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Fernández-González D, Rodriguez-Costa I, Sanz-Esteban I, Estrada-Barranco C. Therapeutic intervention with virtual reality in patients with Parkinson's disease for upper limb motor training: A systematic review. Rehabilitacion (Madr) 2023; 57:100751. [PMID: 36344299 DOI: 10.1016/j.rh.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022]
Abstract
To analyze the scientific evidence regarding changes in upper extremities in patients with Parkinson's disease who use virtual reality as part of their neurological rehabilitation treatment. The search was carried out in the following databases: MEDLINE, Cochrane Library, PEDROs and SCOPUS. The following inclusion criteria were applied to a total of 106 articles: Randomized clinical trials with an age of 5 years, the sample had to be of patients with PD (regardless of their state of involvement) and who had performed RV in the treatment of limbs superiors. A total of n=7 articles were used, in which the variables corresponding to upper limb motor control were measured, such as: fine motor dexterity, gross motor dexterity, strength, tremor, functionality and speed. Virtual Reality as tool in neurorehabilitation in patients with Parkinson's disease shows positive effects in all measurements related to upper limb motor control.
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Affiliation(s)
| | - I Rodriguez-Costa
- Humanization in the Intervention of Physiotherapy for the Integral Attention to the People (HIPATIA) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - I Sanz-Esteban
- Universidad Europea de Madrid, Faculty of Sport Sciences, Department of Physiotherapy, Villaviciosa de Odón, Madrid, Spain
| | - C Estrada-Barranco
- Universidad Europea de Madrid, Faculty of Sport Sciences, Department of Physiotherapy, Villaviciosa de Odón, Madrid, Spain.
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Lewis S, Factor S, Giladi N, Nieuwboer A, Nutt J, Hallett M. Stepping up to meet the challenge of freezing of gait in Parkinson's disease. Transl Neurodegener 2022; 11:23. [PMID: 35490252 PMCID: PMC9057060 DOI: 10.1186/s40035-022-00298-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/31/2022] [Indexed: 11/20/2022] Open
Abstract
There has been a growing appreciation for freezing of gait as a disabling symptom that causes a significant burden in Parkinson’s disease. Previous research has highlighted some of the key components that underlie the phenomenon, but these reductionist approaches have yet to lead to a paradigm shift resulting in the development of novel treatment strategies. Addressing this issue will require greater integration of multi-modal data with complex computational modeling, but there are a number of critical aspects that need to be considered before embarking on such an approach. This paper highlights where the field needs to address current gaps and shortcomings including the standardization of definitions and measurement, phenomenology and pathophysiology, as well as considering what available data exist and how future studies should be constructed to achieve the greatest potential to better understand and treat this devastating symptom.
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Affiliation(s)
- Simon Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia.
| | - Stewart Factor
- Jean and Paul Amos Parkinson's Disease and Movement Disorders Program, Emory University School of Medicine, Atlanta, GA, USA
| | - Nir Giladi
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - John Nutt
- Movement Disorder Section, Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Fathipour-Azar Z, Azad A, Akbarfahimi M, Behzadipour S, Taghizadeh G. Symmetric and asymmetric bimanual coordination and freezing of gait in Parkinsonian patients in drug phases. Ann N Y Acad Sci 2022; 1511:244-261. [PMID: 35194819 DOI: 10.1111/nyas.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Indexed: 11/29/2022]
Abstract
Freezing of gait (FOG) is a debilitating symptom in patients with Parkinson's disease (PD), which may be associated with motor control impairments in tasks other than gait. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in PD with FOG (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. Twenty PD +FOG patients, 20 PD patients without FOG (PD -FOG) performed symmetric and asymmetric functional bimanual tasks (reach to and pick up a box and open a drawer to press a pushbutton inside it, respectively) under single-task and dual-task conditions. PD patients were evaluated during on- and off-drug phases. Kinematic and coordination measures were calculated for each task. PD +FOG patients demonstrated exacerbated impairments of bimanual coordination while performing goal-directed bimanual tasks, which was more evident in the asymmetric bimanual task and under dual-task conditions, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients. Interestingly, 25% and 5% of participants in the PD +FOG and -FOG groups developed upper limb freezing 2 years later, respectively. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in Parkinson's disease with freezing of gait (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. PD +FOG patients demonstrated exacerbated impairment of bimanual coordination while performing goal-directed bimanual tasks, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients.
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Affiliation(s)
- Zeinab Fathipour-Azar
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Azad
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Malahat Akbarfahimi
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Behzadipour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.,Djavad Mowafaghian Research Center for Intelligent Neuro-rehabilitation Technologies, Tehran, Iran
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Martins NIM, Aguiar MMD, Correa CL. Freezing of Upper Limbs in Parkinson’s Disease: A Systematic Review. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2021.1929658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Núbia Isabela Macêdo Martins
- Graduate Program in Physical Education, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Medicine School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Clynton Lourenço Correa
- Graduate Program in Physical Education, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Faculty of Physical Therapy, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Motor blocks during bilateral stepping in Parkinson's disease and effects of dopaminergic medication. Parkinsonism Relat Disord 2021; 85:1-4. [PMID: 33631631 DOI: 10.1016/j.parkreldis.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Freezing of gait (FOG) is a complex symptom in Parkinson's disease (PD) that manifests during walking as limited forward progression despite the intention to walk. It is unclear if lower limb motor blocks (LLMB) that occur independently from FOG are related to overground FOG and the effects of dopaminergic medications. METHODS Nineteen patients with PD were tested on two separate days in the dopaminergic medication "on" and "off" states. The patients completed a series of freezing-provoking tasks while videotaped. Raters assessed videos for FOG presence using Movement Disorders Society Unified Parkinson's Disease Rating Scale item 3.11 score greater than or equal to 1 and FOG severity using the standardized FOG score. Whilst seated in a virtual environment, patients and 20 healthy controls stepped in right-left sequence on foot pedals. Frequency and percent time in LLMB were assessed for accurate classification of FOG presence and correlation to the FOG score. RESULTS Frequency and percent time spent in LLMB predicted the presence of FOG in both medication states. Percent time spent in LLMB correlated with FOG severity in both medication states. LLMB frequency predicted FOG severity in the "off" state only. CONCLUSIONS LLMB during bilateral stepping in a virtual environment predicted the presence and severity of FOG in PD in both "on" and "off" medication states. These findings support the use of this non-walking paradigm to detect and assess FOG in PD patients unable or unsafe to walk.
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Heremans E, Broeder S, Nieuwboer A, Bekkers EM, Ginis P, Janssens L, Nackaerts E. When motor control gets out of hand: Speeding up triggers freezing in the upper limb in Parkinson's disease. Parkinsonism Relat Disord 2019; 64:163-168. [PMID: 30987896 DOI: 10.1016/j.parkreldis.2019.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/10/2018] [Accepted: 04/03/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Patients with Parkinson's disease (PD) can suffer from sudden movement arrests during upper limb tasks. The current study investigated a test to assess freezing of the upper limbs (FOUL) at two speed conditions to improve the sensitivity of FOUL detection. METHODS Forty-nine patients with PD and 10 age-matched controls (HC) performed a freezing-provoking writing task, requiring up- and down-stroke writing at varying sizes in-between visual target zones indicating funnel-shapes on a touch-sensitive tablet. They performed five trials at their preferred speed, referred to as the Normal Funnel Task (NFT) and five trials at maximum speed, referred to as the Fast Funnel Task (FFT), in a random order. RESULTS Based on a combination of kinematic criteria and video analysis, 183 FOUL episodes were detected in 24 participants (23 PD, 1 HC). The number of patients with FOUL, number of FOUL episodes and percentage time frozen were significantly higher during FFT than NFT. Most FOUL episodes occurred during writing at small (51.6%) and decreasing size (36.3%). Additionally, FOUL outcomes significantly correlated with the Montreal Cognitive Assessment and New Freezing of Gait Questionnaire. CONCLUSION As FOUL is more prevalent under higher task demands, these data offer support for the "threshold model", previously proposed to provide insight in freezing of gait (FOG) and underscoring the presupposed link between FOG and FOUL. As well, this study may provide a novel paradigm to assess FOUL in both laboratory and clinical settings.
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Affiliation(s)
- Elke Heremans
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Sanne Broeder
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Esther Mj Bekkers
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Pieter Ginis
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Luc Janssens
- Electrical Engineering (ESAT), Group T Leuven Campus, KU Leuven, Belgium
| | - Evelien Nackaerts
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Belgium.
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A new method based on quiet stance baseline is more effective in identifying freezing in Parkinson's disease. PLoS One 2018; 13:e0207945. [PMID: 30475908 PMCID: PMC6258113 DOI: 10.1371/journal.pone.0207945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/08/2018] [Indexed: 11/24/2022] Open
Abstract
Freezing, an episodic movement breakdown that goes from disrupted gait patterns to complete arrest, is a disabling symptom in Parkinson’s disease. Several efforts have been made to objectively identify freezing episodes (FEs), although a standardized methodology to discriminate freezing from normal movement is lacking. Novel mathematical approaches that provide information in the temporal and frequency domains, such as the continuous wavelet transform, have demonstrated promising results detecting freezing, although still with limited effectiveness. We aimed to determine whether a computerized algorithm using the continuous wavelet transform based on baseline (i.e. no movement) rather than on amplitude decrease is more effective detecting freezing. Twenty-six individuals with Parkinson’s disease performed two trials of a repetitive stepping-in-place task while they were filmed by a video camera and tracked by a motion capture system. The number of FEs and their total duration were determined from a visual inspection of the videos and from three different computed algorithms. Differences in the number and total duration of the FEs between the video inspection and each of the three methods were obtained. The accuracy to identify the time of occurrence of a FE by each method was also calculated. A significant effect of Method was found for the number (p = 0.016) and total duration (p = 0.013) of the FEs, with the method based on baseline being the closest one to the values reported from the videos. Moreover, the same method was the most accurate in detecting the time of occurrence, and the one reaching the highest sensitivity (88.2%). Findings suggest that threshold detection methods based on baseline and movement amplitude decreases capture different characteristics of Parkinsonian gait, with the first one being more effective at detecting FEs. Moreover, robust approaches that consider both time and frequency characteristics are more sensitive in identifying freezing.
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Thomas M, Lenka A, Kumar Pal P. Handwriting Analysis in Parkinson's Disease: Current Status and Future Directions. Mov Disord Clin Pract 2017; 4:806-818. [PMID: 30363367 PMCID: PMC6174397 DOI: 10.1002/mdc3.12552] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The majority of patients with Parkinson's disease (PD) have handwriting abnormalities. Micrographia (abnormally small letter size) is the most commonly reported and easily detectable handwriting abnormality in patients with PD. However, micrographia is perhaps the tip of the iceberg representing the handwriting abnormalities in PD. Digitizing tablet technology, which has evolved over the last 2 decades, has made it possible to study the pressure and kinematic features of handwriting. This has resulted in a surge of studies investigating graphomotor impairment in patients with PD. METHODS The objectives of this study were to review the evolution of the kinematic analysis of handwriting in PD and to provide an overview of handwriting abnormalities observed in PD along with future directions for research in this field. Articles for review were searched from the PubMed and SCOPUS databases. RESULTS Digitizing tablet technologies have resulted in a shift of focus from the analysis of only letter size to the analysis of several kinematic features of handwriting. Studies based on the kinematic analysis of handwriting have revealed that patients with PD may have abnormalities in velocity, fluency, and acceleration in addition to micrographia. The recognition of abnormalities in several kinematic parameters of handwriting has given rise to the term PD dysgraphia. In addition, certain kinematic properties potentially may be helpful in distinguishing PD from other parkinsonian disorders. CONCLUSION The journey from micrographia to PD dysgraphia is indeed a paradigm shift. Further research is warranted to gain better insight into the graphomotor impairments in PD and their clinical implications.
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Affiliation(s)
- Mathew Thomas
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
| | - Abhishek Lenka
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
- Department of Clinical NeurosciencesNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
| | - Pramod Kumar Pal
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
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Heremans E, Nackaerts E, Broeder S, Vervoort G, Swinnen SP, Nieuwboer A. Handwriting Impairments in People With Parkinson's Disease and Freezing of Gait. Neurorehabil Neural Repair 2016; 30:911-919. [PMID: 27094858 DOI: 10.1177/1545968316642743] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent studies show that patients with Parkinson's disease (PD) and freezing of gait (FOG) experience motor problems outside their gait freezing episodes. Because handwriting is also a sequential movement, it may be affected in PD patients with FOG relative to those without. OBJECTIVE The current study aimed to assess the quality of writing in PD patients with and without FOG in comparison to healthy controls (CTs) during various writing tasks. METHODS Handwriting was assessed by the writing of cursive loops on a touch-sensitive writing tablet and by means of the Systematic Screening of Handwriting Difficulties (SOS) test in 30 PD patients with and without freezing and 15 healthy age-matched CTs. The tablet tests were performed at 2 different sizes, either continuously or alternatingly, as indicated by visual target lines. RESULTS Patients with freezing showed decreased writing amplitudes and increased variability compared with CTs and patients without freezing on the writing tablet tests. Writing problems were present during both tests but were more pronounced during writing at alternating compared with writing at continuous size. Patients with freezing also had a higher total score on the SOS test than patients without freezing and CTs, reflecting more extensive handwriting problems, particularly with writing fluency. CONCLUSIONS Writing is more severely affected in PD patients with FOG than in those without FOG. These results indicate that deficient movement sequencing and adaptation is a generic problem in patients with FOG.
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Heremans E, Nackaerts E, Vervoort G, Vercruysse S, Broeder S, Strouwen C, Swinnen SP, Nieuwboer A. Amplitude Manipulation Evokes Upper Limb Freezing during Handwriting in Patients with Parkinson's Disease with Freezing of Gait. PLoS One 2015; 10:e0142874. [PMID: 26580556 PMCID: PMC4651469 DOI: 10.1371/journal.pone.0142874] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/27/2015] [Indexed: 11/19/2022] Open
Abstract
Background Recent studies show that besides freezing of gait (FOG), many people with Parkinson’s disease (PD) also suffer from freezing in the upper limbs (FOUL). Up to now, it is unclear which task constraints provoke and explain upper limb freezing. Objective To investigate whether upper limb freezing and other kinematic abnormalities during writing are provoked by (i) gradual changes in amplitude or by (ii) sustained amplitude generation in patients with and without freezing of gait. Methods Thirty-four patients with PD, including 17 with and 17 without FOG, performed a writing task on a touch-sensitive writing tablet requiring writing at constant small and large size as well as writing at gradually increasing and decreasing size. Patients of both groups were matched for disease severity, tested while ‘on’ medication and compared to healthy age-matched controls. Results Fifty upper limb freezing episodes were detected in 10 patients, including 8 with and 2 without FOG. The majority of the episodes occurred when participants had to write at small or gradually decreasing size. The occurrence of FOUL and the number of FOUL episodes per patient significantly correlated with the occurrence and severity of FOG. Patients with FOUL also showed a significantly smaller amplitude in the writing parts outside the freezing episodes. Conclusions Corroborating findings of gait research, the current study supports a core problem in amplitude control underlying FOUL, both in maintaining as well as in flexibly adapting the cycle size.
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Affiliation(s)
- Elke Heremans
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- * E-mail:
| | - Evelien Nackaerts
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Griet Vervoort
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Sanne Broeder
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Carolien Strouwen
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Stephan P. Swinnen
- Movement Control and Neuroplasticity Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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