameters are computed. METHODS Following the development of a rigorous search strategy, the Web of Science and Scopus were systematically searched for studies involving the use of turning-in-place. From the selected articles, the study population, types of instruments used, turn detection method, and how the turning-in-place characteristics were calculated. RESULTS Twenty-one papers met the inclusion criteria. The subject groups involved in the reviewed studies included young, middle-aged, and older adults, stroke, multiple sclerosis and Parkinson's disease patients. Inertial measurement units (16 studies) and motion camera systems (5 studies) were employed for gathering measurement data, force platforms were rarely used (2 studies). Two studies used commercial software for turn detection, six studies referenced previously published algorithms, two studies developed a custom detector, and eight studies did not provide any details about the turn detection method. The most frequently used parameters were mean angular velocity (14 cases, 7 studies), turn duration (13 cases, 13 studies), peak angular velocity (8 cases, 8 studies), jerkiness (6 cases, 5 studies) and freezing-of-gait ratios (5 cases, 5 studies). Angular velocities were derived from sensors placed on the lower back (7 cases, 4 studies), trunk (4 cases, 2 studies), and shank (2 cases, 1 study). The rest (9 cases, 8 studies) did not report sensor placement. Calculation of the freezing-of-gait ratio was based on the acceleration of the lower limbs in all cases. Jerkiness computation employed acceleration in the medio-lateral (4 cases) and antero-posterior (1 case) direction. One study did not reported any details about jerkiness computation. CONCLUSION This review identified the capabilities of turning-in-place assessment in identifying movement differences between the various subject groups. The results, based on data acquired by inertial measurement units across studies, are comparable. A more in-depth analysis of tests developed for gait, which has been adopted in turning-in-place, is needed to examine their validity and accuracy.
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Affiliation(s)
- Slavka Netukova
- Faculty of Biomedical Engineering, Department of Biomedical Informatics, Czech Technical University, Nam Sitna 3105, Prague, Czech Republic.
| | - Lucie Horakova
- Faculty of Biomedical Engineering, Department of Biomedical Informatics, Czech Technical University, Nam Sitna 3105, Prague, Czech Republic
| | - Zoltan Szabo
- Faculty of Biomedical Engineering, Department of Biomedical Informatics, Czech Technical University, Nam Sitna 3105, Prague, Czech Republic
| | - Radim Krupicka
- Faculty of Biomedical Engineering, Department of Biomedical Informatics, Czech Technical University, Nam Sitna 3105, Prague, Czech Republic
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8
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Seemann J, Traschütz A, Ilg W, Synofzik M. 4-Aminopyridine improves real-life gait performance in SCA27B on a single-subject level: a prospective n-of-1 treatment experience. J Neurol 2023; 270:5629-5634. [PMID: 37439944 PMCID: PMC10576659 DOI: 10.1007/s00415-023-11868-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Jens Seemann
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, Otfried-Müller-Straße 25, 72076, Tübingen, Germany
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany
| | - Andreas Traschütz
- Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, Otfried-Müller-Straße 25, 72076, Tübingen, Germany.
- Centre for Integrative Neuroscience (CIN), Tübingen, Germany.
| | - Matthis Synofzik
- Division Translational Genomics of Neurodegenerative Diseases, Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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9
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Castiglia SF, Trabassi D, Tatarelli A, Ranavolo A, Varrecchia T, Fiori L, Di Lenola D, Cioffi E, Raju M, Coppola G, Caliandro P, Casali C, Serrao M. Identification of Gait Unbalance and Fallers Among Subjects with Cerebellar Ataxia by a Set of Trunk Acceleration-Derived Indices of Gait. CEREBELLUM (LONDON, ENGLAND) 2023; 22:46-58. [PMID: 35079958 DOI: 10.1007/s12311-021-01361-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 02/01/2023]
Abstract
This study aimed to assess the ability of 25 gait indices to characterize gait instability and recurrent fallers among persons with primary degenerative cerebellar ataxia (pwCA), regardless of gait speed, and investigate their correlation with clinical and kinematic variables. Trunk acceleration patterns were acquired during the gait of 34 pwCA, and 34 age- and speed-matched healthy subjects (HSmatched) using an inertial measurement unit. We calculated harmonic ratios (HR), percent recurrence, percent determinism, step length coefficient of variation, short-time largest Lyapunov exponent (sLLE), normalized jerk score, log-dimensionless jerk (LDLJ-A), root mean square (RMS), and root mean square ratio of accelerations (RMSR) in each spatial direction for each participant. Unpaired t-tests or Mann-Whitney tests were performed to identify significant differences between the pwCA and HSmatched groups. Receiver operating characteristics were plotted to assess the ability to characterize gait alterations in pwCA and fallers. Optimal cutoff points were identified, and post-test probabilities were calculated. The HRs showed to characterize gait instability and pwCA fallers with high probabilities. They were correlated with disease severity and stance, swing, and double support duration, regardless of gait speed. sLLEs, RMSs, RMSRs, and LDLJ-A were slightly able to characterize the gait of pwCA but failed to characterize fallers.
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Affiliation(s)
- Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.
| | - Dante Trabassi
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy.,Department of Human Neurosciences, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy
| | - Lorenzo Fiori
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy.,Department of Physiology and Pharmacology, Sapienza University of Rome, piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Davide Di Lenola
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Ettore Cioffi
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.,Department of Human Neurosciences, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Manikandan Raju
- Department of Human Neurosciences, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Gianluca Coppola
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Pietro Caliandro
- Unità Operativa Complessa Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.,Movement Analysis Laboratory, Policlinico Italia, Piazza del Campidano, 6, 00162, Rome, Italy
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10
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Multimodal Mobility Assessment Predicts Fall Frequency and Severity in Cerebellar Ataxia. CEREBELLUM (LONDON, ENGLAND) 2023; 22:85-95. [PMID: 35122222 PMCID: PMC9883327 DOI: 10.1007/s12311-021-01365-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/29/2021] [Indexed: 02/01/2023]
Abstract
This cohort study aims to evaluate the predictive validity of multimodal clinical assessment and quantitative measures of in- and off-laboratory mobility for fall-risk estimation in patients with cerebellar ataxia (CA).Occurrence, severity, and consequences of falling were prospectively assessed for 6 months in 93 patients with hereditary (N = 36) and sporadic or secondary (N = 57) forms of CA and 63 healthy controls. Participants completed a multimodal clinical and functional fall risk assessment, in-laboratory gait examination, and a 2-week inertial sensor-based daily mobility monitoring. Multivariate logistic regression analyses were performed to evaluate the predictive capacity of all clinical and in- and off-laboratory mobility measures with respect to fall (1) status (non-faller vs. faller), (2) frequency (occasional vs. frequent falls), and (3) severity (benign vs. injurious fall) of patients. 64% of patients experienced one or recurrent falls and 65% of these severe fall-related injuries during prospective assessment. Mobility impairments in patients corresponded to a mild-to-moderate ataxic gait disorder. Patients' fall status and frequency could be reliably predicted (78% and 81% accuracy, respectively), primarily based on their retrospective fall status. Clinical scoring of ataxic symptoms and in- and off-laboratory gait and mobility measures improved classification and provided unique information for the prediction of fall severity (84% accuracy).These results encourage a stepwise approach for fall risk assessment in patients with CA: fall history-taking readily and reliably informs the clinician about patients' general fall risk. Clinical scoring and instrument-based mobility measures provide further in-depth information on the risk of recurrent and injurious falling.
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11
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Kushioka J, Sun R, Zhang W, Muaremi A, Leutheuser H, Odonkor CA, Smuck M. Gait Variability to Phenotype Common Orthopedic Gait Impairments Using Wearable Sensors. SENSORS (BASEL, SWITZERLAND) 2022; 22:9301. [PMID: 36502003 PMCID: PMC9739785 DOI: 10.3390/s22239301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Mobility impairments are a common symptom of age-related degenerative diseases. Gait features can discriminate those with mobility disorders from healthy individuals, yet phenotyping specific pathologies remains challenging. This study aims to identify if gait parameters derived from two foot-mounted inertial measurement units (IMU) during the 6 min walk test (6MWT) can phenotype mobility impairment from different pathologies (Lumbar spinal stenosis (LSS)-neurogenic diseases, and knee osteoarthritis (KOA)-structural joint disease). Bilateral foot-mounted IMU data during the 6MWT were collected from patients with LSS and KOA and matched healthy controls (N = 30, 10 for each group). Eleven gait parameters representing four domains (pace, rhythm, asymmetry, variability) were derived for each minute of the 6MWT. In the entire 6MWT, gait parameters in all four domains distinguished between controls and both disease groups; however, the disease groups demonstrated no statistical differences, with a trend toward higher stride length variability in the LSS group (p = 0.057). Additional minute-by-minute comparisons identified stride length variability as a statistically significant marker between disease groups during the middle portion of 6WMT (3rd min: p ≤ 0.05; 4th min: p = 0.06). These findings demonstrate that gait variability measures are a potential biomarker to phenotype mobility impairment from different pathologies. Increased gait variability indicates loss of gait rhythmicity, a common feature in neurologic impairment of locomotor control, thus reflecting the underlying mechanism for the gait impairment in LSS. Findings from this work also identify the middle portion of the 6MWT as a potential window to detect subtle gait differences between individuals with different origins of gait impairment.
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Affiliation(s)
- Junichi Kushioka
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA
| | - Ruopeng Sun
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA 94305, USA
| | - Wei Zhang
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Amir Muaremi
- Novartis Institutes for BioMedical Research, 4056 Basel, Switzerland
| | - Heike Leutheuser
- Machine Learning and Data Analytics Lab (MaD Lab), Department Artificial Intelligence in Biomedical Engineering (AIBE), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91052 Erlangen, Germany
| | - Charles A. Odonkor
- Department of Orthopedics and Rehabilitation, Division of Physiatry, Yale School of Medicine, New Haven, CT 06510, USA
| | - Matthew Smuck
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA
- Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA 94305, USA
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12
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Ilg W, Müller B, Faber J, van Gaalen J, Hengel H, Vogt IR, Hennes G, van de Warrenburg B, Klockgether T, Schöls L, Synofzik M. Digital Gait Biomarkers Allow to Capture 1-Year Longitudinal Change in Spinocerebellar Ataxia Type 3. Mov Disord 2022; 37:2295-2301. [PMID: 36043376 DOI: 10.1002/mds.29206] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 12/19/2022] Open
Abstract
Measures of step variability and body sway during gait have shown to correlate with clinical ataxia severity in several cross-sectional studies. However, to serve as a valid progression biomarker, these gait measures have to prove their sensitivity to robustly capture longitudinal change, ideally within short time frames (eg, 1 year). We present the first multicenter longitudinal gait analysis study in spinocerebellar ataxias. We performed a combined cross-sectional (n = 28) and longitudinal (1-year interval, n = 17) analysis in Spinocerebellar Ataxia type 3 subjects (including seven preataxic mutation carriers). Longitudinal analysis showed significant change in gait measures between baseline and 1-year follow-up, with high effect sizes (stride length variability: P = 0.01, effect size rprb = 0.66; lateral sway: P = 0.007, rprb = 0.73). Sample size estimation for lateral sway indicates a required cohort size of n = 43 for detecting a 50% reduction of natural progression, compared with n = 240 for the clinical ataxia score Scale for the Assessment and Rating of Ataxia (SARA). These measures thus present promising motor biomarkers for upcoming interventional studies. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Björn Müller
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Jennifer Faber
- Department of Neurology, University Hospital Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Judith van Gaalen
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Holger Hengel
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany
| | - Ina R Vogt
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Guido Hennes
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Bart van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas Klockgether
- Department of Neurology, University Hospital Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Ludger Schöls
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany
| | - Matthis Synofzik
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany
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13
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Sethi D, Bharti S, Prakash C. A comprehensive survey on gait analysis: History, parameters, approaches, pose estimation, and future work. Artif Intell Med 2022; 129:102314. [DOI: 10.1016/j.artmed.2022.102314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/15/2022]
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14
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Zhang X, Lu Y, Chien JH, Fu C, Zhou Z, Li H, Hu G, Sun T. The Effect of Inclines on Joint Angles in Stroke Survivors During Treadmill Walking. Front Neurol 2022; 13:850682. [PMID: 35481275 PMCID: PMC9037685 DOI: 10.3389/fneur.2022.850682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/07/2022] [Indexed: 12/03/2022] Open
Abstract
Stroke severely affects the quality of life, specifically in walking independently. Thus, it is crucial to understand the impaired gait pattern. This gait pattern has been widely investigated when walking on a level treadmill. However, knowledge about the gait pattern when walking on inclines is scarce. Therefore, this study attempted to fulfill this knowledge gap. In this study, 15 stroke survivors and 15 age/height/weight healthy controls were recruited. The participants were instructed to walk on three different inclines: 0°, 3°, and 6°. The participants were required to walk on each incline for 2 min and needed to complete each incline two times. The dependent variables were the peak values for ankle/knee/hip joint angles and the respective variability of these peak values. The results showed that an increment of the incline significantly increased the peak of the hip flexion and the peak of the knee flexion but did not affect the peak values of the ankle joints in the paretic leg in these stroke survivors. In comparison with the healthy controls, lower hip extension, lower hip flexion, lower knee flexion, and lower ankle plantar flexion were observed in stroke survivors. A clinical application of this work might assist the physical therapists in building an effective treadmill training protocol.
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Affiliation(s)
- Xin Zhang
- Department of Rehabilitation, School of Medicine, Tongji University, Shanghai, China.,Shanghai Rehabilitation Center, Shanghai First Rehabilitation Hospital, Shanghai, China
| | - Yanting Lu
- Department of Rehabilitation, School of Medicine, Tongji University, Shanghai, China
| | | | - Chenlei Fu
- Shanghai Rehabilitation Center, Shanghai First Rehabilitation Hospital, Shanghai, China
| | - Zhe Zhou
- Nuerological Intensive Rehabilitation Department, Shanghai First Rehabilitation Hospital, Shanghai, China
| | - Hua Li
- Nuerological Intensive Rehabilitation Department, Shanghai First Rehabilitation Hospital, Shanghai, China
| | - Gongwei Hu
- Nuerological Intensive Rehabilitation Department, Shanghai First Rehabilitation Hospital, Shanghai, China
| | - Tianbao Sun
- Shanghai Rehabilitation Center, Shanghai First Rehabilitation Hospital, Shanghai, China
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15
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Cabaraux P, Agrawal SK, Cai H, Calabro RS, Casali C, Damm L, Doss S, Habas C, Horn AKE, Ilg W, Louis ED, Mitoma H, Monaco V, Petracca M, Ranavolo A, Rao AK, Ruggieri S, Schirinzi T, Serrao M, Summa S, Strupp M, Surgent O, Synofzik M, Tao S, Terasi H, Torres-Russotto D, Travers B, Roper JA, Manto M. Consensus Paper: Ataxic Gait. CEREBELLUM (LONDON, ENGLAND) 2022; 22:394-430. [PMID: 35414041 DOI: 10.1007/s12311-022-01373-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/19/2022]
Abstract
The aim of this consensus paper is to discuss the roles of the cerebellum in human gait, as well as its assessment and therapy. Cerebellar vermis is critical for postural control. The cerebellum ensures the mapping of sensory information into temporally relevant motor commands. Mental imagery of gait involves intrinsically connected fronto-parietal networks comprising the cerebellum. Muscular activities in cerebellar patients show impaired timing of discharges, affecting the patterning of the synergies subserving locomotion. Ataxia of stance/gait is amongst the first cerebellar deficits in cerebellar disorders such as degenerative ataxias and is a disabling symptom with a high risk of falls. Prolonged discharges and increased muscle coactivation may be related to compensatory mechanisms and enhanced body sway, respectively. Essential tremor is frequently associated with mild gait ataxia. There is growing evidence for an important role of the cerebellar cortex in the pathogenesis of essential tremor. In multiple sclerosis, balance and gait are affected due to cerebellar and spinal cord involvement, as a result of disseminated demyelination and neurodegeneration impairing proprioception. In orthostatic tremor, patients often show mild-to-moderate limb and gait ataxia. The tremor generator is likely located in the posterior fossa. Tandem gait is impaired in the early stages of cerebellar disorders and may be particularly useful in the evaluation of pre-ataxic stages of progressive ataxias. Impaired inter-joint coordination and enhanced variability of gait temporal and kinetic parameters can be grasped by wearable devices such as accelerometers. Kinect is a promising low cost technology to obtain reliable measurements and remote assessments of gait. Deep learning methods are being developed in order to help clinicians in the diagnosis and decision-making process. Locomotor adaptation is impaired in cerebellar patients. Coordinative training aims to improve the coordinative strategy and foot placements across strides, cerebellar patients benefiting from intense rehabilitation therapies. Robotic training is a promising approach to complement conventional rehabilitation and neuromodulation of the cerebellum. Wearable dynamic orthoses represent a potential aid to assist gait. The panel of experts agree that the understanding of the cerebellar contribution to gait control will lead to a better management of cerebellar ataxias in general and will likely contribute to use gait parameters as robust biomarkers of future clinical trials.
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Affiliation(s)
- Pierre Cabaraux
- Unité Des Ataxies Cérébelleuses, Department of Neurology, CHU de Charleroi, Charleroi, Belgium.
| | | | - Huaying Cai
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | | | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Loic Damm
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France
| | - Sarah Doss
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Christophe Habas
- Université Versailles Saint-Quentin, Versailles, France.,Service de NeuroImagerie, Centre Hospitalier National des 15-20, Paris, France
| | - Anja K E Horn
- Institute of Anatomy and Cell Biology I, Ludwig Maximilians-University Munich, Munich, Germany
| | - Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Maria Petracca
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Ashwini K Rao
- Department of Rehabilitation & Regenerative Medicine (Programs in Physical Therapy), Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Serena Ruggieri
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy.,Neuroimmunology Unit, IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.,Movement Analysis LAB, Policlinico Italia, Rome, Italy
| | - Susanna Summa
- MARlab, Neuroscience and Neurorehabilitation Department, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig Maximilians-University Munich, Munich, Germany
| | - Olivia Surgent
- Neuroscience Training Program and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany
| | - Shuai Tao
- Dalian Key Laboratory of Smart Medical and Health, Dalian University, Dalian, 116622, China
| | - Hiroo Terasi
- Department of Neurology, Tokyo Medical University, Tokyo, Japan
| | - Diego Torres-Russotto
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Brittany Travers
- Department of Kinesiology and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Jaimie A Roper
- School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Mario Manto
- Unité Des Ataxies Cérébelleuses, Department of Neurology, CHU de Charleroi, Charleroi, Belgium.,Service Des Neurosciences, University of Mons, UMons, Mons, Belgium
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16
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Ganapathy VS, James TT, Philip M, Kamble N, Bhattacharya A, Dhargave P, Pal PK. Anteroposterior Stability: A Determinant of Gait Dysfunction and Falls in Spinocerebellar Ataxia. Ann Indian Acad Neurol 2021; 24:518-523. [PMID: 34728944 PMCID: PMC8513964 DOI: 10.4103/aian.aian_1090_20] [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: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Establishing an association between gait variability and direction specific balance indices may help in identifying the risk of falls in patients with spinocerebellar ataxia (SCA) which may help in developing an appropriate intervention. This study is intended to identify the association between balance and gait parameters especially gait variability in these patients. Methods: Patients with genetically confirmed SCA (n = 24) as well as controls (n = 24) who met the study criteria were recruited. Gait was assessed using the GAITRite system and balance was assessed using dynamic posturography (Biodex) to record direction-specific dynamic balance indices. Disease severity was assessed using international cooperative ataxia rating scale (ICARS). Results: The mean age of the SCA group (38.83 ± 13.03 years) and the control group (36.38 ± 9.09 years) were comparable. The age of onset of illness was 32 ± 10.62 years and duration of 5.67 ± 3.62 years. The mean ICARS was 45.10 ± 16.75. There was a significant difference in the overall balance index (OBI), anterior–posterior index (API), medial/lateral index (MLI) between SCA patients (4.56 ± 2.09, 3.49 ± 1.88, 2.94 ± 1.32) and the controls (2.72 ± 1.25, 2.08 ± 0.85, 1.85 ± 0.97). However, correlation was observed only between gait stability and balance parameters in API direction. Conclusions: There was an increased anteroposterior oriented balance deficit in patients with SCA, which was significantly correlating with the gait parameters. The balance training intervention may focus on improving anteroposterior direction to prevent falls and improving walking efficiency.
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Affiliation(s)
- V S Ganapathy
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Tittu T James
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mariamma Philip
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Nitish Kamble
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Amitabh Bhattacharya
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pradnya Dhargave
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pramod Kumar Pal
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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17
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van den Brink W, Bloem R, Ananth A, Kanagasabapathi T, Amelink A, Bouwman J, Gelinck G, van Veen S, Boorsma A, Wopereis S. Digital Resilience Biomarkers for Personalized Health Maintenance and Disease Prevention. Front Digit Health 2021; 2:614670. [PMID: 34713076 PMCID: PMC8521930 DOI: 10.3389/fdgth.2020.614670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/09/2020] [Indexed: 12/26/2022] Open
Abstract
Health maintenance and disease prevention strategies become increasingly prioritized with increasing health and economic burden of chronic, lifestyle-related diseases. A key element in these strategies is the empowerment of individuals to control their health. Self-measurement plays an essential role in achieving such empowerment. Digital measurements have the advantage of being measured non-invasively, passively, continuously, and in a real-world context. An important question is whether such measurement can sensitively measure subtle disbalances in the progression toward disease, as well as the subtle effects of, for example, nutritional improvement. The concept of resilience biomarkers, defined as the dynamic evaluation of the biological response to an external challenge, has been identified as a viable strategy to measure these subtle effects. In this review, we explore the potential of integrating this concept with digital physiological measurements to come to digital resilience biomarkers. Additionally, we discuss the potential of wearable, non-invasive, and continuous measurement of molecular biomarkers. These types of innovative measurements may, in the future, also serve as a digital resilience biomarker to provide even more insight into the personal biological dynamics of an individual. Altogether, digital resilience biomarkers are envisioned to allow for the measurement of subtle effects of health maintenance and disease prevention strategies in a real-world context and thereby give personalized feedback to improve health.
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Affiliation(s)
- Willem van den Brink
- Department of Microbiology and Systems Biology, Netherlands Organization for Applied Scientific Research (TNO), Zeist, Netherlands
| | - Robbert Bloem
- Department of Environmental Modeling Sensing and Analysis, Netherlands Organization for Applied Scientific Research (TNO), Utrecht, Netherlands
| | - Adithya Ananth
- Department of Optics, Netherlands Organization for Applied Scientific Research (TNO), Delft, Netherlands
| | - Thiru Kanagasabapathi
- Holst Center, Netherlands Organization for Applied Scientific Research (TNO), Eindhoven, Netherlands
| | - Arjen Amelink
- Department of Optics, Netherlands Organization for Applied Scientific Research (TNO), Delft, Netherlands
| | - Jildau Bouwman
- Department of Microbiology and Systems Biology, Netherlands Organization for Applied Scientific Research (TNO), Zeist, Netherlands
| | - Gerwin Gelinck
- Holst Center, Netherlands Organization for Applied Scientific Research (TNO), Eindhoven, Netherlands
| | - Sjaak van Veen
- Department of Environmental Modeling Sensing and Analysis, Netherlands Organization for Applied Scientific Research (TNO), Utrecht, Netherlands
| | - Andre Boorsma
- Department of Microbiology and Systems Biology, Netherlands Organization for Applied Scientific Research (TNO), Zeist, Netherlands
| | - Suzan Wopereis
- Department of Microbiology and Systems Biology, Netherlands Organization for Applied Scientific Research (TNO), Zeist, Netherlands
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18
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Lo OY, Halko MA, Devaney KJ, Wayne PM, Lipsitz LA, Manor B. Gait Variability Is Associated With the Strength of Functional Connectivity Between the Default and Dorsal Attention Brain Networks: Evidence From Multiple Cohorts. J Gerontol A Biol Sci Med Sci 2021; 76:e328-e334. [PMID: 34244725 PMCID: PMC8436983 DOI: 10.1093/gerona/glab200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In older adults, elevated gait variability when walking has been associated with both cognitive impairment and future falls. This study leveraged 3 existing data sets to determine relationships between gait variability and the strength of functional connectivity within and between large-scale brain networks in healthy older adults, those with mild-to-moderate functional impairment, and those with Parkinson's disease (PD). METHOD Gait and resting-state functional magnetic resonance imaging data were extracted from existing data sets on: (i) 12 older adults without overt disease yet with slow gait and mild executive dysfunction; (ii) 12 older adults with intact cognitive-motor function and age- and sex-matched to the first cohort; and (iii) 15 individuals with PD. Gait variability (%, coefficient of variation of stride time) during preferred walking speed was measured and correlated with the degree of functional connectivity within and between 7 established large-scale functional brain networks. RESULTS Regression models adjusted for age and sex revealed that in each cohort, those with less gait variability exhibited greater negative correlation between fluctuations in resting-state brain activity between the default network and the dorsal attention network (functionally limited older: β = 4.38, p = .027; healthy older: β = 1.66, p = .032; PD: β = 1.65, p = .005). No other within- or between-network connectivity outcomes were consistently related to gait variability across all 3 cohorts. CONCLUSION These results provide strong evidence that gait variability is uniquely related to functional connectivity between the default network and the dorsal attention network, and that this relationship may be independent of both functional status and underlying brain disease.
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Affiliation(s)
- On-Yee Lo
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Address correspondence to: On-Yee Lo, PhD, Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Harvard Medical School, 1200 Centre St., Boston, MA 02131, USA. E-mail:
| | - Mark A Halko
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
| | - Kathryn J Devaney
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Peter M Wayne
- Harvard Medical School, Boston, Massachusetts, USA
- Osher Center for Integrative Medicine, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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19
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Shah VV, Rodriguez-Labrada R, Horak FB, McNames J, Casey H, Hansson Floyd K, El-Gohary M, Schmahmann JD, Rosenthal LS, Perlman S, Velázquez-Pérez L, Gomez CM. Gait Variability in Spinocerebellar Ataxia Assessed Using Wearable Inertial Sensors. Mov Disord 2021; 36:2922-2931. [PMID: 34424581 DOI: 10.1002/mds.28740] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Quantitative assessment of severity of ataxia-specific gait impairments from wearable technology could provide sensitive performance outcome measures with high face validity to power clinical trials. OBJECTIVES The aim of this study was to identify a set of gait measures from body-worn inertial sensors that best discriminate between people with prodromal or manifest spinocerebellar ataxia (SCA) and age-matched, healthy control subjects (HC) and determine how these measures relate to disease severity. METHODS One hundred and sixty-three people with SCA (subtypes 1, 2, 3, and 6), 42 people with prodromal SCA, and 96 HC wore 6 inertial sensors while performing a natural pace, 2-minute walk. Areas under the receiver operating characteristic curves (AUC) were compared for 25 gait measures, including standard deviations as variability, to discriminate between ataxic and normal gait. Pearson's correlation coefficient assessed the relationships between the gait measures and severity of ataxia. RESULTS Increased gait variability was the most discriminative gait feature of SCA; toe-out angle variability (AUC = 0.936; sensitivity = 0.871; specificity = 0.896) and double-support time variability (AUC = 0.932; sensitivity = 0.834; specificity = 0.865) were the most sensitive and specific measures. These variability measures were also significantly correlated with the scale for the assessment and rating of ataxia (SARA) and disease duration. The same gait measures discriminated gait of people with prodromal SCA from the gait of HC (AUC = 0.610, and 0.670, respectively). CONCLUSIONS Wearable inertial sensors provide sensitive and specific measures of excessive gait variability in both manifest and prodromal SCAs that are reliable and related to the severity of the disease, suggesting they may be useful as clinical trial performance outcome measures. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Roberto Rodriguez-Labrada
- Centre for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba.,Cuban Center for Neuroscience, Havana, Cuba
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,APDM Wearable Technologies, an ERT company, Portland, Oregon, USA
| | - James McNames
- APDM Wearable Technologies, an ERT company, Portland, Oregon, USA.,Department of Electrical and Computer Engineering, Portland State University, Portland, Oregon, USA
| | - Hannah Casey
- The University of Chicago, Chicago, Illinois, USA
| | | | | | - Jeremy D Schmahmann
- Department of Neurology, Ataxia Center, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Perlman
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Luis Velázquez-Pérez
- Centre for the Research and Rehabilitation of Hereditary Ataxias, Holguín, Cuba.,Cuban Academy of Sciences, La Habana, Cuba
| | - Christopher M Gomez
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA.,The University of Chicago, Chicago, Illinois, USA
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20
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Mueller A, Paterson E, McIntosh A, Praestgaard J, Bylo M, Hoefling H, Wells M, Lynch DR, Rummey C, Krishnan ML, Schultz M, Malanga CJ. Digital endpoints for self-administered home-based functional assessment in pediatric Friedreich's ataxia. Ann Clin Transl Neurol 2021; 8:1845-1856. [PMID: 34355532 PMCID: PMC8419399 DOI: 10.1002/acn3.51438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 01/18/2023] Open
Abstract
Background Friedreich’s ataxia is an inherited, progressive, neurodegenerative disease that typically begins in childhood. Disease severity is commonly assessed with rating scales, such as the modified Friedreich’s Ataxia Rating Scale, which are usually administered in the clinic by a neurology specialist. Objective This study evaluated the utility of home‐based, self‐administered digital endpoints in children with Friedreich’s ataxia and unaffected controls and their relationship to standard clinical rating scales. Methods In a cross‐sectional study with 25 participants (13 with Friedreich’s ataxia and 12 unaffected controls, aged 6–15 years), home‐based digital endpoints that reflect activities of daily living were recorded over 1 week. Domains analyzed were hand motor function with a digitized drawing, automated analysis of speech with a recorded oral diadochokinesis test, and gait and balance with wearable sensors. Results Hand‐drawing and speech tests were easy to conduct and generated high‐quality data. The sensor‐based gait and balance tests suffered from technical limitations in this study setup. Several parameters discriminated between groups or correlated strongly with modified Friedreich’s Ataxia Rating Scale total score and activities of daily living total score in the Friedreich’s ataxia group. Hand‐drawing parameters also strongly correlated with standard 9‐hole peg test scores. Interpretation Deploying digital endpoints in home settings is feasible in this population, results in meaningful and robust data collection, and may allow for frequent sampling over longer periods of time to track disease progression. Care must be taken when training participants, and investigators should consider the complexity of the tasks and equipment used.
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Affiliation(s)
- Arne Mueller
- Translational Medicine, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Elaine Paterson
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | | | | | - Mary Bylo
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | - Holger Hoefling
- NIBR Informatics, Novartis Institute of Biomedical Research, Basel, Switzerland
| | - McKenzie Wells
- Division of Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - David R Lynch
- Division of Neurology, Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Michelle L Krishnan
- Translational Medicine, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Meredith Schultz
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | - C J Malanga
- Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
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21
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Patel P, Casamento-Moran A, Christou EA, Lodha N. Force-Control vs. Strength Training: The Effect on Gait Variability in Stroke Survivors. Front Neurol 2021; 12:667340. [PMID: 34335442 PMCID: PMC8319601 DOI: 10.3389/fneur.2021.667340] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/17/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: Increased gait variability in stroke survivors indicates poor dynamic balance and poses a heightened risk of falling. Two primary motor impairments linked with impaired gait are declines in movement precision and strength. The purpose of the study is to determine whether force-control training or strength training is more effective in reducing gait variability in chronic stroke survivors. Methods: Twenty-two chronic stroke survivors were randomized to force-control training or strength training. Participants completed four training sessions over 2 weeks with increasing intensity. The force-control group practiced increasing and decreasing ankle forces while tracking a sinusoid. The strength group practiced fast ankle motor contractions at a percentage of their maximal force. Both forms of training involved unilateral, isometric contraction of the paretic, and non-paretic ankles in plantarflexion and dorsiflexion. Before and after the training, we assessed gait variability as stride length and stride time variability, and gait speed. To determine the task-specific effects of training, we measured strength, accuracy, and steadiness of ankle movements. Results: Stride length variability and stride time variability reduced significantly after force-control training, but not after strength training. Both groups showed modest improvements in gait speed. We found task-specific effects with strength training improving plantarflexion and dorsiflexion strength and force control training improving motor accuracy and steadiness. Conclusion: Force-control training is superior to strength training in reducing gait variability in chronic stroke survivors. Improving ankle force control may be a promising approach to rehabilitate gait variability and improve safe mobility post-stroke.
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Affiliation(s)
- Prakruti Patel
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | - Agostina Casamento-Moran
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
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22
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Impairment of Global Lower Limb Muscle Coactivation During Walking in Cerebellar Ataxias. THE CEREBELLUM 2021; 19:583-596. [PMID: 32410093 DOI: 10.1007/s12311-020-01142-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The aim of this study was to investigate the time-varying multi-muscle coactivation function (TMCf) in the lower limbs during gait and its relationship with the biomechanical and clinical features of patients with cerebellar ataxia. A total of 23 patients with degenerative cerebellar ataxia (16 with spinocerebellar ataxia, 7 with adult-onset ataxia of unknown etiology) and 23 age-, sex-, and speed-matched controls were investigated. The disease severity was assessed using the Scale for the Assessment and Rating of Ataxia (SARA) in all patients. During walking, simultaneous acquisition of kinematic, kinetic, and electromyography data was performed using a motion analysis system. The coactivation was processed throughout the gait cycle using the TMCf, and the following parameters were measured: synthetic coactivation index, full width at half maximum, and center of activity. Spatiotemporal (walking speed, stance duration, swing duration, first and second double-support durations, step length, step width, stride length, Center of Mass displacement), kinetic (vertical component of GRFs), and energy consumption (total energy consumption and mechanical energy recovered) parameters were also measured. The coactivation variables were compared between patients and controls and were correlated with both clinical and gait variables. A significantly increased global TMCf was found in patients compared with controls. In addition, the patients showed a significant shift of the center of activity toward the initial contact and a significant reduction in energy recovery. All coactivation parameters were negatively correlated with gait speed, whereas the coactivation index and center of activity were positively correlated with both center-of-mass mediolateral displacement values and SARA scores. Our findings suggest that patients use global coactivation as a compensatory mechanism during the earliest and most challenging subphase (loading response) of the gait cycle to reduce the lateral body sway, thus improving gait stability at the expense of effective energy recovery. This information could be helpful in optimizing rehabilitative treatment aimed at improving lower limb muscle control during gait in patients with cerebella ataxia.
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23
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Changes in Spatiotemporal Measures and Variability During User-Driven Treadmill, Fixed-Speed Treadmill, and Overground Walking in Young Adults: A Pilot Study. J Appl Biomech 2021; 37:277-281. [PMID: 33931571 DOI: 10.1123/jab.2020-0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 12/21/2020] [Accepted: 01/27/2021] [Indexed: 11/18/2022]
Abstract
Walking is an integral indicator of human health commonly investigated while walking overground and with the use of a treadmill. Unlike fixed-speed treadmills, overground walking is dependent on the preferred walking speed under the individuals' control. Thus, user-driven treadmills may have the ability to better simulate the characteristics of overground walking. This pilot study is the first investigation to compare a user-driven treadmill, a fixed-speed treadmill, and overground walking to understand differences in variability and mean spatiotemporal measures across walking environments. Participants walked fastest overground compared to both fixed and user-driven treadmill conditions. However, gait cycle speed variability in the fixed-speed treadmill condition was significantly lower than the user-driven and overground conditions, with no significant differences present between overground and user-driven treadmill walking. The lack of differences in variability between the user-driven treadmill and overground walking may indicate that the user-driven treadmill can better simulate the variability of overground walking, potentially leading to more natural adaptation and motor control patterns of walking.
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24
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Schniepp R, Huppert A, Decker J, Schenkel F, Schlick C, Rasoul A, Dieterich M, Brandt T, Jahn K, Wuehr M. Fall prediction in neurological gait disorders: differential contributions from clinical assessment, gait analysis, and daily-life mobility monitoring. J Neurol 2021; 268:3421-3434. [PMID: 33713194 PMCID: PMC8357767 DOI: 10.1007/s00415-021-10504-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 11/27/2022]
Abstract
Objective To evaluate the predictive validity of multimodal clinical assessment outcomes and quantitative measures of in- and off-laboratory mobility for fall-risk estimation in patients with different forms of neurological gait disorders. Methods The occurrence, severity, and consequences of falls were prospectively assessed for 6 months in 333 patients with early stage gait disorders due to vestibular, cerebellar, hypokinetic, vascular, functional, or other neurological diseases and 63 healthy controls. At inclusion, participants completed a comprehensive multimodal clinical and functional fall-risk assessment, an in-laboratory gait examination, and an inertial-sensor-based daily mobility monitoring for 14 days. Multivariate logistic regression analyses were performed to identify explanatory characteristics for predicting the (1) the fall status (non-faller vs. faller), (2) the fall frequency (occasional vs. frequent falls), and (3) the fall severity (benign vs. injurious fall) of patients. Results 40% of patients experienced one or frequent falls and 21% severe fall-related injuries during prospective fall assessment. Fall status and frequency could be reliably predicted (accuracy of 78 and 91%, respectively) primarily based on patients' retrospective fall status. Instrumented-based gait and mobility measures further improved prediction and provided independent, unique information for predicting the severity of fall-related consequences. Interpretation Falls- and fall-related injuries are a relevant health problem already in early stage neurological gait disorders. Multivariate regression analysis encourages a stepwise approach for fall assessment in these patients: fall history taking readily informs the clinician about patients' general fall risk. In patients at risk of falling, instrument-based measures of gait and mobility provide critical information on the likelihood of severe fall-related injuries. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10504-x.
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Affiliation(s)
- Roman Schniepp
- Department of Neurology, Ludwig-Maximilians University of Munich, Marchioninistrasse 15, 81377, Munich, Germany. .,German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Munich, Germany.
| | - Anna Huppert
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Julian Decker
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Munich, Germany.,Schön Klinik, Bad Aibling, Germany
| | - Fabian Schenkel
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Cornelia Schlick
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Atal Rasoul
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, Ludwig-Maximilians University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Munich, Germany.,Schön Klinik, Bad Aibling, Germany
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Munich, Germany
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25
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Monaco V, Aprigliano F, Lofrumento M, Martelli D, Micera S. Uncontrolled manifold analysis of the effects of a perturbation-based training on the organization of leg joint variance in cerebellar ataxia. Exp Brain Res 2020; 239:501-513. [PMID: 33245386 DOI: 10.1007/s00221-020-05965-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/17/2020] [Indexed: 12/30/2022]
Abstract
Walking patterns of persons affected by cerebellar ataxia (CA) are characterized by wide stride-to-stride variability ascribable to: the background pathology-related sensory-motor noise; the motor redundancy, i.e., an excess of elemental degrees of freedom that overcomes the number of variables underlying a specific task performance. In this study, we first tested the hypothesis that healthy and, especially, CA subjects can effectively exploit solutions in the domain of segmental angles to stabilize the position of either the foot or the pelvis (task performance) across heel strikes, in accordance with the uncontrolled manifold (UCM) theory. Next, we verified whether a specific perturbation-based training allows CA subjects to further take advantage of this coordination mechanism to better cope with their inherent pathology-related variability. Results always rejected the hypothesis of pelvis stabilization whereas supported the idea that the foot position is stabilized across heel strikes by a synergic covariation of elevation and azimuth angles of lower limb segments in CA subjects only. In addition, it was observed that the perturbation-based training involves a decreasing trend in the variance component orthogonal to the UCM in both groups, reflecting an improved accuracy of the foot control. Concluding, CA subjects can effectively structure the wide amount of pathology-related sensory-motor noise to stabilize specific task performance, such as the foot position across heel strikes. Moreover, the promising effects of the proposed perturbation-based training paradigm are expected to improve the coordinative strategy underlying the stabilization of the foot position across strides, thus ameliorating balance control during treadmill locomotion.
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Affiliation(s)
- Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
- Department of Excellence in Robotics&AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | | | - Margherita Lofrumento
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Dario Martelli
- Department of Mechanical Engineering, The University of Alabama, Tuscaloosa, AL, USA
| | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics&AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Bertarelli Foundation Chair in Translational NeuroEngineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
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O'Keefe JA, Guan J, Robertson E, Biskis A, Joyce J, Ouyang B, Liu Y, Carnes D, Purcell N, Berry-Kravis E, Hall DA. The Effects of Dual Task Cognitive Interference and Fast-Paced Walking on Gait, Turns, and Falls in Men and Women with FXTAS. THE CEREBELLUM 2020; 20:212-221. [PMID: 33118140 DOI: 10.1007/s12311-020-01199-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 12/11/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a genetic neurodegenerative disorder characterized by cerebellar ataxia, tremor, and cognitive dysfunction. We examined the impact of dual-task (DT) cognitive-motor interference and fast-paced (FP) gait on gait and turning in FXTAS. Thirty participants with FXTAS and 35 age-matched controls underwent gait analysis using an inertial sensor-based 2-min walk test under three conditions: (1) self-selected pace (ST), (2) FP, and (3) DT with a concurrent verbal fluency task. Linear regression analyses were performed to assess the association between FXTAS diagnosis and gait and turn outcomes. Correlations between gait variables and fall frequency were also calculated. FXTAS participants had reduced stride length and velocity, swing time, and peak turn velocity and greater double limb support time and number of steps to turn compared to controls under all three conditions. There was greater dual task cost of the verbal fluency task on peak turn velocity in men with FXTAS compared to controls. Additionally, stride length variability was increased and cadence was reduced in FXTAS participants in the FP condition. Stride velocity variability under FP gait was significantly associated with the number of self-reported falls in the last year. Greater motor control requirements for turning likely made men with FXTAS more susceptible to the negative effects of DT cognitive interference. FP gait exacerbated gait deficits in the domains of rhythm and variability, and increased gait variability with FP was associated with increased falls. These data may inform the design of rehabilitation strategies in FXTAS.
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Affiliation(s)
- Joan A O'Keefe
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA.
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA.
| | - Joseph Guan
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Erin Robertson
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Alexandras Biskis
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Jessica Joyce
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Yuanqing Liu
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Danielle Carnes
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Nicollette Purcell
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Elizabeth Berry-Kravis
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
- Departments of Pediatrics and Biochemistry, Rush University Medical Center, Chicago, IL, USA
| | - Deborah A Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, 60612, USA
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Möhwald K, Wuehr M, Schenkel F, Feil K, Strupp M, Schniepp R. The gait disorder in primary orthostatic tremor. J Neurol 2020; 267:285-291. [PMID: 32915312 PMCID: PMC7718181 DOI: 10.1007/s00415-020-10177-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To uncover possible impairments of walking and dynamic postural stability in patients with primary orthostatic tremor (OT). METHODS Spatiotemporal gait characteristics were quantified in 18 patients with primary OT (mean age 70.5 ± 5.9 years, 10 females) and 18 age-matched healthy controls. One-third of patients reported disease-related fall events. Walking performance was assessed on a pressure-sensitive carpet under seven conditions: walking at preferred, slow, and maximal speed, with head reclination or eyes closed, and while performing a cognitive or motor dual-task paradigm. RESULTS Patients exhibited a significant gait impairment characterized by a broadened base of support (p = 0.018) with increased spatiotemporal gait variability (p = 0.010). Walking speed was moderately reduced (p = 0.026) with shortened stride length (p = 0.001) and increased periods of double support (p = 0.001). Gait dysfunction became more pronounced during slow walking (p < 0.001); this was not present during fast walking. Walking with eyes closed aggravated gait disability as did walking during cognitive dual task (p < 0.001). CONCLUSION OT is associated with a specific gait disorder with a staggering wide-based walking pattern indicative of a sensory and/or a cerebellar ataxic gait. The aggravation of gait instability during visual withdrawal and the normalization of walking with faster speeds further suggest a proprioceptive or vestibulo-cerebellar deficit as the primary source of gait disturbance in OT. In addition, the gait decline during cognitive dual task may imply cognitive processing deficits. In the end, OT is presumably a complex network disorder resulting in a specific spino-cerebello-frontocortical gait disorder that goes beyond mere tremor networks.
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Affiliation(s)
- Ken Möhwald
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany. .,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany
| | - Fabian Schenkel
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Feil
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael Strupp
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Roman Schniepp
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Ilg W, Seemann J, Giese M, Traschütz A, Schöls L, Timmann D, Synofzik M. Real-life gait assessment in degenerative cerebellar ataxia. Neurology 2020; 95:e1199-e1210. [DOI: 10.1212/wnl.0000000000010176] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/02/2020] [Indexed: 01/01/2023] Open
Abstract
ObjectivesWith disease-modifying drugs on the horizon for degenerative ataxias, ecologically valid motor biomarkers are highly warranted. In this observational study, we aimed to unravel and validate markers of ataxic gait in real life by using wearable sensors.MethodsWe assessed gait characteristics of 43 patients with degenerative cerebellar disease (Scale for the Assessment and Rating of Ataxia [SARA] 9.4 ± 3.9) compared with 35 controls by 3 body-worn inertial sensors in 3 conditions: (1) laboratory-based walking; (2) supervised free walking; (3) real-life walking during everyday living (subgroup n = 21). Movement analysis focused on measures of spatiotemporal step variability and movement smoothness.ResultsA set of gait variability measures was identified that allowed us to consistently identify ataxic gait changes in all 3 conditions. Lateral step deviation and a compound measure of spatial step variability categorized patients vs controls with a discrimination accuracy of 0.86 in real life. Both were highly correlated with clinical ataxia severity (effect size ρ = 0.76). These measures allowed detecting group differences even for patients who differed only 1 point in the clinical SARAposture&gait subscore, with highest effect sizes for real-life walking (d = 0.67).ConclusionsWe identified measures of ataxic gait that allowed us not only to capture the gait variability inherent in ataxic gait in real life, but also to demonstrate high sensitivity to small differences in disease severity, with the highest effect sizes in real-life walking. They thus represent promising candidates for motor markers for natural history and treatment trials in ecologically valid contexts.Classification of evidenceThis study provides Class I evidence that a set of gait variability measures, even if accessed in real life, correlated with the clinical severity of ataxia in patients with degenerative cerebellar disease.
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Wuehr M, Huppert A, Schenkel F, Decker J, Jahn K, Schniepp R. Independent domains of daily mobility in patients with neurological gait disorders. J Neurol 2020; 267:292-300. [PMID: 32533324 PMCID: PMC7718193 DOI: 10.1007/s00415-020-09893-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 12/31/2022]
Abstract
The aim of this study was to establish a comprehensive and yet parsimonious model of daily mobility activity in patients with neurological gait disorders. Patients (N = 240) with early-stage neurological (peripheral vestibular, cerebellar, hypokinetic, vascular or functional) gait disorders and healthy controls (N = 35) were clinically assessed with standardized scores related to functional mobility, balance confidence, quality of life, cognitive function, and fall history. Subsequently, daily mobility was recorded for 14 days by means of a body-worn inertial sensor (ActivPAL®). Fourteen mobility measures derived from ActivPAL recordings were submitted to principle component analysis (PCA). Group differences within each factor obtained from PCA were analyzed and hierarchical regression analysis was performed to identify predictive characteristics from clinical assessment for each factor. PCA yielded five significant orthogonal factors (i.e., mobility domains) accounting for 92.3% of the total variance from inertial-sensor-recordings: ambulatory volume (38.7%), ambulatory pattern (22.3%), postural transitions (13.3%), sedentary volume (10.8%), and sedentary pattern (7.2%). Patients' mobility performance only exhibited reduced scores in the ambulatory volume domain but near-to-normal scores in all remaining domains. Demographic characteristics, clinical scores, and fall history were differentially associated with each domain explaining 19.2–10.2% of their total variance. This study supports a low-dimensional five-domain model for daily mobility behavior in patients with neurological gait disorders that may facilitate monitoring the course of disease or therapeutic intervention effects in ecologically valid and clinically relevant contexts. Further studies are required to explore the determinants that may explain performance differences of patients within each of these domains and to examine the consequences of altered mobility behavior with respect to patients' risk of falling and quality of life.
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Affiliation(s)
- Max Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany.
| | - A Huppert
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - F Schenkel
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
| | - J Decker
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
- Schoen Clinic, Bad Aibling, Germany
| | - K Jahn
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
- Schoen Clinic, Bad Aibling, Germany
| | - R Schniepp
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University, Marchioninistrasse 15, 81377, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
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Schniepp R, Möhwald K, Wuehr M. Key gait findings for diagnosing three syndromic categories of dynamic instability in patients with balance disorders. J Neurol 2020; 267:301-308. [PMID: 32462346 PMCID: PMC7718186 DOI: 10.1007/s00415-020-09901-5] [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: 03/12/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 01/29/2023]
Abstract
With the emergence of affordable, clinical-orientated gait analysis techniques, clinicians may benefit from a general understanding of quantitative gait analysis procedures and their clinical applications. This article provides an overview of the potential of a quantitative gait analysis for decision support in three clinically relevant scenarios of early stage gait disorders: scenario I: gait ataxia and unsteadiness; scenario II: hypokinesia and slow gait; scenario III: apparently normal gait with a specific fall tendency in complex mobility situations. In a first part, we justify the advantages of standardized data collection and analysis procedures including data normalization and dimensionality reduction techniques that facilitate clinical interpretability of instrument-based gait profiles. We then outline typical patterns of pathological gait and their modulation during different walking conditions (variation of speed, sensory perturbation, and dual tasking) and highlight key aspects that are particularly helpful to support and guide clinical decision-making.
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Affiliation(s)
- Roman Schniepp
- Department of Neurology, Ludwig-Maximilian University of Munich, Munich, Bavaria, Germany. .,German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilian University of Munich, Munich, Bavaria, Germany.
| | - Ken Möhwald
- Department of Neurology, Ludwig-Maximilian University of Munich, Munich, Bavaria, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilian University of Munich, Munich, Bavaria, Germany
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilian University of Munich, Munich, Bavaria, Germany
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Moreira R, Alves J, Matias A, Santos C. Smart and Assistive Walker - ASBGo: Rehabilitation Robotics: A Smart-Walker to Assist Ataxic Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1170:37-68. [PMID: 32067202 DOI: 10.1007/978-3-030-24230-5_2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Locomotion is an important human faculty that affects an individual's life, bringing not only physical and psychosocial implications but also heavy social-economic consequences. Thus, it becomes paramount to find means (augmentative/assistive devices) to empower the user's residual capacities and promote functional recovery.In this context, a smart walker (SW) is explored for further clinical evaluation of ataxic patients during walker-assisted and to serve as a functional compensation and assist-as-needed personalized/customized rehabilitation tool, autonomously adapting assistance to the users' needs, through innovative combination of real-time multimodal sensory information from SW built-in sensors. To meet the users' needs, its design was weighed, considering to whom it is intended.Thereby, this paper presents the system overview, focusing on design considerations, mechanical structure (frame and main components), electronic and mechatronic components, followed by its functionalities. Lastly, it presents results regarding the main functionalities, addressing clinical evidence.
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Affiliation(s)
- Rui Moreira
- Universidade do Minho, Guimarães, Portugal
- Center for Microelectromechanical Systems (CMEMS) / Academic Clinical Center (2CA Braga, Braga Hospital), Guimarães, Portugal
| | - Joana Alves
- Universidade do Minho, Guimarães, Portugal
- Center for Microelectromechanical Systems (CMEMS) / Academic Clinical Center (2CA Braga, Braga Hospital), Guimarães, Portugal
| | - Ana Matias
- Hospital de Braga, Braga, Portugal
- Departamento de Medicina Física e de Reabilitação, Braga, Portugal
| | - Cristina Santos
- Universidade do Minho, Guimarães, Portugal.
- Center for Microelectromechanical Systems (CMEMS) / Academic Clinical Center (2CA Braga, Braga Hospital), Guimarães, Portugal.
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Zilani TA, Al-Turjman F, Khan MB, Zhao N, Yang X. Monitoring Movements of Ataxia Patient by Using UWB Technology. SENSORS (BASEL, SWITZERLAND) 2020; 20:E931. [PMID: 32050576 PMCID: PMC7039007 DOI: 10.3390/s20030931] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/07/2020] [Accepted: 02/07/2020] [Indexed: 01/19/2023]
Abstract
Internet of multimedia things (IoMT) driving innovative product development in health care applications. IoMT requires delay-sensitive and higher bandwidth devices. Ultra-wideband (UWB) technology is a promising solution to improve communication between devices, tracking and monitoring of patients. In the future, this technology has the capability to expand the IoMT world with new capabilities and more devices can be integrated. At the present time, some people face different types of physiological problems because of the damage in different areas of the central nervous system. Thus, they lose their balance coordination. One of these types of coordination problems is named Ataxia, in which patients are unable to control their body movements. This kind of coordination disorder needs a proper supervision system for the caretaker. Previous Ataxia assessment methods are cumbersome and cannot handle regular monitoring and tracking of patients. One of the most challenging tasks is to detect different walking abnormalities of Ataxia patients. In our paper, we present a technique for monitoring and tracking of a patient with the help of UWB technology. This method expands the real-time location systems (RTLS) in the indoor environment by placing wearable receiving tags on the body of Ataxia patients. The location and four different walking movement data are collected by UWB transceiver for the classification and prediction in the two-dimensional path. For accurate classification, we use a support vector machine (SVM) algorithm to clarify the movement variations. Our proposed examined result successfully achieved and the accuracy is above 95%.
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Affiliation(s)
- Tanjila Akter Zilani
- School of Electronic Engineering, Xidian University, Xi’an 710071, China; (T.A.Z.); (M.B.K.); (N.Z.)
| | - Fadi Al-Turjman
- Artificial Intelligence Engineering Department, Near East University, 99138 Nicosia, Mersin 10, Turkey;
- Research Centre for AI and IoT, Near East University, 99138 Nicosia, Mersin 10, Turkey
| | - Muhammad Bilal Khan
- School of Electronic Engineering, Xidian University, Xi’an 710071, China; (T.A.Z.); (M.B.K.); (N.Z.)
| | - Nan Zhao
- School of Electronic Engineering, Xidian University, Xi’an 710071, China; (T.A.Z.); (M.B.K.); (N.Z.)
| | - Xiaodong Yang
- School of Electronic Engineering, Xidian University, Xi’an 710071, China; (T.A.Z.); (M.B.K.); (N.Z.)
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Statistical analysis of the 180 degree walking turn: Common patterns, repeatability and prediction bands of turn signals. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2019.101689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jin L, Lv W, Han G, Ni L, Sun D, Hu X, Cai H. Gait characteristics and clinical relevance of hereditary spinocerebellar ataxia on deep learning. Artif Intell Med 2020; 103:101794. [PMID: 32143799 DOI: 10.1016/j.artmed.2020.101794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/22/2019] [Accepted: 01/03/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Deep learning has always been at the forefront of scientific research. It has also been applied to medical research. Hereditary spinocerebellar ataxia (SCA) is characterized by gait abnormalities and is usually evaluated semi-quantitatively by scales. However, more detailed gait characteristics of SCA and related objective methods have not yet been established. Therefore, the purpose of this study was to evaluate the gait characteristics of SCA patients, as well as to analyze the correlation between gait parameters, clinical scales, and imaging on deep learning. METHODS Twenty SCA patients diagnosed by genetic detection were included in the study. Ten patients who were tested via functional magnetic resonance imaging (fMRI) were included in the SCA imaging subgroup. All SCA patients were evaluated with the International Cooperative Ataxia Rating Scale (ICARS) and Scale for the Assessment and Rating of Ataxia (SARA) clinical scales. The gait control group included 16 healthy subjects, and the imaging control group included seven healthy subjects. Gait data consisting of 10 m of free walking of each individual in the SCA group and the gait control group were detected by wearable gait-detection equipment. Stride length, stride time, velocity, supporting-phase percentage, and swinging-phase percentage were extracted as gait parameters. Cerebellar volume and the midsagittal cerebellar proportion in the posterior fossa (MRVD) were calculated according to MR. RESULTS There were significant differences in stride length, velocity, supporting-phase percentage, and swinging-phase percentage between the SCA group and the gait control group. The stride length and stride velocity of SCA groups were lower while supporting phase was longer than those of the gait control group. SCA group's velocity was negatively correlated with both the ICARS and SARA scores. The cerebellar volume and MRVD of the SCA imaging subgroup were significantly smaller than those of the imaging control group. MRVD was significantly correlated with ICARS and SARA scores, as well as stride velocity variability. CONCLUSION SCA gait parameters were characterized by a reduced stride length, slower walking velocity, and longer supporting phase. Additionally, a smaller cerebellar volume correlated with an increased irregularity in gait. Gait characteristics exhibited considerable clinical relevance to hereditary SCA. We conclude that a combination of gait parameters, ataxia scales, and MRVD may represent more objective markers for clinical evaluations of SCA.
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Affiliation(s)
- Luya Jin
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Wen Lv
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Guocan Han
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Linhui Ni
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Di Sun
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Xingyue Hu
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Huaying Cai
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China.
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The repeatability of the instrumented timed Up & Go test: The performance of older adults and parkinson’s disease patients under different conditions. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Caliandro P, Conte C, Iacovelli C, Tatarelli A, Castiglia SF, Reale G, Serrao M. Exploring Risk of Falls and Dynamic Unbalance in Cerebellar Ataxia by Inertial Sensor Assessment. SENSORS 2019; 19:s19245571. [PMID: 31861099 PMCID: PMC6960492 DOI: 10.3390/s19245571] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 11/23/2022]
Abstract
Background. Patients suffering from cerebellar ataxia have extremely variable gait kinematic features. We investigated whether and how wearable inertial sensors can describe the gait kinematic features among ataxic patients. Methods. We enrolled 17 patients and 16 matched control subjects. We acquired data by means of an inertial sensor attached to an ergonomic belt around pelvis, which was connected to a portable computer via Bluetooth. Recordings of all the patients were obtained during overground walking. From the accelerometric data, we obtained the harmonic ratio (HR), i.e., a measure of the acceleration patterns, smoothness and rhythm, and the step length coefficient of variation (CV), which evaluates the variability of the gait cycle. Results. Compared to controls, patients had a lower HR, meaning a less harmonic and rhythmic acceleration pattern of the trunk, and a higher step length CV, indicating a more variable step length. Both HR and step length CV showed a high effect size in distinguishing patients and controls (p < 0.001 and p = 0.011, respectively). A positive correlation was found between the step length CV and both the number of falls (R = 0.672; p = 0.003) and the clinical severity (ICARS: R = 0.494; p = 0.044; SARA: R = 0.680; p = 0.003). Conclusion. These findings demonstrate that the use of inertial sensors is effective in evaluating gait and balance impairment among ataxic patients.
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Affiliation(s)
- Pietro Caliandro
- Unità Operativa Complessa Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy;
| | - Carmela Conte
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi, 6, 20121 Milan, Italy;
| | - Chiara Iacovelli
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi, 6, 20121 Milan, Italy;
- Correspondence: ; Tel.: +39-0633086554
| | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Italy;
| | - Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, Italy; (S.F.C.); (M.S.)
| | - Giuseppe Reale
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, 00168 Rome, Italy;
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, Italy; (S.F.C.); (M.S.)
- Policlinico Italia, Movement Analysis Laboratory, Piazza del Campidano, 6, 00162 Rome, Italy
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Widener GL, Conley N, Whiteford S, Gee J, Harrell A, Gibson-Horn C, Block V, Allen DD. Changes in standing stability with balance-based torso-weighting with cerebellar ataxia: A pilot study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1814. [PMID: 31749254 PMCID: PMC7050535 DOI: 10.1002/pri.1814] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/12/2019] [Accepted: 08/25/2019] [Indexed: 12/16/2022]
Abstract
Objectives People with cerebellar ataxia have few options to improve the standing stability they need for function. Strategic placement of light weights on the torso using the balance‐based torso‐weighting (BBTW) method has improved stability and reduced falls in people with multiple sclerosis, but has not been tested in cerebellar ataxia. We examined whether torso‐weighting increased standing stability and/or functional movement in people with cerebellar ataxia. Methods Ten people with cerebellar ataxia and 10 matched controls participated in this single‐session quasi‐experimental pilot study. People with ataxia performed the Scale for the Assessment and Rating of Ataxia (SARA) prior to clinical testing. All participants donned inertial sensors that recorded postural sway; stopwatches recorded duration for standing and mobility tasks. All participants stood for up to 30 s on firm and foam surfaces with eyes open then eyes closed, and performed the Timed Up and Go (TUG) test. Light weights (0.57–1.25 kg) were strategically applied to a vest‐like garment. Paired t tests compared within‐group differences with and without BBTW weights. Independent t tests assessed differences from controls. All t tests were one‐tailed with alpha set at .05. Results Duration of standing for people with ataxia was significantly longer with weighting (p = .004); all controls stood for the maximum time of 120 s with and without weights. More severe ataxia according to SARA was moderately correlated with greater improvement in standing duration with BBTW (Pearson r = .54). Tasks with more sensory challenges (eyes closed, standing on firm surface) showed less body sway with weighting. Duration for the TUG was unchanged by torso‐weighting in people with ataxia. Conclusion Strategic weighting improved standing stability but not movement speed in people with ataxia. BBTW has potential for improving stability and response to challenging sensory conditions in this population. Future studies should further examine gait stability measures along with movement speed.
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Affiliation(s)
- Gail L Widener
- Department of Physical Therapy, Samuel Merritt University, Oakland, CA, USA
| | - Nicole Conley
- Graduate Program in Physical Therapy, University of California San Francisco/San Francisco State University, San Francisco, CA, USA
| | - Sarah Whiteford
- Graduate Program in Physical Therapy, University of California San Francisco/San Francisco State University, San Francisco, CA, USA
| | - Jason Gee
- Graduate Program in Physical Therapy, University of California San Francisco/San Francisco State University, San Francisco, CA, USA
| | - Anthony Harrell
- Graduate Program in Physical Therapy, University of California San Francisco/San Francisco State University, San Francisco, CA, USA
| | | | - Valerie Block
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Diane D Allen
- Graduate Program in Physical Therapy, University of California San Francisco/San Francisco State University, San Francisco, CA, USA
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Park SH, Wang Z, McKinney W, Khemani P, Lui S, Christou EA, Mosconi MW. Functional motor control deficits in older FMR1 premutation carriers. Exp Brain Res 2019; 237:2269-2278. [PMID: 31161414 PMCID: PMC6679741 DOI: 10.1007/s00221-019-05566-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023]
Abstract
Individuals with fragile X mental retardation 1 (FMR1) gene premutations are at increased risk for fragile X-associated tremor/ataxia syndrome (FXTAS) during aging. However, it is unknown whether older FMR1 premutation carriers, with or without FXTAS, exhibit functional motor control deficits compared with healthy individuals. The purpose of this study, therefore, was to determine whether older FMR1 premutation carriers exhibit impaired ability to perform functional motor tasks. Eight FMR1 premutation carriers (age: 58.88 ± 8.36 years) and eight age- and sex-matched healthy individuals (60.13 ± 9.25 years) performed (1) a steady isometric force control task with the index finger at 20% of their maximum voluntary contraction (MVC) and; (2) a single-step task. During the finger abduction task, firing rate of multiple motor units of the first dorsal interosseous (FDI) muscle was recorded. Compared with healthy controls, FMR1 premutation carriers exhibited (1) greater force variability (coefficient of variation of force) during isometric force (1.48 ± 1.02 vs. 0.63 ± 0.37%; P = 0.04); (2) reduced firing rate of multiple motor units during steady force, and; (3) reduced velocity of their weight transfer during stepping (156.62 ± 26.24 vs. 191.86 ± 18.83 cm/s; P = 0.01). These findings suggest that older FMR1 premutation carriers exhibit functional motor control deficits that reflect either subclinical issues associated with premutations independent of FXTAS, or prodromal markers of the development of FXTAS.
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Affiliation(s)
- Seoung Hoon Park
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Zheng Wang
- Department of Occupational Therapy, University of Florida, Gainesville, FL, USA
| | - Walker McKinney
- Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS, USA
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
- Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, USA
| | - Pravin Khemani
- Department of Neurology, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Su Lui
- Department of Radiology, Huaxi Magnetic Resonance Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Matthew W Mosconi
- Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS, USA.
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA.
- Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS, USA.
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de Moura MCDS, Hazime FA, Marotti Aparicio LV, Grecco LAC, Brunoni AR, Hasue RH. Effects of transcranial direct current stimulation (tDCS) on balance improvement: a systematic review and meta-analysis. Somatosens Mot Res 2019; 36:122-135. [PMID: 31181963 DOI: 10.1080/08990220.2019.1624517] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Transcranial direct current stimulation (tDCS) has emerged as a promising therapeutic tool to improve balance and optimize rehabilitation strategies. However, current literature shows the methodological heterogeneity of tDCS protocols and results, hindering any clear conclusions about the effects of tDCS on postural control. Objective: Evaluate the effectiveness of tDCS on postural control, and identify the most beneficial target brain areas and the effect on different populations. Methods: Two independent reviewers selected randomized tDCS clinical-trials studies from PubMed, Scopus, Web of Science, and reference lists of retrieved articles published between 1998 and 2017. Most frequently reported centre of pressure (COP) variables were selected for meta-analysis. Other postural control outcomes were discussed in the review. Results: Thirty studies were included in the systematic review, and 11 were submitted to a meta-analysis. A reduction of COP displacement area has been significantly achieved by tDCS, evidencing an improvement in balance control. Individuals with cerebral palsy (CP) and healthy young adults are mostly affected by stimulation. The analysis of the impact of tDCS over different brain areas revealed a significant effect after primary motor cortex (M1) stimulation, however, with no clear results after cerebellar stimulation due to divergent results among studies. Conclusions: tDCS appears to improve balance control, more evident in healthy and CP subjects. Effects are observed when primary MI is stimulated. Cerebellar stimulation should be better investigated.
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Affiliation(s)
- Maria Clara D Soares de Moura
- a Department of Physical Therapy, Communication Sciences and Disorders, and Occupational Therapy, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
| | - Fuad A Hazime
- b Department of Physical Therapy , Federal University of Piauí , Piauí , Brazil
| | - Luana V Marotti Aparicio
- c Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Psychiatry (INBioN), Department and Institute of Psychiatry, Hospital of Clinics, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
| | | | - André R Brunoni
- c Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Psychiatry (INBioN), Department and Institute of Psychiatry, Hospital of Clinics, Faculty of Medicine , University of São Paulo , São Paulo , Brazil.,e Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Renata Hydeé Hasue
- a Department of Physical Therapy, Communication Sciences and Disorders, and Occupational Therapy, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
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Schniepp R, Möhwald K, Wuehr M. Clinical and automated gait analysis in patients with vestibular, cerebellar, and functional gait disorders: perspectives and limitations. J Neurol 2019; 266:118-122. [PMID: 31134375 DOI: 10.1007/s00415-019-09378-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 02/01/2023]
Abstract
This article outlines recent developments in the clinical and automated assessment of neurological gait disorders. With a primary focus on vestibular, cerebellar, and functional gait disorders, we discuss how instrumented gait examination may assist clinical decision making in these disorders with respect to the initial differential diagnosis and prognosis as well as the objective monitoring of disease progression and therapeutic interventions. We delineate strategies for data handling and analysis of quantitative gait examinations that can facilitate the clinical characterization and interpretation of walking impairments. These strategies include data normalization and dimensionality reduction procedures. We further emphasize the value of a comprehensive, standardized gait assessment protocol. Accordingly, the examination of walking conditions that challenge patients with respect to their biomechanical, sensory, or cognitive resources are particularly helpful to disclose and characterize the causes underlying their gait impairment. Finally, we provide a perspective on the emerging implementation of pattern recognition approaches within the framework of clinical management of gait disorders and discuss their potential to assist clinical decision making with respect to the differential diagnosis and the prognosis of fall risk in individual patients.
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Affiliation(s)
- Roman Schniepp
- Department of Neurology, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany. .,German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Ken Möhwald
- Department of Neurology, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Caballero C, Davids K, Heller B, Wheat J, Moreno FJ. Movement variability emerges in gait as adaptation to task constraints in dynamic environments. Gait Posture 2019; 70:1-5. [PMID: 30771594 DOI: 10.1016/j.gaitpost.2019.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 01/27/2019] [Accepted: 02/02/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Motor variability has been related to motor control playing a functional role in human adaptive behaviours. However, the direction of the relationship between variability and motor control can be unclear. The specific relations that exist between task constraints and movement (re)organization could explain some of this controversy. RESEARCH QUESTION This study sought to understand whether manipulation of task constraints result in changes in the magnitude or structure of motor system variability observed in a basic walking task. We also investigated the relationship between performance in achieving task goals and the structure of motor variability. METHODS Twenty volunteers walked around a circular track with binary combinations of 3 task constraints, providing 8 conditions. The manipulated task constraints were: 1) track width; 2) surface stiffness; and 3), walking direction. Performance was analysed using standard deviation (SD) of sacral displacement and its mean velocity (MV). Fuzzy Entropy (FE) and Detrended Fluctuation Analysis (DFA) were used to assess the kinematic variability structure. RESULTS Individuals showed lower SD and MV walking on the narrower track. These changes were also followed by higher DFA values, indicating a more auto-correlated structure of variability. The foam surface was also associated with an increase in amplitude, velocity and irregularity (FE) of movement. SIGNIFICANCE Results of this study describe how specific task constraints, such as the width of the walking track and the surface stiffness, shape emergent movement coordination patterns as participants search for functional information from the environment to regulate performance behaviors. Changes in variability structure could reveal the search for adaptive strategies during walking. Smaller movement fluctuations and higher velocity in gait patterns are related to greater irregularity and lower autocorrelation in the kinematic variability structure, demonstrating that a specific relationship emerges between system variability and movement performance, which is driven by task constraints.
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Affiliation(s)
- Carla Caballero
- Department of Sport Sciences. Sport Research Center, Miguel Hernández University of Elche, Av. de la Universidad s/n., CP: 03202, Elche, Alicante, Spain.
| | - Keith Davids
- Centre of Sports Engineering Research, Sheffield Hallam University, Collegiate Hall, Collegiate Campus, Sheffield, S1 1WB, United Kingdom.
| | - Ben Heller
- Centre of Sports Engineering Research, Sheffield Hallam University, Collegiate Hall, Collegiate Campus, Sheffield, S1 1WB, United Kingdom.
| | - Jonathan Wheat
- Academy of Sport and Physical Activity. Sheffield Hallam University, Collegiate Hall, Collegiate Campus, Sheffield, S1 1WB, United Kingdom.
| | - Francisco J Moreno
- Department of Sport Sciences. Sport Research Center, Miguel Hernández University of Elche, Av. de la Universidad s/n., CP: 03202, Elche, Alicante, Spain.
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Aprigliano F, Martelli D, Kang J, Kuo SH, Kang UJ, Monaco V, Micera S, Agrawal SK. Effects of repeated waist-pull perturbations on gait stability in subjects with cerebellar ataxia. J Neuroeng Rehabil 2019; 16:50. [PMID: 30975168 PMCID: PMC6460671 DOI: 10.1186/s12984-019-0522-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/03/2019] [Indexed: 02/06/2023] Open
Abstract
Background Damage to the cerebellum can affect neural structures involved in locomotion, causing gait and balance disorders. However, the integrity of cerebellum does not seem to be critical in managing sudden and unexpected environmental changes such as disturbances during walking. The cerebellum also plays a functional role in motor learning. Only a few effective therapies exist for individuals with cerebellar ataxia. With these in mind, we aimed at investigating: (1) corrective response of participants with cerebellar ataxia (CA) to unexpected gait perturbations; and (2) the effectiveness of a perturbation-based training to improve their dynamic stability during balance recovery responses and steady walking. Specifically, we hypothesized that: (1) CA group can show a corrective behavior similar to that of a healthy control group; (2) the exposure to a perturbation-based treatment can exploit residual learning capability, thus improving their dynamic stability during balance recovery responses and steady locomotion. Methods Ten participants with cerebellar ataxia and eight age-matched healthy adults were exposed to a single perturbation-based training session. The Active Tethered Pelvic Assist Device applied unexpected waist-pull perturbations while participants walked on a treadmill. Spatio-temporal parameters and dynamic stability were determined during corrective responses and steady locomotion, before and after the training. The ANalysis Of VAriance was the main statistical test used to assess the effects of group (healthy vs CA) and training (baseline vs post) on spatio-temporal parameters of the gait and margin of stability. Results Data analysis revealed that individuals with cerebellar ataxia behaved differently from healthy volunteers: (1) they retained a wider base of support during corrective responses and steady gait both before and after the training; (2) due to the training, patients improved their anterior-posterior margin of stability during steady walking only. Conclusions Our results revealed that participants with cerebellar ataxia could still rely on their learning capability to modify the gait towards a safer behavior. However, they could not take advantage from their residual learning capability while managing sudden and unexpected perturbations. Accordingly, the proposed training paradigm can be considered as a promising approach to improve balance control during steady walking in these individuals.
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Affiliation(s)
| | - Dario Martelli
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Jiyeon Kang
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Un J Kang
- Division of Movement Disorders, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Federale de Lausanne (EPFL), Lausanne, Switzerland
| | - Sunil K Agrawal
- Department of Mechanical Engineering, Columbia University, New York, NY, USA.
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Wuehr M, Schlick C, Möhwald K, Schniepp R. Walking in orthostatic tremor modulates tremor features and is characterized by impaired gait stability. Sci Rep 2018; 8:14152. [PMID: 30237442 PMCID: PMC6147915 DOI: 10.1038/s41598-018-32526-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/06/2018] [Indexed: 11/13/2022] Open
Abstract
Primary orthostatic tremor (OT) is characterized by high-frequency lower-limb muscle contractions and a disabling sense of unsteadiness while standing. Patients consistently report a relief of symptoms when starting to ambulate. Here, we systematically examined and linked tremor and gait characteristics in patients with OT. Tremor and gait features were examined in nine OT patients and controls on a pressure-sensitive treadmill for one minute of walking framed by two one-minute periods of standing. Tremor characteristics were assessed by time-frequency analysis of surface EMG-recordings from four leg muscles. High-frequency tremor during standing (15.29 ± 0.17 Hz) persisted while walking but was consistently reset to higher frequencies (16.34 ± 0.25 Hz; p < 0.001). Tremor intensity was phase-dependently modulated, being predominantly observable during stance phases (p < 0.001). Tremor intensity scaled with the force applied during stepping (p < 0.001) and was linked to specific gait alterations, i.e., wide base walking (p = 0.019) and increased stride-to-stride fluctuations (p = 0.002). OT during walking persists but is reset to higher frequencies, indicating the involvement of supraspinal locomotor centers in the generation of OT rhythm. Tremor intensity is modulated during the gait cycle, pointing at specific pathways mediating the peripheral manifestation of OT. Finally, OT during walking is linked to gait alterations resembling a cerebellar and/or sensory ataxic gait disorder.
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Affiliation(s)
- M Wuehr
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.
| | - C Schlick
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany
| | - K Möhwald
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - R Schniepp
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Munich, Germany
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Portnoy S, Maayan C, Tsenter J, Ofran Y, Goldman V, Hiller N, Karniel N, Schwartz I. Characteristics of ataxic gait in familial dysautonomia patients. PLoS One 2018; 13:e0196599. [PMID: 29698477 PMCID: PMC5919612 DOI: 10.1371/journal.pone.0196599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 04/16/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction and objectives Progressive ataxic gait is a common symptom in individuals with Familial Dysautonomia (FD). At least 50% of adults with FD require assistance with walking. Our aims were to describe the medical condition of individuals with FD (ii) compare their gait characteristics to healthy individuals, and (iii) assess correlations between gait measures, presence of unstable gait pattern and frequency of falls. Methods Twelve subjects with FD (7 males, age 25.3±10.6 years) and 16 healthy participants (6 males, age 35.9±11.9 years) were recruited. Gait kinematics, gait symmetry, dynamic muscle activity, and foot deep vibration sensation were recorded. Results Ataxic gait degrees were: severe (6 out of 12), moderate (4 out of 12) and low (2 out of 12). The number of falls correlated with base width asymmetry. Crouch gait was noted in 3 out of 12 of the subjects. Conclusions In-depth quantitative gait analysis of individuals with FD revealed ataxic gait. The ataxic pattern might be a result of combined neurological deficiencies and osseous deformities. Increasing the base of support of patients with FD might increase the symmetry of the base width during gait and decrease the number of falls. Additionally, perturbation treatment and dynamic balance exercises may be recommended in order to improve compensatory strategies. Future investigation of this population should include quantification of osseous rotations of the lower limb in order to fully understand its effect on their gait pattern and falls.
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Affiliation(s)
- Sigal Portnoy
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center, Hebrew University Hadassah medical school, Jerusalem, Israel
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Channa Maayan
- Familial Dysautonomia Center, Pediatric department, Hadassah Medical Center, Hebrew University Hadassah medical school, Jerusalem, Israel
| | - Jeanna Tsenter
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center, Hebrew University Hadassah medical school, Jerusalem, Israel
| | - Yonah Ofran
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center, Hebrew University Hadassah medical school, Jerusalem, Israel
| | - Vladimir Goldman
- Department of Orthopedic Surgery, Hadassah Medical Center, Hebrew University Hadassah medical school, Jerusalem, Israel
| | - Nurit Hiller
- Department of Radiology, Hadassah Medical Center, Hebrew University Hadassah medical school, Jerusalem, Israel
| | - Naama Karniel
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center, Hebrew University Hadassah medical school, Jerusalem, Israel
| | - Isabella Schwartz
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center, Hebrew University Hadassah medical school, Jerusalem, Israel
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Consensus Paper: Neurophysiological Assessments of Ataxias in Daily Practice. THE CEREBELLUM 2018; 17:628-653. [DOI: 10.1007/s12311-018-0937-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Progression of Gait Ataxia in Patients with Degenerative Cerebellar Disorders: a 4-Year Follow-Up Study. THE CEREBELLUM 2018; 16:629-637. [PMID: 27924492 DOI: 10.1007/s12311-016-0837-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In the present study, the progression of gait impairment in a group of patients with primary degenerative cerebellar ataxias was observed over a period of 4 years. A total of 30 patients underwent an initial gait analysis study, and thereafter only 12 were evaluated because they completed the 2- and 4-year follow-up evaluations. Time-distance parameters, trunk and joint range of motion (RoM), and variability parameters (e.g., coefficients of variation) were measured at the baseline and at each follow-up evaluation. The scale for the assessment and rating of ataxia (SARA) was used to evaluate disease severity. We found a significant increase in the SARA score at both the 2- and 4-year follow-up evaluations. Almost all the gait variables changed significantly only at the 4-year follow-up. Particularly, we found a significant decrease in the step length and in the hip, knee, and ankle joint RoM values and noted a significant increase in the trunk rotation RoM and stride-to-stride and step length variability. Furthermore, a significant difference in ankle joint RoM was found between spinocerebellar ataxia and sporadic adult-onset ataxia patients, with the value being lower in the former group of patients. Our findings suggest that patients with degenerative cerebellar ataxias exhibit gait decline after 4 years from the baseline. Moreover, patients try to maintain an effective gait by adopting different compensatory mechanisms during the course of the disease in spite of disease progression.
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Psychometric properties of outcome measures evaluating decline in gait in cerebellar ataxia: A systematic review. Gait Posture 2018; 61:149-162. [PMID: 29351857 DOI: 10.1016/j.gaitpost.2017.12.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/14/2017] [Accepted: 12/29/2017] [Indexed: 02/02/2023]
Abstract
Cerebellar ataxia often results in impairment in ambulation secondary to gait pattern dysfunction and compensatory gait adjustments. Pharmaceutical and therapy-based interventions with potential benefit for gait in ataxia are starting to emerge, however evaluation of such interventions is hampered by the lack of outcome measures that are responsive, valid and reliable for measurement of gait decline in cerebellar ataxia. This systematic review aimed for the first time to evaluate the psychometric properties of gait and walking outcomes applicable to individuals with cerebellar ataxia. Only studies evaluating straight walking were included. A comprehensive search of three databases (MEDLINE, CINAHL and EMBASE) identified 53 studies meeting inclusion criteria. Forty-nine were rated as 'poor' as assessed by the COnsensus-based Standards for the selection of health Measurement INstruments checklist. The primary objective of most studies was to explore changes in gait related to ataxia, rather than to examine psychometric properties of outcomes. This resulted in methodologies not specific for psychometric assessment. Thirty-nine studies examined validity, 11 examined responsiveness and 12 measured reliability. Review of the data identified double and single support and swing percentage of the gait cycle, velocity, step length and the Scale for Assessment and Rating of Ataxia (SARA) gait item as the most valid and responsive measures of gait in cerebellar ataxia. However, further evaluation to establish their reliability and applicability for use in clinical trials is clearly warranted. We recommend that inter-session reliability of gait outcomes should be evaluated to ensure changes are reflective of intervention effectiveness in cerebellar ataxia.
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Selge C, Schoeberl F, Zwergal A, Nuebling G, Brandt T, Dieterich M, Schniepp R, Jahn K. Gait analysis in PSP and NPH. Neurology 2018; 90:e1021-e1028. [DOI: 10.1212/wnl.0000000000005168] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/22/2017] [Indexed: 12/21/2022] Open
Abstract
ObjectiveTo test whether quantitative gait analysis of gait under single- and dual-task conditions can be used for a differential diagnosis of progressive supranuclear palsy (PSP) and idiopathic normal-pressure hydrocephalus (iNPH).MethodsIn this cross-sectional study, temporal and spatial gait parameters were analyzed in 38 patients with PSP (Neurological Disorders and Stroke and Society for Progressive Supranuclear Palsy diagnostic criteria), 27 patients with iNPH (international iNPH guidelines), and 38 healthy controls. A pressure-sensitive carpet was used to examine gait under 5 conditions: single task (preferred, slow, and maximal speed), cognitive dual task (walking with serial 7 subtractions), and motor dual task (walking while carrying a tray).ResultsThe main results were as follows. First, both patients with PSP and those with iNPH exhibited significant gait dysfunction, which was worse in patients with iNPH with a more broad-based gait (p < 0.001). Second, stride time variability was increased in both patient groups, more pronounced in PSP (p = 0.009). Third, cognitive dual task led to a greater reduction of gait velocity in PSP (PSP 34.4% vs iNPH 16.9%, p = 0.002). Motor dual task revealed a dissociation of gait performance: patients with PSP considerably worsened, but patients with iNPH tended to improve.ConclusionPatients with PSP seem to be more sensitive to dual-task perturbations than patients with iNPH. An increased step width and anisotropy of the effect of dual-task conditions (cognitive vs motor) seem to be good diagnostic tools for iNPH.
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Buckley E, Mazzà C, McNeill A. A systematic review of the gait characteristics associated with Cerebellar Ataxia. Gait Posture 2018; 60:154-163. [PMID: 29220753 DOI: 10.1016/j.gaitpost.2017.11.024] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/07/2017] [Accepted: 11/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cerebellar Ataxias are a group of gait disorders resulting from dysfunction of the cerebellum, commonly characterised by slowly progressing incoordination that manifests as problems with balance and walking leading to considerable disability. There is increasing acceptance of gait analysis techniques to quantify subtle gait characteristics that are unmeasurable by current clinical methods This systematic review aims to identify the gait characteristics able to differentiate between Cerebellar Ataxia and healthy controls. METHODS Following systematic search and critical appraisal of the literature, gait data relating to preferred paced walking in Cerebellar Ataxia was extracted from 21 studies. A random-effect model meta-analysis was performed for 14 spatiotemporal parameters. Quality assessment was completed to detect risk of bias. RESULTS There is strong evidence that compared with healthy controls, Cerebellar Ataxia patients walk with a reduced walking speed and cadence, reduced step length, stride length, and swing phase, increased walking base width, stride time, step time, stance phase and double limb support phase with increased variability of step length, stride length, and stride time. CONCLUSION The consensus description provided here, clarifies the gait pattern associated with ataxic gait disturbance in a large cohort of participants. High quality research and reporting is needed to explore specific genetic diagnoses and identify biomarkers for disease progression in order to develop well-evidenced clinical guidelines and interventions for Cerebellar Ataxia.
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Affiliation(s)
- Ellen Buckley
- Department of Neuroscience, University of Sheffield, UK.
| | - Claudia Mazzà
- Department of Mechanical Engineering, University of Sheffield, UK; INSIGNEO Institute for In Silico Medicine, University of Sheffield, UK.
| | - Alisdair McNeill
- Department of Neuroscience, University of Sheffield, UK; INSIGNEO Institute for In Silico Medicine, University of Sheffield, UK; Sheffield Children's Hospital, UK.
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Abstract
The cerebellum plays an integral role in the control of limb and ocular movements, balance, and walking. Cerebellar disorders may be classified as sporadic or hereditary with clinical presentation varying with the extent and site of cerebellar damage and extracerebellar signs. Deficits in balance and walking reflect the cerebellum's proposed role in coordination, sensory integration, coordinate transformation, motor learning, and adaptation. Cerebellar dysfunction results in increased postural sway, hypermetric postural responses to perturbations and optokinetic stimuli, and postural responses that are poorly coordinated with volitional movement. Gait variability is characteristic and may arise from a combination of balance impairments, interlimb incoordination, and incoordination between postural activity and leg movement. Intrinsic problems with balance lead to a high prevalence of injurious falls. Evidence for pharmacologic management is limited, although aminopyridines reduce attacks in episodic ataxias and may have a role in improving gait ataxia in other conditions. Intensive exercises targeting balance and coordination lead to improvements in balance and walking but require ongoing training to maintain/maximize any effects. Noninvasive brain stimulation of the cerebellum may become a useful adjunct to therapy in the future. Walking aids, orthoses, specialized footwear and seating may be required for more severe cases of cerebellar ataxia.
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Affiliation(s)
- Jonathan F Marsden
- Department of Rehabilitation, School of Health Professions, University of Plymouth, Plymouth, United Kingdom.
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