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Mustile M, Kourtis D, Ladouce S, Edwards MG, Volpe D, Pilleri M, Pelosin E, Donaldson DI, Ietswaart M. Investigating the Brain Mechanisms of Externally Cued Sit-to-Stand Movement in Parkinson's Disease. Mov Disord 2024. [PMID: 38984716 DOI: 10.1002/mds.29889] [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: 02/09/2024] [Revised: 05/01/2024] [Accepted: 05/28/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND One of the more challenging daily-life actions for Parkinson's disease patients is starting to stand from a sitting position. Parkinson's disease patients are known to have difficulty with self-initiated movements and benefit from external cues. However, the brain processes underlying external cueing as an aid remain unknown. The advent of mobile electroencephalography (EEG) now enables the investigation of these processes in dynamic sit-to-stand movements. OBJECTIVE To identify cortical correlates of the mechanisms underlying auditory cued sit-to-stand movement in Parkinson's disease. METHODS Twenty-two Parkinson's disease patients and 24 healthy age-matched participants performed self-initiated and externally cued sit-to-stand movements while cortical activity was recorded through 32-channel mobile EEG. RESULTS Overall impaired integration of sensory and motor information can be seen in the Parkinson's disease patients exhibiting less modulation in the θ band during movement compared to healthy age-matched controls. How Parkinson's disease patients use external cueing of sit-to-stand movements can be seen in larger high β power over sensorimotor brain areas compared to healthy controls, signaling sensory integration supporting the maintenance of motor output. This appears to require changes in cognitive processing to update the motor plan, reflected in frontal θ power increases in Parkinson's disease patients when cued. CONCLUSION These findings provide the first neural evidence for why and how cueing improves motor function in sit-to-stand movement in Parkinson's disease. The Parkinson's disease patients' neural correlates indicate that cueing induces greater activation of motor cortical areas supporting the maintenance of a more stable motor output, but involves the use of cognitive resources to update the motor plan. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Magda Mustile
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
- The Psychological Sciences Research Institute, University of Louvain, Louvain-la-Neuve, Belgium
| | - Dimitrios Kourtis
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Simon Ladouce
- Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Martin G Edwards
- The Psychological Sciences Research Institute, University of Louvain, Louvain-la-Neuve, Belgium
| | - Daniele Volpe
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
| | - Manuela Pilleri
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy
- IRCCS, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - David I Donaldson
- School of Psychology and Neuroscience, University of St Andrews, St. Andrews, United Kingdom
| | - Magdalena Ietswaart
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
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Elbatanouny H, Kleanthous N, Dahrouj H, Alusi S, Almajali E, Mahmoud S, Hussain A. Insights into Parkinson's Disease-Related Freezing of Gait Detection and Prediction Approaches: A Meta Analysis. SENSORS (BASEL, SWITZERLAND) 2024; 24:3959. [PMID: 38931743 PMCID: PMC11207947 DOI: 10.3390/s24123959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
Parkinson's Disease (PD) is a complex neurodegenerative disorder characterized by a spectrum of motor and non-motor symptoms, prominently featuring the freezing of gait (FOG), which significantly impairs patients' quality of life. Despite extensive research, the precise mechanisms underlying FOG remain elusive, posing challenges for effective management and treatment. This paper presents a comprehensive meta-analysis of FOG prediction and detection methodologies, with a focus on the integration of wearable sensor technology and machine learning (ML) approaches. Through an exhaustive review of the literature, this study identifies key trends, datasets, preprocessing techniques, feature extraction methods, evaluation metrics, and comparative analyses between ML and non-ML approaches. The analysis also explores the utilization of cueing devices. The limited adoption of explainable AI (XAI) approaches in FOG prediction research represents a significant gap. Improving user acceptance and comprehension requires an understanding of the logic underlying algorithm predictions. Current FOG detection and prediction research has a number of limitations, which are identified in the discussion. These include issues with cueing devices, dataset constraints, ethical and privacy concerns, financial and accessibility restrictions, and the requirement for multidisciplinary collaboration. Future research avenues center on refining explainability, expanding and diversifying datasets, adhering to user requirements, and increasing detection and prediction accuracy. The findings contribute to advancing the understanding of FOG and offer valuable guidance for the development of more effective detection and prediction methodologies, ultimately benefiting individuals affected by PD.
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Affiliation(s)
- Hagar Elbatanouny
- Department of Electrical Engineering, University of Sharjah, Sharjah 27272, United Arab Emirates; (H.D.); (E.A.); (S.M.)
| | | | - Hayssam Dahrouj
- Department of Electrical Engineering, University of Sharjah, Sharjah 27272, United Arab Emirates; (H.D.); (E.A.); (S.M.)
| | - Sundus Alusi
- The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK;
| | - Eqab Almajali
- Department of Electrical Engineering, University of Sharjah, Sharjah 27272, United Arab Emirates; (H.D.); (E.A.); (S.M.)
| | - Soliman Mahmoud
- Department of Electrical Engineering, University of Sharjah, Sharjah 27272, United Arab Emirates; (H.D.); (E.A.); (S.M.)
- University of Khorfakkan, Khorfakkan, Sharjah 18119, United Arab Emirates
| | - Abir Hussain
- Department of Electrical Engineering, University of Sharjah, Sharjah 27272, United Arab Emirates; (H.D.); (E.A.); (S.M.)
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Li D, Hallack A, Gwilym S, Li D, Hu MT, Cantley J. Investigating gait-responsive somatosensory cueing from a wearable device to improve walking in Parkinson's disease. Biomed Eng Online 2023; 22:108. [PMID: 37974260 PMCID: PMC10652624 DOI: 10.1186/s12938-023-01167-y] [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: 06/16/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023] Open
Abstract
Freezing-of-gait (FOG) and impaired walking are common features of Parkinson's disease (PD). Provision of external stimuli (cueing) can improve gait, however, many cueing methods are simplistic, increase task loading or have limited utility in a real-world setting. Closed-loop (automated) somatosensory cueing systems have the potential to deliver personalised, discrete cues at the appropriate time, without requiring user input. Further development of cue delivery methods and FOG-detection are required to achieve this. In this feasibility study, we aimed to test if FOG-initiated vibration cues applied to the lower-leg via wearable devices can improve gait in PD, and to develop real-time FOG-detection algorithms. 17 participants with Parkinson's disease and daily FOG were recruited. During 1 h study sessions, participants undertook 4 complex walking circuits, each with a different intervention: continuous rhythmic vibration cueing (CC), responsive cueing (RC; cues initiated by the research team in response to FOG), device worn with no cueing (NC), or no device (ND). Study sessions were grouped into 3 stages/blocks (A-C), separated by a gap of several weeks, enabling improvements to circuit design and the cueing device to be implemented. Video and onboard inertial measurement unit (IMU) data were analyzed for FOG events and gait metrics. RC significantly improved circuit completion times demonstrating improved overall performance across a range of walking activities. Step frequency was significantly enhanced by RC during stages B and C. During stage C, > 10 FOG events were recorded in 45% of participants without cueing (NC), which was significantly reduced by RC. A machine learning framework achieved 83% sensitivity and 80% specificity for FOG detection using IMU data. Together, these data support the feasibility of closed-loop cueing approaches coupling real-time FOG detection with responsive somatosensory lower-leg cueing to improve gait in PD.
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Affiliation(s)
- Dongli Li
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX2 3PT, UK
| | - Andre Hallack
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX2 3PT, UK
| | - Sophie Gwilym
- Oxfordshire Neurophysiotherapy, The Bosworth Clinic, Quarry Court, Bell Lane, Cassington, OX29 4DS, UK
| | - Dongcheng Li
- Department of Computer Science, University of Texas at Dallas, Richardson, TX, 75082, USA
| | - Michele T Hu
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, Division of Neurology, University of Oxford, Oxford, Oxfordshire, UK
| | - James Cantley
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX2 3PT, UK.
- Division of Systems Medicine, Ninewells Hospital & Medical School, University of Dundee, James Arrott Drive, Dundee, DD1 9SY, UK.
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Scataglini S, Van Dyck Z, Declercq V, Van Cleemput G, Struyf N, Truijen S. Effect of Music Based Therapy Rhythmic Auditory Stimulation (RAS) Using Wearable Device in Rehabilitation of Neurological Patients: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:5933. [PMID: 37447782 DOI: 10.3390/s23135933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 07/15/2023]
Abstract
(1) Background: Even though music therapy is acknowledged to have positive benefits in neurology, there is still a lack of knowledge in the literature about the applicability of music treatments in clinical practice with a neurological population using wearable devices. (2) Methods: a systematic review was conducted following PRISMA 2020 guidelines on the 29 October 2022, searching in five databases: PubMed, PEDro, Medline, Web of Science, and Science Direct. (3) Results: A total of 2964 articles were found, including 413 from PubMed, 248 from Web of Science, 2110 from Science Direct, 163 from Medline, and none from PEDro. Duplicate entries, of which there were 1262, were eliminated. In the first screening phase, 1702 papers were screened for title and abstract. Subsequently, 1667 papers were removed, based on population, duplicate, outcome, and poor study design. Only 15 studies were considered after 35 papers had their full texts verified. Results showed significant values of spatiotemporal gait parameters in music-based therapy rhythmic auditory stimulation (RAS), including speed, stride length, cadence, and ROM. (4) Conclusions: The current findings confirm the value of music-based therapy RAS as a favorable and effective tool to implement in the health care system for the rehabilitation of patients with movement disorders.
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Affiliation(s)
- Sofia Scataglini
- 4D4ALL Lab, Department of Rehabilitation Sciences and Physiotherapy, Center for Health and Technology (CHaT), Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium
| | - Zala Van Dyck
- 4D4ALL Lab, Department of Rehabilitation Sciences and Physiotherapy, Center for Health and Technology (CHaT), Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium
| | - Véronique Declercq
- 4D4ALL Lab, Department of Rehabilitation Sciences and Physiotherapy, Center for Health and Technology (CHaT), Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium
| | - Gitte Van Cleemput
- 4D4ALL Lab, Department of Rehabilitation Sciences and Physiotherapy, Center for Health and Technology (CHaT), Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium
| | - Nele Struyf
- 4D4ALL Lab, Department of Rehabilitation Sciences and Physiotherapy, Center for Health and Technology (CHaT), Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium
| | - Steven Truijen
- 4D4ALL Lab, Department of Rehabilitation Sciences and Physiotherapy, Center for Health and Technology (CHaT), Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium
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Battel I, Walshe M. An intensive neurorehabilitation programme with sEMG biofeedback to improve swallowing in idiopathic Parkinson's disease (IPD): A feasibility study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:813-825. [PMID: 36478035 DOI: 10.1111/1460-6984.12824] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/25/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Studies suggest swallow intervention programmes that incorporate visual biofeedback and motor programming principles can improve swallowing and quality of life for people with idiopathic Parkinson's disease (IPD) and dysphagia. Few studies have examined outcomes using instrumentation. AIMS Using fibreoptic endoscopic examination of swallowing (FEES), this study examines the effectiveness of a neurorehabilitation intervention involving biofeedback via surface electromyography (sEMG) to improve swallowing in people with IPD, and to explore the feasibility of the intervention approach. METHODS & PROCEDURES We recruited 12 participants with IPD and dysphagia. A total of 10 completed the study. Intervention was delivered for 1 h per day, 5 days per week, for 4 weeks (20 h). Swallowing tasks using sEMG biofeedback incorporated principles of motor learning and neuroplasticity. Instrumental and non-instrumental assessment, including quality-of-life measures carried out at four different time points (two pre-treatment and two post-treatment). The final assessment was at 3 months post-intervention. OUTCOME & RESULTS Statistically significant improvement (p < 0.05) in oral intake methods (95% confidence interval (CI) = 4.70-5.50) and in pharyngeal residue from saliva (95% CI = 2.14-3.15) and solids (95% CI = 2.4-3.5) post-intervention were confirmed using FEES with improvements at 3 months. The intervention protocol was well tolerated. Participants reported positive change in saliva control and duration of mealtimes as well as unanticipated improvements in voice and cognitive attention. CONCLUSIONS & IMPLICATIONS An intensive neurorehabilitation with biofeedback shows positive effects in improving swallow function in IPD. This protocol is feasible with amendments to inform a larger clinical trial. WHAT THIS PAPER ADDS What is already known on the subject Biofeedback has positive effects on increasing swallowing function and quality of life in people with IPD and dysphagia. sEMG is the most common method used to deliver swallowing biofeedback in this population. The quality of the evidence on the intervention, based on findings from a recent systematic review, is low. Included studies in this review were heterogeneous in terms of type and frequency of biofeedback, study design and outcome measures. The majority of outcome measures were subjective and higher quality studies to examine the efficacy of biofeedback using sEMG are needed. What this study adds Recognizing the limitations of earlier studies, this within-subject feasibility study examined the efficacy and effectiveness of an intensive biofeedback intervention using sEMG in a sample of people with dysphagia and IPD. Valid and reliable outcome measures were used and repeated after a 3-month period. The feasibility of the methodological approach was also tested and a qualitative component was included in the study. Positive findings were evident. Qualitative information added new perspectives and provided direction for new outcomes to be included in future studies. This study helps to inform further research trials as well as clinical practice. Clinical implications of this study This intensive intervention using principles of neuroplasticity and motor programming with sEMG biofeedback led not only to positive swallowing outcomes but also to unexpected benefits such as improved voice production and general attention skills. No adverse events were reported. Improvement in function was retained at 3 months post-intervention. Despite the small sample size, participants described the benefits of the treatment, and enjoyed sEMG biofeedback tasks, especially using an sEMG game mode. This suggests that intensive biofeedback not only improved swallowing but also was acceptable to these participants. This intensive protocol has merit and is worth considering further in clinical practice.
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Affiliation(s)
- Irene Battel
- Department of Clinical Speech & Language Studies, University of Dublin, Trinity College Dublin, Dublin, Ireland
- Department of Biomedical, Surgical and Dental Sciences, University 'La Statale', Milan, Italy
| | - Margaret Walshe
- Department of Clinical Speech & Language Studies, University of Dublin, Trinity College Dublin, Dublin, Ireland
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Cosentino C, Putzolu M, Mezzarobba S, Cecchella M, Innocenti T, Bonassi G, Botta A, Lagravinese G, Avanzino L, Pelosin E. One cue does not fit all: a systematic review with meta-analysis of the effectiveness of cueing on freezing of gait in Parkinson's disease. Neurosci Biobehav Rev 2023; 150:105189. [PMID: 37086934 DOI: 10.1016/j.neubiorev.2023.105189] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/03/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Abstract
The difficulty in assessing FOG and the variety of existing cues, hamper to determine which cueing modality should be applied and which FOG-related aspect should be targeted to reach personalized treatments for FOG. This systematic review aimed to highlight: i) whether cues could reduce FOG and improve FOG-related gait parameters, ii) which cues are the most effective, iii) whether medication state (ON-OFF) affects cues-related results. Thirty-three repeated measure design studies assessing cueing effectiveness were included and subdivided according to gait tasks (gait initiation, walking, turning) and to the medication state. Main results reveal that: preparatory phase of gait initiation benefit from visual and auditory cues; spatio-temporal parameters (e.g., step and stride length) and are improved by visual cues during walking; turning time and step time variability are reduced by applying auditory and visual cues. Some findings on the potential benefits of cueing on FOG and FOG gait-related parameters were found. Questions remain about which are the best behavioral strategies according to FOG features and PD clinical characteristics.
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Affiliation(s)
- Carola Cosentino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy
| | - Martina Putzolu
- Department of Experimental Medicine (DIMES), Section of Human Physiology, University of Genoa, Genoa, Italy
| | - Susanna Mezzarobba
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy; IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | - Margherita Cecchella
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy
| | - Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; GIMBE Foundation, Bologna, Italy
| | - Gaia Bonassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy
| | | | - Giovanna Lagravinese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy; IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Avanzino
- Department of Experimental Medicine (DIMES), Section of Human Physiology, University of Genoa, Genoa, Italy; IRCCS, Ospedale Policlinico San Martino, Genoa, Italy.
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy; IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
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7
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Klaver EC, van Vugt JPP, Bloem BR, van Wezel RJA, Nonnekes J, Tjepkema-Cloostermans MC. Good vibrations: tactile cueing for freezing of gait in Parkinson's disease. J Neurol 2023:10.1007/s00415-023-11663-9. [PMID: 36944760 DOI: 10.1007/s00415-023-11663-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Cueing strategies can alleviate freezing of gait (FOG) in people with Parkinson's disease (PD). We evaluated tactile cueing delivered via vibrating socks, which has the benefit of not being noticeable to bystanders. OBJECTIVE To evaluate the effect of tactile cueing compared to auditory cueing on FOG. METHODS Thirty-one persons with PD with FOG performed gait tasks during both ON and OFF state. The effect of open loop and closed loop tactile cueing, as delivered by vibrating socks, was compared to an active control group (auditory cueing) and to a baseline condition (uncued gait). These four conditions were balanced between subjects. Gait tasks were videotaped and annotated for FOG by two experienced raters. Motion data were collected to analyze spatiotemporal gait parameters. Responders were defined as manifesting a relative reduction of > 10% in the percent time frozen compared to uncued gait. RESULTS The average percent time frozen during uncued gait was 11.2% in ON and 21.5% in OFF state. None of the three tested cueing modalities affected the percentage of time frozen in either the ON (p = 0.20) or OFF state (p = 0.12). The number of FOG episodes and spatiotemporal gait parameters were also not affected. We found that 22 out of 31 subjects responded to cueing, the response to the three types of cueing was highly individual. CONCLUSIONS Cueing did not improve FOG at the group level; however, tactile as well as auditory cueing improved FOG in many individuals. This highlights the need for a personalized approach when using cueing to treat FOG.
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Affiliation(s)
- E C Klaver
- Department of Neurology and Clinical Neurophysiology, Medical Spectrum Twente, Enschede, The Netherlands.
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Heyendaalseweg 135, P.O. Box 9102, 6525 AJ, Nijmegen, The Netherlands.
| | - J P P van Vugt
- Department of Neurology and Clinical Neurophysiology, Medical Spectrum Twente, Enschede, The Netherlands
| | - B R Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R J A van Wezel
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Heyendaalseweg 135, P.O. Box 9102, 6525 AJ, Nijmegen, The Netherlands
- Department of Biomedical Signals and Systems, MedTech Centre, University of Twente, Enschede, The Netherlands
| | - J Nonnekes
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - M C Tjepkema-Cloostermans
- Department of Neurology and Clinical Neurophysiology, Medical Spectrum Twente, Enschede, The Netherlands
- MedTech Centre, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
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Geritz J, Welzel J, Hansen C, Maetzler C, Hobert MA, Elshehabi M, Knacke H, Aleknonytė-Resch M, Kudelka J, Bunzeck N, Maetzler W. Cognitive parameters can predict change of walking performance in advanced Parkinson's disease - Chances and limits of early rehabilitation. Front Aging Neurosci 2022; 14:1070093. [PMID: 36620765 PMCID: PMC9813446 DOI: 10.3389/fnagi.2022.1070093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Links between cognition and walking performance in patients with Parkinson's disease (PD), which both decline with disease progression, are well known. There is lack of knowledge regarding the predictive value of cognition for changes in walking performance after individualized therapy. The aim of this study is to identify relevant predictive cognitive and affective parameters, measurable in daily clinical routines, for change in quantitative walking performance after early geriatric rehabilitation. Methods Forty-seven acutely hospitalized patients with advanced PD were assessed at baseline (T1) and at the end (T2) of a 2-week early rehabilitative geriatric complex treatment (ERGCT). Global cognitive performance (Montreal Cognitive Assessment, MoCA), EF and divided attention (Trail Making Test B minus A, delta TMT), depressive symptoms, and fear of falling were assessed at T1. Change in walking performance was determined by the difference in quantitative walking parameters extracted from a sensor-based movement analysis over 20 m straight walking in single (ST, fast and normal pace) and dual task (DT, with secondary cognitive, respectively, motor task) conditions between T1 and T2. Bayesian regression (using Bayes Factor BF10) and multiple linear regression models were used to determine the association of non-motor characteristics for change in walking performance. Results Under ST, there was moderate evidence (BF10 = 7.8, respectively, BF10 = 4.4) that lower performance in the ∆TMT at baseline is associated with lower reduction of step time asymmetry after treatment (R 2 adj = 0.26, p ≤ 0.008, respectively, R 2 adj = 0.18, p ≤ 0.009). Under DT walking-cognitive, there was strong evidence (BF10 = 29.9, respectively, BF10 = 27.9) that lower performance in the ∆TMT is associated with more reduced stride time and double limb support (R 2 adj = 0.62, p ≤ 0.002, respectively, R 2 adj = 0.51, p ≤ 0.009). There was moderate evidence (BF10 = 5.1) that a higher MoCA total score was associated with increased gait speed after treatment (R 2 adj = 0.30, p ≤ 0.02). Discussion Our results indicate that the effect of ERGT on change in walking performance is limited for patients with deficits in EF and divided attention. However, these patients also seem to walk more cautiously after treatment in walking situations with additional cognitive demand. Therefore, future development of individualized treatment algorithms is required, which address individual needs of these vulnerable patients.
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Affiliation(s)
- Johanna Geritz
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany,Department of Psychology, University of Lübeck, Lübeck, Germany,*Correspondence: Johanna Geritz,
| | - Julius Welzel
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Markus A. Hobert
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Morad Elshehabi
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Henrike Knacke
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Jennifer Kudelka
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nico Bunzeck
- Department of Psychology, University of Lübeck, Lübeck, Germany,Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
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Does Cueing Need Attention? A Pilot Study in People with Parkinson's Disease. Neuroscience 2022; 507:36-51. [PMID: 36368603 DOI: 10.1016/j.neuroscience.2022.10.023] [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: 06/12/2022] [Revised: 10/03/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
We previously showed that both open-loop (beat of a metronome) and closed-loop (phase-dependent tactile feedback) cueing may be similarly effective in reducing Freezing of Gait (FoG), assessed with a quantitative FoG Index, while turning in place in the laboratory in a group of people with Parkinson's disease (PD). Despite the similar changes on the FoG Index, it is not known whether both cueing responses require attentional control, which would explain FoG Index improvement. The mechanisms underlying cueing responses are poorly understood. Here, we tested the hypothesis that the salience network would predict responsiveness (i.e., FoG Index improvement) to open-loop and closed-loop cueing in people with and without FoG of PD, as salience network contributes to tasks requiring attention to external stimuli in healthy adults. Thirteen people with PD with high-quality imaging data were analyzed to characterize relationships between resting-state MRI functional connectivity and responses to cues. The interaction of the salience network and retrosplenial-temporal networks was the best predictor of responsiveness to open-loop cueing, presenting the largest effect size (d = 1.16). The interaction between the salience network and subcortical as well as cingulo-parietal and subcortical networks were the strongest predictors of responsiveness to closed-loop cueing, presenting the largest effect sizes (d = 1.06 and d = 0.84, respectively). Salience network activity was a common predictor of responsiveness to both cueing, which suggests that auditory and proprioceptive stimuli during turning may require some level of cognitive and insular activity, anchored within the salience network, which explain FoG Index improvements in people with PD.
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10
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Shah VV, Vitorio R, Hasegawa N, Carlson-Kuhta P, Nutt JG, King LA, Mancini M, Horak FB. Effects of a Cognitively Challenging Agility Boot Camp Program on Balance and Gait in People With Parkinson's Disease: Does Freezing of Gait Status Matter? Neurorehabil Neural Repair 2022; 36:603-612. [PMID: 36004814 DOI: 10.1177/15459683221119757] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIM Individuals with Parkinson's disease (PD) with and without freezing of Gait (FoG) may respond differently to exercise interventions for several reasons, including disease duration. This study aimed to determine whether both people with and without FoG benefit from the Agility Boot Camp with Cognitive Challenges (ABC-C) program. METHODS This secondary analysis of our ABC-C trial included 86 PD subjects: 44 without FoG (PD-FoG) and 42 with FoG (PD + FoG). We collected measures of standing sway balance, anticipatory postural adjustments, postural responses, and a 2-minute walk with and without a cognitive task. Two-way repeated analysis of variance, with disease duration as covariate, was used to investigate the effects of ABC-C program. Effect sizes were calculated using standardized response mean (SRM) for PD-FoG and PD + FoG, separately. RESULTS The ABC-C program was effective in improving gait performance in both PD-FoG and PD + FoG, even after controlling for disease duration. Specifically, dual-task gait speed (P < .0001), dual-cost stride length (P = .012), and these single-task measures: arm range of motion (P < .0001), toe-off angle (P = .005), gait cycle duration variability (P = .019), trunk coronal range of motion (P = .042), and stance time (P = .046) improved in both PD-FoG and PD + FoG. There was no interaction effect between time (before and after exercise) and group (PD-FoG/PD + FoG) in all 24 objective measures of balance and gait. Dual-task gait speed improved the most in PD + FoG (SRM = 1.01), whereas single-task arm range of motion improved the most in PD-FoG (SRM = 1.01). CONCLUSION The ABC-C program was similarly effective in improving gait (and not balance) performance in both PD-FoG and PD + FoG.
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Affiliation(s)
- Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, UK
| | - Naoya Hasegawa
- Department of Rehabilitation Science, Hokkaido University, Sapporo, Hokkaido, Japan
| | | | - John G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- APDM Wearable Technologies, A Clario company, Portland, OR, USA
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11
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Guo Y, Yang J, Liu Y, Chen X, Yang GZ. Detection and assessment of Parkinson's disease based on gait analysis: A survey. Front Aging Neurosci 2022; 14:916971. [PMID: 35992585 PMCID: PMC9382193 DOI: 10.3389/fnagi.2022.916971] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Neurological disorders represent one of the leading causes of disability and mortality in the world. Parkinson's Disease (PD), for example, affecting millions of people worldwide is often manifested as impaired posture and gait. These impairments have been used as a clinical sign for the early detection of PD, as well as an objective index for pervasive monitoring of the PD patients in daily life. This review presents the evidence that demonstrates the relationship between human gait and PD, and illustrates the role of different gait analysis systems based on vision or wearable sensors. It also provides a comprehensive overview of the available automatic recognition systems for the detection and management of PD. The intervening measures for improving gait performance are summarized, in which the smart devices for gait intervention are emphasized. Finally, this review highlights some of the new opportunities in detecting, monitoring, and treating of PD based on gait, which could facilitate the development of objective gait-based biomarkers for personalized support and treatment of PD.
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Affiliation(s)
- Yao Guo
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Jianxin Yang
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Yuxuan Liu
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Xun Chen
- Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei, China
| | - Guang-Zhong Yang
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
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12
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Shi B, Tay A, Au WL, Tan DML, Chia NSY, Yen SC. Detection of Freezing of Gait Using Convolutional Neural Networks and Data From Lower Limb Motion Sensors. IEEE Trans Biomed Eng 2022; 69:2256-2267. [PMID: 34986092 DOI: 10.1109/tbme.2022.3140258] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Parkinson's disease (PD) is a chronic, non-reversible neurodegenerative disorder, and freezing of gait (FOG) is one of the most disabling symptoms in PD as it is often the leading cause of falls and injuries that drastically reduces patients' quality of life. In order to monitor continuously and objectively PD patients who suffer from FOG and enable the possibility of on-demand cueing assistance, a sensor-based FOG detection solution can help clinicians manage the disease and help patients overcome freezing episodes. Many recent studies have leveraged deep learning models to detect FOG using signals extracted from inertial measurement unit (IMU) devices. Usually, the latent features and patterns of FOG are discovered from either the time or frequency domain. In this study, we investigated the use of the time-frequency domain by applying the Continuous Wavelet Transform to signals from IMUs placed on the lower limbs of 63 PD patients who suffered from FOG. We built convolutional neural networks to detect the FOG occurrences, and employed the Bayesian Optimisation approach to obtain the hyper-parameters. The results showed that the proposed subject-independent model was able to achieve a geometric mean of 90.7% and a F1 score of 91.5%.
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13
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Fujikawa J, Morigaki R, Yamamoto N, Oda T, Nakanishi H, Izumi Y, Takagi Y. Therapeutic Devices for Motor Symptoms in Parkinson’s Disease: Current Progress and a Systematic Review of Recent Randomized Controlled Trials. Front Aging Neurosci 2022; 14:807909. [PMID: 35462692 PMCID: PMC9020378 DOI: 10.3389/fnagi.2022.807909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pharmacotherapy is the first-line treatment option for Parkinson’s disease, and levodopa is considered the most effective drug for managing motor symptoms. However, side effects such as motor fluctuation and dyskinesia have been associated with levodopa treatment. For these conditions, alternative therapies, including invasive and non-invasive medical devices, may be helpful. This review sheds light on current progress in the development of devices to alleviate motor symptoms in Parkinson’s disease. Methods We first conducted a narrative literature review to obtain an overview of current invasive and non-invasive medical devices and thereafter performed a systematic review of recent randomized controlled trials (RCTs) of these devices. Results Our review revealed different characteristics of each device and their effectiveness for motor symptoms. Although invasive medical devices are usually highly effective, surgical procedures can be burdensome for patients and have serious side effects. In contrast, non-pharmacological/non-surgical devices have fewer complications. RCTs of non-invasive devices, especially non-invasive brain stimulation and mechanical peripheral stimulation devices, have proven effectiveness on motor symptoms. Nearly no non-invasive devices have yet received Food and Drug Administration certification or a CE mark. Conclusion Invasive and non-invasive medical devices have unique characteristics, and several RCTs have been conducted for each device. Invasive devices are more effective, while non-invasive devices are less effective and have lower hurdles and risks. It is important to understand the characteristics of each device and capitalize on these.
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Affiliation(s)
- Joji Fujikawa
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Ryoma Morigaki
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- *Correspondence: Ryoma Morigaki,
| | - Nobuaki Yamamoto
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Teruo Oda
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Hiroshi Nakanishi
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yuishin Izumi
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yasushi Takagi
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
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14
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Filtjens B, Ginis P, Nieuwboer A, Afzal MR, Spildooren J, Vanrumste B, Slaets P. Modelling and identification of characteristic kinematic features preceding freezing of gait with convolutional neural networks and layer-wise relevance propagation. BMC Med Inform Decis Mak 2021; 21:341. [PMID: 34876110 PMCID: PMC8650332 DOI: 10.1186/s12911-021-01699-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/23/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although deep neural networks (DNNs) are showing state of the art performance in clinical gait analysis, they are considered to be black-box algorithms. In other words, there is a lack of direct understanding of a DNN's ability to identify relevant features, hindering clinical acceptance. Interpretability methods have been developed to ameliorate this concern by providing a way to explain DNN predictions. METHODS This paper proposes the use of an interpretability method to explain DNN decisions for classifying the movement that precedes freezing of gait (FOG), one of the most debilitating symptoms of Parkinson's disease (PD). The proposed two-stage pipeline consists of (1) a convolutional neural network (CNN) to model the reduction of movement present before a FOG episode, and (2) layer-wise relevance propagation (LRP) to visualize the underlying features that the CNN perceives as important to model the pathology. The CNN was trained with the sagittal plane kinematics from a motion capture dataset of fourteen PD patients with FOG. The robustness of the model predictions and learned features was further assessed on fourteen PD patients without FOG and fourteen age-matched healthy controls. RESULTS The CNN proved highly accurate in modelling the movement that precedes FOG, with 86.8% of the strides being correctly identified. However, the CNN model was unable to model the movement for one of the seven patients that froze during the protocol. The LRP interpretability case study shows that (1) the kinematic features perceived as most relevant by the CNN are the reduced peak knee flexion and the fixed ankle dorsiflexion during the swing phase, (2) very little relevance for FOG is observed in the PD patients without FOG and the healthy control subjects, and (3) the poor predictive performance of one subject is attributed to the patient's unique and severely flexed gait signature. CONCLUSIONS The proposed pipeline can aid clinicians in explaining DNN decisions in clinical gait analysis and aid machine learning practitioners in assessing the generalization of their models by ensuring that the predictions are based on meaningful kinematic features.
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Affiliation(s)
- Benjamin Filtjens
- Intelligent Mobile Platform Research Group, Department of Mechanical Engineering, KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium.
- eMedia Research Lab/STADIUS, Department of Electrical Engineering (ESAT), KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium.
| | - Pieter Ginis
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Alice Nieuwboer
- Research Group for Neurorehabilitation (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001, Heverlee, Belgium
| | - Muhammad Raheel Afzal
- Intelligent Mobile Platform Research Group, Department of Mechanical Engineering, KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium
| | - Joke Spildooren
- Faculty of Rehabilitation Sciences, REVAL - Rehabilitation Research Center, Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
| | - Bart Vanrumste
- eMedia Research Lab/STADIUS, Department of Electrical Engineering (ESAT), KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium
| | - Peter Slaets
- Intelligent Mobile Platform Research Group, Department of Mechanical Engineering, KU Leuven, Andreas Vesaliusstraat 13, 3000, Leuven, Belgium
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15
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Zoetewei D, Herman T, Brozgol M, Ginis P, Thumm PC, Ceulemans E, Decaluwé E, Palmerini L, Ferrari A, Nieuwboer A, Hausdorff JM. Protocol for the DeFOG trial: A randomized controlled trial on the effects of smartphone-based, on-demand cueing for freezing of gait in Parkinson's disease. Contemp Clin Trials Commun 2021; 24:100817. [PMID: 34816053 PMCID: PMC8591418 DOI: 10.1016/j.conctc.2021.100817] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 12/16/2022] Open
Abstract
Background Freezing of gait (FOG) is a highly incapacitating symptom that affects many people with Parkinson's disease (PD). Cueing triggered upon real-time FOG detection (on-demand cueing) shows promise for FOG treatment. Yet, the feasibility of implementation and efficacy in daily life is still unknown. Therefore, this study aims to investigate the effectiveness of DeFOG: a smartphone and sensor-based on-demand cueing solution for FOG. Methods Sixty-two PD patients with FOG will be recruited for this single-blind, multi-center, randomized controlled phase II trial. Patients will be randomized into either the intervention group or the active control group. For four weeks, both groups will receive feedback about their physical activity using the wearable DeFOG system in daily life. In addition, the intervention group will also receive on-demand auditory cueing and instructions. Before and after the intervention, home-based assessments will be performed to evaluate the primary outcome, i.e., “percentage time frozen” during a FOG-provoking protocol. Secondary outcomes include the training effects on physical activity monitored over 7 days and the user-friendliness of the technology. Discussion The DeFOG trial will investigate the effectiveness of personalized on-demand cueing in a controlled design, delivered for 4 weeks in the patient's home environment. We anticipate that DeFOG will reduce FOG to a greater degree than in the control group and we will explore the impact of the intervention on physical activity levels. We expect to gain in-depth insight into whether and how patients control FOG using cueing methods in their daily lives. Trial registration Clinicaltrials.gov NCT03978507.
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Affiliation(s)
- Demi Zoetewei
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Talia Herman
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Marina Brozgol
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Pieter Ginis
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Pablo Cornejo Thumm
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eva Ceulemans
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Eva Decaluwé
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Luca Palmerini
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, 40136, Bologna, Italy.,Health Sciences and Technologies-Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, 40126, Bologna, Italy
| | - Alberto Ferrari
- Department of Engineering "Enzo Ferrari" University of Modena and Reggio Emilia, Modena, Italy.,Science & Technology Park for Medicine, TPM, Democenter Foundation, Mirandola, Modena, Italy
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Israel.,Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University, Chicago, IL, USA
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16
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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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17
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Lingo VanGilder J, Lopez-Lennon C, Paul SS, Dibble LE, Duff K, Schaefer SY. Relating Global Cognition With Upper-Extremity Motor Skill Retention in Individuals With Mild-to-Moderate Parkinson's Disease. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:754118. [PMID: 36188810 PMCID: PMC9397847 DOI: 10.3389/fresc.2021.754118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022]
Abstract
Background and Purpose: Cognition has been linked to rehabilitation outcomes in stroke populations, but this remains unexplored in individuals with Parkinson's disease (PD). The purpose of this secondary data analysis from a recent clinical trial (NCT02600858) was to determine if global cognition was related to skill performance after motor training in individuals with PD. Methods: Twenty-three participants with idiopathic PD completed 3 days of training on an upper-extremity task. For the purposes of the original clinical trial, participants trained either "on" or "off" their dopamine replacement medication. Baseline, training, and 48-h retention data have been previously published. Global cognition was evaluated using the Montreal Cognitive Assessment (MoCA). Linear regression examined whether MoCA score predicted longer-term retention at nine-day follow-up; baseline motor task performance, age, PD severity, depressive symptoms, and group (medication "on"/"off") were included as covariates. Baseline and follow-up motor task performance were assessed for all participants while "on" their medication. Results: MoCA score was positively related to follow-up motor task performance, such that individuals with better cognition were faster than those with poorer cognition. Baseline task performance, age, PD severity, depressive symptoms, and medication status were unrelated to follow-up performance. Discussion and Conclusions: Results of this secondary analysis align with previous work that suggest cognitive impairment may interfere with motor learning in PD and support the premise that cognitive training prior to or concurrent with motor training may enhance rehabilitative outcomes for individuals with PD. Findings also suggest that assessing cognition in individuals with PD could provide prognostic information about their responsiveness to motor rehabilitation.
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Affiliation(s)
- Jennapher Lingo VanGilder
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Cielita Lopez-Lennon
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Serene S. Paul
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Leland E. Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Kevin Duff
- Center for Alzheimer's Care, Imaging and Research, University of Utah Health Sciences Center, Salt Lake City, UT, United States
- Department of Neurology, University of Utah Hospital, Salt Lake City, UT, United States
| | - Sydney Y. Schaefer
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
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18
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Capato TTC, de Vries NM, IntHout J, Barbosa ER, Nonnekes J, Bloem BR. Multimodal Balance Training Supported by Rhythmical Auditory Stimuli in Parkinson's Disease: A Randomized Clinical Trial. JOURNAL OF PARKINSONS DISEASE 2021; 10:333-346. [PMID: 31884492 PMCID: PMC7029328 DOI: 10.3233/jpd-191752] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Balance impairment in Parkinson’s disease (PD) improves only partially with dopaminergic medication. Therefore, non-pharmacological interventions such as physiotherapy are important elements in clinical management. External cues are often applied to improve gait, but their effects on balance control are unclear. Objective/Methods: We performed a prospective, single-blind, randomized clinical trial to study the effectiveness of balance training with and without rhythmical auditory cues. We screened 201 volunteers by telephone; 154 were assigned randomly into three groups: (1) multimodal balance training supported by rhythmical auditory stimuli (n = 56) (RAS-supported multimodal balance training); (2) regular multimodal balance training without rhythmical auditory stimuli (n = 50); and (3) control intervention involving a general education program (n = 48). Training was performed for 5 weeks, two times/week. Linear mixed models were used for all outcomes. Primary outcome was the Mini-BESTest (MBEST) score immediately after the training period. Assessments were performed by a single, blinded assessor at baseline, immediately post intervention, and after one and 6-months follow-up. Results: Immediately post intervention, RAS-supported multimodal balance training was more effective than regular multimodal balance training on MBEST (difference 3.5 (95% Confidence Interval (CI) 2.2; 4.8)), p < 0.001). Patients allocated to both active interventions improved compared to controls (MBEST estimated mean difference versus controls 6.6 (CI 5.2; 8.0), p < 0.001 for RAS-supported multimodal balance training; and 3.0 (CI 2.7; 5.3), p < 0.001 for regular multimodal balance training). Improvements were retained at one-month follow-up for both active interventions, but only the RAS-supported multimodal balance training group maintained its improvement at 6 months. Conclusion: Both RAS-supported multimodal balance training and regular multimodal balance training improve balance, but RAS-supported multimodal balance training–adding rhythmical auditory cues to regular multimodal balance training–has greater and more sustained effects.
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Affiliation(s)
- Tamine T C Capato
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands.,Department of Neurology, University of São Paulo, Movement Disorder Center, São Paulo, Brazil
| | - Nienke M de Vries
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Joanna IntHout
- Department for Health Evidence, Radboud University Medial Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Egberto R Barbosa
- Department of Neurology, University of São Paulo, Movement Disorder Center, São Paulo, Brazil
| | - Jorik Nonnekes
- Department of Rehabilitation, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
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19
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Morris R, Mancin M. Lab-on-a-chip: wearables as a one stop shop for free-living assessments. Digit Health 2021. [DOI: 10.1016/b978-0-12-818914-6.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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20
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Smith MD, Brazier DE, Henderson EJ. Current Perspectives on the Assessment and Management of Gait Disorders in Parkinson's Disease. Neuropsychiatr Dis Treat 2021; 17:2965-2985. [PMID: 34584414 PMCID: PMC8464370 DOI: 10.2147/ndt.s304567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/25/2021] [Indexed: 12/31/2022] Open
Abstract
Gait dysfunction is a key defining feature of Parkinson's disease (PD), and is associated with symptoms of freezing and an increased risk of falls. In this narrative review, we cover the putative mechanisms of gait dysfunction in PD, the assessment of gait abnormalities, and the management of symptoms caused by the inherent difficulty in walking. Our understanding of the causes of gait problems in PD has progressed in recent times, moving from neurocognitive theory to correlates of affected neuronal pathways. In particular, this can be shown to correspond with abnormalities in responses to dual-task paradigms and dysfunction in cholinergic signaling. Great progress has been made in the sophistication and precision of gait assessment; however, it has firmly remained in the research domain. There is significant momentum behind wearable technologies that can be used by patients in their own environment, acting as digital biomarkers that can not only reflect progression but also independently discriminate PD from non-PD individuals. The treatment of gait dysfunction has historically relied on physical therapies and training combined with a view to mitigating the impact of such consequences as falls. Pharmacological therapies that are the mainstay of treatment in PD have tended to address symptoms like bradykinesia; however, optimization of dopaminergic therapies likely has a positive effect on quality of gait. Other targets have been assessed with the goal of improving gait, of which medications that improve cholinergic signaling appear most promising. Neuromodulation techniques are increasingly used in the form of deep-brain stimulation; however, standard targets, such as the globus pallidus interna, have a modest effect on gait. Considerable benefit has been seen through targeting the pedunculopontine nucleus, and a dual-target approach may be warranted. Stimulation of the spinal cord and brain through direct or magnetic approaches has been assessed, but requires further evidence.
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Affiliation(s)
- Matthew D Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
| | - Danielle E Brazier
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
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21
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Maslivec A, Fielding A, Wilson M, Norris M, Young W. 'Recoupling' the attentional and motor control of preparatory postural adjustments to overcome freezing of gait in Parkinson's. J Neuroeng Rehabil 2020; 17:146. [PMID: 33129334 PMCID: PMC7603666 DOI: 10.1186/s12984-020-00776-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives This study examined if people with Parkinson’s and freezing of gait pathology (FoG) could be trained to increase preparatory weight-shift amplitude, and facilitate step initiation during FoG. Methods Thirty-five people with Parkinson’s and FoG attempted to initiate forward walking from a stationary position caused by a freeze (n = 17, FoG-F) or voluntarily stop (n = 18, FoG-NF) in a Baseline condition and two conditions where an increased weight-shift amplitude was trained via: (i) explicit verbal instruction, and (ii) implicit movement analogies. Results At Baseline, weight-shift amplitudes were smaller during: (i) unsuccessful, compared to successful step initiations (FoG-F group), and (ii) successful step initiations in the FoG-F group compared to FoG-NF. Both Verbal and Analogy training resulted in significant increases in weight-shift amplitude in both groups, and a corresponding pronounced reduction in unsuccessful attempts to initiate stepping (FoG-F group). Conclusions Hypometric preparatory weight-shifting is associated with failure to initiate forward stepping in people with Parkinson’s and FoG. However, impaired weight-shift characteristics are modifiable through conscious strategies. This current study provides a novel and critical evaluation of preparatory weight-shift amplitudes during FoG events. The intervention described represents an attractive ‘rescue’ strategy and should be further scrutinised regarding limitations posed by physical and cognitive deficits.
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Affiliation(s)
- Amy Maslivec
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anna Fielding
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Mark Wilson
- School of Sport and Health Sciences, University of Exeter, Exeter, EX1 2LU, UK
| | - Meriel Norris
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - William Young
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK. .,School of Sport and Health Sciences, University of Exeter, Exeter, EX1 2LU, UK.
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22
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D'Cruz N, Seuthe J, Ginis P, Hulzinga F, Schlenstedt C, Nieuwboer A. Short-Term Effects of Single-Session Split-Belt Treadmill Training on Dual-Task Performance in Parkinson's Disease and Healthy Elderly. Front Neurol 2020; 11:560084. [PMID: 33101174 PMCID: PMC7554617 DOI: 10.3389/fneur.2020.560084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/19/2020] [Indexed: 12/30/2022] Open
Abstract
Background: Dual-tasking is challenging for people with Parkinson's disease and freezing of gait (PD+FOG) and can exacerbate freezing episodes and falls. Split-belt treadmill training (SBT) is a novel tool to train complex gait and may improve dual-task (DT) walking and turning. Objective: To investigate the single-session effects of SBT on DT walking and DT turning performance in PD+FOG and older adults (OA), compared to regular treadmill training. Methods: Forty-five PD+FOG and 36 OA participated in a single training session (30 min). They were randomized into one of four training groups: (A) SB75—steady belt speed ratio 0.75:1; (B) SB50—steady belt speed ratio 0.5:1; (C) SBCR—changing belt speed ratios between 0.75:1 and 0.5:1; and (D) Tied-Belt (TBT). Over-ground straight-line gait and an alternating turning in place task combined with a cognitive dual-task (DT) (auditory Stroop) were assessed pre- and post-training, and the following day (retention). Constrained longitudinal data analysis was used to investigate the training effects for all participants and for PD+FOG alone. Results: DT gait speed improved at post-training for all groups (p < 0.001). However, SBT (SB50 and SBCR) led to larger post-training improvements compared to TBT, which were still visible at retention (SB50). For mean DT turning speed and Stroop response time while walking, only SBT groups showed significant improvements at post-training or retention. DT stride length, peak DT turning speed, and Stroop performance index while walking also showed larger gains in SBT compared to TBT. Results for PD+FOG alone showed similar effects although with smaller effect sizes. Conclusions: A single session of SBT in PD+FOG and OA showed larger short-term effects on DT walking and turning compared to TBT. Cognitive DT performance was also improved in SBT, likely due to reduced cortical control of gait. These results illustrate the potential for SBT to improve DT during complex gait and possibly reduce fall risk in clinical and healthy populations.
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Affiliation(s)
- Nicholas D'Cruz
- Neurorehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Jana Seuthe
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University (CAU) Kiel, Kiel, Germany
| | - Pieter Ginis
- Neurorehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Femke Hulzinga
- Neurorehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Christian Schlenstedt
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University (CAU) Kiel, Kiel, Germany
| | - Alice Nieuwboer
- Neurorehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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23
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Battel I, Calvo I, Walshe M. Interventions Involving Biofeedback to Improve Swallowing in People With Parkinson Disease and Dysphagia: A Systematic Review. Arch Phys Med Rehabil 2020; 102:314-322. [PMID: 32861667 DOI: 10.1016/j.apmr.2020.06.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 06/01/2020] [Accepted: 06/22/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the effectiveness of biofeedback used in the treatment of adults with Parkinson disease (PD) and dysphagia, define the factors associated with biofeedback treatment outcomes, and inform a theory to guide the implementation of biofeedback in future dysphagia interventions. DATA SOURCES A systematic review using a narrative synthesis approach of all published and unpublished studies were sought with no date or language restrictions. Ten electronic databases (EMBASE, PubMed, CINAHL, Web of Science, Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, ProQuest Dissertations and Theses A & I, Google Scholar) were searched from inception to April 2019. This search was updated in January 2020. The methodological quality of included studies was assessed using Downs and Black checklist. STUDY SELECTION Four studies were included. The methodological quality of the included studies was low with a high risk of bias. Data were analyzed narratively and descriptively. Despite the heterogeneity of the included studies, the findings suggest that interventions incorporating visual biofeedback may have positive effects on swallowing-related quality of life. CONCLUSIONS Based on these preliminary findings, we provide directions for further research and clinical interventions that incorporate an augmentative biofeedback component of swallowing interventions in people with PD. Future studies should be rigorously designed and set appropriate biofeedback treatment in terms of types, schedules, and timing.
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Affiliation(s)
- Irene Battel
- Department of Clinical Speech & Language Studies, University of Dublin, Trinity College Dublin, Dublin, Republic of Ireland.
| | - Irene Calvo
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milan, Italy
| | - Margaret Walshe
- Department of Clinical Speech & Language Studies, University of Dublin, Trinity College Dublin, Dublin, Republic of Ireland
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24
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Capato TTC, de Vries NM, IntHout J, Ramjith J, Barbosa ER, Nonnekes J, Bloem BR. Multimodal Balance Training Supported by Rhythmic Auditory Stimuli in Parkinson Disease: Effects in Freezers and Nonfreezers. Phys Ther 2020; 100:2023-2034. [PMID: 32737973 PMCID: PMC7596891 DOI: 10.1093/ptj/pzaa146] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/04/2020] [Accepted: 07/05/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To fulfill the potential of nonpharmacological interventions for people with Parkinson disease (PD), individually tailored treatment is needed. Multimodal balance training supported by rhythmic auditory stimuli (RAS) can improve balance and gait in people with PD. The purpose of this study was to determine whether both freezers and nonfreezers benefit. METHODS A secondary analysis was conducted on a large randomized controlled trial that included 154 patients with PD (Hoehn & Yahr Stages 1-3 while ON-medication) who were assigned randomly to 3 groups: (1) multimodal balance training with RAS delivered by a metronome (RAS-supported multimodal balance training); (2) regular multimodal balance training without rhythmic auditory cues; and (3) a control intervention (involving an educational program). Training was performed for 5 weeks, twice per week. The primary outcome was the Mini-BESTest score directly after the training period. Assessments were performed by a single, masked assessor at baseline, directly postintervention, and after 1-month and 6-month follow-up. Outcomes were analyzed in 1 analysis, and the results were presented separately for freezers and nonfreezers with a linear mixed model, adjusted for baseline Mini-BESTest scores, Unified Parkinson's Disease Rating Scale scores, and levodopa equivalent dose. RESULTS In both freezers and nonfreezers, both RAS-supported multimodal training and regular training significantly improved the Mini-BESTest scores compared with baseline scores and with the control group scores. The improvement was larger for RAS-supported training compared with regular training, for both freezers and nonfreezers. Only the RAS-supported training group retained the improvements compared with baseline measurements at 6-month follow-up, and this was true for both freezers and nonfreezers. CONCLUSIONS RAS-supported multimodal training is effective in improving balance performance in both freezers and nonfreezers. IMPACT Until this study, it was unknown whether both freezers and nonfreezers could benefit from multimodal balance training. With this information, clinicians who work with people with PD will be better able to apply personalized gait rehabilitation. LAY SUMMARY Adding rhythmic auditory stimuli (RAS) to balance training is beneficial for both freezers and nonfreezers, at least in persons with mild to moderate disease stages. This RAS-supported multimodal training has good potential for a wider clinical implementation with good long-term effects.
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Affiliation(s)
| | - Nienke M de Vries
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, and Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center
| | - Joanna IntHout
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center
| | - Jordache Ramjith
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center
| | - Egberto R Barbosa
- Movement Disorders Clinic, Department of Neurology, University of São Paulo
| | - Jorik Nonnekes
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, and Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center; and Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Bastiaan R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, and Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center
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25
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Prefrontal Cortical Activation With Open and Closed-Loop Tactile Cueing When Walking and Turning in Parkinson Disease: A Pilot Study. J Neurol Phys Ther 2020; 44:121-131. [DOI: 10.1097/npt.0000000000000286] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Amaral-Felipe KMD, Yamada PDA, Abreu DCCD, Freire Júnior RC, Stroppa-Marques AEZ, Faganello-Navega FR. Kinematic gait parameters for older adults with Parkinson's disease during street crossing simulation. Hum Mov Sci 2020; 70:102599. [PMID: 32217200 DOI: 10.1016/j.humov.2020.102599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/14/2020] [Accepted: 02/27/2020] [Indexed: 12/11/2022]
Abstract
Safe street crossing is important for older adults' social inclusion. We assessed gait kinematic adaptation under different simulated street crossing conditions in older adults with Parkinson's disease (PD) and made comparisons with older adults without PD to understand how PD interferes in outdoor task performance, helping in the development of strategies to reduce road traffic accident risk. In 20 older adults without PD (control group - CG) and 20 with PD (GPD), we assessed usual gait (C1), gait during street crossing simulation (C2), and gait during reduced-time street crossing simulation (C3). Velocity, step length, and step, swing, stance, and double support time were analyzed. Spatiotemporal differences in gait between groups and conditions were analyzed. The GPD walked 16% slower in C1 and 12% slower in C2 and C3 than the CG. GPD also took 11% shorter steps in C1 and 9.5% shorter steps in C2. The double support time was 8.5% greater in C1. In intragroup comparisons, there were significant differences in all gait conditions. The CG showed increased velocity (C2 15% > C1; C3 13% > C2; C3 26% > C1), step length (C2 8% > C1; C3 5% > C2; C3 13% > C1), and swing time (C2 2% > C1; C3 3.7% > C2; C3 6% > C1), and decreased step time (C2 7.5% < C1; C3 8% < C2; C3 15% < C1), stance time (C2 1.3% < C1; C3 2.5% < C2; C3 3.6% < C1), and double support time (C2 6.3% < C1; C3 10.5% < C2; C3 16% < C1). GPD showed increased velocity (C2 19% > C1; C3 13.5% > C2; C3 29.7% > C1), step length, (C2 6% > C1; C3 7% > C2; C3 16% > C1), and swing time (C2 3% > C1; C3 3% > C2; C3 5.5% > C1) and decreased step time (C2 10.3% < C1; C3 7.7% < C2; C3 17% < C1), stance time (C2 1.7% < C1; C3 1.7% < C2; C3 3.4% < C1), and double support time (C2 7% < C1; C3 9.5% < C2; C3 16% < C1). Kinematic changes observed in the intergroup comparison show that participants with PD had lower velocity in all conditions. However, per the intragroup results, both participants with and without PD managed to significantly modify gait variables to attempt to cross the street in the given time. It is necessary to assess whether this increases fall risk by exposing them to road traffic accidents.
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Affiliation(s)
- Késia Maísa do Amaral-Felipe
- Institute of Biosciences, São Paulo State University (UNESP), Avenida vinte e quatro A, 1515, CEP 13506-900 Rio Claro, São Paulo, Brazil; Faculty Anhanguera of Jundiaí, Rua do Retiro, 3000, CEP 13209-002 Jundiaí, São Paulo, Brazil.
| | - Patrícia de Aguiar Yamada
- Institute of Biosciences, São Paulo State University (UNESP), Avenida vinte e quatro A, 1515, CEP 13506-900 Rio Claro, São Paulo, Brazil; Faculty of Higher Education of Interior São Paulo (FAIP), Avenida Antonieta Altenfelder, 65, CEP 17512-130 Marília, São Paulo, Brazil
| | - Daniela Cristina Carvalho de Abreu
- Laboratory of Assessment and Rehabilitation of Equilibrium, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, CEP 14049-900 Ribeirão Preto, São Paulo, Brazil
| | - Renato Campos Freire Júnior
- Laboratory of Assessment and Rehabilitation of Equilibrium, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, CEP 14049-900 Ribeirão Preto, São Paulo, Brazil; Faculty of Physical Education and Physiotherapy, Federal University of Amazonas, Avenida General Rodrigo Octavio Jordão Ramos, 1200, CEP 69067-005 Manaus, Amazonas, Brazil
| | - Ana Elisa Zuliani Stroppa-Marques
- Department of Physical Therapy and Occupational Therapy, School of Philosophy and Science, São Paulo State University (UNESP), Avenida Hygino Muzzi FIlho, 737, CEP 17525-000 Marília, São Paulo, Brazil
| | - Flávia Roberta Faganello-Navega
- Institute of Biosciences, São Paulo State University (UNESP), Avenida vinte e quatro A, 1515, CEP 13506-900 Rio Claro, São Paulo, Brazil; Department of Physical Therapy and Occupational Therapy, School of Philosophy and Science, São Paulo State University (UNESP), Avenida Hygino Muzzi FIlho, 737, CEP 17525-000 Marília, São Paulo, Brazil
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27
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Sweeney D, Quinlan LR, Richardson M, Meskell P, ÓLaighin G. Double-Tap Interaction as an Actuation Mechanism for On-Demand Cueing in Parkinson's Disease. SENSORS 2019; 19:s19235167. [PMID: 31779099 PMCID: PMC6928615 DOI: 10.3390/s19235167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 11/16/2022]
Abstract
Freezing of Gait (FoG) is one of the most debilitating symptoms of Parkinson’s disease and is an important contributor to falls. When the management of freezing episodes cannot be achieved through medication or surgery, non-pharmacological methods, such as cueing, have emerged as effective techniques, which ameliorates FoG. The use of On-Demand cueing systems (systems that only provide cueing stimuli during a FoG episode) has received attention in recent years. For such systems, the most common method of triggering the onset of cueing stimuli, utilize autonomous real-time FoG detection algorithms. In this article, we assessed the potential of a simple double-tap gesture interaction to trigger the onset of cueing stimuli. The intended purpose of our study was to validate the use of double-tap gesture interaction to facilitate Self-activated On-Demand cueing. We present analyses that assess if PwP can perform a double-tap gesture, if the gesture can be detected using an accelerometer’s embedded gestural interaction recognition function and if the action of performing the gesture aggravates FoG episodes. Our results demonstrate that a double-tap gesture may provide an effective actuation method for triggering On-Demand cueing. This opens up the potential future development of self-activated cueing devices as a method of On-Demand cueing for PwP and others.
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Affiliation(s)
- Dean Sweeney
- Electrical & Electronic Engineering, School of Engineering, NUI Galway, University Road, H91 HX31 Galway, Ireland; (D.S.); (G.Ó.)
- Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, NUI Galway, University Road, H91 HX31 Galway, Ireland
| | - Leo R. Quinlan
- Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, NUI Galway, University Road, H91 HX31 Galway, Ireland
- Physiology, School of Medicine, NUI Galway, University Road, H91 W5P7 Galway, Ireland
- Correspondence:
| | - Margaret Richardson
- Neurology Department University Hospital Limerick, Dooradoyle, V94 F858 Limerick, Ireland;
| | - Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Castletroy, V94 X5K6 Limerick, Ireland;
| | - Gearóid ÓLaighin
- Electrical & Electronic Engineering, School of Engineering, NUI Galway, University Road, H91 HX31 Galway, Ireland; (D.S.); (G.Ó.)
- Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, NUI Galway, University Road, H91 HX31 Galway, Ireland
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28
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Delgado-Alvarado M, Marano M, Santurtún A, Urtiaga-Gallano A, Tordesillas-Gutierrez D, Infante J. Nonpharmacological, nonsurgical treatments for freezing of gait in Parkinson's disease: A systematic review. Mov Disord 2019; 35:204-214. [PMID: 31769904 DOI: 10.1002/mds.27913] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/20/2019] [Accepted: 09/27/2019] [Indexed: 01/12/2023] Open
Abstract
Freezing of gait is a disabling phenomenon that appears in a substantial number of Parkinson's disease (PD) patients as the disease evolves. It is considered to be one of the most relevant contributing factors to worsening of quality of life. Current pharmacological or surgical treatment options have limited efficacy. Thus, alternative nonpharmacological/nonsurgical approaches have emerged in recent years in an attempt to improve quality of life in PD. This systematic review summarizes studies of such therapies over the past 5 years. Thirty-five studies were evaluated by use of a qualitative evaluation, while the methodological quality was assessed using validated tools. According to our results, there appear to be two broad categories of nonpharmacological therapies: those that seek a long-lasting benefit and those that aim to achieve a transient effect to overcome the freezing of gait episode. Among the former, it is possible to differentiate between "passive" therapies, which include transcranial magnetic stimulation or transcranial direct current stimulation, and "active" therapies, which are based on different cognitive or physical training programs. Finally, "transient effect" therapies use different types of cues, such as visual, auditory, or proprioceptive stimuli, to attempt to shift the patient's habitual motor control to a goal-directed one. In conclusion, a broad spectrum of nonpharmacological/nonsurgical approaches for freezing of gait has emerged in recent years with promising results. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Manuel Delgado-Alvarado
- Neurology Department, Sierrallana Hospital, Torrelavega, Spain.,Psychiatry Research Area, IDIVAL, University Hospital Marqués de Valdecilla, Santander, Spain.,Biomedical Research Networking Center for Mental Health (CIBERSAM), Madrid, Spain
| | - Massimo Marano
- Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Ana Santurtún
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain
| | | | - Diana Tordesillas-Gutierrez
- Biomedical Research Networking Center for Mental Health (CIBERSAM), Madrid, Spain.,Neuroimaging Unit, Technological Facilities, Valdecilla Biomedical Research Institute IDIVAL, Santander, Spain
| | - Jon Infante
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain.,Centro de investigación en red de enfermedades neurodegenerativas (CIBERNED), Madrid, Spain
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29
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Nonnekes J, Nieuwboer A. Towards Personalized Rehabilitation for Gait Impairments in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2019; 8:S101-S106. [PMID: 30584154 PMCID: PMC6311370 DOI: 10.3233/jpd-181464] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Non-pharmacological interventions are essential in the management of gait impairments in Parkinson’s disease. The evidence for these interventions is growing rapidly. However, studies evaluating these interventions do generally evaluate a one-size-fits-all concept, and do usually not distinguish between subgroups, treatment dose and delivery mode. For two main reasons, this approach will not reach the full potential of gait rehabilitation. First, non-pharmacological interventions (e.g., external cueing) can improve gait in certain patients, but have no effect or sometimes even exacerbate gait deficits in others. Second, the success and benefit of gait rehabilitation relies on therapy adherence and training intensity achieved, and multi-target therapy not tailored to the individual runs the risk of hitting nothing. Hence, to apply non-pharmacological interventions in an individualized and evidence-based manner, clinicians and therapists need to know which patient characteristics predict the efficacy of various training modes and what type of training delivery works best. Current evidence is not sufficient to develop such personalized rehabilitation programs. In this viewpoint, however, we describe how tailored use of gait rehabilitation can be reached within a 20-year time frame.
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Affiliation(s)
- Jorik Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands.,Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest, Belgium
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30
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Corzani M, Ferrari A, Ginis P, Nieuwboer A, Chiari L. Motor Adaptation in Parkinson's Disease During Prolonged Walking in Response to Corrective Acoustic Messages. Front Aging Neurosci 2019; 11:265. [PMID: 31607899 PMCID: PMC6769108 DOI: 10.3389/fnagi.2019.00265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/10/2019] [Indexed: 11/13/2022] Open
Abstract
Wearable sensing technology is a new way to deliver corrective feedback. It is highly applicable to gait rehabilitation for persons with Parkinson’s disease (PD) because feedback potentially engages spared neural function. Our study characterizes participants’ motor adaptation to feedback signaling a deviation from their normal cadence during prolonged walking, providing insight into possible novel therapeutic devices for gait re-training. Twenty-eight persons with PD (15 with freezing, 13 without) and 13 age-matched healthy elderly (HE) walked for two 30-minute sessions. When their cadence varied, they heard either intelligent cueing (IntCue: bouts of ten beats indicating normal cadence) or intelligent feedback (IntFB: verbal instruction to increase or decrease cadence). We created a model that compares the effectiveness of the two conditions by quantifying the number of steps needed to return to the target cadence for every deviation. The model fits the short-term motor responses to the external step inputs (collected with wearable sensors). We found some significant difference in motor adaptation among groups and subgroups for the IntCue condition only. Both conditions were instead able to identify different types of responders among persons with PD, although showing opposite trends in their speed of adaptation. Increasing rather than decreasing the pace appeared to be more difficult for both groups. In fact, under IntFB the PD group required about seven steps to increase their cadence, whereas they only needed about three steps to decrease their cadence. However, it is important to note that this difference was not significant; perhaps future work could include more participants and/or more sessions, increasing the total number of deviations for analysis. Notably, a significant negative correlation, r = −0.57 (p-value = 0.008), was found between speed of adaptation and number of deviations during IntCue, but not during IntFB, suggesting that, for people who struggle with gait, such as those with PD, verbal instructions rather than metronome beats might be more effective at restoring normal cadence. Clinicians and biofeedback developers designing novel therapeutic devices could apply our findings to determine the optimal timing for corrective feedback, optimizing gait rehabilitation while minimizing the risk of cue-dependency.
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Affiliation(s)
- Mattia Corzani
- Department of Electrical, Electronic, and Information Engineering, University of Bologna, Bologna, Italy
| | - Alberto Ferrari
- Department of Electrical, Electronic, and Information Engineering, University of Bologna, Bologna, Italy
| | - Pieter Ginis
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, Leuven, Belgium
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, Leuven, Belgium
| | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering, University of Bologna, Bologna, Italy
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31
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Müller MLTM, Marusic U, van Emde Boas M, Weiss D, Bohnen NI. Treatment options for postural instability and gait difficulties in Parkinson's disease. Expert Rev Neurother 2019; 19:1229-1251. [PMID: 31418599 DOI: 10.1080/14737175.2019.1656067] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Gait and balance disorders in Parkinson's disease (PD) represent a major therapeutic challenge as frequent falls and freezing of gait impair quality of life and predict mortality. Limited dopaminergic therapy responses implicate non-dopaminergic mechanisms calling for alternative therapies.Areas covered: The authors provide a review that encompasses pathophysiological changes involved in axial motor impairments in PD, pharmacological approaches, exercise, and physical therapy, improving physical activity levels, invasive and non-invasive neurostimulation, cueing interventions and wearable technology, and cognitive interventions.Expert opinion: There are many promising therapies available that, to a variable degree, affect gait and balance disorders in PD. However, not one therapy is the 'silver bullet' that provides full relief and ultimately meaningfully improves the patient's quality of life. Sedentariness, apathy, and emergence of frailty in advancing PD, especially in the setting of medical comorbidities, are perhaps the biggest threats to experience sustained benefits with any of the available therapeutic options and therefore need to be aggressively treated as early as possible. Multimodal or combination therapies may provide complementary benefits to manage axial motor features in PD, but selection of treatment modalities should be tailored to the individual patient's needs.
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Affiliation(s)
- Martijn L T M Müller
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Uros Marusic
- Institute for Kinesiology Research, Science and Research Centre of Koper, Koper, Slovenia.,Department of Health Sciences, Alma Mater Europaea - ECM, Maribor, Slovenia
| | - Miriam van Emde Boas
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Nicolaas I Bohnen
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA.,Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, USA
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Gál O, Poláková K, Hoskovcová M, Tomandl J, Čapek V, Berka R, Brožová H, Šestáková I, Růžička E. Pavement patterns can be designed to improve gait in Parkinson's disease patients. Mov Disord 2019; 34:1831-1838. [PMID: 31442358 DOI: 10.1002/mds.27831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/14/2019] [Accepted: 07/29/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Public spaces are usually designed with respect to various patient populations, but not Parkinson's disease. The objective of this study was to explore what type of easily applicable visual cueing might be used in public spaces and some interiors to improve gait in people with Parkinson's disease. METHODS Thirty-two patients with freezing of gait walked an 8-meter track on 6 different floor patterns in single- and dual-task conditions in random sequence. The reference pattern was a virtual large transverse chessboard, and the other patterns differed either in size (small floor stones), orientation (diagonal), nature (real paving), regularity (irregular), or no pattern. Time, number of steps, velocity, step length, cadence, and dual-task effect were calculated. The number and total duration of freezing episodes were analyzed. RESULTS Virtual, large, transverse floor stones improve time (P = 0.0101), velocity (P = 0.0029), number of steps (P = 0.0291), and step length (P = 0.0254) in Parkinson's disease patients compared with walking on no pattern. Virtual floor stones were superior in time and velocity to the real ones. Transverse floor stones were better than diagonal, whereas regular pattern stones were superior to irregular in some gait parameters. Subjectively, the reference pattern was preferred to the irregular one and to no pattern. No direct effect on freezing of gait was observed. CONCLUSIONS Parkinson's disease patients may benefit from floor patterns incorporating transverse oriented large rectangular visual cues. Because public space can be regulated with respect to people with medical conditions, the relevant legislative documents should be extended to allow for parkinsonian gait disorder. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ota Gál
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Kamila Poláková
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Martina Hoskovcová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Jan Tomandl
- Faculty of Architecture, Czech Technical University in Prague, Prague, Czech Republic
| | - Václav Čapek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Roman Berka
- Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Hana Brožová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Irena Šestáková
- Faculty of Architecture, Czech Technical University in Prague, Prague, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
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The CuePed Trial: How Does Environmental Complexity Impact Cue Effectiveness? A Comparison of Tonic and Phasic Visual Cueing in Simple and Complex Environments in a Parkinson's Disease Population with Freezing of Gait. PARKINSONS DISEASE 2019; 2019:2478980. [PMID: 31428302 PMCID: PMC6681574 DOI: 10.1155/2019/2478980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/23/2019] [Accepted: 07/08/2019] [Indexed: 01/23/2023]
Abstract
Background The optimal prescription of cueing for the treatment of freezing of gait (FoG) in Parkinson's disease (PD) is currently a difficult problem for clinicians due to the heterogeneity of cueing modalities, devices, and the limited comparative trial evidence. There has been a rise in the development of motion-sensitive, wearable cueing devices for the treatment of FoG in PD. These devices generally produce cues after signature gait or electroencephalographic antecedents of FoG episodes are detected (phasic cues). It is not known whether these devices offer benefit over simple (tonic) cueing devices. Methods We assembled 20 participants with PD and FoG and familiarized them with a belt-worn, laser-light cueing device (Agilitas™). The device was designed with 2 cueing modalities—gait-dependent or “phasic” cueing and gait-independent or “tonic” cueing. Participants used the device sequentially in the off, phasic, or tonic modes, across 2 tasks—a 2-minute walk and an obstacle course. Results A significant improvement in mean distance walked during the 2-minute walk test was observed for the tonic mode (127.3 m) compared with the off (111.4 m) and phasic (116.1 m) conditions. In contrast, there was a nonsignificant trend toward improvement in FoG frequency, duration, and course time when the device was switched from off to tonic and to phasic modes for the obstacle course. Conclusions Parkinson's disease patients with FoG demonstrated an improvement in distance walked during the two-minute walk test when a cueing device was switched from off to phasic and to tonic modes of operation. However, this benefit was lost when patients negotiated an obstacle course.
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Fundarò C, Maestri R, Ferriero G, Chimento P, Taveggia G, Casale R. Self-selected speed gait training in Parkinson's disease: robot-assisted gait training with virtual reality versus gait training on the ground. Eur J Phys Rehabil Med 2019; 55:456-462. [DOI: 10.23736/s1973-9087.18.05368-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Broeder S, Heremans E, Pinto Pereira M, Nackaerts E, Meesen R, Verheyden G, Nieuwboer A. Does transcranial direct current stimulation during writing alleviate upper limb freezing in people with Parkinson’s disease? A pilot study. Hum Mov Sci 2019; 65:S0167-9457(17)30936-3. [DOI: 10.1016/j.humov.2018.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/17/2018] [Accepted: 02/19/2018] [Indexed: 11/15/2022]
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Nackaerts E, D'Cruz N, Dijkstra BW, Gilat M, Kramer T, Nieuwboer A. Towards understanding neural network signatures of motor skill learning in Parkinson's disease and healthy aging. Br J Radiol 2019; 92:20190071. [PMID: 30982328 DOI: 10.1259/bjr.20190071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In the past decade, neurorehabilitation has been shown to be an effective therapeutic supplement for patients with Parkinson's disease (PD). However, patients still experience severe problems with the consolidation of learned motor skills. Knowledge on the neural correlates underlying this process is thus essential to optimize rehabilitation for PD. This review investigates the existing studies on neural network connectivity changes in relation to motor learning in healthy aging and PD and critically evaluates the imaging methods used from a methodological point of view. The results indicate that despite neurodegeneration there is still potential to modify connectivity within and between motor and cognitive networks in response to motor training, although these alterations largely bypass the most affected regions in PD. However, so far training-related changes are inferred and possible relationships are not substantiated by brain-behavior correlations. Furthermore, the studies included suffer from many methodological drawbacks. This review also highlights the potential for using neural network measures as predictors for the response to rehabilitation, mainly based on work in young healthy adults. We speculate that future approaches, including graph theory and multimodal neuroimaging, may be more sensitive than brain activation patterns and model-based connectivity maps to capture the effects of motor learning. Overall, this review suggests that methodological developments in neuroimaging will eventually provide more detailed knowledge on how neural networks are modified by training, thereby paving the way for optimized neurorehabilitation for patients.
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Affiliation(s)
| | - Nicholas D'Cruz
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Bauke W Dijkstra
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Moran Gilat
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Thomas Kramer
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Alice Nieuwboer
- 1Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Mirelman A, Bonato P, Camicioli R, Ellis TD, Giladi N, Hamilton JL, Hass CJ, Hausdorff JM, Pelosin E, Almeida QJ. Gait impairments in Parkinson's disease. Lancet Neurol 2019; 18:697-708. [PMID: 30975519 DOI: 10.1016/s1474-4422(19)30044-4] [Citation(s) in RCA: 312] [Impact Index Per Article: 62.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 12/19/2022]
Abstract
Gait impairments are among the most common and disabling symptoms of Parkinson's disease. Nonetheless, gait is not routinely assessed quantitatively but is described in general terms that are not sensitive to changes ensuing with disease progression. Quantifying multiple gait features (eg, speed, variability, and asymmetry) under natural and more challenging conditions (eg, dual-tasking, turning, and daily living) enhanced sensitivity of gait quantification. Studies of neural connectivity and structural network topology have provided information on the mechanisms of gait impairment. Advances in the understanding of the multifactorial origins of gait changes in patients with Parkinson's disease promoted the development of new intervention strategies, such as neurostimulation and virtual reality, aimed at alleviating gait impairments and enhancing functional mobility. For clinical applicability, it is important to establish clear links between specific gait impairments, their underlying mechanisms, and disease progression to foster the acceptance and usability of quantitative gait measures as outcomes in future disease-modifying clinical trials.
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Affiliation(s)
- Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | | | - Terry D Ellis
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, USA
| | - Nir Giladi
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jamie L Hamilton
- Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Chris J Hass
- College of Health and Human Performance, Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Jeffrey M Hausdorff
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elisa Pelosin
- Department of Neuroscience (DINOGMI), University of Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Quincy J Almeida
- Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, ON, Canada
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Mancini M, Smulders K, Harker G, Stuart S, Nutt JG. Assessment of the ability of open- and closed-loop cueing to improve turning and freezing in people with Parkinson's disease. Sci Rep 2018; 8:12773. [PMID: 30143726 PMCID: PMC6109152 DOI: 10.1038/s41598-018-31156-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/13/2018] [Indexed: 01/04/2023] Open
Abstract
Turning impairments are common in Parkinson’s disease (PD) and can elicit freezing of gait (FoG). Extensive examination of open-loop cueing interventions has demonstrated that they can ameliorate gait deficits in PD; less is known about efficacy to improve turning. Here, we investigate the immediate effectiveness of open- and closed-loop cueing in improving turning characteristics in people with PD. Twenty-five subjects with and 18 subjects without FoG participated in the study. Subjects turned in place for one minute under single- and dual-task for 3 randomized conditions: (i) Baseline; (ii) Turning to the beat of a metronome (open-loop); and (iii) Turning with phase-dependent tactile biofeedback (closed-loop). Objective measures of freezing, such as % time spent freezing and FoG-ratio, significantly improved when turning with both open-loop and closed-loop cueing compared to baseline. Dual-tasking did not worsen FoG in freezers, but significantly slowed down turns in both groups. Both cueing modalities significantly improved turning smoothness in both groups, but reduced turning velocity and number of turns compared to baseline. Both open and closed-loop cueing markedly improved turning in people with PD. These preliminary observations warrant further exploration of vibrotactile closed-loop cueing to improve mobility in everyday life.
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Affiliation(s)
- Martina Mancini
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, OP-32, 97239, Portland, OR, USA.
| | - Katrijn Smulders
- Sint Maartenskliniek, Research Department, PO Box 9011, 6500 GM, Nijmegen, The Netherlands
| | - Graham Harker
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, OP-32, 97239, Portland, OR, USA
| | - Samuel Stuart
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, OP-32, 97239, Portland, OR, USA
| | - John G Nutt
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, OP-32, 97239, Portland, OR, USA
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Debû B, De Oliveira Godeiro C, Lino JC, Moro E. Managing Gait, Balance, and Posture in Parkinson's Disease. Curr Neurol Neurosci Rep 2018; 18:23. [PMID: 29623455 DOI: 10.1007/s11910-018-0828-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Postural instability and gait difficulties inexorably worsen with Parkinson's disease (PD) progression and become treatment resistant, with a severe impact on autonomy and quality of life. We review the main characteristics of balance instability, gait disabilities, and static postural alterations in advanced PD, and the available treatment strategies. RECENT FINDINGS It remains very difficult to satisfactorily alleviate gait and postural disturbances in advanced PD. Medical and surgical interventions often fail to provide satisfactory or durable alleviation of these axial symptoms, that may actually call for differential treatments. Exercise and adapted physical activity programs can contribute to improving the patients' condition. Gait, balance, and postural disabilities are often lumped together under the Postural Instability and Gait Difficulties umbrella term. This may lead to sub-optimal patients' management as data suggest that postural, balance, and gait problems might depend on distinct underlying mechanisms. We advocate for a multidisciplinary approach from the day of diagnosis.
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Affiliation(s)
- Bettina Debû
- University Grenoble Alpes, Grenoble, France.
- INSERM U1216, Grenoble, France.
| | - Clecio De Oliveira Godeiro
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
- Division of Neurology, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Jarbas Correa Lino
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
- Division of Neurology, CHU Amiens, Amiens, France
| | - Elena Moro
- University Grenoble Alpes, Grenoble, France
- INSERM U1216, Grenoble, France
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France
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Altered effective connectivity contributes to micrographia in patients with Parkinson’s disease and freezing of gait. J Neurol 2017; 265:336-347. [DOI: 10.1007/s00415-017-8709-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/08/2017] [Accepted: 12/09/2017] [Indexed: 02/06/2023]
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Cueing for people with Parkinson's disease with freezing of gait: A narrative review of the state-of-the-art and novel perspectives. Ann Phys Rehabil Med 2017; 61:407-413. [PMID: 28890341 DOI: 10.1016/j.rehab.2017.08.002] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 11/20/2022]
Abstract
Freezing, which manifests during gait and other movements, is an incapacitating motor symptom experienced by many patients with Parkinson's disease (PD). In rehabilitation, auditory and visual cueing methods are commonly applied to evoke a more goal-directed type of motor control and, as such, reduce freezing severity in patients with PD. In this narrative review, we summarize the current evidence regarding the effects of external cueing in patients with PD with freezing of gait (FOG) and provide suggestions on how to further improve cueing effectiveness with emerging technological developments. For this paper, we reviewed 24 articles describing the assessment of the effects of cues in patients with FOG (n=354). Because these studies mostly involved quasi-experimental designs, no methodological analysis was undertaken. In general, the evidence suggests that cue-augmented training can reduce FOG severity, improve gait parameters and improve upper-limb movements immediately after training. However, findings were not univocal, and long-term consolidation and transfer of the effects appear to be hampered specifically in this subgroup. With the increasing use of wearable technology, new possibilities are allowing for adapting the cue type, cue content and dose of cues to the needs of individual patients, which may boost the clinical use and efficiency of cued training in PD patients with FOG.
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