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Jacobsen NA, Ferris DP. Exploring Electrocortical Signatures of Gait Adaptation: Differential Neural Dynamics in Slow and Fast Gait Adapters. eNeuro 2024; 11:ENEURO.0515-23.2024. [PMID: 38871456 PMCID: PMC11242882 DOI: 10.1523/eneuro.0515-23.2024] [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: 12/06/2023] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/15/2024] Open
Abstract
Individuals exhibit significant variability in their ability to adapt locomotor skills, with some adapting quickly and others more slowly. Differences in brain activity likely contribute to this variability, but direct neural evidence is lacking. We investigated individual differences in electrocortical activity that led to faster locomotor adaptation rates. We recorded high-density electroencephalography while young, neurotypical adults adapted their walking on a split-belt treadmill and grouped them based on how quickly they restored their gait symmetry. Results revealed unique spectral signatures within the posterior parietal, bilateral sensorimotor, and right visual cortices that differ between fast and slow adapters. Specifically, fast adapters exhibited lower alpha power in the posterior parietal and right visual cortices during early adaptation, associated with quicker attainment of steady-state step length symmetry. Decreased posterior parietal alpha may reflect enhanced spatial attention, sensory integration, and movement planning to facilitate faster locomotor adaptation. Conversely, slow adapters displayed greater alpha and beta power in the right visual cortex during late adaptation, suggesting potential differences in visuospatial processing. Additionally, fast adapters demonstrated reduced spectral power in the bilateral sensorimotor cortices compared with slow adapters, particularly in the theta band, which may suggest variations in perception of the split-belt perturbation. These findings suggest that alpha and beta oscillations in the posterior parietal and visual cortices and theta oscillations in the sensorimotor cortex are related to the rate of gait adaptation.
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Affiliation(s)
- Noelle A Jacobsen
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida 32611-6131
| | - Daniel P Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida 32611-6131
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Magris R, Nardello F, Bombieri F, Monte A, Zamparo P. Characterization of the vastus lateralis torque-length, and knee extensors torque-velocity and power-velocity relationships in people with Parkinson's disease. Front Sports Act Living 2024; 6:1380864. [PMID: 38725475 PMCID: PMC11079174 DOI: 10.3389/fspor.2024.1380864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Parkinson's disease (PD) is a prevalent neurodegenerative condition observed primarily in the elderly population that gives rise to motor and non-motor symptoms, one of which is muscle weakness. The aim of this study was to characterize the vastus lateralis torque-fascicle length (T-L) and the knee extensors torque-angular velocity (T-V) and power-angular velocity (P-V) relationships in PD patients and to investigate the influence of muscle geometry on muscle mechanics. Methods Participants (11 PD: patients, 9 CR: age matched healthy controls; 10 CY: young healthy controls) performed: (i) isometric contractions (e.g., MVC) to obtain the torque-angle and T-L relationships; (ii) isokinetic (e.g., iso-velocity) contractions to obtain the T-V and P-V relationships. During the experiments, the architecture of vastus lateralis (pennation angle, fascicle length, muscle thickness) was also determined by using an ultrasound apparatus. Results Significant differences were observed between PD patients and physically matched control groups (CR and CY) in terms of maximum isometric force (calculated as the apex of the T-L curve) and maximum mechanical power (apex of the P-V curve), but not in maximum shortening velocity. Among the mechanical variables investigated, mechanical power was able to identify differences between the less and the more affected side in PD patients, suggesting that this parameter could be useful for clinical evaluation in this population. Conclusions The observed results cannot be explained by differences in muscle geometry at rest (similar in the three cohorts), but rather by the muscle capacity to change in shape during contraction, that is impaired in PD patients.
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Affiliation(s)
- Riccardo Magris
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Jacobsen NA, Ferris DP. Electrocortical activity correlated with locomotor adaptation during split-belt treadmill walking. J Physiol 2023; 601:3921-3944. [PMID: 37522890 PMCID: PMC10528133 DOI: 10.1113/jp284505] [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: 02/07/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
Locomotor adaptation is crucial for daily gait adjustments to changing environmental demands and obstacle avoidance. Mobile brain imaging with high-density electroencephalography (EEG) now permits quantification of electrocortical dynamics during human locomotion. To determine the brain areas involved in human locomotor adaptation, we recorded high-density EEG from healthy, young adults during split-belt treadmill walking. We incorporated a dual-electrode EEG system and neck electromyography to decrease motion and muscle artefacts. Voluntary movement preparation and execution have been linked to alpha (8-13 Hz) and beta band (13-30 Hz) desynchronizations in the sensorimotor and posterior parietal cortices, whereas theta band (4-7 Hz) modulations in the anterior cingulate have been correlated with movement error monitoring. We hypothesized that relative to normal walking, split-belt walking would elicit: (1) decreases in alpha and beta band power in sensorimotor and posterior parietal cortices, reflecting enhanced motor flexibility; and (2) increases in theta band power in anterior cingulate cortex, reflecting instability and balance errors that will diminish with practice. We found electrocortical activity in multiple regions that was associated with stages of gait adaptation. Data indicated that sensorimotor and posterior parietal cortices had decreased alpha and beta band spectral power during early adaptation to split-belt treadmill walking that gradually returned to pre-adaptation levels by the end of the adaptation period. Our findings emphasize that multiple brain areas are involved in adjusting gait under changing environmental demands during human walking. Future studies could use these findings on healthy, young participants to identify dysfunctional supraspinal mechanisms that may be impairing gait adaptation. KEY POINTS: Identifying the location and time course of electrical changes in the brain correlating with gait adaptation increases our understanding of brain function and provides targets for brain stimulation interventions. Using high-density EEG in combination with 3D biomechanics, we found changes in neural oscillations localized near the sensorimotor, posterior parietal and cingulate cortices during split-belt treadmill adaptation. These findings suggest that multiple cortical mechanisms may be associated with locomotor adaptation, and their temporal dynamics can be quantified using mobile EEG. Results from this study can serve as a reference model to examine brain dynamics in individuals with movement disorders that cause gait asymmetry and reduced gait adaptation.
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Affiliation(s)
- Noelle A Jacobsen
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Daniel P Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
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Phothirook P, Amatachaya S, Peungsuwan P. Muscle Activity and Co-Activation of Gait Cycle during Walking in Water and on Land in People with Spastic Cerebral Palsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1854. [PMID: 36767224 PMCID: PMC9914649 DOI: 10.3390/ijerph20031854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the differences in the muscle activity and co-activation index (CoA) of the rectus femoris (RF), biceps femoris (BF), gastrocnemius medialis (GM,) and tibialis anterior (TA) during walking on land and in water in healthy adolescents compared with those with spastic diplegia cerebral palsy (CP) adolescents. METHODS Four healthy individuals (median; age: 14 years, height: 1.57 cm, BMI: 16.58 kg/m2) and nine CP individuals (median; age: 15 years, height: 1.42 cm, BMI: 17.82 kg/m2) participated in this study and performed three walking trials under both conditions. An electromyography (EMG) collection was recorded with a wireless system Cometa miniwave infinity waterproof device, and the signals were collected using customized software named EMG and Motion Tools, Inc. software version 7 (Cometa slr, Milan, Italy) and was synchronized with an underwater VDO camera. RESULTS A significant decrease in the muscle activity of all muscles and CoA of RF/BF muscles, but an increase in TA/GM was observed within the CP group while walking in water during the stance phase. Between groups, there was a lower CoA of RF/BF and a greater CoA of TA/GM during the stance phase while walking in water and on land in the CP group. A non-significant difference was observed within the healthy group. CONCLUSION Walking in water can decrease muscle activity in lower limbs and co-activation of thigh muscles in people with spastic CP, whereas CoA muscles around ankle joints increased to stabilize foot weight acceptance.
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Affiliation(s)
- Pariyaporn Phothirook
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sugalya Amatachaya
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Punnee Peungsuwan
- Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
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Silveira-Ciola AP, Barbieri FA, Soares CF, Marques NR, Simieli L, Faganello-Navega FR. The effect of whole body vibration on gait stability in individuals with Parkinson's disease: a preliminary study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2023. [DOI: 10.12968/ijtr.2020.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background/Aims Whole body vibration could benefit functional mobility in people with Parkinson's disease. A preliminary study was undertaken to analyse the acute effect of whole body vibration on unobstructed walking and obstacle circumvention in people with Parkinson's disease. Methods People with Parkinson's disease and typically healthy individuals as matched controls were divided into four groups with nine individuals in each: experimental or placebo for people with Parkinson's disease and experimental or placebo for the control group. The participants were evaluated in two different gait conditions: unobstructed walking and obstacle circumvention. Then the participants undertook a session of whole body vibration on a KIKOS P201 lateral vibratory platform in two positions: feet shoulder-width apart, and feet shoulder-width apart with slightly flexed knees. The participants were re-evaluated after this session. Results After whole body vibration, those in the experimental Parkinson's disease group had a reduced co-contraction of the tibialis anterior and the gastrocnemius lateralis muscles during unobstructed walking, whereas the co-contraction of the tibialis anterior and the gastrocnemius lateralis muscles increased in the experimental control group. In addition, those in the experimental control group had reduced stride duration in unobstructed walking and in obstacle circumvention. After the placebo intervention, the co-contraction of the tibialis anterior and the gastrocnemius lateralis muscles increased in all conditions and stride duration was reduced in unobstructed walking. Conclusions Although whole body vibration had no acute efficiency on gait (unobstructed walking and obstacle circumvention), it can improve other components, such as strength, which could be important for people with Parkinson's disease.
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Affiliation(s)
- Aline Prieto Silveira-Ciola
- School of Sciences, Department of Physical Education, Human Movement Research Laboratory, Graduate Program in Movement Sciences, São Paulo State University, Bauru, Brazil
| | - Fabio Augusto Barbieri
- School of Sciences, Department of Physical Education, Human Movement Research Laboratory, Graduate Program in Movement Sciences, São Paulo State University, Bauru, Brazil
| | - Carolina Favarin Soares
- School of Philosophy and Sciences, Department of Physiotherapy and Occupational Therapy, Research Laboratory of Neuromuscular Disorders, São Paulo State University, Marília, Brazil
| | | | - Lucas Simieli
- School of Sciences, Department of Physical Education, Human Movement Research Laboratory, Graduate Program in Movement Sciences, São Paulo State University, Bauru, Brazil
| | - Flávia Roberta Faganello-Navega
- School of Philosophy and Sciences, Department of Physiotherapy and Occupational Therapy, Research Laboratory of Neuromuscular Disorders, São Paulo State University, Marília, Brazil
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Thompson E, Reisman DS. Split-Belt Adaptation and Savings in People With Parkinson Disease. J Neurol Phys Ther 2022; 46:293-301. [PMID: 35980730 PMCID: PMC9529810 DOI: 10.1097/npt.0000000000000411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Upper extremity studies suggest that implicit adaptation is less impaired than explicit learning in persons with Parkinson disease (PD). Little work has explored implicit locomotor adaptation and savings in this population, yet implicit locomotor learning is critical for everyday function. This cross-sectional study examined adaptation and savings in individuals with PD during split-belt treadmill walking. METHODS Fourteen participants completed the following treadmill protocol: Baseline (6 minutes belts tied), Adaptation (10 minutes split), Washout (10 minutes tied), and Readaptation (10 minutes split). Step length and step symmetry index (SSI) were calculated to determine magnitude and rate of adaptation and savings. Rate was calculated as strides to reach SSI plateau during Adaptation and Readaptation. RESULTS During Early Adaptation and Early Readaptation, SSI was perturbed from Baseline ( P < 0.001 and P = 0.002, respectively). Less perturbation in Early Readaptation ( P < 0.001) demonstrated savings. In Late Adaptation and Late Readaptation, participants returned to Baseline symmetry ( P = 0.026 and P = 0.022, respectively, with adjusted level of significance = 0.007). Adaptation was also seen in reverse asymmetry observed in Early Washout ( P = 0.003 vs Baseline). Readaptation rate was faster than in Adaptation ( P = 0.015), demonstrating savings. DISCUSSION AND CONCLUSIONS Individuals with PD showed locomotor adaptation in an implicit sensorimotor adaptation task. They also demonstrated savings, with less perturbation and faster adaptation during the second split-belt exposure. However, performance was variable; some individuals showed minimal adaptation. Variations in learning, savings, and clinical presentation highlight the need to further explore characteristics of individuals with PD most likely to benefit from adaptation-based locomotor training.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A395 ).
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Affiliation(s)
- Elizabeth Thompson
- Department of Physical Therapy, University of Delaware, Newark, Delaware 19713
| | - Darcy S. Reisman
- Department of Physical Therapy, University of Delaware, Newark, Delaware 19713
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Romanato M, Piatkowska W, Spolaor F, To DK, Volpe D, Sawacha Z. Different perspectives in understanding muscle functions in Parkinson’s disease through surface electromyography: exploring multiple activation patterns. J Electromyogr Kinesiol 2022; 64:102658. [DOI: 10.1016/j.jelekin.2022.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 11/25/2022] Open
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Arippa F, Leban B, Monticone M, Cossu G, Casula C, Pau M. A Study on Lower Limb Asymmetries in Parkinson’s Disease during Gait Assessed through Kinematic-Derived Parameters. Bioengineering (Basel) 2022; 9:bioengineering9030120. [PMID: 35324809 PMCID: PMC8945156 DOI: 10.3390/bioengineering9030120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
Unilaterality of motor symptoms is a distinctive feature of Parkinson’s Disease (PD) and represents an important co-factor involved in motor deficits and limitations of functional abilities including postural instability and asymmetrical gait. In recent times, an increasing number of studies focused on the characterization of such alterations, which have been associated with increased metabolic cost and risk of falls and may severely compromise their quality of life. Although a large number of studies investigated the gait alterations in people with PD (pwPD), few focused on kinematic parameters and even less investigated interlimb asymmetry under a kinematic point of view. This retrospective study aimed to characterize such aspects in a cohort of 61 pwPD (aged 68.9 ± 9.3 years) and 47 unaffected individuals age- and sex-matched (66.0 ± 8.3 years), by means of computerized 3D gait analysis performed using an optical motion-capture system. The angular trends at hip, knee and ankle joints of pwPD during the gait cycle were extracted and compared with those of unaffected individuals on a point-by-point basis. Interlimb asymmetry was assessed using angle–angle diagrams (cyclograms); in particular, we analyzed area, orientation, trend symmetry and range offset. The results showed that pwPD are characterized by a modified gait pattern particularly at the terminal stance/early swing phase of the gait cycle. Significant alterations of interlimb coordination were detected at the ankle joint (cyclogram orientation and trend symmetry) and at the hip joint (range offset). Such findings might be useful in clinical routine to characterize asymmetry during gait and thus support physicians in the early diagnosis and in the evaluation of the disease progression.
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Affiliation(s)
- Federico Arippa
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (F.A.); (B.L.)
- Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, ARNAS “G. Brotzu”, 09134 Cagliari, Italy;
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (F.A.); (B.L.)
| | - Marco Monticone
- Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, ARNAS “G. Brotzu”, 09134 Cagliari, Italy;
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy
| | - Giovanni Cossu
- Neurophysiology and Movement Disorders Unit, Department of Neurology, ARNAS “G. Brotzu”, 09134 Cagliari, Italy;
| | - Carlo Casula
- Physical Medicine and Rehabilitation Unit, ARNAS “G. Brotzu”, 09134 Cagliari, Italy;
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (F.A.); (B.L.)
- Correspondence:
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Chang CM, Tsai CH, Lu MK, Tseng HC, Lu G, Liu BL, Lin HC. The neuromuscular responses in patients with Parkinson's disease under different conditions during whole-body vibration training. BMC Complement Med Ther 2022; 22:2. [PMID: 34980075 PMCID: PMC8722001 DOI: 10.1186/s12906-021-03481-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/03/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Whole-body vibration (WBV) training can provoke reactive muscle response and thus exert beneficial effects in various neurological patients. This study aimed to investigate the muscles activation and acceleration transmissibility of the lower extremity to try to understand the neuromuscular control in the Parkinson's disease (PD) patients under different conditions of the WBV training, including position and frequency. METHODS Sixteen PD patients and sixteen controls were enrolled. Each of them would receive two WBV training sessions with 3 and 20 Hz mechanical vibration in separated days. In each session, they were asked to stand on the WBV machine with straight and then bended knee joint positions, while the vibration stimulation was delivered or not. The electromyographic (EMG) signals and the segmental acceleration from the lower extremity were recorded and processed. The amplitude, co-contraction indexes (CCI), and normalized median frequency slope (NMFS) from the EMG signals, and the acceleration transmissibility were calculated. RESULTS The results showed larger rectus femoris (RF) amplitudes under 3 Hz vibration than those in 20 Hz and no vibration conditions; larger tibialis anterior (TA) in 20 Hz than in no vibration; larger gastrocnemius (GAS) in 20 Hz than in 3 Hz and no vibration. These results indicated that different vibration frequencies mainly induced reactive responses in different muscles, by showing higher activation of the knee extensors in 3 Hz and of the lower leg muscles in 20 Hz condition, respectively. Comparing between groups, the PD patients reacted to the WBV stimulation by showing larger muscle activations in hamstring (HAM), TA and GAS, and smaller CCI in thigh than those in the controls. In bended knee, it demonstrated a higher RF amplitude and a steeper NMFS but smaller HAM activations than in straight knee position. The higher acceleration transmissibility was found in the control group, in the straight knee position and in the 3 Hz vibration conditions. CONCLUSION The PD patients demonstrated altered neuromuscular control compared with the controls in responding to the WBV stimulations, with generally higher EMG amplitude of lower extremity muscles. For designing WBV strengthening protocol in the PD population, the 3 Hz with straight or flexed knee protocol was recommended to recruit more thigh muscles; the bended knee position with 20 Hz vibration was for the shank muscles.
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Affiliation(s)
- Chia-Ming Chang
- Department of Physical Therapy, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, Taiwan, 406040, R.O.C
| | - Chon-Haw Tsai
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Kuei Lu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Hsin-Chun Tseng
- Department of Physical Therapy, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, Taiwan, 406040, R.O.C
| | - Grace Lu
- Department of Physical Therapy, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, Taiwan, 406040, R.O.C
| | - Bey-Ling Liu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Hsiu-Chen Lin
- Department of Physical Therapy, China Medical University, No. 100, Sec. 1, Jingmao Rd, Taichung, Taiwan, 406040, R.O.C.
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Wang H, Esi Acquah ME, Zhang X, Xu Q, Chen W, Gu DY. The effect of visual cues on muscular activation in the lower limbs of Parkinson's disease patients with freezing of gait: a preliminary study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6211-6214. [PMID: 34892534 DOI: 10.1109/embc46164.2021.9629712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Freezing of gait (FOG) is a disabling symptom of Parkinson's disease (PD) patients, especially in advanced stages. Visual cues, such as the laser, have been confirmed to improve kinematic performance and alleviate FOG incidences. However, the muscular effect is unknown. In this study, we aim to investigate the effect of visual cues on muscular activity in the lower limbs of PD patients with FOG. Surface EMG signals of the tibialis anterior (TA), lateral gastrocnemius (GL), rectus femoris (RF), and biceps femoris (BF) muscles were collected from eight patients (FOGer) and eight healthy elderly (HC) in both normal walking and walking with laser cues. Results showed that visual cues improved FOGer's muscular activation pattern towards normal. The RMS of TA was significantly increased in the loading response phase (p=0.02) and decreased in the pre-swing phase for FOGer (p=0.005) under visual cue. The RMS of GL in FOGer was considerably reduced in the loading response phase (p<0.001) and increased in the pre-swing phase (p=0.008) of their gait cycle. A significant strong correlation was also observed between the decrement in GL RMS during the loading response phase and the increment in GL RMS during the pre-swing phase (R=-0.952, p<0.001) incurred by visual cue in FOGer. These results indicate that the visual cues can help FOGer to modulate their muscular activation of ankle muscles, especially to normalize GL's activation distribution during stance. For clinical purposes, future rehabilitative strategies aimed at the modulation of ankle muscles are suggested.
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Keloth SM, Arjunan SP, Raghav S, Kumar DK. Muscle activation strategies of people with early-stage Parkinson's during walking. J Neuroeng Rehabil 2021; 18:133. [PMID: 34496882 PMCID: PMC8425033 DOI: 10.1186/s12984-021-00932-1] [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] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Some people with Parkinson’s disease (PD) frequently have an unsteady gait with shuffling, reduced strength, and increased rigidity. This study has investigated the difference in the neuromuscular strategies of people with early-stage PD, healthy older adults (HOA) and healthy young adult (HYA) during short-distance walking. Method Surface electromyogram (sEMG) was recorded from tibialis anterior (TA) and medial gastrocnemius (MG) muscles along with the acceleration data from the lower leg from 72 subjects—24 people with early-stage PD, 24 HOA and 24 HYA during short-distance walking on a level surface using wearable sensors. Results There was a significant increase in the co-activation, a reduction in the TA modulation and an increase in the TA-MG lateral asymmetry among the people with PD during a level, straight-line walking. For people with PD, the gait impairment scale was low with an average postural instability and gait disturbance (PIGD) score = 5.29 out of a maximum score of 20. Investigating the single and double support phases of the gait revealed that while the muscle activity and co-activation index (CI) of controls modulated over the gait cycle, this was highly diminished for people with PD. The biggest difference between CI of controls and people with PD was during the double support phase of gait. Discussion The study has shown that people with early-stage PD have high asymmetry, reduced modulation, and higher co-activation. They have reduced muscle activity, ability to inhibit antagonist, and modulate their muscle activities. This has the potential for diagnosis and regular assessment of people with PD to detect gait impairments using wearable sensors.
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Affiliation(s)
- Sana M Keloth
- Biosignals Lab, School of Engineering, RMIT University, Melbourne, VIC, Australia
| | - Sridhar P Arjunan
- Department of Electronics and Instrumentation, SRM Institute of Science and Technology, Chennai, India
| | | | - Dinesh Kant Kumar
- Biosignals Lab, School of Engineering, RMIT University, Melbourne, VIC, Australia.
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Hinton DC, Conradsson DM, Paquette C. Understanding Human Neural Control of Short-term Gait Adaptation to the Split-belt Treadmill. Neuroscience 2020; 451:36-50. [DOI: 10.1016/j.neuroscience.2020.09.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 09/22/2020] [Accepted: 09/27/2020] [Indexed: 12/31/2022]
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Unilateral step training can drive faster learning of novel gait patterns. Sci Rep 2020; 10:18628. [PMID: 33122783 PMCID: PMC7596053 DOI: 10.1038/s41598-020-75839-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/19/2020] [Indexed: 11/09/2022] Open
Abstract
Humans are capable of learning many new walking patterns. People have learned to snowshoe up mountains, racewalk marathons, and march in precise synchrony. But what is required to learn a new walking pattern? Here, we demonstrate that people can learn new walking patterns without actually walking. Through a series of experiments, we observe that stepping with only one leg can facilitate learning of an entirely new walking pattern (i.e., split-belt treadmill walking). We find that the nervous system learns from the relative speed difference between the legs-whether or not both legs are moving-and can transfer this learning to novel gaits. We also show that locomotor learning requires active movement: observing another person adapt their gait did not result in significantly faster learning. These findings reveal that people can learn new walking patterns without bilateral gait training, as stepping with one leg can facilitate adaptive learning that transfers to novel gait patterns.
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Keloth SM, Radcliffe PJ, Raghav S, Arjunan SP, Kumar D. Differentiating between Parkinson's disease patients and controls using variability in muscle activation during walking. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3158-3161. [PMID: 33018675 DOI: 10.1109/embc44109.2020.9176490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Surface electromyography (sEMG) of the lower limb muscles has been proposed to evaluate motor dysfunctions in Parkinson's disease (PD) patients. Variability in the sEMG could be used as an indicator of poor muscle coordination, but previous studies have reported conflicting results. This study has examined the variability of muscle using the coefficients of variance of Tibialis anterior (TA) and Medial gastrocnemius (MG) lower limb muscles for 24 PD, 24 age matched controls (CO), and 24 young controls (YC), during different phases of the gait cycle. The gait intervals were measured using the inertial measurement unit (IMU). We observed a statistically significant difference between PD and control for the variability of lower limb muscle when comparing the sub-phases of the gait. It was also found that the difference was more pronounced for the TA muscle.
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15
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A Statistical Approach for the Assessment of Muscle Activation Patterns during Gait in Parkinson’s Disease. ELECTRONICS 2020. [DOI: 10.3390/electronics9101641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recently, the statistical analysis of muscle activation patterns highlighted that not only one, but several activation patterns can be identified in the gait of healthy adults, with different occurrence. Although its potential, the application of this approach in pathological populations is still limited and specific implementation issues need to be addressed. This study aims at applying a statistical approach to analyze muscle activation patterns of gait in Parkinson’s Disease, integrating gait symmetry and co-activation. Surface electromyographic signal of tibialis anterior and gastrocnemius medialis were recorded during a 6-min walking test in 20 patients. Symmetry between right and left stride time series was verified, different activation patterns identified, and their occurrence (number and timing) quantified, as well as the co-activation of antagonist muscles. Gastrocnemius medialis presented five activation patterns (mean occurrence ranging from 2% to 43%) showing, with respect to healthy adults, the presence of a first shorted and delayed activation (between flat foot contact and push off, and in the final swing) and highlighting a new second region of anticipated activation (during early/mid swing). Tibialis anterior presented five activation patterns (mean occurrence ranging from 3% to 40%) highlighting absent or delayed activity at the beginning of the gait cycle, and generally shorter and anticipated activations during the swing phase with respect to healthy adults. Three regions of co-contraction were identified: from heel strike to mid-stance, from the pre- to initial swing, and during late swing. This study provided a novel insight in the analysis of muscle activation patterns in Parkinson’s Disease patients with respect to the literature, where unique, at times conflicting, average patterns were reported. The proposed integrated methodology is meant to be generalized for the analysis of muscle activation patterns in pathologic subjects.
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16
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Ben-Gal O, Benady A, Zadik S, Doniger GM, Schnaider Beeri M, Plotnik M. Using the loading response peak for defining gait cycle timing: A novel solution for the double-belt problem. J Biomech 2020; 110:109963. [PMID: 32889150 DOI: 10.1016/j.jbiomech.2020.109963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
Split-belt treadmills (SBTM) contain force plates under each belt that measure ground reaction force (GRF). Initial contact (IC) detection for each gait cycle obtained from the GRF is used for calculating temporal gait parameters (e.g., gait variability, step time, stride time). Occasionally, the participant steps with one leg on the contralateral belt (i.e., crossing) making the IC undetectable and the calculation of temporal gait parameters are compromised. We term this the double-belt problem (DBP). OBJECTIVE here we developed a complementary detection method using the loading response peak (LRP), anchor point for calculating gait parameters. METHODS we used GRF gait data from twenty adults (age 56.45 ± 4.81 y; 6 males) who walked on an SBTM. First, we used no-crossing gait periods free of the DBP to calculate stride time, step time, and stride time to stride time coefficient of variation and evaluated the true error and the normalized true error of the LRP detection method. Then, we used multiple comparisons between no-crossing data and crossing data. RESULTS we found that normalized errors (in comparison to the IC method) are ≤5.1%. Strong correlations were found between gait parameters computed based on the two detection methods (Intraclass correlation coefficient ≥0.97; p ≤ 0.001). CONCLUSION detecting gait cycle timing based on the LRP detection method is reliable for estimating temporal gait parameters, demonstrating high correspondence with the gold standard IC detection method.
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Affiliation(s)
- Oran Ben-Gal
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Amit Benady
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel; St George's University of London Medical School, Sheba Medical Center, Ramat Gan, Israel
| | - Sean Zadik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel; St George's University of London Medical School, Sheba Medical Center, Ramat Gan, Israel
| | - Glen M Doniger
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Michal Schnaider Beeri
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel; Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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17
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Yokoyama H, Yoshida T, Zabjek K, Chen R, Masani K. Defective corticomuscular connectivity during walking in patients with Parkinson's disease. J Neurophysiol 2020; 124:1399-1414. [PMID: 32938303 DOI: 10.1152/jn.00109.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Gait disturbances are common in individuals with Parkinson's disease (PD). Although the basic patterns of walking are thought to be controlled by the brainstem and spinal networks, recent studies have found significant corticomuscular coherence in healthy individuals during walking. However, it still remains unknown how PD affects the cortical control of muscles during walking. As PD typically develops in older adults, it is important to investigate the effects of both aging and PD when examining disorders in patients with PD. Here, we assessed the effects of PD and aging on corticomuscular communication during walking by investigating corticomuscular coherence. We recorded electroencephalographic and electromyographic signals in 10 individuals with PD, 9 healthy older individuals, and 15 healthy young individuals. We assessed the corticomuscular coherence between the motor cortex and two lower leg muscles, tibialis anterior (TA) and medial gastrocnemius, during walking. Older and young groups showed sharp peaks in muscle activation patterns at specific gait phases, whereas the PD group showed prolonged patterns. Smaller corticomuscular coherence was found in the PD group compared with the healthy older group in the α band (8-12 Hz) for both muscles, and in the β band (16-32 Hz) for TA. Older and young groups did not differ in the magnitude of corticomuscular coherence. Our results indicated that PD decreased the corticomuscular coherence during walking, whereas it was not affected by aging. This lower corticomuscular coherence in PD may indicate lower-than-normal corticomuscular communication, although direct or indirect communication is unknown, and may cause impaired muscle control during walking.NEW & NOTEWORTHY Mechanisms behind how Parkinson's disease (PD) affects cortical control of muscles during walking remain unclear. As PD typically develops in the elderly, investigation of aging effects is important to examine deficits regarding PD. Here, we demonstrated that PD causes weak corticomuscular synchronization during walking, but aging does not. This lower-than-normal corticomuscular communication may cause impaired muscle control during walking.
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Affiliation(s)
- Hikaru Yokoyama
- Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Department of Electrical and Electronic Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Takashi Yoshida
- Applied Rehabilitation Technology Lab (ART-Lab), University Medical Center Göttingen, Göttingen, Germany
| | - Karl Zabjek
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Ontario, Canada
| | - Kei Masani
- Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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18
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Effect of Parkinson's disease and two therapeutic interventions on muscle activity during walking: a systematic review. NPJ PARKINSONS DISEASE 2020; 6:22. [PMID: 32964107 PMCID: PMC7481232 DOI: 10.1038/s41531-020-00119-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Abstract
Gait deficits are a common feature of Parkinson’s disease (PD) and predictors of future motor and cognitive impairment. Understanding how muscle activity contributes to gait impairment and effects of therapeutic interventions on motor behaviour is crucial for identifying potential biomarkers and developing rehabilitation strategies. This article reviews sixteen studies that investigate the electromyographic (EMG) activity of lower limb muscles in people with PD during walking and reports on their quality. The weight of evidence establishing differences in motor activity between people with PD and healthy older adults (HOAs) is considered. Additionally, the effect of dopaminergic medication and deep brain stimulation (DBS) on modifying motor activity is assessed. Results indicated greater proximal and decreased distal activity of lower limb muscles during walking in individuals with PD compared to HOA. Dopaminergic medication was associated with increased distal lower limb muscle activity whereas subthalamic nucleus DBS increased activity of both proximal and distal lower limb muscles. Tibialis anterior was impacted most by the interventions. Quality of the studies was not strong, with a median score of 61%. Most studies investigated only distal muscles, involved small sample sizes, extracted limited EMG features and lacked rigorous signal processing. Few studies related changes in motor activity with functional gait measures. Understanding mechanisms underpinning gait impairment in PD is essential for development of personalised rehabilitative interventions. Recommendations for future studies include greater participant numbers, recording more functionally diverse muscles, applying multi-muscle analyses, and relating EMG to functional gait measures.
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19
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Lallemant-Dudek P, Durr A. Clinical and genetic update of hereditary spastic paraparesis. Rev Neurol (Paris) 2020; 177:550-556. [PMID: 32807405 DOI: 10.1016/j.neurol.2020.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023]
Abstract
Hereditary spastic paraparesis is a group of inherited neurological diseases characterized by underlying wide genetic heterogeneity. It should be suspected if there is a positive familial history, a common genetic alteration (i.e. SPG4, the most overall frequent form), or association with other signs, such as cerebellar ataxia (i.e. SPG7), early cognitive impairment or even cognitive deficit (i.e. SPG11), or peripheral neuropathy (i.e. SACS). The natural history is known for certain genetic subgroups, with genotype-phenotype correlations partially explaining childhood or late onset. However, the search for genetic modifying factors, in addition to the causal pathogenic variant or environmental influencers, is still needed. Novel approaches to provide etiological treatment are in the pipeline for SPG11. Symptomatic treatments are available but would benefit from randomized controlled trials.
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Affiliation(s)
- P Lallemant-Dudek
- Paris Brain Institute (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France.
| | - A Durr
- Paris Brain Institute (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Genetics Department, Pitié-Salpêtrière University Hospital, Paris, France
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20
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Wilson JM, Thompson CK, McPherson LM, Zadikoff C, Heckman C, MacKinnon CD. Motor Unit Discharge Variability Is Increased in Mild-To-Moderate Parkinson's Disease. Front Neurol 2020; 11:477. [PMID: 32547482 PMCID: PMC7272659 DOI: 10.3389/fneur.2020.00477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/01/2020] [Indexed: 11/13/2022] Open
Abstract
Individuals with Parkinson's disease (PD) demonstrate deficits in muscle activation such as decreased amplitude and inappropriate bursting. There is evidence that some of these disturbances are more pronounced in extensor vs. flexor muscles. Surface EMG has been used widely to quantify muscle activation deficits in PD, but analysis of discharge of the underlying motor units may provide greater insight and be more sensitive to changes early in the disease. Of the few studies that have examined motor unit discharge in PD, the majority were conducted in the first dorsal interosseous, and no studies have measured motor units from extensor and flexor muscles within the same cohort. The objective of this study was to characterize the firing behavior of single motor units in the elbow flexor and extensor muscles during isometric contractions in people with mild-to-moderate PD. Ten individuals with PD (off-medication) and nine healthy controls were tested. Motor unit spike times were recorded via intramuscular EMG from the biceps and triceps brachii muscles during 30-s isometric contractions at 10% maximum voluntary elbow flexion and elbow extension torque, respectively. We selected variables of mean motor unit discharge rate, discharge variability, and torque variability to evaluate motor abnormalities in the PD group. The effects of group, muscle, and group-by-muscle on each variable were determined using separate linear mixed models. Discharge rate and torque variability were not different between groups, but discharge variability was significantly higher in the PD group for both muscles combined (p < 0.0001). We also evaluated the asymmetry in these motor variables between the triceps and biceps for each individual participant with PD to evaluate whether there was an association with disease severity. The difference in torque variability between elbow flexion and extension was significantly correlated with both the Hoehn and Yahr scale (rho = 0.71) and UPDRS (rho = 0.62). Our findings demonstrate that variability in motor output, rather than decreased discharge rates, may contribute to motor dysfunction in people with mild-to-moderate PD. Our findings provide insight into altered neural control of movement in PD and demonstrate the importance of measuring from multiple muscles within the same cohort.
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Affiliation(s)
- Jessica M. Wilson
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - Christopher K. Thompson
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States
| | - Laura Miller McPherson
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Cindy Zadikoff
- Department of Neurology, Northwestern University, Chicago, IL, United States
| | - C.J. Heckman
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
- Department of Physiology, Northwestern University, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Colum D. MacKinnon
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
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21
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Filippin NT, Martins KC, Narimoto LR, Da Costa PHL, Mattioli R. Lower limb coordination during gait in people with moderate Parkinson's disease. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2017.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Parkinson's disease interferes with the control of movement, which can cause changes in coordination. The aim of this study was to compare intralimb and interlimb coordination during gait in people with Parkinson's disease and in typically healthy people. Methods Participants were split into two groups. A total of 10 participants with Parkinson's disease were in the study group and 10 typically healthy participants were in the control group. All participants underwent a clinical evaluation, a gait kinematic evaluation for spatiotemporal variables and joint angle range of motion and an intralimb and interlimb coordination analysis. Results The duration of the stride, stance and swing phases of the gait cycle were longer in individuals with Parkinson's disease, who also displayed shorter stride length, slower speed and reduced cadence and joint range of motion than participants in the control group. Intralimb and interlimb coordination did not differ significantly between the groups. Conclusions Participants with Parkinson's disease presented with alterations in spatiotemporal variables and joint range of motion but were able to adapt to the limitations imposed by the disease and accomplish a functional gait without undermining their intralimb and interlimb coordination pattern.
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Affiliation(s)
| | - Karina C Martins
- Federal University of Sao Carlos Centre for Biological and Health Sciences, São Paulo, Brazil
| | - Lidiane R Narimoto
- Federal University of Sao Carlos Centre for Biological and Health Sciences, São Paulo, Brazil
| | - Paula HL Da Costa
- Movement Analysis Laboratory, Department of Physical Education, Federal University of São Carlos, São Paulo, Brazil
| | - Rosana Mattioli
- Laboratory of Neuroscience, Department of Physical Therapy, Federal University of São Carlos, São Paulo, Brazil
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22
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Cofré Lizama LE, Bastani A, van der Walt A, Kilpatrick T, Khan F, Galea MP. Increased ankle muscle coactivation in the early stages of multiple sclerosis. Mult Scler J Exp Transl Clin 2020; 6:2055217320905870. [PMID: 32110431 PMCID: PMC7016311 DOI: 10.1177/2055217320905870] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/30/2019] [Accepted: 01/21/2020] [Indexed: 01/20/2023] Open
Abstract
Background Neural damage at early stages of multiple sclerosis (MS) can subtly affect gait muscle activation patterns. Detecting these changes using current clinical tools, however, is not possible. We propose using muscle coactivation measures to detect these subtle gait changes. This may also help in identifying people with MS (PwMS) that may benefit from strategies aimed at preventing further mobility impairments. Objective We aimed to determine if coactivation of ankle muscles during gait is greater in PwMS with Expanded Disability Status Scale (EDSS) score <3.5. A secondary aim is to determine whether coactivation increases are speed dependent. Methods For this study 30 PwMS and 15 healthy controls (HC) walked on a treadmill at 1.0 m/s, 1.2 m/s and 1.4 m/s. Electromyography was recorded from the tibialis anterior (TA), soleus (SO) and lateral gastrocnemius (LG). The coactivation index was calculated between SO/TA and LG/TA. Ankle kinematics data were also collected. Results Compared with HC, PwMS exhibited significantly greater SO/TA and LG/TA coactivation, which was greater during early stance and swing phases (p < .01). Speed did not affect coactivation except during early stance. Ankle kinematic changes were also observed. Conclusion PwMS exhibited greater ankle muscles coactivation than controls regardless of the speed of walking. These changes in muscle activation may serve as a biomarker of neurodegeneration occurring at early stages of the disease.
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Affiliation(s)
- L Eduardo Cofré Lizama
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Andisheh Bastani
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Anneke van der Walt
- Department of Neurosciences, Alfred Health, Central Clinical School, Monash University, Melbourne, Australia
| | - Trevor Kilpatrick
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Fary Khan
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia.,Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Melbourne, Australia.,Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Mary P Galea
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia.,Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Melbourne, Australia.,Department of Rehabilitation Medicine, Royal Melbourne Hospital, Melbourne, Australia
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23
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Corticomuscular control of walking in older people and people with Parkinson's disease. Sci Rep 2020; 10:2980. [PMID: 32076045 PMCID: PMC7031238 DOI: 10.1038/s41598-020-59810-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/30/2020] [Indexed: 12/29/2022] Open
Abstract
Changes in human gait resulting from ageing or neurodegenerative diseases are multifactorial. Here we assess the effects of age and Parkinson’s disease (PD) on corticospinal activity recorded during treadmill and overground walking. Electroencephalography (EEG) from 10 electrodes and electromyography (EMG) from bilateral tibialis anterior muscles were acquired from 22 healthy young, 24 healthy older and 20 adults with PD. Event-related power, corticomuscular coherence (CMC) and inter-trial coherence were assessed for EEG from bilateral sensorimotor cortices and EMG during the double-support phase of the gait cycle. CMC and EMG power at low beta frequencies (13–21 Hz) was significantly decreased in older and PD participants compared to young people, but there was no difference between older and PD groups. Older and PD participants spent shorter time in the swing phase than young individuals. These findings indicate age-related changes in the temporal coordination of gait. The decrease in low-beta CMC suggests reduced cortical input to spinal motor neurons in older people during the double-support phase. We also observed multiple changes in electrophysiological measures at low-gamma frequencies during treadmill compared to overground walking, indicating task-dependent differences in corticospinal locomotor control. These findings may be affected by artefacts and should be interpreted with caution.
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24
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Hinton DC, Thiel A, Soucy JP, Bouyer L, Paquette C. Adjusting gait step-by-step: Brain activation during split-belt treadmill walking. Neuroimage 2019; 202:116095. [PMID: 31430533 DOI: 10.1016/j.neuroimage.2019.116095] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/09/2019] [Accepted: 08/11/2019] [Indexed: 12/29/2022] Open
Abstract
When walking on a split-belt treadmill, where each leg is driven at a different speed, a temporary change is made to the typical steady-state walking pattern. The exact ways in which the brain controls these temporary changes to walking are still unknown. Ten young adults (23±3y) walked on a split-belt treadmill for 30 min on 2 separate occasions: tied-belt control with both belts at comfortable walking speed, and continuous adjustment where speed ratio between belts changed every 15 seconds. 18F-fluorodeoxyglucose (18FDG) positron emission tomography (PET) imaging measured whole brain glucose metabolism distribution, or activation, during each treadmill walking condition. The continuous adjustment condition, compared to the tied-belt control, was associated with increased activity of supplementary motor areas (SMA), posterior parietal cortex (PPC), anterior cingulate cortex and anterior lateral cerebellum, and decreased activity of posterior cingulate and medial prefrontal cortex. In addition, peak activation of the PPC, SMA and PFC were correlated with cadence and temporal gait variability. We propose that a "fine-tuning" network for human locomotion exists which includes brain areas for sensorimotor integration, motor planning and goal directed attention. These findings suggest that distinct regions govern the inherent flexibility of the human locomotor plan to maintain a successful and adjustable walking pattern.
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Affiliation(s)
- Dorelle C Hinton
- Department of Kinesiology and Physical Education, McGill University, Montreal, H2W 1S4, Canada; Centre for Interdisciplinary Research in Rehabilitation of Montreal (CRIR), Montreal, H3S 1M9, Canada
| | - Alexander Thiel
- Department of Neurology and Neurosurgery, McGill University, Montreal, H3A 2B4, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, H3T 1E2, Canada
| | - Jean-Paul Soucy
- Department of Neurology and Neurosurgery, McGill University, Montreal, H3A 2B4, Canada
| | - Laurent Bouyer
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec, G1M 2S8, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, G1V 0A6, Canada
| | - Caroline Paquette
- Department of Kinesiology and Physical Education, McGill University, Montreal, H2W 1S4, Canada; Centre for Interdisciplinary Research in Rehabilitation of Montreal (CRIR), Montreal, H3S 1M9, Canada.
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25
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Porta M, Pilloni G, Arippa F, Casula C, Cossu G, Pau M. Similarities and Differences of Gait Patterns in Women and Men With Parkinson Disease With Mild Disability. Arch Phys Med Rehabil 2019; 100:2039-2045. [PMID: 31103431 DOI: 10.1016/j.apmr.2019.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to quantitatively investigate the existence of differences in spatiotemporal and kinematic parameters of gait in men and women with Parkinson disease (PD) using computerized 3-dimensional gait analysis. DESIGN Retrospective cohort study. SETTING Laboratory of Biomechanics. PARTICIPANTS Individuals with PD (N=35; 17 female, 18 male) of mean age 70.7 years characterized by mild disability (Hoehn and Yahr ≤2.5) who were tested in On medication state approximately 60 to 90 minutes after intake of the usual morning Levodopa dose. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Spatiotemporal parameters of gait (speed, stride length, cadence, step width, duration of stance, swing, double support phases) and kinematics of hip, knee, and ankle joints in the sagittal plane. RESULTS Men and women exhibit similar spatiotemporal parameters, except for step width (wider in men). In contrast, relevant differences were found in terms of ankle kinematics. In particular, women presented increased ankle dorsiflexion through all the stance phase and mid to late swing phase, and reduced plantarflexion at the stance-swing phase transition. CONCLUSIONS Gait patterns of men and women with PD with mild disability are similar in terms of spatiotemporal parameters but characterized by marked differences regarding the ankle kinematics on the sagittal plane. The findings of the present study support the concept that investigations seeking to clarify the complex pathophysiology of PD-related gait disturbances should consider the role played by an individual's sex, thereby achieving more effective designing of physical and rehabilitative treatments.
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Affiliation(s)
- Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Giuseppina Pilloni
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Federico Arippa
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Carlo Casula
- A.O. G. Brotzu General Hospital, Cagliari, Italy
| | | | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy.
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26
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Split-belt treadmill walking in patients with Parkinson's disease: A systematic review. Gait Posture 2019; 69:187-194. [PMID: 30771729 DOI: 10.1016/j.gaitpost.2019.01.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/17/2019] [Accepted: 01/20/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Walking on a split-belt treadmill (SBT) can help to modulate an asymmetric gait, particularly for people with neurological conditions, such as Parkinson's disease (PD), where asymmetry plays a role due to the laterality of the disease. RESEARCH QUESTION This systematic review critically evaluates the literature on SBT in PD. First, different SBT paradigms and methodological approaches were evaluated. Second, the review explored how people with PD adapt their gait to different SBT conditions compared to healthy controls (HC). METHODS We conducted a systematic search of the PubMED, PsychINFO, and Web of Knowledge databases. Original research articles, published in English and investigating SBT walking in people with PD, were included. RESULTS From the 925 studies originally identified, seven met the inclusion criteria and were selected for evaluation (n = 118 individuals with PD of whom 44 had freezing of gait (FOG)). The SBT paradigms varied across studies regarding the SBT settings, definitions of gait variables, and criteria for determining dominance of body side. Gait variability and bilateral coordination were found to adapt to the SBT condition similarly in people with PD and healthy controls (HC). Inconsistent results were found with respect to the adaptation of gait asymmetry, for the differences between PD and HC participants. The subgroup of people with PD and FOG showed reduced accuracy in detecting belt speed differences and slower adaptation to SBT conditions. CONCLUSION Individuals with mild to moderately severe PD adapted similarly to HCs to SBT walking for gait variability and bilateral gait coordination. However, those with FOG had impaired perception of belt speed differences and did not adapt their gait so readily. Although SBT can be useful for modulating gait asymmetry in some people with PD, it was not beneficial for all. We recommend standardization of SBT protocols for clinical practice in future studies.
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Bae CH, Jeong HW, Yun JY, Lee JE, Han SJ. Spatiotemporal Gait Parameter Comparison for Parkinson's Disease, Multiple System Atrophy, and Other Parkinsonism Diseases. BRAIN & NEUROREHABILITATION 2019. [DOI: 10.12786/bn.2019.12.e20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Chang Hoon Bae
- Department of Rehabilitation Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hye Won Jeong
- Department of Rehabilitation Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ji Young Yun
- Department of Neurology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jeong Eun Lee
- Department of Rehabilitation Medicine, Seoul Metropolitan Seonam Hospital, Seoul, Korea
| | - Soo Jeong Han
- Department of Rehabilitation Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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Kinematic and Kinetic Patterns Related to Free-Walking in Parkinson's Disease. SENSORS 2018; 18:s18124224. [PMID: 30513798 PMCID: PMC6308417 DOI: 10.3390/s18124224] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/23/2018] [Accepted: 11/29/2018] [Indexed: 11/16/2022]
Abstract
The aim of this study is to compare the properties of free-walking at a natural pace between mild Parkinson’s disease (PD) patients during the ON-clinical status and two control groups. In-shoe pressure-sensitive insoles were used to quantify the temporal and force characteristics of a 5-min free-walking in 11 PD patients, in 16 young healthy controls, and in 12 age-matched healthy controls. Inferential statistics analyses were performed on the kinematic and kinetic parameters to compare groups’ performances, whereas feature selection analyses and automatic classification were used to identify the signature of parkinsonian gait and to assess the performance of group classification, respectively. Compared to healthy subjects, the PD patients’ gait pattern presented significant differences in kinematic parameters associated with bilateral coordination but not in kinetics. Specifically, patients showed an increased variability in double support time, greater gait asymmetry and phase deviation, and also poorer phase coordination. Feature selection analyses based on the ReliefF algorithm on the differential parameters in PD patients revealed an effect of the clinical status, especially true in double support time variability and gait asymmetry. Automatic classification of PD patients, young and senior subjects confirmed that kinematic predictors produced a slightly better classification performance than kinetic predictors. Overall, classification accuracy of groups with a linear discriminant model which included the whole set of features (i.e., demographics and parameters extracted from the sensors) was 64.1%.
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Malling ASB, Morberg BM, Wermuth L, Gredal O, Bech P, Jensen BR. Effect of transcranial pulsed electromagnetic fields (T-PEMF) on functional rate of force development and movement speed in persons with Parkinson's disease: A randomized clinical trial. PLoS One 2018; 13:e0204478. [PMID: 30252895 PMCID: PMC6155540 DOI: 10.1371/journal.pone.0204478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/06/2018] [Indexed: 11/18/2022] Open
Abstract
Background Parkinson’s disease is caused by dopaminergic neurodegeneration resulting in motor impairments as slow movement speed and impaired balance and coordination. Pulsed electromagnetic fields are suggested to have neuroprotective effects, and could alleviate symptoms. Objective To study 1) effects of 8-week daily transcranial pulsed electromagnetic field treatment on functional rate of force development and movement speed during two motor tasks with different levels of complexity, 2) if treatment effects depend on motor performance at baseline. Methods Ninety-seven persons with Parkinson’s disease were randomized to active transcranial pulsed electromagnetic field (squared bipolar 3 ms pulses, 50 Hz) or placebo treatment with homebased treatment 30 min/day for 8 weeks. Functional rate of force development and completion time of a sit-to-stand and a dynamic postural balance task were assessed pre and post intervention. Participants were sub-grouped in high- and low-performers according to their baseline motor performance level. Repeated measure ANOVAs were used. Results Active treatment tended to improve rate of force development during chair rise more than placebo (P = 0.064). High-performers receiving active treatment improved rate of force development during chair rise more than high-performers receiving placebo treatment (P = 0.049, active/placebo: 11.9±1.1 to 12.5±1.9 BW/s ≈ 5% / 12.4±1.3 to 12.2±1.3 BW/s, no change). No other between-treatment-group or between-treatment-subgroup differences were found. Data on rate of force development of the dynamic balance task and completion times of both motor tasks improved but did not allow for between-treatment differentiation. Conclusion Treatment with transcranial pulsed electromagnetic fields was superior to placebo regarding functional rate of force development during chair rise among high-performers. Active treatment tended to increase functional rate of force development while placebo did not. Our results suggest that mildly affected persons with Parkinson’s disease have a larger potential for neural rehabilitation than more severely affected persons and indicate that early treatment initiation may be beneficial.
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Affiliation(s)
- Anne Sofie Bøgh Malling
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- * E-mail: (ASBM); (BRJ)
| | - Bo Mohr Morberg
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lene Wermuth
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Gredal
- The Danish Rehabilitation Centre for Neuromuscular Diseases, Taastrup, Denmark
| | - Per Bech
- Psychiatric Research Unit, Psychiatric Centre North Zealand, University of Copenhagen, Hillerød, Denmark
| | - Bente Rona Jensen
- Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- * E-mail: (ASBM); (BRJ)
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Bello O, Marquez G, Fernandez-Del-Olmo M. Effect of Treadmill Walking on Leg Muscle Activation in Parkinson's Disease. Rejuvenation Res 2018; 22:71-78. [PMID: 29962320 DOI: 10.1089/rej.2018.2084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Treadmills are often used as rehabilitation devices to improve gait in Parkinson's disease (PD). Kinematic differences between treadmill and overground gait have been reported. However, electromyographic (EMG) patterns during treadmill and overground walking have not been systematically compared. The aim of this study was to assess the effects of treadmill gait on the magnitude of the EMG activity of the lower limb muscles in PD. We measured EMG activity of the tibialis anterior, gastrocnemius medialis, vastus lateralis, and biceps femoris of nine individuals with PD and nine healthy matched controls. Comparisons between walking overground with walking on a treadmill and with walking with a treadmill simulator were carried out. The treadmill simulator is a device that simulates treadmill conditions with the exception of the belt. Our results have shown that treadmill walking is associated with several EMG differences compared with overground walking. The key finding of the study is that coactivation of the thigh muscles was significantly decreased (37%; p = 0.008) in PD subjects when walking on the treadmill in comparison with overground walking. The changes observed in the coactivation level may be related to the belt movement, since no changes were reported during walking with the treadmill simulator. Understanding the differences between treadmill and overground gait as well as the mechanisms that result in improvement of gait disturbances may optimize rehabilitative protocols for patients with PD.
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Affiliation(s)
- Olalla Bello
- 1 Learning and Human Movement Control Group, INEF Galicia, University of A Coruña, A Coruña, Spain.,2 Department of Physical Therapy, Faculty of Physical Therapy, University of A Coruña, A Coruña, Spain
| | - Gonzalo Marquez
- 3 Neuroscience of Human Movement, Faculty of Sport, Catholic University of Murcia (UCAM), Murcia, Spain
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Taniguchi S, Peper F, Shimokawa T. Assessment of leg muscle activity using toe tapping in patients with Parkinson's disease: comparison of two types of toe tapping. J Phys Ther Sci 2018; 30:689-693. [PMID: 29765181 PMCID: PMC5940473 DOI: 10.1589/jpts.30.689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/19/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigates two types of toe tapping, i.e., “closed,” with both
feet on the floor, and “open,” in which the foot does not touch the ground, and evaluates
their usefulness in combination with monitoring of muscle activity during toe tapping.
[Subjects and Methods] The study enrolled 11 patients with Parkinson’s disease (PD) and 9
controls (Controls). The tibialis anterior (TA) and gastrocnemius (GS) muscle activity
during toe tapping was measured using surface electromyography. [Results] In closed
tapping, the minima in GS activation with the first tap was significantly higher in
patients with PD than in Controls. In open tapping, the coefficient of variation (CV) of
local maxima in TA activation was significantly higher in patients with PD than in
Controls. In both types of tapping, the CV of extrema in GS activities increased with
disease duration, but this may be due to the long-term administration of Levodopa, which
itself tends to cause excessive GS activities. [Conclusion] Closed tapping is suitable for
the assessment of GS activity and can detect excessive activities, which is observed as
visible movement. Open tapping, on the other hand, is suitable for assessment of TA
activity.
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Affiliation(s)
- Seira Taniguchi
- Kobe University Graduate School of Health Sciences: 7-10-2 Tomogaoka, Suma-ku, Kobe, Hyogo 654-0142, Japan
| | - Ferdinand Peper
- Kobe University Graduate School of Health Sciences: 7-10-2 Tomogaoka, Suma-ku, Kobe, Hyogo 654-0142, Japan
| | - Tetsuya Shimokawa
- Kobe University Graduate School of Health Sciences: 7-10-2 Tomogaoka, Suma-ku, Kobe, Hyogo 654-0142, Japan
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Bailey CA, Corona F, Murgia M, Pili R, Pau M, Côté JN. Electromyographical Gait Characteristics in Parkinson's Disease: Effects of Combined Physical Therapy and Rhythmic Auditory Stimulation. Front Neurol 2018; 9:211. [PMID: 29670571 PMCID: PMC5893942 DOI: 10.3389/fneur.2018.00211] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/16/2018] [Indexed: 11/16/2022] Open
Abstract
Background In persons with Parkinson’s disease (PD), gait dysfunctions are often associated with abnormal neuromuscular function. Physical therapy combined with auditory stimulation has been recently shown to improve motor function and gait kinematic patterns; however, the underlying neuromuscular control patterns leading to this improvement have never been identified. Objectives (1) Assess the relationships between motor dysfunction and lower limb muscle activity during gait in persons with PD; (2) Quantify the effects of physical therapy with rhythmic auditory stimulation (PT-RAS) on lower limb muscle activity during gait in persons with PD. Methods Participants (15 with PD) completed a 17-week intervention of PT-RAS. Gait was analyzed at baseline, after 5 weeks of supervised treatment (T5), and at a 12-week follow-up (T17). For each session, motor dysfunction was scored using the United Parkinson Disease Rating Scale, and muscle activation amplitude, modulation, variability, and asymmetry were measured for the rectus femoris, tibialis anterior, and gastrocnemius lateralis (GL). Spearman correlation analyses assessed the relationships between dysfunction and muscle activity, and mixed effect models (session × muscle) tested for intervention effects. Results PT-RAS was effective in decreasing motor dysfunction by an average of 23 (T5) to 36% (T17). Higher GL activity variability and bilateral asymmetry were correlated to higher dysfunction (ρ = 0.301 −0.610, p’s < 0.05) and asymmetry significantly decreased during the intervention (p < 0.05). Conclusion Results suggest that gait motor dysfunction in PD may be explained by neuromuscular control impairments of GL that go beyond simple muscle amplitude change. Physical therapy with RAS improves bilateral symmetry, but its effect on muscle variability requires future investigation.
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Affiliation(s)
- Christopher A Bailey
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Federica Corona
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Mauro Murgia
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Roberta Pili
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Julie N Côté
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
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Rinaldi M, Ranavolo A, Conforto S, Martino G, Draicchio F, Conte C, Varrecchia T, Bini F, Casali C, Pierelli F, Serrao M. Increased lower limb muscle coactivation reduces gait performance and increases metabolic cost in patients with hereditary spastic paraparesis. Clin Biomech (Bristol, Avon) 2017; 48:63-72. [PMID: 28779695 DOI: 10.1016/j.clinbiomech.2017.07.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/22/2017] [Accepted: 07/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to investigate the lower limb muscle coactivation and its relationship with muscles spasticity, gait performance, and metabolic cost in patients with hereditary spastic paraparesis. METHODS Kinematic, kinetic, electromyographic and energetic parameters of 23 patients and 23 controls were evaluated by computerized gait analysis system. We computed ankle and knee antagonist muscle coactivation indexes throughout the gait cycle and during the subphases of gait. Energy consumption and energy recovery were measured as well. In addition to the correlation analysis between coactivation indexes and clinical variables, correlations between coactivation indexes and time-distance, kinematic, kinetic, and energetic parameters were estimated. FINDINGS Increased coactivity indexes of both knee and ankle muscles throughout the gait cycle and during the subphases of gait were observed in patients compared with controls. Energetic parameters were significantly higher in patients than in controls. Both knee and ankle muscle coactivation indexes were positively correlated with knee and ankle spasticity (Ashworth score), respectively. Knee and ankle muscle coactivation indexes were both positively correlated with energy consumption and both negatively correlated with energy recovery. INTERPRETATION Positive correlations between the Ashworth score and lower limb muscle coactivation suggest that abnormal lower limb muscle coactivation in patients with hereditary spastic paraparesis reflects a primary deficit linked to lower limb spasticity. Furthermore, these abnormalities influence the energetic mechanisms during walking. Identifying excessive muscle coactivation may be helpful in individuating the rehabilitative treatments and designing specific orthosis to restrain spasticity.
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Affiliation(s)
- Martina Rinaldi
- Department of Engineering, Roma TRE University, Via Ostiense 159, 00154 Rome, Italy; Rehabilitation Centre, Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy.
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Silvia Conforto
- Department of Engineering, Roma TRE University, Via Ostiense 159, 00154 Rome, Italy.
| | - Giovanni Martino
- Centre of Space Bio-Medicine, University of Rome Tor Vergata, Via Orazio Raimondo 18, 00173 Rome, Italy; Laboratory of Neuromotor Physiology, Istituto Di Ricovero e Cura a Carattere Scientifico Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy.
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Carmela Conte
- Fondazione Don Gnocchi, Piazzale Morandi 6, 20121 Milan, Italy
| | - Tiwana Varrecchia
- Department of Engineering, Roma TRE University, Via Ostiense 159, 00154 Rome, Italy; Rehabilitation Centre, Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy
| | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, Mechanical & Thermal Measurement Lab, University of Rome Sapienza, Via Eudossiana 18, 00184 Rome, Italy.
| | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Via Faggiana 34, 04100 Latina, Italy.
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Via Faggiana 34, 04100 Latina, Italy.
| | - Mariano Serrao
- Rehabilitation Centre, Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy; Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Via Faggiana 34, 04100 Latina, Italy.
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Aspectos biomecânicos da locomoção de pessoas com doença de Parkinson: revisão narrativa. REVISTA BRASILEIRA DE CIÊNCIAS DO ESPORTE 2017. [DOI: 10.1016/j.rbce.2016.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Tramonti C, Di Martino S, Unti E, Frosini D, Bonuccelli U, Rossi B, Ceravolo R, Chisari C. Gait dynamics in Pisa syndrome and Camptocormia: The role of stride length and hip kinematics. Gait Posture 2017. [PMID: 28623760 DOI: 10.1016/j.gaitpost.2017.05.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This is an observational cross-sectional study evaluating gait dynamics in patients with Parkinson's Disease (PD) and severe postural deformities, PD without axial deviations and healthy subjects. Ten PS individuals with Pisa syndrome (PS) and nine subjects with Camptocormia (CC) performed 3-D Gait Analysis and were evaluated with walking and balance scales. Correlations with clinical and functional scales were investigated. Spatio-temporal and kinematic data were compared to ten PD subjects without postural deformities (PP) and ten healthy matched individuals (CG). Data obtained showed decreased walking velocity, stride and step length in PP, PS and CC groups compared to controls. The correlation analysis showed that stride and step length were associated with reduced functional abilities and disease severity in PS and CC groups. Kinematic data revealed marked reduction in range of movements (ROMs) at all lower-extremity joints in PS group. While, in CC group the main differences were pronounced in hip and knee joints. PS and CC groups presented a more pronounced reduction in hip articular excursion compared to PP subjects, revealing an increased hip flexion pattern during gait cycle. Moreover, the increased hip and knee flexion pattern adversely affected functional performance during walking tests. Results obtained provide evidence that step length, along with stride length, can be proposed as simple and clear indicators of disease severity and reduced functional abilities. The reduction of ROMs at hip joint represented an important mechanism contributing to decreased walking velocity, balance impairment and reduced gait performance in PD patients with postural deformities.
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Affiliation(s)
- C Tramonti
- Unit of Neurorehabilitation, Department of Medical Specialties, University Hospital of Pisa, Italy.
| | - S Di Martino
- Unit of Neurorehabilitation, Department of Medical Specialties, University Hospital of Pisa, Italy.
| | - E Unti
- Unit of Neurology, Department of Medical Specialties, University Hospital of Pisa, Italy.
| | - D Frosini
- Unit of Neurology, Department of Medical Specialties, University Hospital of Pisa, Italy.
| | - U Bonuccelli
- Unit of Neurology, Department of Medical Specialties, University Hospital of Pisa, Italy.
| | - B Rossi
- Unit of Neurorehabilitation, Department of Medical Specialties, University Hospital of Pisa, Italy.
| | - R Ceravolo
- Unit of Neurology, Department of Medical Specialties, University Hospital of Pisa, Italy.
| | - C Chisari
- Unit of Neurorehabilitation, Department of Medical Specialties, University Hospital of Pisa, Italy.
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Filippin N, da Costa PHL, Mattioli R. Treadmill training with additional body load: Effects on the gait of people with Parkinson's disease. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.6.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aim: The aim of this study was to assess the effects of treadmill walking training with additional body load on the gait of people with moderate Parkinson's disease. Methods: Nine people with Parkinson's disease (Hoehn and Yahr Scale 2–3) and gait disturbance participated in this study. This study was an A1–B–A2 single-case. Phases A1 and A2 included 6 weeks of gait training on a treadmill with a 10% increase of normal body mass. Phase B included 6 weeks of conventional physical therapy (control condition). Measurements included ground reaction forces, spatiotemporal and kinematic variables during walking on the ground at baseline and after each phase. Findings: A significant increase in propulsive forces, stride length, speed, and maximum hip extension during stance were observed after the training programme. No changes in joint range of motion of ankle, knee, and hip were observed. Conclusions: Treadmill training with additional body load was associated with an improvement in important variables for the maintenance of a functional gait, and it is a promising alternative to optimise the rehabilitation process together with conventional physical therapy. However, further studies are needed.
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Affiliation(s)
- Nadiesca Filippin
- Professor, Department of Physical Therapy, Franciscan University Center, Santa Maria, Rio Grande do Sul, Brazil
| | - Paula Hentschel Lobo da Costa
- Professor, Department of Physical Education, Movement Analysis Laboratory, Federal University of São Carlos, São Paulo, Brazil
| | - Rosana Mattioli
- Professor, Department of Physical Therapy, Laboratory of Neuroscience, Federal University of São Carlos, São Paulo, Brazil
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Allen JL, McKay JL, Sawers A, Hackney ME, Ting LH. Increased neuromuscular consistency in gait and balance after partnered, dance-based rehabilitation in Parkinson's disease. J Neurophysiol 2017; 118:363-373. [PMID: 28381488 DOI: 10.1152/jn.00813.2016] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/07/2017] [Accepted: 04/05/2017] [Indexed: 11/22/2022] Open
Abstract
Here we examined changes in muscle coordination associated with improved motor performance after partnered, dance-based rehabilitation in individuals with mild to moderate idiopathic Parkinson's disease. Using motor module (a.k.a. muscle synergy) analysis, we identified changes in the modular control of overground walking and standing reactive balance that accompanied clinically meaningful improvements in behavioral measures of balance, gait, and disease symptoms after 3 wk of daily Adapted Tango classes. In contrast to previous studies that revealed a positive association between motor module number and motor performance, none of the six participants in this pilot study increased motor module number despite improvements in behavioral measures of balance and gait performance. Instead, motor modules were more consistently recruited and distinctly organized immediately after rehabilitation, suggesting more reliable motor output. Furthermore, the pool of motor modules shared between walking and reactive balance increased after rehabilitation, suggesting greater generalizability of motor module function across tasks. Our work is the first to show that motor module distinctness, consistency, and generalizability are more sensitive to improvements in gait and balance function after short-term rehabilitation than motor module number. Moreover, as similar differences in motor module distinctness, consistency, and generalizability have been demonstrated previously in healthy young adults with and without long-term motor training, our work suggests commonalities in the structure of muscle coordination associated with differences in motor performance across the spectrum from motor impairment to expertise.NEW & NOTEWORTHY We demonstrate changes in neuromuscular control of gait and balance in individuals with Parkinson's disease after short-term, dance-based rehabilitation. Our work is the first to show that motor module distinctness, consistency, and generalizability across gait and balance are more sensitive than motor module number to improvements in motor performance following short-term rehabilitation. Our results indicate commonalities in muscle coordination improvements associated with motor skill reacquisition due to rehabilitation and motor skill acquisition in healthy individuals.
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Affiliation(s)
- Jessica L Allen
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia
| | - J Lucas McKay
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia
| | - Andrew Sawers
- Department of Kinesiology, University of Illinois at Chicago, Chicago, Illinois
| | - Madeleine E Hackney
- Atlanta Department of Veterans Affairs Center of Excellence for Visual and Neurocognitive Rehabilitation, Atlanta, Georgia.,Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; and
| | - Lena H Ting
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia; .,Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
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Reactive but not predictive locomotor adaptability is impaired in young Parkinson's disease patients. Gait Posture 2016; 48:177-182. [PMID: 27285477 DOI: 10.1016/j.gaitpost.2016.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait and balance disorders are common in Parkinson's disease (PD) and major contributors to increased falling risk. Predictive and reactive adjustments can improve recovery performance after gait perturbations. However, these mechanisms have not been investigated in young-onset PD. OBJECTIVE We aimed to investigate the effect of gait perturbations on dynamic stability control as well as predictive and reactive adaptability to repeated gait perturbations in young PD patients. METHODS Fifteen healthy controls and twenty-five young patients (48±5yrs.) walked on a walkway. By means of a covered exchangeable element, the floor surface condition was altered to induce gait perturbations. The experimental protocol included a baseline on a hard surface, an unexpected trial on a soft surface and an adaptation phase with 5 soft trials to quantify the reactive adaptation. After the first and sixth soft trials, the surface was changed to hard, to examine after-effects and, thus, predictive motor control. Dynamic stability was assessed using the 'extrapolated center of mass' concept. RESULTS Patients' unperturbed walking was less stable than controls' and this persisted in the perturbed trials. Both groups demonstrated after-effects directly after the first perturbation, showing similar predictive responses. However, PD patients did not improve their reactive behavior after repeated perturbations while controls showed clear locomotor adaptation. CONCLUSIONS Our data suggest that more unstable gait patterns and a less effective reactive adaptation to perturbed walking may be a disease-related characteristic in young PD patients. These deficits were related to reduced ability to increase the base of support.
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Fasano A, Schlenstedt C, Herzog J, Plotnik M, Rose FEM, Volkmann J, Deuschl G. Split-belt locomotion in Parkinson's disease links asymmetry, dyscoordination and sequence effect. Gait Posture 2016; 48:6-12. [PMID: 27477701 DOI: 10.1016/j.gaitpost.2016.04.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 02/15/2016] [Accepted: 04/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The pathophysiology behind gait impairments seen in Parkinson's disease (PD), in particular freezing of gait (FOG), is not fully understood. Here we study the interplay between several gait features related to FOG during different split-belt treadmill (SBTM) conditions. METHODS We investigated the spatiotemporal properties, the phenomenon of sequence effect and the inter-limb symmetry and temporal coordination of gait during different split-belt conditions in 20 patients with advanced Parkinson's disease and different severities of freezing. Subjects were tested in four belt configurations: tied, split while reducing the velocity of leg with the shorter (worst side reduction, WSR) and longer (best side reduction, BSR) step length, and tied again to measure the after-effect. RESULTS We found that in spite of an improvement of spatial symmetry, the BSR led to a worsening of coordination (i.e. the left-right anti-phased stepping) and an increased sequence effect (i.e. progressive shortening of the step length). By contrast, in spite of a worsened spatial symmetry, WSR improved inter-limbs coordination and reduced the sequence effect. After prolonged split-belt walking gait was differently modulated according to the reduction of the best or worst leg velocity: BSR led to positive after effects in symmetry, bilateral coordination and sequence effect. CONCLUSIONS These findings support the hypothesis that the irregularity of inter-limb coordination and defective amplitude generation leading to sequence effect might be coupled and result from the same maladaptive motor behavior. Furthermore, our results show that SBTM can be an effective tool to improve parkinsonian gait.
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Affiliation(s)
- Alfonso Fasano
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany; Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
| | | | - Jan Herzog
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Meir Plotnik
- Advanced Technologies Center, Department of Neurological Rehabilitation, Rehabilitation Hospital, Sheba Medical Center, Tel Hashomer, Israel; Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Gonda Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | | | - Jens Volkmann
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany; Department of Neurology, University of Würzburg, Germany
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
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Cole MH, Naughton GA, Silburn PA. Neuromuscular Impairments Are Associated With Impaired Head and Trunk Stability During Gait in Parkinson Fallers. Neurorehabil Neural Repair 2016; 31:34-47. [PMID: 27354398 DOI: 10.1177/1545968316656057] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The trunk plays a critical role in attenuating movement-related forces that threaten to challenge the body's postural control system. For people with Parkinson's disease (PD), disease progression often leads to dopamine-resistant axial symptoms, which impair trunk control and increase falls risk. Objective This prospective study aimed to evaluate the relationship between impaired trunk muscle function, segmental coordination, and future falls in people with PD. Methods Seventy-nine PD patients and 82 age-matched controls completed clinical assessments and questionnaires to establish their medical history, symptom severity, balance confidence, and falls history. Gait characteristics and trunk muscle activity were assessed using 3-dimensional motion analysis and surface electromyography. The incidence, cause, and consequence of any falls experienced over the next 12 months were recorded and indicated that 48 PD and 29 control participants fell at least once during this time. Results PD fallers had greater peak and baseline lumbar multifidus (LMF) and thoracic erector spinae (TES) activations than control fallers and nonfallers. Analysis of covariance indicated that the higher LMF activity was attributable to the stooped posture adopted by PD fallers, but TES activity was independent of medication use, symptom severity, and trunk orientation. Furthermore, greater LMF and TES baseline activity contributed to increasing lateral head, trunk, and pelvis movements in PD fallers but not nonfallers or controls. Conclusions The results provide evidence of neuromuscular deficits for PD fallers that are independent of medications, symptom severity, and posture and contribute to impaired head, trunk, and pelvis control associated with falls in this population.
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Affiliation(s)
- Michael H Cole
- Australian Catholic University, Banyo, Queensland, Australia
| | | | - Peter A Silburn
- The University of Queensland, Brisbane, Queensland, Australia
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Boudarham J, Hameau S, Zory R, Hardy A, Bensmail D, Roche N. Coactivation of Lower Limb Muscles during Gait in Patients with Multiple Sclerosis. PLoS One 2016; 11:e0158267. [PMID: 27336442 PMCID: PMC4919099 DOI: 10.1371/journal.pone.0158267] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 06/13/2016] [Indexed: 11/18/2022] Open
Abstract
Background Coactivation of agonist and antagonist lower limb muscles during gait stiffens joints and ensures stability. In patients with multiple sclerosis, coactivation of lower limb muscles might be a compensatory mechanism to cope with impairments of balance and gait. Objective The aim of this study was to assess coactivation of agonist and antagonist muscles at the knee and ankle joints during gait in patients with multiple sclerosis, and to evaluate the relationship between muscle coactivation and disability, gait performance, dynamic ankle strength measured during gait, and postural stability. Methods The magnitude and duration of coactivation of agonist-antagonist muscle pairs at the knee and ankle were determined for both lower limbs (more and less-affected) in 14 patients with multiple sclerosis and 11 healthy subjects walking at a spontaneous speed, using 3D-gait analysis. Results In the patient group, coactivation was increased in the knee muscles during single support (proximal strategy) and in the ankle muscles during double support (distal strategy). The magnitude of coactivation was highest in the patients with the slowest gait, the greatest motor impairment and the most instability. Conclusion Increased muscle coactivation is likely a compensatory mechanism to limit the number of degrees of freedom during gait in patients with multiple sclerosis, particularly when postural stability is impaired.
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Affiliation(s)
- Julien Boudarham
- INSERM 1179, CIC 1429, CHU Raymond Poincaré, APHP, University of Versailles Saint Quentin en Yvelines, Garches, France
- * E-mail:
| | - Sophie Hameau
- INSERM 1179, CIC 1429, CHU Raymond Poincaré, APHP, University of Versailles Saint Quentin en Yvelines, Garches, France
| | - Raphael Zory
- LAMHESS, EA 6312, University of Nice Sophia Antipolis, Nice, France
| | - Alexandre Hardy
- INSERM 1179, CIC 1429, CHU Raymond Poincaré, APHP, University of Versailles Saint Quentin en Yvelines, Garches, France
| | - Djamel Bensmail
- INSERM 1179, CIC 1429, CHU Raymond Poincaré, APHP, University of Versailles Saint Quentin en Yvelines, Garches, France
| | - Nicolas Roche
- INSERM 1179, CIC 1429, CHU Raymond Poincaré, APHP, University of Versailles Saint Quentin en Yvelines, Garches, France
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Santiago LMDM, de Oliveira DA, de Macêdo Ferreira LGL, de Brito Pinto HY, Spaniol AP, de Lucena Trigueiro LC, Ribeiro TS, de Sousa AVC, Piemonte MEP, Lindquist ARR. Immediate effects of adding mental practice to physical practice on the gait of individuals with Parkinson's disease: Randomized clinical trial. NeuroRehabilitation 2016; 37:263-71. [PMID: 26484518 DOI: 10.3233/nre-151259] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mental practice has shown benefits in the rehabilitation of neurological patients, however, there is no evidence of immediate effects on gait of individuals with Parkinson's disease. OBJECTIVE Determine the effects of mental practice activity added to physical practice on the gait of individuals with Idiopathic Parkinson's Disease (IPD). METHODS 20 patients classified with stage 2 and 3, according to the Hoehn and Yahr scale were randomized into 2 groups. The experimental group (N = 10) was submitted to a single session of mental practice and physical practice gait protocol and the control group (N = 10) only to physical practice. The primary outcomes were stride length and total stance and swing time. Secondary outcomes were hip range of motion, velocity and mobility. Subjects were reassessed 10 minutes, 1 day and 7 days after the end of the session. RESULTS There was no statistically significant difference between the groups. An intragroup difference was observed in velocity, stride length, hip range of motion, and mobility, as well as total stance and swing time. These results were also observed on follow-ups. CONCLUSIONS Mental practice did not have a greater effect on the gait of individuals with IPD than physical practice, after a single session.
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Affiliation(s)
| | | | | | | | - Ana Paula Spaniol
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Tatiana Souza Ribeiro
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Natal, Brazil
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Dipaola M, Pavan EE, Cattaneo A, Frazzitta G, Pezzoli G, Cavallari P, Frigo CA, Isaias IU. Mechanical Energy Recovery during Walking in Patients with Parkinson Disease. PLoS One 2016; 11:e0156420. [PMID: 27258183 PMCID: PMC4892681 DOI: 10.1371/journal.pone.0156420] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 05/15/2016] [Indexed: 11/18/2022] Open
Abstract
The mechanisms of mechanical energy recovery during gait have been thoroughly investigated in healthy subjects, but never described in patients with Parkinson disease (PD). The aim of this study was to investigate whether such mechanisms are preserved in PD patients despite an altered pattern of locomotion. We consecutively enrolled 23 PD patients (mean age 64±9 years) with bilateral symptoms (H&Y ≥II) if able to walk unassisted in medication-off condition (overnight suspension of all dopaminergic drugs). Ten healthy subjects (mean age 62±3 years) walked both at their 'preferred' and 'slow' speeds, to match the whole range of PD velocities. Kinematic data were recorded by means of an optoelectronic motion analyzer. For each stride we computed spatio-temporal parameters, time-course and range of motion (ROM) of hip, knee and ankle joint angles. We also measured kinetic (Wk), potential (Wp), total (WtotCM) energy variations and the energy recovery index (ER). Along with PD progression, we found a significant correlation of WtotCM and Wp with knee ROM and in particular with knee extension in terminal stance phase. Wk and ER were instead mainly related to gait velocity. In PD subjects, the reduction of knee ROM significantly diminished both Wp and WtotCM. Rehabilitation treatments should possibly integrate passive and active mobilization of knee to prevent a reduction of gait-related energetic components.
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Affiliation(s)
- Mariangela Dipaola
- Department of Pathophysiology and Transplantation, Human Physiology Section, Università degli Studi di Milano, Milan, Italy
- Movement Biomechanics and Motor Control Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Esteban E. Pavan
- Movement Biomechanics and Motor Control Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Andrea Cattaneo
- Department of Pathophysiology and Transplantation, Human Physiology Section, Università degli Studi di Milano, Milan, Italy
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | | | | | - Paolo Cavallari
- Department of Pathophysiology and Transplantation, Human Physiology Section, Università degli Studi di Milano, Milan, Italy
| | - Carlo A. Frigo
- Movement Biomechanics and Motor Control Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Ioannis U. Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- Parkinson Institute, Pini-CTO (ex ICP) Milan, Italy
- Fondazione Europea di Ricerca Biomedica FERB Onlus, Milan, Italy
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Skinner JW, Lee HK, Roemmich RT, Amano S, Hass CJ. Execution of Activities of Daily Living in Persons with Parkinson Disease. Med Sci Sports Exerc 2016; 47:1906-12. [PMID: 25494393 DOI: 10.1249/mss.0000000000000598] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Muscular weakness and the motor difficulties associated with Parkinson disease (PD) often impair the performance of activities of daily living (ADL). However, little is known about the magnitude and distribution of relative muscular effort of persons with PD during ADL. The purpose of this investigation was to determine the relative magnitude of lower extremity moment production that persons with PD use to perform common ADL. METHODS Fifteen participants with mild-to-moderate PD and 14 age/sex-matched controls volunteered. Participants performed a series of ADL tasks, as follows: gait initiation (GI), gait, and stair ascending tasks. Participants were then asked to perform maximal-effort isokinetic tests of hip and knee extension and ankle plantarflexion at speeds of 90° per second and 120° per second. Relative effort was quantified as a percentage of the maximal isokinetic value produced by a joint during performance of the ADL. Relative effort and peak isokinetic joint moments were analyzed using a mixed-model ANOVA with repeated measures. All other comparisons were evaluated using independent t-tests. RESULTS Persons with PD produced smaller ankle plantarflexion moment at both 90° per second and 120° per second (P < 0.05). Relative effort during GI (271% vs 189%, P < 0.05) and gait (270% vs 161%, P < 0.05) was significantly greater at the ankle in persons with PD. Contribution of the ankle to the support moment was lower in PD during stair ascending (24% vs 34%) and GI (63% vs 57%) compared with that in controls. CONCLUSIONS The reduced ankle moments during ADL are indicative of deficits in muscular capabilities in those with PD. Moreover, PD caused a redistribution of joint torques, such that PD participants used their hip extensors more and ankle plantarflexors less.
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Affiliation(s)
- Jared W Skinner
- 1Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL; 2Motion Analysis Laboratory, Kennedy Krieger Institute, Baltimore, MD; 3Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD; 4Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens OH; and 5Center for Movement Disorders and Neurorestoration, Gainesville, FL
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Abstract
People with Parkinson's disease exhibit debilitating gait impairments, including gait slowness, increased step variability, and poor postural control. A widespread supraspinal locomotor network including the cortex, cerebellum, basal ganglia, and brain stem contributes to the control of human locomotion, and altered activity of these structures underlies gait dysfunction due to Parkinson's disease.
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Affiliation(s)
- D S Peterson
- Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon; and Oregon Health & Science University, Department of Neurology, Portland, Oregon
| | - F B Horak
- Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon; and Oregon Health & Science University, Department of Neurology, Portland, Oregon
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Roper JA, Terza MJ, Tillman MD, Hass CJ. Adaptation Strategies of Individuals With Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2016; 4:2325967115627611. [PMID: 26894200 PMCID: PMC4748157 DOI: 10.1177/2325967115627611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Despite the strong implications for rehabilitation design, the capability of individuals with anterior cruciate ligament reconstruction (ACLR) to adapt and store novel gait patterns have not been well studied. Purpose: To investigate how reconstructive surgery may affect the ability to adapt and store novel gait patterns in persons with ACLR while walking on a split-belt treadmill. Study Design: Controlled laboratory study. Methods: Gait adaptation was compared between 20 participants with ACLR and 20 healthy controls during split-belt treadmill walking. Gait adaptation was assessed in slow- and fast-adapting parameters by (1) the magnitude of symmetry during late adaptation and (2) the amount of the asymmetry during de-adaptation. Results: Healthy individuals adapted a new walking pattern and stored the new walking pattern equally in both the dominant and nondominant limbs. Conversely, individuals with ACLR displayed impairments in both slow-adapting and fast-adapting derived gait adaptation and significant differences in behavior between the reconstructed and uninjured limb. Conclusion: While surgical reconstruction and physical therapy are aimed at improving mechanical stability to the knee, the study data suggest that fundamental features of motor control remain altered. After ACLR, participants display an altered ability to learn and store functional gait patterns.
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Affiliation(s)
- Jaimie A Roper
- Applied Physiology and Kinesiology Department, College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
| | - Matthew J Terza
- Applied Physiology and Kinesiology Department, College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
| | - Mark D Tillman
- Department of Kinesiology and Health Promotion, College of Health and Human Services, Troy University, Troy, Alabama, USA
| | - Chris J Hass
- Applied Physiology and Kinesiology Department, College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
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Xiong QL, Wu XY, Xiao N, Zeng SY, Wan XP, Zheng XL, Hou WS. Antagonist muscle co-activation of limbs in human infant crawling: A pilot study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:2115-8. [PMID: 26736706 DOI: 10.1109/embc.2015.7318806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Muscle Co-activation (MCo) is the simultaneous muscular activation of agonist and antagonist muscle groups, which provides adequate joint stability, movement accuracy during movement. Infant crawling is an important stage of motor function development that manifests non-synchronization growth and development of upper and lower limbs due to the well-known gross motor development principle of head to toe. However, the effect of MCo level for agonist and antagonist muscle groups on motor function development of limbs has not been previously reported. In this paper, sEMG signals were collected from triceps brachii (TB) and biceps brachii (BB), quadriceps femoris (QF) and hamstrings (HS) of limbs when fourteen infants were crawling at their self-selected speed. Antagonist muscle co-activation was evaluated by measuring two common indexes (co-activation index and Pearson's correlation coefficient).A significant difference was observed between upper limbs and lower limbs, but the relationship between MCo and speed of crawling was poor. This study is an opening for further investigation including a longitudinal study and compare against infant with CNS disorders.
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Hinkel-Lipsker JW, Hahn ME. Novel Kinetic Strategies Adopted in Asymmetric Split-Belt Treadmill Walking. J Mot Behav 2015; 48:209-17. [PMID: 26359780 DOI: 10.1080/00222895.2015.1073137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The hip and ankle strategies that affect learning of a novel gait have not been fully determined, and could be of importance in design of clinical gait interventions. The authors' purpose was to determine the effects of asymmetric split-belt treadmill walking on ankle and hip work during propulsion. Participants were randomized into either a gradual training group or a sudden training group and later returned for a retention test. The gradual training group performed significantly more work at the hip joint of the slow limb during acquisition, and decreased the hip joint work performed during retention. These findings reveal the hip joint on the slow limb during initial swing as a possible site of adaptation to a novel locomotor pattern.
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Affiliation(s)
| | - Michael E Hahn
- a Department of Human Physiology , University of Oregon , Eugene
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Huynh KV, Sarmento CH, Roemmich RT, Stegemöller EL, Hass CJ. Comparing aftereffects after split-belt treadmill walking and unilateral stepping. Med Sci Sports Exerc 2015; 46:1392-9. [PMID: 24389526 DOI: 10.1249/mss.0000000000000240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Asymmetric step length is a problem common to many orthopedic and neurologic populations. Herein, we compare step length aftereffects during overground gait after two rehabilitation intervention strategies to combat step length asymmetry: split-belt treadmill (SBT) walking and unilateral stepping. METHODS Eighteen healthy young adults (22 ± 3 yr) first performed 10 overground gait trials. Participants then walked for 10 min under three different treadmill conditions in a randomized order: SBT walking, slow unilateral stepping, and fast unilateral stepping. Immediately after each treadmill condition, participants performed ten overground gait trials. Mean step length asymmetry was calculated across the first five strides of the overground gait trials to assess the storage of aftereffects after each treadmill condition. We also explored the lower extremity kinematics during each treadmill condition to investigate movement patterns that lead to greatest aftereffects. RESULTS Significantly higher step length asymmetry was observed in overground gait trials after SBT walking compared to those after slow and fast unilateral stepping, indicating greater aftereffect/carryover of the SBT walking pattern to overground gait. During fast unilateral stepping, increased flexion in the hip, knee, and ankle of the stationary limb was significantly associated with increased step length aftereffects. CONCLUSIONS The aftereffects observed after acute SBT walking were significantly greater than those after unilateral stepping. Both exercises induce aftereffects of similar kinematic patterns, although likely through different mechanisms. In sum, SBT walking induces the greatest aftereffects, although unilateral stepping also induces a change in gait behavior. During unilateral stepping, the largest aftereffects occur when the walker does not simply fully extend the stationary limb and allow the treadmill to passively move the stepping limb during stance.
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Affiliation(s)
- Kristin V Huynh
- Department of Applied Physiology and Kinesiology University of Florida, Gainesville, FL
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