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Caparrós-Manosalva C, Espinoza J, Caballero PM, da Cunha MJ, Yang F, Galen S, Pagnussat AS. Movement strategies during obstacle crossing in people with Parkinson disease: A systematic review with meta-analysis. PM R 2024. [PMID: 38656703 DOI: 10.1002/pmrj.13166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/07/2023] [Accepted: 12/01/2023] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Navigating obstacles involves adjusting walking patterns, particularly when stepping over them. This task may be particularly challenging for people with Parkinson disease (PD) for several reasons. This review aims to compare the spatiotemporal gait parameters of people with and without PD while stepping over obstacles. LITERATURE SURVEY A systematic literature search was conducted in six databases (PubMed, Scopus, Web of Science, EBSCO, Embase, and SciELO) from inception to September 2023. METHODOLOGY Studies were selected that evaluated gait parameters of people with and without PD while walking over obstacles. Two independent researchers evaluated the eligibility and extracted gait parameters during obstacle crossing. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Heterogeneity was assessed using I2-tests. Random effects models were determined for effect sizes as standardized mean differences (SMD). SYNTHESIS Twenty-five studies were included in the review and 17 in the meta-analysis. Most of the studies (58%) showed a low risk of bias. People with PD exhibit a shorter step when landing after crossing an obstacle (SMD = -0.50 [-0.69 to -0.31]). Compared to people without PD, people with PD also widen their support base (SMD = 0.27 [0.07-0.47]) and reduce gait velocity (SMD = -0.60 [-0.80 to -0.39]) when crossing the obstacle. CONCLUSIONS People with PD adopt a more conservative motor behavior during obstacle crossing than those without PD, with a shorter step length when landing after crossing an obstacle, greater step width and lower crossing speed.
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Affiliation(s)
- Cristian Caparrós-Manosalva
- Department of Human Movement Sciences, Faculty of Health Sciences, University of Talca, Talca, Chile
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Jessica Espinoza
- Department of Human Movement Sciences, Faculty of Health Sciences, University of Talca, Talca, Chile
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Paula M Caballero
- Department of Human Movement Sciences, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Maira J da Cunha
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, UFCSPA, Porto Alegre, Brazil
| | - Feng Yang
- Department of Kinesiology and Health, Georgia State University, Atlanta, Georgia, USA
| | - Sujay Galen
- Department of Physical Therapy, Georgia State University, Atlanta, Georgia, USA
| | - Aline S Pagnussat
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, UFCSPA, Porto Alegre, Brazil
- Department of Physical Therapy, Georgia State University, Atlanta, Georgia, USA
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Conde CI, Lang C, Baumann CR, Easthope CA, Taylor WR, Ravi DK. Triggers for freezing of gait in individuals with Parkinson's disease: a systematic review. Front Neurol 2023; 14:1326300. [PMID: 38187152 PMCID: PMC10771308 DOI: 10.3389/fneur.2023.1326300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Background Freezing of Gait (FOG) is a motor symptom frequently observed in advanced Parkinson's disease. However, due to its paroxysmal nature and diverse presentation, assessing FOG in a clinical setting can be challenging. Before FOG can be fully investigated, it is critical that a reliable experimental setting is established in which FOG can be evoked in a standardized manner, but the efficacy of various gait tasks and triggers for eliciting FOG remains unclear. Objectives This study aimed to conduct a systematic review of the existing literature and evaluate the available evidence for the relationship between specific motor tasks, triggers, and FOG episodes in individuals with Parkinson's disease (PwPD). Methods We conducted a literature search on four online databases (PubMed, Web of Science, EMBASE, and Cochrane Library) using the keywords "Parkinson's disease," "Freezing of Gait", "triggers" and "tasks". A total of 128 articles met the inclusion criteria and were included in our analysis. Results The review found that a wide range of gait tasks were employed in studies assessing FOG among PD patients. However, three tasks (turning, dual tasking, and straight walking) emerged as the most frequently used. Turning (28%) appears to be the most effective trigger for eliciting FOG in PwPD, followed by walking through a doorway (14%) and dual tasking (10%). Conclusion This review thereby supports the utilisation of turning, especially a 360-degree turn, as a reliable trigger for FOG in PwPD. This finding could be beneficial to clinicians conducting clinical evaluations and researchers aiming to assess FOG in a laboratory environment.
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Affiliation(s)
| | - Charlotte Lang
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Christian R. Baumann
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland
- The LOOP Zurich – Medical Research Center, Zürich, Switzerland
| | - Chris A. Easthope
- The LOOP Zurich – Medical Research Center, Zürich, Switzerland
- Lake Lucerne Institute, Vitznau, Switzerland
- creneo Foundation – Center for Interdisciplinary Research, Vitznau, Switzerland
| | - William R. Taylor
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
- The LOOP Zurich – Medical Research Center, Zürich, Switzerland
| | - Deepak K. Ravi
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
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Longhurst JK, Rider JV, Cummings JL, John SE, Poston B, Landers MR. Cognitive-motor dual-task interference in Alzheimer's disease, Parkinson's disease, and prodromal neurodegeneration: A scoping review. Gait Posture 2023; 105:58-74. [PMID: 37487365 PMCID: PMC10720398 DOI: 10.1016/j.gaitpost.2023.07.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/20/2022] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Cognitive-motor interference (CMI) is a common deficit in Alzheimer's (AD) disease and Parkinson's disease (PD) and may have utility in identification of prodromal neurodegeneration. There is lack of consensus regarding measurement of CMI resulting from dual task paradigms. RESEARCH QUESTION How are individuals with AD, PD, and prodromal neurodegeneration impacted by CMI as measured by dual-task (DT) performance? METHODS A systematic literature search was performed in six datasets using the PRISMA guidelines. Studies were included if they had samples of participants with AD, PD, or prodromal neurodegeneration and reported at least one measure of cognitive-motor DT performance. RESULTS 4741 articles were screened and 95 included as part of this scoping review. Articles were divided into three non-mutually exclusive groups based on diagnoses, with 26 articles in AD, 56 articles in PD, and 29 articles in prodromal neurodegeneration, and results presented accordingly. SIGNIFICANCE Individuals with AD and PD are both impacted by CMI, though the impact is likely different for each disease. We found a robust body of evidence regarding the utility of measures of DT performance in the detection of subtle deficits in prodromal AD and some signals of utility in prodromal PD. There are several key methodological challenges related to DT paradigms for the measurement of CMI in neurodegeneration. Overall, DT paradigms show good potential as a clinical method to probe specific brain regions, networks, and function; however, task selection and effect measurement should be carefully considered.
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Affiliation(s)
- Jason K Longhurst
- Department of Physical Therapy and Athletic Training, Saint Louis University, 3437 Caroline St. Suite, 1011 St. Louis, MO, USA.
| | - John V Rider
- School of Occupational Therapy, Touro University Nevada, Henderson, NV, USA; Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA.
| | | | - Samantha E John
- Department of Brain Health, University of Nevada, Las Vegas, NV, USA.
| | - Brach Poston
- Department of Kinesiology and Nutrition, University of Nevada, Las Vegas, NV, USA.
| | - Merrill R Landers
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA.
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Vitório R, Lirani-Silva E, Orcioli-Silva D, Beretta VS, Oliveira AS, Gobbi LTB. Electrocortical Dynamics of Usual Walking and the Planning to Step over Obstacles in Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2023; 23:4866. [PMID: 37430780 DOI: 10.3390/s23104866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 07/12/2023]
Abstract
The neural correlates of locomotion impairments observed in people with Parkinson's disease (PD) are not fully understood. We investigated whether people with PD present distinct brain electrocortical activity during usual walking and the approach phase of obstacle avoidance when compared to healthy individuals. Fifteen people with PD and fourteen older adults walked overground in two conditions: usual walking and obstacle crossing. Scalp electroencephalography (EEG) was recorded using a mobile 64-channel EEG system. Independent components were clustered using a k-means clustering algorithm. Outcome measures included absolute power in several frequency bands and alpha/beta ratio. During the usual walk, people with PD presented a greater alpha/beta ratio in the left sensorimotor cortex than healthy individuals. While approaching obstacles, both groups reduced alpha and beta power in the premotor and right sensorimotor cortices (balance demand) and increased gamma power in the primary visual cortex (visual demand). Only people with PD reduced alpha power and alpha/beta ratio in the left sensorimotor cortex when approaching obstacles. These findings suggest that PD affects the cortical control of usual walking, leading to a greater proportion of low-frequency (alpha) neuronal firing in the sensorimotor cortex. Moreover, the planning for obstacle avoidance changes the electrocortical dynamics associated with increased balance and visual demands. People with PD rely on increased sensorimotor integration to modulate locomotion.
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Affiliation(s)
- Rodrigo Vitório
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Ellen Lirani-Silva
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Diego Orcioli-Silva
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
| | - Victor Spiandor Beretta
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- School of Technology and Sciences, Sao Paulo State University (UNESP), Presidente Prudente 19060-900, Brazil
| | | | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Sao Paulo State University (UNESP), Rio Claro 13506-900, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro 13506-900, Brazil
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Monaghan AS, Gordon E, Graham L, Hughes E, Peterson DS, Morris R. Cognition and freezing of gait in Parkinson's disease: A systematic review and meta-analysis. Neurosci Biobehav Rev 2023; 147:105068. [PMID: 36738813 DOI: 10.1016/j.neubiorev.2023.105068] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023]
Abstract
Freezing of gait (FOG) is a common and disabling symptom in people with Parkinson's Disease (PwPD). Although cognition is thought to be worse in PwPD who freeze, a comprehensive analysis of this relationship will inform future research and clinical care. This systematic review and meta-analysis compared cognition between PwPD who do and do not exhibit FOG across a range of cognitive domains and assessed the impact of disease severity and medication status on this relationship. 145 papers (n = 9010 participants) were included in the analysis, with 144 and 138 articles meeting the criteria to assess moderating effects of disease severity and medication status, respectively. PwPD who freeze exhibited worse cognition than PwPD without FOG across global cognition, executive function/attention, language, memory, and visuospatial domains. Greater disease severity and "ON" levodopa medication status moderated the FOG status-cognition relationship in global cognitive performance but not in other cognitive domains. This meta-analysis confirmed that cognition is worse in PwPD with FOG and highlights the importance of disease severity and medication status in this relationship.
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Affiliation(s)
- A S Monaghan
- College of Health Solutions, Arizona State University, 5th St., Phoenix, AZ 85282, USA
| | - E Gordon
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - L Graham
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - E Hughes
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - D S Peterson
- College of Health Solutions, Arizona State University, 5th St., Phoenix, AZ 85282, USA; Phoenix VA Health Care Center, 650 E Indian School Rd, Phoenix, AZ, USA.
| | - R Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
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Monaghan AS, Ragothaman A, Harker GR, Carlson-Kuhta P, Horak FB, Peterson DS. Freezing of Gait in Parkinson's Disease: Implications for Dual-Task Walking. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1035-1046. [PMID: 37574744 PMCID: PMC10578213 DOI: 10.3233/jpd-230063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The simultaneous completion of multiple tasks (dual-tasking, DT) often leads to poorer task performance (DT cost, DTC). People with Parkinson's disease (PwPD) exhibit difficulty with DT, and DTC may be particularly pronounced in PwPD with freezing of gait (FOG). OBJECTIVE This study assessed the relationship between FOG status and DTC during gait. METHODS Gait parameters were collected using inertial sensors in 106 PwPD (off-medication), including definite-freezers (dFOG; n = 25), possible-freezers (pFOG; n = 16), and non-freezers (nFOG; n = 65) during single (ST)-and DT walking. RESULTS PwPD with dFOG had larger (worse) DTC than nFOG for foot-strike angle, stride length, toe-off angle, variability of foot-strike angle, and arm range of motion (ROM). After accounting for covariates, DTC for toe-off angle and stride length remained worse in PwPD who freeze. Worse cognition predicted larger DTC for stride length, gait cycle duration, gait speed, and step duration across groups. Men had larger DTC compared to women for gait speed, variability in foot-strike angle, stride length, and arm ROM. Increased variability in gait speed DTC was associated with increased disease severity. CONCLUSION These findings provide additional support that PwPD who freeze may rely on greater cortical control for the execution of specific gait metrics. The results also underscore the importance of considering cognition when assessing DT ability in PwPD.
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Affiliation(s)
| | | | - Graham R. Harker
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | | | - Fay B. Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Daniel S. Peterson
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
- Phoenix VA Health Care Center, Phoenix, AZ, USA
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Lu SH, Kuan YC, Wu KW, Lu HY, Tsai YL, Chen HH, Lu TW. Kinematic strategies for obstacle-crossing in older adults with mild cognitive impairment. Front Aging Neurosci 2022; 14:950411. [PMID: 36583190 PMCID: PMC9792980 DOI: 10.3389/fnagi.2022.950411] [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: 05/22/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Mild cognitive impairment (MCI) is considered a transitional stage between soundness of mind and dementia, often involving problems with memory, which may lead to abnormal postural control and altered end-point control when dealing with neuromechanical challenges during obstacle-crossing. The study aimed to identify the end-point control and angular kinematics of the pelvis-leg apparatus while crossing obstacles for both leading and trailing limbs. Methods 12 patients with MCI (age: 66.7 ± 4.2 y/o; height: 161.3 ± 7.3 cm; mass: 62.0 ± 13.6 kg) and 12 healthy adults (age: 67.7 ± 2.9 y/o; height: 159.3 ± 6.1 cm; mass: 61.2 ± 12.0 kg) each walked and crossed obstacles of three different heights (10, 20, and 30% of leg length). Angular motions of the pelvis and lower limbs and toe-obstacle clearances during leading- and trailing-limb crossings were calculated. Two-way analyses of variance were used to study between-subject (group) and within-subject (obstacle height) effects on the variables. Whenever a height effect was found, a polynomial test was used to determine the trend. A significance level of α = 0.05 was set for all tests. Results Patients with MCI significantly increased pelvic anterior tilt, hip abduction, and knee adduction in the swing limb during leading-limb crossing when compared to controls (p < 0.05). During trailing-limb crossing, the MCI group showed significantly decreased pelvic posterior tilt, as well as ankle dorsiflexion in the trailing swing limb (p < 0.05). Conclusion Patients with MCI adopt altered kinematic strategies for successful obstacle-crossing. The patients were able to maintain normal leading and trailing toe-obstacle clearances for all tested obstacle heights with a specific kinematic strategy, namely increased pelvic anterior tilt, swing hip abduction, and knee adduction during leading-limb crossing, and decreased pelvic posterior tilt and swing ankle dorsiflexion during trailing-limb crossing. The current results suggest that regular monitoring of obstacle-crossing kinematics for reduced toe-obstacle clearance or any signs of changes in crossing strategy may be helpful for early detection of compromised obstacle-crossing ability in patients with single-domain amnestic MCI. Further studies using a motor/cognitive dual-task approach on the kinematic strategies adopted by multiple-domain MCI will be needed for a complete picture of the functional adaptations in such a patient group.
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Affiliation(s)
- Shiuan-Huei Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan
| | - Yi-Chun Kuan
- Department of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan,Taipei Neuroscience Institute, Taipei Medical University, Taipei City, Taiwan,Dementia Center and Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Kuan-Wen Wu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, University, Taipei City, Taiwan
| | - Hsuan-Yu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan
| | - Yu-Lin Tsai
- Department of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan,Department of Orthopaedic Surgery, National Taiwan University Hospital, University, Taipei City, Taiwan
| | - Hsiang-Ho Chen
- School of Biomedical Engineering, Taipei Medical University, Taipei City, Taiwan,Department of Biomedical Engineering and Center for Biomedical Engineering, Chang Gung University, Taoyuan City, Taiwan,*Correspondence: Hsiang-Ho Chen, ; Tung-Wu Lu,
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan,Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei City, Taiwan,*Correspondence: Hsiang-Ho Chen, ; Tung-Wu Lu,
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Parati M, Ambrosini E, DE Maria B, Gallotta M, Dalla Vecchia LA, Ferriero G, Ferrante S. The reliability of gait parameters captured via instrumented walkways: a systematic review and meta-analysis. Eur J Phys Rehabil Med 2022; 58:363-377. [PMID: 34985239 PMCID: PMC9987464 DOI: 10.23736/s1973-9087.22.07037-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Electronic pressure-sensitive walkways are commonly available solutions to quantitatively assess gait parameters for clinical and research purposes. Many studies have evaluated their measurement properties in different conditions with variable findings. In order to be informed about the current evidence of their reliability for optimal clinical and scientific decision making, this systematic review provided a quantitative synthesis of the test-retest reliability and minimal detectable change of the captured gait parameters across different test conditions (single and cognitive dual-task conditions) and population groups. EVIDENCE ACQUISITION A literature search was conducted in PubMed, Embase, and Scopus until November 2021 to identify articles that examined the test-retest reliability properties of the gait parameters captured by pressure-sensitive walkways (gait speed, cadence, stride length and time, double support time, base of support) in adult healthy individuals or patients. The methodological quality was rated using the Consensus-Based Standards for the Selection of Health Measurement Instruments Checklist. Data were meta-analyzed on intraclass correlation coefficient to examine the test-retest relative reliability. Quantitative synthesis was performed for absolute reliability, examined by the weighted average of minimal detectable change values. EVIDENCE SYNTHESIS A total of 44 studies were included in this systematic review. The methodological quality was adequate in half of the included studies. The main finding was that pressure-sensitive walkways are reliable tools for objective assessment of spatial and temporal gait parameters both in single-and cognitive dual-task conditions. Despite few exceptions, the review identified intraclass correlation coefficient higher than 0.75 and minimal detectable change lower than 30%, demonstrating satisfactory relative and absolute reliability in all examined populations (healthy adults, elderly, patients with cognitive impairment, spinocerebellar ataxia type 14, Huntington's disease, multiple sclerosis, Parkinson's disease, rheumatoid arthritis, spinal cord injury, stroke or vestibular dysfunction). CONCLUSIONS Current evidence suggested that, despite different populations and testing protocols used in the included studies, the test-retest reliability of the examined gait parameters was acceptable under single and cognitive dual-task conditions. Further high-quality studies with powered sample sizes are needed to examine the reliability findings of the currently understudied and unexplored pathologies and test conditions.
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Affiliation(s)
- Monica Parati
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | | | | | - Giorgio Ferriero
- Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Varese, Italy -
| | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Schneider L, Gossé L, Montgomery M, Wehmeier M, Villringer A, Fritz TH. Components of Active Music Interventions in Therapeutic Settings-Present and Future Applications. Brain Sci 2022; 12:622. [PMID: 35625009 PMCID: PMC9139247 DOI: 10.3390/brainsci12050622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023] Open
Abstract
Musical interventions in therapy have become increasingly relevant for rehabilitation in many clinics. What was long known for physiotherapy training-that the agency of the participant is crucial and moving is much more efficient for rehabilitation success than being moved-has over recent years also been shown to be true for music therapy. Accumulating evidence suggests that active musical interventions are especially efficient at helping rehabilitation success. Here, we review various approaches to active music therapy. Furthermore, we present several components that allow for manipulating musical expressiveness and physical engagement during active musical interventions, applying a technology-based music feedback paradigm. This paper will allow for a transfer of insights to other domains of music-based therapeutic interventions.
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Affiliation(s)
- Lydia Schneider
- Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1A, 04103 Leipzig, Germany; (M.M.); (M.W.); (A.V.)
| | - Louisa Gossé
- Centre for Brain and Cognitive Development, Birkbeck University of London, Malet Street, London WC1E 7HX, UK;
| | - Max Montgomery
- Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1A, 04103 Leipzig, Germany; (M.M.); (M.W.); (A.V.)
- Institute for Psychoacoustics and Electronic Music (IPEM), Ghent University, Blandijnberg 2, 9000 Ghent, Belgium
| | - Moritz Wehmeier
- Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1A, 04103 Leipzig, Germany; (M.M.); (M.W.); (A.V.)
| | - Arno Villringer
- Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1A, 04103 Leipzig, Germany; (M.M.); (M.W.); (A.V.)
| | - Thomas Hans Fritz
- Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstrasse 1A, 04103 Leipzig, Germany; (M.M.); (M.W.); (A.V.)
- Institute for Psychoacoustics and Electronic Music (IPEM), Ghent University, Blandijnberg 2, 9000 Ghent, Belgium
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Liu X, Huang H, Snutch TP, Cao P, Wang L, Wang F. The Superior Colliculus: Cell Types, Connectivity, and Behavior. Neurosci Bull 2022; 38:1519-1540. [PMID: 35484472 DOI: 10.1007/s12264-022-00858-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/16/2022] [Indexed: 10/18/2022] Open
Abstract
The superior colliculus (SC), one of the most well-characterized midbrain sensorimotor structures where visual, auditory, and somatosensory information are integrated to initiate motor commands, is highly conserved across vertebrate evolution. Moreover, cell-type-specific SC neurons integrate afferent signals within local networks to generate defined output related to innate and cognitive behaviors. This review focuses on the recent progress in understanding of phenotypic diversity amongst SC neurons and their intrinsic circuits and long-projection targets. We further describe relevant neural circuits and specific cell types in relation to behavioral outputs and cognitive functions. The systematic delineation of SC organization, cell types, and neural connections is further put into context across species as these depend upon laminar architecture. Moreover, we focus on SC neural circuitry involving saccadic eye movement, and cognitive and innate behaviors. Overall, the review provides insight into SC functioning and represents a basis for further understanding of the pathology associated with SC dysfunction.
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Affiliation(s)
- Xue Liu
- Shenzhen Key Lab of Neuropsychiatric Modulation, Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, 518055, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Hongren Huang
- Shenzhen Key Lab of Neuropsychiatric Modulation, Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, 518055, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Terrance P Snutch
- Michael Smith Laboratories and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, V6T 1Z4, Canada
| | - Peng Cao
- National Institute of Biological Sciences, Beijing, 100049, China
| | - Liping Wang
- Shenzhen Key Lab of Neuropsychiatric Modulation, Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, 518055, China.
| | - Feng Wang
- Shenzhen Key Lab of Neuropsychiatric Modulation, Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, the Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, 518055, China.
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Crisafulli O, Trompetto C, Puce L, Marinelli L, Costi S, Abbruzzese G, Avanzino L, Pelosin E. Dual task gait deteriorates gait performance in cervical dystonia patients: a pilot study. J Neural Transm (Vienna) 2021; 128:1677-1685. [PMID: 34324056 PMCID: PMC8536592 DOI: 10.1007/s00702-021-02393-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/26/2021] [Indexed: 01/22/2023]
Abstract
Day-to-day walking-related activities frequently involve the simultaneous performance of two or more tasks (i.e., dual task). Dual task ability is influenced by higher order cognitive and cortical control mechanisms. Recently, it has been shown that the concomitant execution of an attention-demanding task affected postural control in subject with cervical dystonia (CD). However, no study has investigated whether dual tasking might deteriorate gait performance in CD patients. To investigate whether adding a concomitant motor and cognitive tasks could affect walking performance in CD subjects.17 CD patients and 19 healthy subjects (HS) participated in this pilot case–control study. Gait performance was evaluated during four walking tasks: usual, fast, cognitive dual task and obstacle negotiation. Spatiotemporal parameters, dual-task cost and coefficients of variability (CV%) were measured by GaitRite® and were used to detect differences between groups. Balance performance was also assessed with Mini-BEST and Four Step Square tests. In CD participants, correlation analysis was computed between gait parameters and clinical data. Significant differences in complex gait and balance performance were found between groups. CD patients showed lower speed, longer stance time and higher CV% and dual-task cost compared to HS. In CD, altered gait parameters correlated with balance performance and were not associated with clinical features of CD. Our findings suggest that complex walking performance is impaired in patients with CD and that balance and gait deficits might be related
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Affiliation(s)
- Oscar Crisafulli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Stefania Costi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Laura Avanzino
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy.
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy.
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
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12
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Genoves GG, Cruz CF, Doná F, Andrade TAM, Ferraz HB, Barela JA. Detection of passive movement in lower limb joints is impaired in individuals with Parkinson's disease. Neurophysiol Clin 2021; 51:279-285. [PMID: 33934993 DOI: 10.1016/j.neucli.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Sensory information is crucial when performing daily activities, and Parkinson's disease may diminish sensitivity to sensory cues. This study aimed to examine the detection threshold of passive motion of knee and ankle joints in individuals with Parkinson's disease. METHODS Eighteen individuals in the early stages of idiopathic Parkinson's disease (age: 62.7 ± 7.3 years) and 18 healthy matched controls (age: 62.5 ± 7.1 years) first performed a simple reaction time test. Participants were asked to perform ten trials, during which they had to watch a square on a screen and press a button as quickly as possible when the square lit up. Thereafter, the participants were tested for their detection threshold of passive motion of their lower limb joints. Participants were seated in a specially designed chair and their knee or ankle joint was passively moved at a velocity of 0.5º/s. Participants kept their eyes closed and were instructed to press a button as quickly as possible when any joint motion was detected. RESULTS Individuals with Parkinson's disease needed more time to perform the reaction time test than did the control participants. Individuals with Parkinson's disease also needed larger angular displacement, even when reaction time was used as a covariate measure, to detect any passive motion, in both knee (0.70º ± 0.20º) and ankle (1.03º ± 0.23º) joints than did the control participants [(0.57º ± 0.20º) and (0.84º ± 0.27º), respectively]. CONCLUSION Impaired joint proprioception can be observed in the early stages of Parkinson's disease, which may compromise the use of proprioception cues from lower limbs.
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Affiliation(s)
- Giovanna Gracioli Genoves
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - Caio Ferraz Cruz
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil
| | - Flávia Doná
- Federal University of São Paulo, São Paulo, SP, Brazil
| | | | | | - José Angelo Barela
- Institute of Biosciences, São Paulo State University, Rio Claro, SP, Brazil.
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13
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Vitorio R, Hasegawa N, Carlson-Kuhta P, Nutt JG, Horak FB, Mancini M, Shah VV. Dual-Task Costs of Quantitative Gait Parameters While Walking and Turning in People with Parkinson's Disease: Beyond Gait Speed. JOURNAL OF PARKINSONS DISEASE 2021; 11:653-664. [PMID: 33386812 DOI: 10.3233/jpd-202289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is a lack of recommendations for selecting the most appropriate gait measures of Parkinson's disease (PD)-specific dual-task costs to use in clinical practice and research. OBJECTIVE We aimed to identify measures of dual-task costs of gait and turning that best discriminate performance in people with PD from healthy individuals. We also investigated the relationship between the most discriminative measures of dual-task costs of gait and turning with disease severity and disease duration. METHODS People with mild-to-moderate PD (n = 144) and age-matched healthy individuals (n = 79) wore 8 inertial sensors while walking under single and dual-task (reciting every other letter of the alphabet) conditions. Outcome measures included 26 objective measures within four gait domains (upper/lower body, turning and variability). The area under the curve (AUC) from the receiver-operator characteristic plot was calculated to compare discriminative ability of dual-task costs on gait across outcome measures. RESULTS PD-specific, dual-task interference was identified for arm range of motion, foot strike angle, turn velocity and turn duration. Arm range of motion (AUC = 0.73) and foot strike angle (AUC = 0.68) had the largest AUCs across dual-task costs measures and they were associated with disease severity and/or disease duration. In contrast, the most commonly used dual-task gait measure, gait speed, showed an AUC of only 0.54. CONCLUSION Findings suggest that people with PD rely more than healthy individuals on executive-attentional resources to control arm swing, foot strike, and turning, but not gait speed. The dual-task costs of arm range of motion best discriminated people with PD from healthy individuals.
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Affiliation(s)
- Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Naoya Hasegawa
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | | | - John G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
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14
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Orcioli-Silva D, Vitório R, Nóbrega-Sousa P, Beretta VS, Conceição NRD, Oliveira AS, Pereira MP, Gobbi LTB. Cortical Activity Underlying Gait Improvements Achieved With Dopaminergic Medication During Usual Walking and Obstacle Avoidance in Parkinson Disease. Neurorehabil Neural Repair 2021; 35:406-418. [PMID: 33754884 DOI: 10.1177/15459683211000736] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dopaminergic medication improves gait in people with Parkinson disease (PD). However, it remains unclear if dopaminergic medication modulates cortical activity while walking. OBJECTIVE We investigated the effects of dopaminergic medication on cortical activity during unobstructed walking and obstacle avoidance in people with PD. METHODS A total of 23 individuals with PD, in both off (PDOFF) and on (PDON) medication states, and 30 healthy older adults (control group [CG]) performed unobstructed walking and obstacle avoidance conditions. Cortical activity was acquired through a combined functional near-infrared spectroscopy electroencephalography (EEG) system, along with gait parameters, through an electronic carpet. Prefrontal cortex (PFC) oxygenated hemoglobin (HbO2) and EEG absolute power from FCz, Cz, and CPz channels were calculated. RESULTS HbO2 concentration reduced for people with PDOFF during obstacle avoidance compared with unobstructed walking. In contrast, both people with PDON and the CG had increased HbO2 concentration when avoiding obstacles compared with unobstructed walking. Dopaminergic medication increased step length, step velocity, and β and γ power in the CPz channel, regardless of walking condition. Moreover, dopaminergic-related changes (ie, on-off) in FCz/CPz γ power were associated with dopaminergic-related changes in step length for both walking conditions. CONCLUSIONS PD compromises the activation of the PFC during obstacle avoidance, and dopaminergic medication facilitates its recruitment. In addition, PD medication increases sensorimotor integration during walking by increasing posterior parietal cortex (CPz) activity. Increased γ power in the CPz and FCz channels is correlated with step length improvements achieved with dopaminergic medication during unobstructed walking and obstacle avoidance in PD.
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Affiliation(s)
- Diego Orcioli-Silva
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Rodrigo Vitório
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Priscila Nóbrega-Sousa
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Victor Spiandor Beretta
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Núbia Ribeiro da Conceição
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | | | - Marcelo Pinto Pereira
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, São Paulo, Brazil
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15
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Facilitatory rTMS over the Supplementary Motor Cortex Impedes Gait Performance in Parkinson Patients with Freezing of Gait. Brain Sci 2021; 11:brainsci11030321. [PMID: 33802532 PMCID: PMC7999694 DOI: 10.3390/brainsci11030321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
Freezing of gait (FOG) in Parkinson’s disease (PD) occurs frequently in situations with high environmental complexity. The supplementary motor cortex (SMC) is regarded as a major network node that exerts cortical input for motor control in these situations. We aimed at assessing the impact of single-session (excitatory) intermittent theta burst stimulation (iTBS) of the SMC on established walking during FOG provoking situations such as passing through narrow spaces and turning for directional changes. Twelve PD patients with FOG underwent two visits in the off-medication state with either iTBS or sham stimulation. At each visit, spatiotemporal gait parameters were measured during walking without obstacles and in FOG-provoking situations before and after stimulation. When patients passed through narrow spaces, decreased stride time along with increased stride length and walking speed (i.e., improved gait) was observed after both sham stimulation and iTBS. These effects, particularly on stride time, were attenuated by real iTBS. During turning, iTBS resulted in decreased stride time along with unchanged stride length, a constellation compatible with increased stepping frequency. The observed iTBS effects are regarded as relative gait deterioration. We conclude that iTBS over the SMC increases stepping frequency in PD patients with FOG, particularly in FOG provoking situations.
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16
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Chow R, Tripp BP, Rzondzinski D, Almeida QJ. Investigating Therapies for Freezing of Gait Targeting the Cognitive, Limbic, and Sensorimotor Domains. Neurorehabil Neural Repair 2021; 35:290-299. [PMID: 33559531 PMCID: PMC7934156 DOI: 10.1177/1545968321992331] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Freezing of gait (FOG) is arguably the most disabling motor symptom experienced with Parkinson’s disease (PD), but treatments are extremely limited due to our poor understanding of the underlying mechanisms. Three cortical domains are postulated in recent research (ie, the cognitive, limbic, and sensorimotor domains), thus, treatments targeting these mechanisms of FOG may potentially be effective. Cognitive training, cognitive behavioral therapy (CBT, a well-known anxiety intervention), and proprioceptive training may address the cognitive, limbic, and sensorimotor domains, respectively. Objective To investigate whether these 3 treatments could improve functional outcomes of FOG. Methods In a single-blind, randomized crossover design, 15 individuals with PD and FOG were randomized into different, counterbalanced orders of receiving the interventions. Each consisted of eight 1-hour sessions, twice weekly for 4 weeks. FOG severity was assessed as the primary outcome using a novel gait paradigm that was aimed at evoking FOG when the cognitive, limbic, or sensorimotor domains were independently challenged. Results FOG severity significantly improved after the cognitive intervention, with strong trends toward improvement specifically in the baseline and cognitive-challenge assessment conditions. CBT, as the anxiety intervention, resulted in significantly worse FOG severity. In contrast, proprioceptive training significantly improved FOG severity, with consistent trends across all conditions. Conclusions The cognitive and proprioceptive treatments appeared to improve different aspects of FOG. Thus, either of these interventions could potentially be a viable treatment for FOG. However, although the results were statistically significant, they could be sensitive to the relatively small number of participants in the study. Considering the significant results together with nonsignificant trends in both FOG and gait measures, and given equal time for each intervention, proprioceptive training produced the most consistent indications of benefits in this study. (clinicaltrials.gov NCT03065127).
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Affiliation(s)
- Rebecca Chow
- Wilfrid Laurier University, Waterloo, Ontario, Canada
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17
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Pelosin E, Cerulli C, Ogliastro C, Lagravinese G, Mori L, Bonassi G, Mirelman A, Hausdorff JM, Abbruzzese G, Marchese R, Avanzino L. A Multimodal Training Modulates Short Afferent Inhibition and Improves Complex Walking in a Cohort of Faller Older Adults With an Increased Prevalence of Parkinson's Disease. J Gerontol A Biol Sci Med Sci 2021; 75:722-728. [PMID: 30874799 DOI: 10.1093/gerona/glz072] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Falls are frequent in Parkinson's disease and aging. Impairments in the cholinergic-mediated attentional supervision of gait may contribute to increased fall risk, especially when obstacles challenge gait. Interventions combining motor-cognitive approaches have been shown to improve motor performance, cognitive skills, and falls number. Here, we hypothesized that an intervention simulating an attention-demanding walking condition could affect not only complex gait performance and fall risk but also short-latency afferent inhibition (SAI), as a marker of cholinergic activity. METHODS Thirty-nine participants at falls risk (24 Parkinson's disease participants and 15 older adults) were recruited in a randomized controlled trial. Participants were assigned to treadmill training or treadmill training with non-immersive virtual reality intervention and trained three times a week for 6 weeks. SAI, a transcranial magnetic stimulation paradigm, was used to assess cholinergic activity. Gait kinematics was measured during usual walking and while negotiating physical obstacles. Transcranial magnetic stimulation and gait assessments were performed pre, post, and 6 months post-intervention. RESULTS Treadmill training combined with non-immersive virtual reality induced an increase in inhibition of the SAI protocol on cortical excitability, improved obstacle negotiation performance, and induced a reduction of the number of falls compared with treadmill training. Furthermore, the more SAI increased after training, the more the obstacle negotiation performance improved and fall rate decreased. CONCLUSIONS We provide evidence that an innovative rehabilitation approach targeting cognitive components of complex motor actions can induce changes in cortical cholinergic activity, as indexed by SAI, thereby enabling functional gait improvements.
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Affiliation(s)
- Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Italy.,Ospedale Policlinico San Martino, IRCSS, Genova, Italy
| | - Cecilia Cerulli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Italy
| | - Carla Ogliastro
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Italy.,Ospedale Policlinico San Martino, IRCSS, Genova, Italy
| | - Giovanna Lagravinese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Italy
| | - Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Italy.,Ospedale Policlinico San Martino, IRCSS, Genova, Italy
| | - Gaia Bonassi
- Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Italy
| | - Anat Mirelman
- Center for the Study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Israel.,Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Israel.,Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Israel.,Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Italy.,Ospedale Policlinico San Martino, IRCSS, Genova, Italy
| | | | - Laura Avanzino
- Ospedale Policlinico San Martino, IRCSS, Genova, Italy.,Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Italy
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18
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Lee A, Hellmers N, Vo M, Wang F, Popa P, Barkan S, Patel D, Campbell C, Henchcliffe C, Sarva H. Can google glass™ technology improve freezing of gait in parkinsonism? A pilot study. Disabil Rehabil Assist Technol 2020; 18:327-332. [PMID: 33216658 DOI: 10.1080/17483107.2020.1849433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Freezing of gait (FOG) is a disabling phenomenon defined by the periodic absence or reduction of forward progression of the feet despite the intention to walk. We sought to understand whether Google Glass (GG), a lightweight wearable device that provides simultaneous visual-auditory cues, might improve FOG in parkinsonism. METHODS Patients with parkinsonism and FOG utilized GG custom-made auditory-visual cue applications: "Walk With Me" and "Unfreeze Me" in a single session intervention. We recorded ambulation time with and without GG under multiple conditions including 25 feet straight walk, dual task of performing serial 7's while straight walking, 180 degree turn after walking 25 feet, and walking through a doorway. FOG and patient experience questionnaires were administered. RESULTS Using the GG "Walk With Me" program, improvements were noted in the following: average 25 feet straight walk by 0.32 s (SD 2.12); average dual task of serial 7's and 25 feet straight walk by 1.79 s (SD 2.91); and average walk through doorway by 0.59 s (SD 0.81). Average 180 degree turn after 25 feet walk worsened by 1.89 s (SD 10.66). Using the "Unfreeze Me" program, only the average dual task of serial 7's and 25 feet straight walk improved (better by 0.82 s (SD 3.08 sec). All other tasks had worse performance in terms of speed of completion. CONCLUSION This feasibility study provides preliminary data suggesting that some walking tasks may improve with GG, which uses various musical dance programs to provide visual and auditory cueing for patients with FOG.IMPLICATIONS FOR REHABILITATIONFreezing of gait in parkinsonian syndromes is a disabling motor block described by patients as having their feet stuck to the floor leading to difficulty in initiation of gait and increased risk for falls.Wearable assistive devices such as Google Glass™ use visual and auditory cueing that may improve gait pattern in patients with freezing of gait.Augmented reality programs using wearable assistive devices are a home-based therapy, with the potential for reinforcing physical therapy techniques; this is especially meaningful during the COVID-19 pandemic when access to both medical and rehabilitative care has been curtailed.
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Affiliation(s)
- Andrea Lee
- Weill Cornell Medical College, New York, NY, USA
| | | | - Mary Vo
- Weill Cornell Medical College, New York, NY, USA
| | - Fei Wang
- Weill Cornell Medical College, New York, NY, USA
| | - Paul Popa
- Weill Cornell Medical College, New York, NY, USA
| | | | - Dylon Patel
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Harini Sarva
- Weill Cornell Medical College, New York, NY, USA
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19
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Fearon C, Butler JS, Waechter SM, Killane I, Kelly SP, Reilly RB, Lynch T. Neurophysiological correlates of dual tasking in people with Parkinson's disease and freezing of gait. Exp Brain Res 2020; 239:175-187. [PMID: 33135132 DOI: 10.1007/s00221-020-05968-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/21/2020] [Indexed: 11/24/2022]
Abstract
Freezing of gait in people with Parkinson's disease (PwP) is associated with executive dysfunction and motor preparation deficits. We have recently shown that electrophysiological markers of motor preparation, rather than decision-making, differentiate PwP with freezing of gait (FOG +) and without (FOG -) while sitting. To examine the effect of locomotion on these results, we measured behavioural and electrophysiological responses in PwP with and without FOG during a target response time task while sitting (single-task) and stepping-in-place (dual-task). Behavioural and electroencephalographic data were acquired from 18 PwP (eight FOG +) and seven young controls performing the task while sitting and stepping-in-place. FOG + had slower response times while stepping compared with sitting. However, response times were significantly faster while stepping compared with sitting for controls. Electrophysiological responses showed no difference in decision-making potentials (centroparietal positivity) between groups or conditions but there were differences in neurophysiological markers of response inhibition (N2) and motor preparation (lateralized readiness potential, LRP) in FOG + while performing a dual-task. This suggests that the addition of a second complex motor task (stepping-in-place) impacts automatic allocation of resources in FOG +, resulting in delayed response times. The impact of locomotion on the generation of the N2 and LRP potentials, particularly in freezers, indirectly implies that these functions compete with locomotion for resources. In the setting of multiple complex tasks or cognitive impairment, severe motor dysfunction may result, leading to freezing of gait.
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Affiliation(s)
- Conor Fearon
- Trinity Centre for Bioengineering, The School of Medicine and the School of Engineering, Trinity College, The University of Dublin, Dublin 2, Ireland.
- School of Engineering, Trinity College, The University of Dublin, Dublin 2, Ireland.
- Dublin Neurological Institute at the Mater Misericordiae University Hospital, 57 Eccles Street, Dublin 7, Ireland.
| | - John S Butler
- Trinity Centre for Bioengineering, The School of Medicine and the School of Engineering, Trinity College, The University of Dublin, Dublin 2, Ireland.
- School of Mathematical Sciences, Technological University Dublin, Kevin Street, Dublin, Ireland.
- School of Medicine, Trinity College, The University of Dublin, Dublin 2, Ireland.
| | - Saskia M Waechter
- Trinity Centre for Bioengineering, The School of Medicine and the School of Engineering, Trinity College, The University of Dublin, Dublin 2, Ireland
- School of Engineering, Trinity College, The University of Dublin, Dublin 2, Ireland
| | - Isabelle Killane
- Trinity Centre for Bioengineering, The School of Medicine and the School of Engineering, Trinity College, The University of Dublin, Dublin 2, Ireland
- School of Engineering, Trinity College, The University of Dublin, Dublin 2, Ireland
- School of Mechanical and Design Engineering, Technological University Dublin, Bolton Street, Dublin, Ireland
| | - Simon P Kelly
- School of Electrical and Electronic Engineering, University College Dublin, Dublin 4, Ireland
| | - Richard B Reilly
- Trinity Centre for Bioengineering, The School of Medicine and the School of Engineering, Trinity College, The University of Dublin, Dublin 2, Ireland
- School of Engineering, Trinity College, The University of Dublin, Dublin 2, Ireland
- School of Medicine, Trinity College, The University of Dublin, Dublin 2, Ireland
| | - Timothy Lynch
- Dublin Neurological Institute at the Mater Misericordiae University Hospital, 57 Eccles Street, Dublin 7, Ireland
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20
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Hardeman LES, Kal EC, Young WR, van der Kamp J, Ellmers TJ. Visuomotor control of walking in Parkinson's disease: Exploring possible links between conscious movement processing and freezing of gait. Behav Brain Res 2020; 395:112837. [PMID: 32739286 DOI: 10.1016/j.bbr.2020.112837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/10/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Changes in visual attention have been argued to influence freezing of gait (FOG) in people with Parkinson's Disease (PD). However, the specific visual search patterns of people with FOG pathology (PD + FOG) and potential underlying mechanisms are not well understood. The current study explored visual search behavior in PD + FOG while walking on a pathway featuring environmental features known to exacerbate FOG (e.g., narrow doorway and tripping hazards). Potential underpinning attentional mechanisms were also assessed, such as conscious movement processing. METHODS Visual search behavior of twelve people with PD + FOG tested in ON-state (Mage = 74.3) and twelve age-matched healthy controls (Mage = 72.5) were analyzed during a complex walking task. The task required participants to step over an obstacle and navigate through a narrow doorway, surrounded by clutter. RESULTS People with PD + FOG more frequently directed visual attention to ongoing and imminent steps compared to healthy controls (Mdn = 26% vs Mdn = 14%, respectively; p = 0.042). Self-reported conscious movement processing was also significantly higher in people with PD + FOG. The one participant who froze during the walking task fixated the future trip hazard (obstacle, approximately 6 steps ahead) almost exclusively during freezing trials (i.e., 60-100% of the trial). In contrast, during 'non-freeze' trials, this participant increased the duration of fixations towards ongoing and imminent steps. CONCLUSION Results suggest that people with PD + FOG strongly monitor/control ongoing and immediately upcoming stepping movements. However, prolonged fixations towards threats to future movements might prevent people with PD + FOG from processing the visual information needed to do this, thereby provoke freezing episodes.
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Affiliation(s)
- L E S Hardeman
- Faculty of Behavioral and Movement Sciences, VU University Amsterdam, Netherlands; College of Health, Medicine and Life Sciences, Brunel University London, UK
| | - E C Kal
- College of Health, Medicine and Life Sciences, Brunel University London, UK; Centre for Cognitive Neuroscience, Brunel University London, UK
| | - W R Young
- College of Health, Medicine and Life Sciences, Brunel University London, UK; School of Sport and Health Sciences, University of Exeter, UK
| | - J van der Kamp
- Faculty of Behavioral and Movement Sciences, VU University Amsterdam, Netherlands
| | - T J Ellmers
- College of Health, Medicine and Life Sciences, Brunel University London, UK; Centre for Cognitive Neuroscience, Brunel University London, UK.
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Ehgoetz Martens KA, Peterson DS, Almeida QJ, Lewis SJG, Hausdorff JM, Nieuwboer A. Behavioural manifestations and associated non-motor features of freezing of gait: A narrative review and theoretical framework. Neurosci Biobehav Rev 2020; 116:350-364. [PMID: 32603716 DOI: 10.1016/j.neubiorev.2020.06.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022]
Abstract
Over the past decade, non-motor related symptoms and provocative contexts have offered unique opportunities to gain insight into the potential mechanisms that may underpin freezing of gait (FOG) in Parkinson's disease (PD). While this large body of work has informed several theoretical models, to date, few are capable of explaining behavioural findings across multiple domains (i.e. cognitive, sensory-perceptual and affective) and in different behavorial contexts. As such, the exact nature of these interrelationships and their neural basis remain quite enigmatic. Here, the non-motor, behavioural evidence for cognitive, sensory-perceptual and affective contributors to FOG are reviewed and synthesized by systematically examining (i) studies that manipulated contextual environments that provoke freezing of gait, (ii) studies that uncovered factors that have been proposed to contribute to freezing, and (iii) studies that longitudinally tracked factors that predict the future development of freezing of gait. After consolidating the evidence, we offer a novel perspective for integrating these multi-faceted behavioural patterns and identify key challenges that warrant consideration in future work.
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Affiliation(s)
| | - Daniel S Peterson
- College of Health Solutions, Arizona State University, Arizona, USA; Phoenix Veterans Affairs Medical Centre, Arizona, USA
| | - Quincy J Almeida
- Movement Disorders Research & Rehabilitation Centre, Laurier University, Waterloo, ON, Canada
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Dept of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alice Nieuwboer
- Department of Rehabilitation Science, University of Leuven, Leuven, Belgium
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22
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Pieruccini-Faria F, Montero-Odasso M. Obstacle Negotiation, Gait Variability, and Risk of Falling: Results From the "Gait and Brain Study". J Gerontol A Biol Sci Med Sci 2020; 74:1422-1428. [PMID: 30380013 DOI: 10.1093/gerona/gly254] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Gait variability is an early fall predictor. However, it is unknown how gait variability of older adults at high risk of falls is affected by an obstacle negotiation task. We aimed to compare gait performance between older adults with significant history of falls (i.e. fallers) and nonfallers while approaching an obstacle crossing. METHODS A total of 137 older adults without dementia were enrolled (72.7 ± 5.1 years of age; 60.5% women) from the "Gait and Brain Study." Fallers were defined as having at least one injurious fall or at least two noninjurious falls in the previous 12 months. Participants performed gait assessments under unobstructed and obstructed conditions. During the obstructed condition, participants walked and stepped over an ad hoc obstacle set at 15% of participants' height, transversally placed on a 6-meter electronic walkway. Gait speed and step-to-step variabilities were quantified from the last six steps prior to obstacle crossing. Analysis of variance models adjusted for age, sex, fear of falling, comorbidities, and unobstructed gait were used to compare gait performance of fallers and nonfallers during an obstacle approaching. RESULTS In the study, 27 older adults were identified as fallers and 110 as nonfallers. Fallers had higher step time variability and step length variability when approaching an obstacle compared with nonfallers, although groups had comparable gait performance during unobstructed walking. CONCLUSION Gait variability of older individuals at high risk of falling is more disturbed, compared with low-risk individuals, while approaching an obstacle crossing. High gait variability prior to crossing an obstacle may be a risk factor for falls.
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Affiliation(s)
- Frederico Pieruccini-Faria
- Division of Geriatric Medicine, Department of Medicine, University of Western Ontario, London.,Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, London, ON
| | - Manuel Montero-Odasso
- Division of Geriatric Medicine, Department of Medicine, University of Western Ontario, London.,Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, London, ON.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada
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23
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Alcock L, Galna B, Hausdorff JM, Lord S, Rochester L. Enhanced Obstacle Contrast to Promote Visual Scanning in Fallers with Parkinson's Disease: Role of Executive Function. Neuroscience 2020; 436:82-92. [PMID: 32222557 DOI: 10.1016/j.neuroscience.2020.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 03/01/2020] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Abstract
The ability to perceive differences in environmental contrast is critical for navigating complex environments safely. People with Parkinson's disease (PD) report a multitude of visual and cognitive deficits which may impede safe obstacle negotiation and increase fall risk. Enhancing obstacle contrast may influence the content of visual information acquired within complex environments and thus target environmental fall risk factors. 17 PD with a history of falls and 18 controls walked over an obstacle covered in a high and low contrast material in separate trials whilst eye movements were recorded. Measures of visual function and cognition were obtained. Gaze location was extracted during the approach phase. PD spent longer looking at the obstacle compared to controls regardless of contrast (p < .05), however group differences were largest for the low contrast obstacle. When accounting for group differences in approach time, PD spent longer looking at the low contrast obstacle and less time looking at the ground beyond the low contrast obstacle compared to controls (p < .05). The response to obstacle contrast in PD (high-low) was significantly associated with executive function. Better executive function was associated with spending longer looking at the low contrast obstacle and at the ground beyond the high contrast obstacle. Enhancing the contrast of ground-based trip hazards may improve visual processing of environmental cues in PD, particularly for individuals with better executive function. Manipulating contrast to attract visual attention is already in use in the public domain, however its utility for reducing fall risk in PD is yet to be formally tested in habitual settings.
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Affiliation(s)
- Lisa Alcock
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Brook Galna
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA; Sagol School of Neuroscience and Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sue Lord
- School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Lynn Rochester
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
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24
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Rutz DG, Benninger DH. Physical Therapy for Freezing of Gait and Gait Impairments in Parkinson Disease: A Systematic Review. PM R 2020; 12:1140-1156. [PMID: 31994842 DOI: 10.1002/pmrj.12337] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 01/20/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Freezing of gait (FOG) is a major cause of falls and disability in Parkinson disease (PD). As FOG only partially improves in response to dopaminergic medication, physical therapy is an important element of its management. OBJECTIVE To assess the evidence for the physical interventions for FOG and gait impairments and to establish recommendations for clinical practice. LITERATURE SURVEY This review follows the guidelines for systematic reviews: the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Systematic search in PubMed, Embase, Physiotherapy Evidence Databases, and CINAHL for randomized controlled trials of PT interventions for FOG in PD patients until April 2018. SYNTHESIS Twenty randomized controlled trials (RCTs) were reviewed. In 12 RCTs, PT for FOG was assessed, which was the primary outcome measure in nine of these RCTs. In eight RCTs, PT for gait impairment (not targeting specifically FOG) in PD was assessed. The following PT interventions reduce FOG with a good category A recommendation: cueing strategies (P < .05) (visual and auditory); treadmill walking (P < .05); aquatic obstacle training (P < .01); supervised slackline training (P < .05). These interventions can be combined and maintain their efficacy when being applied concurrently: though there is a lack of long-term follow-up studies. The following PT interventions show possible benefit and need further investigations: balance and coordination training; aquatic gait training; sensory (tactile) cues. The treadmill training and auditory and visual cues are effective also for other gait disturbances in PD and improve gait kinematics. CONCLUSIONS Visual and auditory cueing and the treadmill training are effective interventions for FOG and gait impairments in PD patients (evidence level A- according to the European Federation of Neurological Societies). Tactile cues and other specific therapies targeting FOG are probably effective but need further studies.
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Affiliation(s)
- Dionys G Rutz
- Physical Therapy Unit, Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - David H Benninger
- Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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25
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Zhang W, Low LF, Schwenk M, Mills N, Gwynn JD, Clemson L. Review of Gait, Cognition, and Fall Risks with Implications for Fall Prevention in Older Adults with Dementia. Dement Geriatr Cogn Disord 2020; 48:17-29. [PMID: 31743907 DOI: 10.1159/000504340] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Older people with cognitive impairment are at increased risk of falls; however, fall prevention strategies have limited success in this population. The aim of this paper is to review the literature to inform a theoretical framework for fall prevention in older adults with dementia. SUMMARY A narrative review was conducted on fall risk factors in people with cognitive impairment, the relationship between cognition and gait, and their joint impact on the risk of falls. This was used to develop a theoretical framework for fall prevention for people with dementia. Executive function and motor function are closely related as they share neuroanatomy. This close relationship has been confirmed by observational studies including neuroimaging and intervention studies. Executive function is the cognitive domain most commonly associated with gait dysfunction. Attention, sensory integration, and motor planning are the sub-domains of executive function associated with risk of falls through gait dysfunction, whereas cognitive flexibility, judgement, and inhibitory control affect risk of falls through risk-taking behaviour. Key Messages: Gait, cognition, and falls are closely related. The comorbidity and interaction between gait abnormality and cognitive impairment may underpin the high prevalence of falls in older adults with dementia. Gait assessment and cognitive assessment, particularly executive function, should be integrated in fall risk screening. Assessment results should be interpreted and utilised using a multidisciplinary approach; specific strategies such as customised gait training and behavioural modulation should be considered as part of falls prevention for people with dementia.
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Affiliation(s)
- Weihong Zhang
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia, .,Department of Occupational Therapy, Wolper Jewish Hospital, Sydney, New South Wales, Australia,
| | - Lee-Fay Low
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Michael Schwenk
- Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Nicholas Mills
- Department of Geriatric Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Josephine Diana Gwynn
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Lindy Clemson
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
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26
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Stern RB, d'Alencar MS, Uscapi YL, Gubitoso MD, Roque AC, Helene AF, Piemonte MEP. Goalkeeper Game: A New Assessment Tool for Prediction of Gait Performance Under Complex Condition in People With Parkinson's Disease. Front Aging Neurosci 2020; 12:50. [PMID: 32194393 PMCID: PMC7064547 DOI: 10.3389/fnagi.2020.00050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 02/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background: People with Parkinson's disease (PD) display poorer gait performance when walking under complex conditions than under simple conditions. Screening tests that evaluate gait performance changes under complex walking conditions may be valuable tools for early intervention, especially if allowing for massive data collection. Objectives: To investigate the use of the Goalkeeper Game (GG) to predict impairment in gait performance under complex conditions in people with Parkinson's disease (PPD) and compare its predictive power with the one of the Montreal Cognitive Assessment (MoCA) test. Methods: 74 PPD (HY stages: 23 in stage 1; 31 in stage 2; 20 in stage 3), without dementia (MoCA cut-off 21), tested in ON period with dopaminergic medication were submitted to single individual cognitive/motor evaluation sessions. MoCA and GG were used to assess cognition, and the dynamic gait index (DGI) test was used to assess gait performance under complex condition. GG test resulted in 9 measures extracted via a statistical model. The predictive power of the GG measures and the MoCA score with respect to gait performance, as assessed by DGI, were compared. Results: The predictive models based on GG obtained a better score of prediction (65%) then MoCA (56%) for DGI scores (at a 50% specificity). Conclusion: GG is a novel tool for noninvasive screening that showed a superior predictive power in assessing gait performance under complex condition in people with PD than the well-established MoCa test.
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Affiliation(s)
- Rafael B. Stern
- Department of Statistics, Federal University of São Carlos, São Carlos, Brazil
| | - Matheus Silva d'Alencar
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
| | - Yanina L. Uscapi
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Marco D. Gubitoso
- Department of Computer Science, Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Antonio C. Roque
- Department of Physics, School of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - André F. Helene
- Department of Physiology, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Maria Elisa Pimentel Piemonte
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, Faculty of Medical Science, University of São Paulo, São Paulo, Brazil
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27
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Montero-Odasso M, Almeida QJ, Bherer L, Burhan AM, Camicioli R, Doyon J, Fraser S, Muir-Hunter S, Li KZH, Liu-Ambrose T, McIlroy W, Middleton L, Morais JA, Sakurai R, Speechley M, Vasudev A, Beauchet O, Hausdorff JM, Rosano C, Studenski S, Verghese J. Consensus on Shared Measures of Mobility and Cognition: From the Canadian Consortium on Neurodegeneration in Aging (CCNA). J Gerontol A Biol Sci Med Sci 2020; 74:897-909. [PMID: 30101279 PMCID: PMC6521916 DOI: 10.1093/gerona/gly148] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Indexed: 02/02/2023] Open
Abstract
Background A new paradigm is emerging in which mobility and cognitive impairments, previously studied, diagnosed, and managed separately in older adults, are in fact regulated by shared brain resources. Deterioration in these shared brain mechanisms by normal aging and neurodegeneration increases the risk of developing dementia, falls, and fractures. This new paradigm requires an integrated approach to measuring both domains. We aim to identify a complementary battery of existing tests of mobility and cognition in community-dwelling older adults that enable assessment of motor-cognitive interactions. Methods Experts on mobility and cognition in aging participated in a semistructured consensus based on the Delphi process. After performing a scoping review to select candidate tests, multiple rounds of consultations provided structured feedback on tests that captured shared characteristics of mobility and cognition. These tests needed to be sensitive to changes in both mobility and cognition, applicable across research studies and clinics, sensitive to interventions, feasible to perform in older adults, been previously validated, and have minimal ceiling/floor effects. Results From 17 tests appraised, 10 tests fulfilled prespecified criteria and were selected as part of the “Core-battery” of tests. The expert panel also recommended a “Minimum-battery” of tests that included gait speed, dual-task gait speed, the Montreal Cognitive Assessment and Trail Making Test A&B. Conclusions A standardized assessment battery that captures shared characteristics of mobility and cognition seen in aging and neurodegeneration may increase comparability across research studies, detection of subtle or common reversible factors, and accelerate research progress in dementia, falls, and aging-related disabilities.
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Affiliation(s)
- Manuel Montero-Odasso
- Department of Medicine, Division of Geriatric Medicine, University of Western Ontario, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
- Address correspondence to: Manuel Montero-Odasso MD, PhD, AGSF, FRCPC, FGSA, Gait and Brain Lab, Parkwood Institute, University of Western Ontario and Lawson Health Research Institute, 550 Wellington Road, London, Ontario N6C 0A7, Canada. E-mail:
| | - Quincy J Almeida
- Department of Kinesiology and Physical Education, Sun Life Financial Movement Disorders Research Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Louis Bherer
- Department of Psychology and PERFORM Centre, Concordia University, Montréal, Quebec, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Quebec, Canada
- Department of Medicine, University of Montreal, Quebec, Canada
- Montreal Heart Institute, Research Centre, Quebec, Canada
| | - Amer M Burhan
- Department of Psychiatry, Geriatric Psychiatry, Schulich School of Medicine, University of Western Ontario, London, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Richard Camicioli
- Department of Medicine, Geriatric and Cognitive Neurology, University of Alberta, Edmonton, Canada
| | - Julien Doyon
- Functional Neuroimaging Unit, University of Montreal, Quebec, Canada
| | - Sarah Fraser
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Susan Muir-Hunter
- Department of Medicine, Division of Geriatric Medicine, University of Western Ontario, London, Canada
- Faculty of Health Sciences, School of Physical Therapy, University of Western Ontario, London, Canada
| | - Karen Z H Li
- Department of Psychology and PERFORM Centre, Concordia University, Montréal, Quebec, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Centre for Hip Health and Mobility, University of British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Research Institute, University of British Columbia, Canada
| | - William McIlroy
- Division of Neurology and Department of Medicine, University of Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada
- Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - Laura Middleton
- Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - José A Morais
- Department of Medicine, Division of Geriatrics and Centre of Excellence in Aging and Chronic Disease, McGill University, Montréal, Quebec, Canada
| | - Ryota Sakurai
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Akshya Vasudev
- Department of Psychiatry, Geriatric Psychiatry, Schulich School of Medicine, University of Western Ontario, London, Canada
- Department of Medicine, Division of Clinical Pharmacology, University of Western Ontario, London, Canada
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montréal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec, Canada
- RUIS McGill Centre of Excellence on Aging and Chronic Disease – CEViMaC, Montréal, Quebec, Canada
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Israel
- Rush Alzheimer’s Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Stephanie Studenski
- Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pennsylvania
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
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28
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Ferrazzoli D, Ortelli P, Cucca A, Bakdounes L, Canesi M, Volpe D. Motor-cognitive approach and aerobic training: a synergism for rehabilitative intervention in Parkinson's disease. Neurodegener Dis Manag 2020; 10:41-55. [PMID: 32039653 DOI: 10.2217/nmt-2019-0025] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Parkinson's disease (PD) results in a complex deterioration of motor behavior. Effective pharmacological or surgical treatments addressing the whole spectrum of both motor and cognitive symptoms are lacking. The cumulative functional impairment may have devastating socio-economic consequences on both patients and caregivers. Comprehensive models of care based on multidisciplinary approaches may succeed in better addressing the overall complexity of PD. Neurorehabilitation is a highly promising non-pharmacological intervention for managing PD. The scientific rationale beyond rehabilitation and its practical applicability remain to be established. In the present perspective, we aim to discuss the current evidence supporting integrated motor-cognitive and aerobic rehabilitation approaches for patients with PD while suggesting a practical framework to optimize this intervention in the next future.
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Affiliation(s)
- Davide Ferrazzoli
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Paola Ortelli
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Alberto Cucca
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy.,The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, Department of Neurology, NYU School of Medicine, New York, NY 10017, USA
| | - Leila Bakdounes
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy
| | - Margherita Canesi
- Fresco Parkinson Center, Department of Parkinson's disease, Movement Disorders & Brain Injury Rehabilitation, 'Moriggia-Pelascini' Hospital - Gravedona ed Uniti, Como, 22015, Italy
| | - Daniele Volpe
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, 36057, Italy
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29
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Lord SR, Bindels H, Ketheeswaran M, Brodie MA, Lawrence AD, Close JCT, Whone AL, Ben-Shlomo Y, Henderson EJ. Freezing of Gait in People with Parkinson's Disease: Nature, Occurrence, and Risk Factors. JOURNAL OF PARKINSON'S DISEASE 2020; 10:631-640. [PMID: 32116261 DOI: 10.3233/jpd-191813] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is a common symptom of Parkinson's disease (PD) which can result in falls and fall related injuries, poor quality of life and reduced functional independence. It is a heterogeneous phenomenon that is difficult to quantify and eludes a unified pathophysiological framework. OBJECTIVE Our aim was to document the occurrence and nature of freezing, cognitive stops and stumbles in people with PD during walks with varying cognitive loads and conditions designed to elicit FOG. METHODS 130 people with PD walked under four conditions (normal walking, walking plus easy and hard dual-tasks, and a FOG elicitation condition. Video and accelerometry recordings were examined to document freezes and other gait disruptions. RESULTS Participants experienced 391 freezes, 97 cognitive stops and 73 stumbles in the trial walks; with total gait disruptions increasing with task complexity. Most freezes in the FOG elicitation condition occurred during turning and approach destination. People who experienced freezing during the walks were more likely to have Postural Instability and Gait Difficulty (PIGD) subtype, longer disease duration and more severe UPDRS part II and part III sub-scores than people who did not freeze. They also took higher doses of levodopa, reported freezing in the past month, more prior falls, had poorer executive function, poorer proprioception, slower reaction time, poorer standing and leaning balance, more depressive symptoms, lower quality of life and greater fear of falling. PD disease duration, reduced controlled leaning balance and poor proprioception were identified as independent and significant determinants of freezing in logistic regression analysis. CONCLUSION The multiple motor and cognitive factors identified as being associated with freezing, including poor proprioception and impaired controlled leaning balance provide new insights into this debilitating PD symptom and may contribute to potential new targets for rehabilitation.
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Affiliation(s)
- Stephen R Lord
- Neuroscience Research Australia, UNSW, Sydney, Australia
| | - Helen Bindels
- Department of Applied Health Sciences, University of Applied Sciences, Bochum, Germany
| | | | | | - Andrew D Lawrence
- School of Psychology and Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, UK
| | - Jacqueline C T Close
- Neuroscience Research Australia, UNSW, Sydney, Australia
- Prince of Wales Clinical School, UNSW, Sydney, NSW, Australia
| | - Alan L Whone
- Translational Health Sciences, Bristol Medical School, University of Bristol, UK
- Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- Royal United Hospitals NHS Bath Foundation Trust, Combe Park, Bath, UK
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30
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Ehgoetz Martens KA, Hall JM, Georgiades MJ, Gilat M, Walton CC, Matar E, Lewis SJG, Shine JM. The functional network signature of heterogeneity in freezing of gait. Brain 2019; 141:1145-1160. [PMID: 29444207 DOI: 10.1093/brain/awy019] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/12/2017] [Indexed: 11/12/2022] Open
Abstract
Freezing of gait is a complex, heterogeneous, and highly variable phenomenon whose pathophysiology and neural signature remains enigmatic. Evidence suggests that freezing is associated with impairments across cognitive, motor and affective domains; however, most research to date has focused on investigating one axis of freezing of gait in isolation. This has led to inconsistent findings and a range of different pathophysiological models of freezing of gait, due in large part to the tendency for studies to investigate freezing of gait as a homogeneous entity. To investigate the neural mechanisms of this heterogeneity, we used an established virtual reality paradigm to elicit freezing behaviour in 41 Parkinson's disease patients with freezing of gait and examined individual differences in the component processes (i.e. cognitive, motor and affective function) that underlie freezing of gait in conjunction with task-based functional MRI. First, we combined three unique components of the freezing phenotype: impaired set-shifting ability, step time variability, and self-reported anxiety and depression in a principal components analysis to estimate the severity of freezing behaviour with a multivariate approach. By combining these measures, we were then able to interrogate the pattern of task-based functional connectivity associated with freezing (compared to normal foot tapping) in a sub-cohort of 20 participants who experienced sufficient amounts of freezing during task functional MRI. Specifically, we used the first principal component from our behavioural analysis to classify patterns of functional connectivity into those that were associated with: (i) increased severity; (ii) increased compensation; or (iii) those that were independent of freezing severity. Coupling between the cognitive and limbic networks was associated with 'worse freezing severity', whereas anti-coupling between the putamen and the cognitive and limbic networks was related to 'increased compensation'. Additionally, anti-coupling between cognitive cortical regions and the caudate nucleus were 'independent of freezing severity' and thus may represent common neural underpinnings of freezing that are unaffected by heterogenous factors. Finally, we related these connectivity patterns to each of the individual components (cognitive, motor, affective) in turn, thus exposing latent heterogeneity in the freezing phenotype, while also identifying critical functional network signatures that may represent potential targets for novel therapeutic intervention. In conclusion, our findings provide confirmatory evidence for systems-level impairments in the pathophysiology of freezing of gait and further advance our understanding of the whole-brain deficits that mediate symptom expression in Parkinson's disease.
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Affiliation(s)
- Kaylena A Ehgoetz Martens
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia
| | - Julie M Hall
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia.,School of Social Sciences and Psychology, Western Sydney University, Australia
| | - Matthew J Georgiades
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia
| | - Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia
| | - Courtney C Walton
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia
| | - Elie Matar
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia
| | - James M Shine
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.,ForeFront, Brain and Mind Centre, University of Sydney, Australia
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Maidan I, Jacob Y, Giladi N, Hausdorff JM, Mirelman A. Altered organization of the dorsal attention network is associated with freezing of gait in Parkinson's disease. Parkinsonism Relat Disord 2019; 63:77-82. [DOI: 10.1016/j.parkreldis.2019.02.036] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 02/20/2019] [Accepted: 02/22/2019] [Indexed: 01/29/2023]
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Martin JA, Zimmermann N, Scheef L, Jankowski J, Paus S, Schild HH, Klockgether T, Boecker H. Disentangling motor planning and motor execution in unmedicated de novo Parkinson's disease patients: An fMRI study. NEUROIMAGE-CLINICAL 2019; 22:101784. [PMID: 30925383 PMCID: PMC6438987 DOI: 10.1016/j.nicl.2019.101784] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/27/2019] [Accepted: 03/16/2019] [Indexed: 11/28/2022]
Abstract
Many studies have used functional magnetic resonance imaging to unravel the neuronal underpinnings of motor system abnormalities in Parkinson's disease, indicating functional inhibition at the level of basal ganglia-thalamo-cortical motor networks. The study aim was to extend the characterization of functional motor changes in Parkinson's Disease by dissociating between two phases of action (i.e. motor planning and motor execution) during an automated unilateral finger movement sequence with the left and right hand, separately. In essence, we wished to identify neuronal dysfunction and potential neuronal compensation before (planning) and during (execution) automated sequential motor behavior in unmedicated early stage Parkinson's Disease patients. Twenty-two Parkinson's Disease patients (14 males; 53 ± 11 years; Hoehn and Yahr score 1.4 ± 0.6; UPDRS (part 3) motor score 16 ± 6) and 22 healthy controls (14 males; 49 ± 12 years) performed a pre-learnt four finger sequence (index, ring, middle and little finger, in order), either self-initiated (FREE) or externally triggered (REACT), within an 8-second time window. Findings were most pronounced during FREE with the clinically most affected side, where motor execution revealed significant underactivity of contralateral primary motor cortex, contralateral posterior putamen (sensorimotor territory), ipsilateral anterior cerebellum / cerebellar vermis, along with underactivity in supplementary motor area (based on ROI analyses only), corroborating previous findings in Parkinson's Disease. During motor planning, Parkinson's Disease patients showed a significant relative overactivity in dorsolateral prefrontal cortex (DLPFC), suggesting a compensatory overactivity. To a variable extent this relative overactivity in the DLPFC went along with a relative overactivity in the precuneus and the ipsilateral anterior cerebellum/cerebellar vermis Our study illustrates that a refined view of disturbances in motor function and compensatory processes can be gained from experimental designs that try to dissociate motor planning from motor execution, emphasizing that compensatory mechanisms are triggered in Parkinson's Disease when voluntary movements are conceptualized for action. Dissociated activations in early stage PD for motor planning and motor execution PD patients show frontal-parietal network compensation during self-initiated movement. Compensation for an impaired basal ganglia-premotor circuit occurs during planning.
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Affiliation(s)
- Jason A Martin
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
| | - Nadine Zimmermann
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany; Department of Neurology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Lukas Scheef
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Jakob Jankowski
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Sebastian Paus
- Department of Neurology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Hans H Schild
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Thomas Klockgether
- Department of Neurology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Henning Boecker
- Functional Neuroimaging Group, Department of Radiology, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
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Batistela RA, Oates A, Moraes R. Haptic information provided by anchors and the presence of cognitive tasks contribute separately to reducing postural sway in young adults. Gait Posture 2019; 68:213-219. [PMID: 30517906 DOI: 10.1016/j.gaitpost.2018.11.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 11/12/2018] [Accepted: 11/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Haptic information provided by the anchors reduces postural sway while standing upright. It is unclear whether this benefit would remain in the presence of cognitive tasks combined with a more challenging postural task. RESEARCH QUESTION Our aim was to investigate the effects of the anchors and visual and auditory cognitive tasks on postural control in young adults in a challenging balancing task. METHODS Twenty young adults stood upright on a balance beam with the central portion of each foot placed over the beam and feet at shoulder width without and with the use of the anchors in three cognitive conditions: control, visual Stroop task, and auditory digit-monitoring task. Each anchor consisted of a flexible cable with a light load (125 g) attached at one end of the cable. With the anchors, the participants held the flexible cable in each hand with the light load resting on the ground while keeping tension in the cable. RESULTS Both visual and auditory cognitive tasks reduced the center of pressure (COP) ellipse area, the root mean square of the margin of dynamic stability (based on the extrapolated center of mass, COM) and increased the COM time-to-contact relative to the boundaries of the base of support in the AP direction. The anchors reduced the COP ellipse area. SIGNIFICANCE There is a functional integration between postural control and cognitive tasks, such that postural sway was reduced to facilitate the execution of the cognitive tasks. Anchors were effective in reducing postural sway, suggesting that haptic information was able to benefit postural control in a challenging balancing task regardless of the cognitive task.
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Affiliation(s)
- Rosangela Alice Batistela
- Graduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Alison Oates
- College of Kinesiology, University of Saskatchewan, Canada
| | - Renato Moraes
- Graduate Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Brazil; School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Brazil.
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Intzandt B, Beck EN, Silveira CR. The effects of exercise on cognition and gait in Parkinson’s disease: A scoping review. Neurosci Biobehav Rev 2018; 95:136-169. [DOI: 10.1016/j.neubiorev.2018.09.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/23/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
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Chakravarthy S, Balasubramani PP, Mandali A, Jahanshahi M, Moustafa AA. The many facets of dopamine: Toward an integrative theory of the role of dopamine in managing the body's energy resources. Physiol Behav 2018; 195:128-141. [DOI: 10.1016/j.physbeh.2018.06.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/07/2018] [Accepted: 06/20/2018] [Indexed: 02/07/2023]
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Mezzarobba S, Grassi M, Valentini R, Bernardis P. Postural control deficit during sit-to-walk in patients with Parkinson's disease and freezing of gait. Gait Posture 2018; 61:325-330. [PMID: 29413805 DOI: 10.1016/j.gaitpost.2018.01.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 01/08/2018] [Accepted: 01/28/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The intricate linkage between Freezing of Gait (FoG) and postural control in Parkinson's disease (PD) is unclear. We analyzed the impact of FoG on dynamic postural control. METHODS 24 PD patients, 12 with (PD + FoG), 12 without FoG (PD-FoG), and 12 healthy controls, were assessed in ON state. Mobility and postural control were measured with clinical scales (UPDRS III, BBS, MPAS) and with kinematic and kinetic analysis during three tasks, characterized by levels of increasing difficulty to plan sequential movement of postural control: walk (W), gait initiation (GI) and sit-to-walk (STW). RESULTS The groups were balanced by age, disease duration, disease severity, mobility and balance. During STW, the spatial distribution of COP trajectories in PD + FoG patients are spread over medial-lateral space more than in the PD-FoG (p < .001). Moreover, the distribution of COP positions. in the transition between sit-to-stand and gait initiation, is not properly shifted toward the leading leg, as in PD-FoG and healthy controls, but it is more centrally dispersed (p < .01) with a delayed weight forward progression (p < .05). In GI task and walk task, COM and COP differences are less evident and even absent between PD patients. CONCLUSION PD + FoG show postural control differences in STW, compared with PD-FoG and healthy. Different spatial distribution of COP trajectories, between two PD groups are probably due to a deficit to plan postural control during a more demanding motor pattern, such as STW.
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Affiliation(s)
- Susanna Mezzarobba
- Department of Life Sciences, University of Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy
| | - Michele Grassi
- Department of Life Sciences, University of Trieste, Italy
| | - Roberto Valentini
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy
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Orcioli-Silva D, Barbieri FA, Simieli L, Vitorio R, Santos PCRD, Beretta VS, Gobbi LTB. Walking behavior over multiple obstacles in people with Parkinson's disease. Gait Posture 2017; 58:510-515. [PMID: 28957776 DOI: 10.1016/j.gaitpost.2017.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 02/02/2023]
Abstract
The presence of a second obstacle changed the planning and adjustments for obstacle avoidance performance, but this context is poorly understood in Parkinson's disease (PD). The aim of this study was to investigate the walking behavior over multiple obstacles in people with PD. Nineteen people with PD and 19 healthy individuals walked across an 8m pathway, performing three trials for following conditions: unobstructed walking, walking with one obstacle avoidance (Single), and walking with two obstacles avoidance (Double). In the Double condition, the analysis was performed only for the first obstacle (First Double). The dependent variables were calculated separately for the approach and crossing phases in the obstacle conditions. The main results show that people with PD decreased single support and increased double support phase in both Single and Double conditions compared to the unobstructed walking. Both groups increased stride duration during approach phase in the Double condition compared to the unobstructed walking and Single conditions. The presence of the second obstacle led to a decrease in trailing toe clearance during obstacle avoidance of the First Double. In conclusion, people with PD use a conservative strategy while approaching obstacles. Both groups need more time to obtain and process environmental information and plan the action in environments with multiple obstacles. The smaller leading toe clearance might be an indicative that the presence of a second obstacle increase the likelihood of tripping during obstacle avoidance in both people with PD and healthy individuals.
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Affiliation(s)
- Diego Orcioli-Silva
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
| | - Fabio Augusto Barbieri
- Universidade Estadual Paulista (Unesp), Faculdade de Ciências, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Lucas Simieli
- Universidade Estadual Paulista (Unesp), Faculdade de Ciências, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Rodrigo Vitorio
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Paulo Cezar Rocha Dos Santos
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Victor Spiandor Beretta
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- Universidade Estadual Paulista (Unesp), Instituto de Biociências, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
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External input for gait in people with Parkinson’s disease with and without freezing of gait: One size does not fit all. J Neurol 2017; 264:1488-1496. [DOI: 10.1007/s00415-017-8552-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
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Soares SC, Maior RS, Isbell LA, Tomaz C, Nishijo H. Fast Detector/First Responder: Interactions between the Superior Colliculus-Pulvinar Pathway and Stimuli Relevant to Primates. Front Neurosci 2017; 11:67. [PMID: 28261046 PMCID: PMC5314318 DOI: 10.3389/fnins.2017.00067] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/30/2017] [Indexed: 12/17/2022] Open
Abstract
Primates are distinguished from other mammals by their heavy reliance on the visual sense, which occurred as a result of natural selection continually favoring those individuals whose visual systems were more responsive to challenges in the natural world. Here we describe two independent but also interrelated visual systems, one cortical and the other subcortical, both of which have been modified and expanded in primates for different functions. Available evidence suggests that while the cortical visual system mainly functions to give primates the ability to assess and adjust to fluid social and ecological environments, the subcortical visual system appears to function as a rapid detector and first responder when time is of the essence, i.e., when survival requires very quick action. We focus here on the subcortical visual system with a review of behavioral and neurophysiological evidence that demonstrates its sensitivity to particular, often emotionally charged, ecological and social stimuli, i.e., snakes and fearful and aggressive facial expressions in conspecifics. We also review the literature on subcortical involvement during another, less emotional, situation that requires rapid detection and response-visually guided reaching and grasping during locomotion-to further emphasize our argument that the subcortical visual system evolved as a rapid detector/first responder, a function that remains in place today. Finally, we argue that investigating deficits in this subcortical system may provide greater understanding of Parkinson's disease and Autism Spectrum disorders (ASD).
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Affiliation(s)
- Sandra C. Soares
- Department of Education and Psychology, CINTESIS.UA, University of AveiroAveiro, Portugal
- Division of Psychology, Department of Clinical Neuroscience, Karolinska InstituteStockholm, Sweden
- William James Research Center, Instituto Superior de Psicologia AplicadaLisbon, Portugal
| | - Rafael S. Maior
- Division of Psychology, Department of Clinical Neuroscience, Karolinska InstituteStockholm, Sweden
- Department of Physiological Sciences, Primate Center, Institute of Biology, University of BrasíliaBrasília, Brazil
| | - Lynne A. Isbell
- Department of Anthropology, University of California, DavisDavis, CA, USA
| | - Carlos Tomaz
- Department of Physiological Sciences, Primate Center, Institute of Biology, University of BrasíliaBrasília, Brazil
- Ceuma University, Neuroscience Research CoordinationSão Luis, Brazil
| | - Hisao Nishijo
- System Emotional Science, Graduate School of Medicine and Pharmaceutical Sciences, University of ToyamaToyama, Japan
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Muralidharan V, Balasubramani PP, Chakravarthy VS, Gilat M, Lewis SJG, Moustafa AA. A Neurocomputational Model of the Effect of Cognitive Load on Freezing of Gait in Parkinson's Disease. Front Hum Neurosci 2017; 10:649. [PMID: 28119584 PMCID: PMC5220109 DOI: 10.3389/fnhum.2016.00649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 12/08/2016] [Indexed: 01/05/2023] Open
Abstract
Experimental data show that perceptual cues can either exacerbate or ameliorate freezing of gait (FOG) in Parkinson's Disease (PD). For example, simple visual stimuli like stripes on the floor can alleviate freezing whereas complex stimuli like narrow doorways can trigger it. We present a computational model of the cognitive and motor cortico-basal ganglia loops that explains the effects of sensory and cognitive processes on FOG. The model simulates strong causative factors of FOG including decision conflict (a disagreement of various sensory stimuli in their association with a response) and cognitive load (complexity of coupling a stimulus with downstream mechanisms that control gait execution). Specifically, the model simulates gait of PD patients (freezers and non-freezers) as they navigate a series of doorways while simultaneously responding to several Stroop word cues in a virtual reality setup. The model is based on an actor-critic architecture of Reinforcement Learning involving Utility-based decision making, where Utility is a weighted sum of Value and Risk functions. The model accounts for the following experimental data: (a) the increased foot-step latency seen in relation to high conflict cues, (b) the high number of motor arrests seen in PD freezers when faced with a complex cue compared to the simple cue, and (c) the effect of dopamine medication on these motor arrests. The freezing behavior arises as a result of addition of task parameters (doorways and cues) and not due to inherent differences in the subject group. The model predicts a differential role of risk sensitivity in PD freezers and non-freezers in the cognitive and motor loops. Additionally this first-of-its-kind model provides a plausible framework for understanding the influence of cognition on automatic motor actions in controls and Parkinson's Disease.
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Affiliation(s)
| | | | | | - Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, University of Sydney Sydney, NSW, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, University of Sydney Sydney, NSW, Australia
| | - Ahmed A Moustafa
- MARCS Institute for Brain and Behaviour and School of Social Sciences and Psychology, Western Sydney University Sydney, NSW, Australia
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Bluett B, Litvan I, Cheng S, Juncos J, Riley DE, Standaert DG, Reich SG, Hall DA, Kluger B, Shprecher D, Marras C, Jankovic J. Understanding falls in progressive supranuclear palsy. Parkinsonism Relat Disord 2016; 35:75-81. [PMID: 28007518 DOI: 10.1016/j.parkreldis.2016.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/12/2016] [Accepted: 12/14/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Progressive supranuclear palsy (PSP) is characterized by frequent falls which worsen with disease progression, causing substantial morbidity and mortality. Few studies have investigated which factors contribute to falls in PSP, and all have involved few participants, thus lacking necessary statistical power. The aim of this study was to identify clinical parameters most significantly associated with increasing falls in PSP, using the largest sample of patients to date. METHODS Comprehensive clinical data were collected from 339 not demented PSP patients meeting the NINDS-SPSP criteria, who were divided into two groups - Infrequent Fallers (IF; n = 118) with rare falls, and Frequent Fallers (FF; n = 221) who fell occasionally to multiple times a day. Of 198 clinical parameters, we hypothesized 38 to be correlated with an increasing risk of falls. These 38 parameters were analyzed via univariate regression analysis to determine the strength of their association with fall frequency. Unit odds ratios identified the magnitude with which each parameter resulted in an increasing risk of falls. RESULTS Twenty-five of 38 parameters analyzed were significantly associated with fall frequency based on univariate analysis. Symptom duration, clinical measures of disease severity, and several motoric and oculomotor clinical parameters were associated with FF. Examined cognitive parameters and slowing of vertical saccades were not. CONCLUSIONS The clinical parameters identified as associated with increased frequency of falls improve our understanding of why they occur and may help identify not demented PSP patients at risk for increasing falls.
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Affiliation(s)
- Brent Bluett
- Cleveland Clinic Lou Ruvo Center for Brain Health, USA; University of California San Diego, Department of Neurosciences, USA
| | - Irene Litvan
- University of California San Diego, Department of Neurosciences, USA.
| | | | | | | | | | | | | | | | - David Shprecher
- University of Utah, USA; Banner Sun Health Research Institute, USA
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Research, Toronto Western Hospital, Canada
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Honma M, Kuroda T, Futamura A, Shiromaru A, Kawamura M. Dysfunctional counting of mental time in Parkinson's disease. Sci Rep 2016; 6:25421. [PMID: 27146904 PMCID: PMC4857080 DOI: 10.1038/srep25421] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 04/18/2016] [Indexed: 11/09/2022] Open
Abstract
Patients with Parkinson’s disease (PD) often underestimate time intervals, however it remains unclear why they underestimate rather than overestimate them. The current study examined time underestimation and counting in patients with PD, in relation to dopamine transporter (DaT) located on presynaptic nerve endings in the striatum. Nineteen non-dementia patients with PD and 20 age- and sex-matched healthy controls performed two time estimation tasks to produce or reproduce time intervals with counting in the head, to examine dysfunctional time counting processing. They also performed tapping tasks to measure cycles of counting with 1 s interval with time estimation. Compared to controls, patients underestimated time intervals above 10 s on time production not reproduction tasks, and the underestimation correlated with fast counting on the tapping task. Furthermore, striatal DaT protein levels strongly correlated with underestimation of time intervals. These findings suggest that distortion of time intervals is guided by cumulative output of fast cycle counting and that this is linked with striatal DaT protein deficit.
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Affiliation(s)
- Motoyasu Honma
- Department of Neurology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Takeshi Kuroda
- Department of Neurology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Akinori Futamura
- Department of Neurology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Azusa Shiromaru
- Department of Neurology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Mitsuru Kawamura
- Department of Neurology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
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Pieruccini-Faria F, Jones J, Almeida Q. Insight into dopamine-dependent planning deficits in Parkinson’s disease: A sharing of cognitive & sensory resources. Neuroscience 2016; 318:219-29. [DOI: 10.1016/j.neuroscience.2016.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/16/2015] [Accepted: 01/08/2016] [Indexed: 11/15/2022]
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Beck EN, Ehgoetz Martens KA, Almeida QJ. Freezing of Gait in Parkinson's Disease: An Overload Problem? PLoS One 2015; 10:e0144986. [PMID: 26678262 PMCID: PMC4682987 DOI: 10.1371/journal.pone.0144986] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/26/2015] [Indexed: 11/18/2022] Open
Abstract
Freezing of gait (FOG) is arguably the most severe symptom associated with Parkinson's disease (PD), and often occurs while performing dual tasks or approaching narrowed and cluttered spaces. While it is well known that visual cues alleviate FOG, it is not clear if this effect may be the result of cognitive or sensorimotor mechanisms. Nevertheless, the role of vision may be a critical link that might allow us to disentangle this question. Gaze behaviour has yet to be carefully investigated while freezers approach narrow spaces, thus the overall objective of this study was to explore the interaction between cognitive and sensory-perceptual influences on FOG. In experiment #1, if cognitive load is the underlying factor leading to FOG, then one might expect that a dual-task would elicit FOG episodes even in the presence of visual cues, since the load on attention would interfere with utilization of visual cues. Alternatively, if visual cues alleviate gait despite performance of a dual-task, then it may be more probable that sensory mechanisms are at play. In compliment to this, the aim of experiment#2 was to further challenge the sensory systems, by removing vision of the lower-limbs and thereby forcing participants to rely on other forms of sensory feedback rather than vision while walking toward the narrow space. Spatiotemporal aspects of gait, percentage of gaze fixation frequency and duration, as well as skin conductance levels were measured in freezers and non-freezers across both experiments. Results from experiment#1 indicated that although freezers and non-freezers both walked with worse gait while performing the dual-task, in freezers, gait was relieved by visual cues regardless of whether the cognitive demands of the dual-task were present. At baseline and while dual-tasking, freezers demonstrated a gaze behaviour that neglected the doorway and instead focused primarily on the pathway, a strategy that non-freezers adopted only when performing the dual-task. Interestingly, with the combination of visual cues and dual-task, freezers increased the frequency and duration of fixations toward the doorway, compared to non-freezers. These results suggest that although increasing demand on attention does significantly deteriorate gait in freezers, an increase in cognitive demand is not exclusively responsible for freezing (since visual cues were able to overcome any interference elicited by the dual-task). When vision of the lower limbs was removed in experiment#2, only the freezers' gait was affected. However, when visual cues were present, freezers' gait improved regardless of the dual-task. This gait behaviour was accompanied by greater amount of time spent looking at the visual cues irrespective of the dual-task. Since removing vision of the lower-limbs hindered gait even under low attentional demand, restricted sensory feedback may be an important factor to the mechanisms underlying FOG.
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Affiliation(s)
- Eric N. Beck
- Sun Life Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Kaylena A. Ehgoetz Martens
- Sun Life Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Quincy J. Almeida
- Sun Life Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
- * E-mail:
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Killane I, Fearon C, Newman L, McDonnell C, Waechter SM, Sons K, Lynch T, Reilly RB. Dual Motor-Cognitive Virtual Reality Training Impacts Dual-Task Performance in Freezing of Gait. IEEE J Biomed Health Inform 2015; 19:1855-61. [DOI: 10.1109/jbhi.2015.2479625] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gilat M, Shine JM, Walton CC, O'Callaghan C, Hall JM, Lewis SJG. Brain activation underlying turning in Parkinson's disease patients with and without freezing of gait: a virtual reality fMRI study. NPJ PARKINSONS DISEASE 2015; 1:15020. [PMID: 28725687 PMCID: PMC5516618 DOI: 10.1038/npjparkd.2015.20] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/21/2015] [Accepted: 08/24/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Freezing of gait is a debilitating symptom affecting many patients with Parkinson's disease (PD), causing severe immobility and decreased quality of life. Turning is known to be the most common trigger for freezing and also causes the highest rates of falls. However, the pathophysiological basis for these effects is not well understood. METHODS This study used a virtual reality paradigm in combination with functional magnetic resonance imaging to explore the neural correlates underlying turning in 17 PD patients with freezing of gait (FOG) and 10 PD patients without FOG while off their dopaminergic medication. Participants used foot pedals to navigate a virtual environment, which allowed for blood oxygen level-dependent (BOLD) responses and footstep latencies to be compared between periods of straight "walking" and periods of turning through 90°. BOLD data were then analyzed using a mixed effects analysis. RESULTS Within group similarities revealed that overall, PD patients with freezing relied heavily on cortical control to enable effective stepping with increased visual cortex activation during turning. Between groups differences showed that when turning, patients with freezing preferentially activated inferior frontal regions that have been implicated in the recruitment of a putative stopping network. In addition, freezers failed to activate premotor and superior parietal cortices. Finally, increased task-based functional connectivity was found in subcortical regions associated with gait and stopping within the freezers group during turning. CONCLUSIONS These findings suggest that an increased propensity towards stopping in combination with reduced sensorimotor integration may underlie the neurobiology of freezing of gait during turning.
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Affiliation(s)
- Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - James M Shine
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia.,Department of Psychology, Stanford University, Stanford, CA, USA
| | - Courtney C Walton
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Claire O'Callaghan
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia.,Department of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Julie M Hall
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia.,School of Social Sciences and Psychology, University of Western Sydney, Sydney, NSW, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia
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Silveira CRA, Ehgoetz Martens KA, Pieruccini-Faria F, Bell-Boucher D, Roy EA, Almeida QJ. Disentangling perceptual judgment and online feedback deficits in Parkinson's freezing of gait. J Neurol 2015; 262:1629-36. [PMID: 25929667 PMCID: PMC4503856 DOI: 10.1007/s00415-015-7759-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/18/2015] [Accepted: 04/20/2015] [Indexed: 12/04/2022]
Abstract
Although the underlying mechanisms of freezing of gait in Parkinson’s disease (PD) are not fully understood, impaired sensory–perceptual processing has been proposed as an important contributor to freezing episodes. The aims of this cross-sectional study were to disentangle how sensory–perceptual deficits involved in planning (prior to movement) and sensory–perceptual feedback processing (during movement execution) contribute to freezing of gait in narrow spaces. Thirteen PD participants with freezing (PD FOG), 14 PD participants without freezing (PD non-FOG), and 15 healthy individuals made a perceptual estimate of the width of the distal opening of a corridor in two conditions: parallel and narrowing walls. Gait characteristics and number of freezing episodes were then compared while participants walked in baseline (no corridor), and through parallel walls and narrowing walls corridors. Visuospatial abilities were also assessed using neuropsychological tests. PD FOG had lower scores in the copy of the pentagons (p = 0.044) and had greater error variability in the perceptual judgment task (p = 0.008) than healthy participants. Although a similar number of freezing episodes occurred in both corridor conditions, PD FOG had greater step length variability while walking through the parallel walls corridor compared to healthy (p < 0.001) and PD non-FOG (p = 0.017) participants. Regression analysis revealed that error variability in perceptual judgment predicted the percentage of time spent in double support (R2 = 0.347) only in the narrowing walls condition for PD FOG. These results support the notion that sensory–perceptual deficits both prior to movement planning and during movement execution are important factors contributing to freezing of gait.
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Affiliation(s)
- Carolina R. A. Silveira
- />Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON N2L 3C5 Canada
- />Department of Kinesiology, University of Waterloo, Waterloo, ON Canada
| | - Kaylena A. Ehgoetz Martens
- />Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON N2L 3C5 Canada
- />Department of Psychology, University of Waterloo, Waterloo, ON Canada
| | - Frederico Pieruccini-Faria
- />Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON N2L 3C5 Canada
- />Department of Psychology, Wilfrid Laurier University, Waterloo, ON Canada
| | - Danielle Bell-Boucher
- />Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON N2L 3C5 Canada
- />Department of Health and Rehabilitation Sciences, Western University, London, ON Canada
| | - Eric A. Roy
- />Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON N2L 3C5 Canada
- />Department of Kinesiology, University of Waterloo, Waterloo, ON Canada
| | - Quincy J. Almeida
- />Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON N2L 3C5 Canada
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Pieruccini-Faria F, Ehgoetz Martens KA, Silveira CR, Jones JA, Almeida QJ. Interactions between cognitive and sensory load while planning and controlling complex gait adaptations in Parkinson's disease. BMC Neurol 2014; 14:250. [PMID: 25528474 PMCID: PMC4302136 DOI: 10.1186/s12883-014-0250-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 12/11/2014] [Indexed: 11/14/2022] Open
Abstract
Background Recent research has argued that removal of relevant sensory information during the planning and control of simple, self-paced walking can result in increased demand on central processing resources in Parkinson’s disease (PD). However, little is known about more complex gait tasks that require planning of gait adaptations to cross over an obstacle in PD. Methods In order to understand the interaction between availability of visual information relevant for self-motion and cognitive load, the current study evaluated PD participants and healthy controls while walking toward and stepping over an obstacle in three visual feedback conditions: (i) no visual restrictions; (ii) vision of the obstacle and their lower limbs while in complete darkness; (iii) vision of the obstacle only while in complete darkness; as well as two conditions including a cognitive load (with a dual task versus without a dual task). Each walk trial was divided into an early and late phase to examine changes associated with planning of step adjustments when approaching the obstacle. Results Interactions between visual feedback and dual task conditions during the obstacle approach were not significant. Patients with PD had greater deceleration and step time variability in the late phase of the obstacle approach phase while walking in both dark conditions compared to control participants. Additionally, participants with PD had a greater number of obstacle contacts when vision of their lower limbs was not available specifically during the dual task condition. Dual task performance was worse in PD compared to healthy control participants, but notably only while walking in the dark regardless of visual feedback. Conclusions These results suggest that reducing visual feedback while approaching an obstacle shifts processing to somatosensory feedback to guide movement which imposes a greater demand on planning resources. These results are key to fully understanding why trips and falls occur in those with PD.
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Affiliation(s)
- Frederico Pieruccini-Faria
- Sun Life Financial Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, ON, N2L 3C5, Canada. .,Psychology Department, Wilfrid Laurier University, Waterloo, ON, N2L 3C5, Canada.
| | - Kaylena A Ehgoetz Martens
- Sun Life Financial Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, ON, N2L 3C5, Canada.
| | - Carolina Ra Silveira
- Sun Life Financial Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, ON, N2L 3C5, Canada.
| | - Jeffery A Jones
- Sun Life Financial Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, ON, N2L 3C5, Canada. .,Psychology Department, Wilfrid Laurier University, Waterloo, ON, N2L 3C5, Canada. .,Laurier Centre for Cognitive Neuroscience, Wilfrid Laurier University, Waterloo, ON, N2L 3C5, Canada.
| | - Quincy J Almeida
- Sun Life Financial Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, ON, N2L 3C5, Canada.
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Walton CC, Shine JM, Mowszowski L, Gilat M, Hall JM, O’Callaghan C, Naismith SL, Lewis SJG. Impaired cognitive control in Parkinson’s disease patients with freezing of gait in response to cognitive load. J Neural Transm (Vienna) 2014; 122:653-60. [DOI: 10.1007/s00702-014-1271-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 07/03/2014] [Indexed: 10/25/2022]
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