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Lahuerta-Martín S, Ceballos-Laita L, Jiménez-Del-Barrio S, Llamas-Ramos R, Llamas-Ramos I, Mingo-Gómez MT. The effectiveness of action observation and motor imagery in freezing of gait, speed, physical function and balance in Parkinson's disease: a systematic review and meta-analysis. Physiother Theory Pract 2024:1-19. [PMID: 39298350 DOI: 10.1080/09593985.2024.2404600] [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: 09/09/2023] [Revised: 09/10/2024] [Accepted: 09/10/2024] [Indexed: 09/21/2024]
Abstract
BACKGROUND Parkinson's Disease (PD) is a neurodegenerative disease that produces balance and gait disorders. Action observation (AO) and motor imagery (MI) therapies appear to facilitate motor planning influencing balance and gait relearning. OBJECTIVE To investigate the effectiveness of AO and MI in isolation or combined (AO-MI), compared to sham interventions for the improvement of freezing of gait (FOG), speed, physical function and balance among individuals with PD. METHODS PubMed, Web of science, PEDro, Scopus and Cochrane Library were searched from inception to January 2024. Studies included were randomized controlled trials (RCTs). The study quality and risk of bias were assessed with PEDro scale and the Cochrane tool, respectively. The certainty of evidence was evaluated with GRADEpro GDT. RESULTS Eight RCTs were included, with a methodological quality ranged from fair to high. There were statistically significant results in FOG at follow-up when comparing AO to sham intervention (SMD= -0.50, 95% CI -0.88, -0.11; I2: 0%) 3 studies, 107 participants). Interventions based on MI compared to sham intervention were statistically significant in speed at post-treatment (MD = -0.06, 95% CI -0.04, -0.08; I2: 0%) and balance at post-treatment (SMD = -0.97; 95% CI -1.79, -0.15). CONCLUSIONS Very low certainty of evidence was found proposing that: AO produce improvements in FOG at follow-up; and MI produce improvements in speed and balance at post-treatment.
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Affiliation(s)
- Silvia Lahuerta-Martín
- Clinical Research in Health Sciences Group, Department of Surgery, Ophtalmology, Otorhinolaryngology, and Physiotherapy, University of Valladolid, Soria, Spain
| | - Luis Ceballos-Laita
- Clinical Research in Health Sciences Group, Department of Surgery, Ophtalmology, Otorhinolaryngology, and Physiotherapy, University of Valladolid, Soria, Spain
| | - Sandra Jiménez-Del-Barrio
- Clinical Research in Health Sciences Group, Department of Surgery, Ophtalmology, Otorhinolaryngology, and Physiotherapy, University of Valladolid, Soria, Spain
| | - Rocío Llamas-Ramos
- Department of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
| | - Inés Llamas-Ramos
- Department of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
- University Hospital of Salamanca, Salamanca, Spain
| | - María Teresa Mingo-Gómez
- Clinical Research in Health Sciences Group, Department of Surgery, Ophtalmology, Otorhinolaryngology, and Physiotherapy, University of Valladolid, Soria, Spain
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2
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Cockx HM, Oostenveld R, Flórez R YA, Bloem BR, Cameron IGM, van Wezel RJA. Freezing of gait in Parkinson's disease is related to imbalanced stopping-related cortical activity. Brain Commun 2024; 6:fcae259. [PMID: 39229492 PMCID: PMC11369826 DOI: 10.1093/braincomms/fcae259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 05/17/2024] [Accepted: 07/31/2024] [Indexed: 09/05/2024] Open
Abstract
Freezing of gait, characterized by involuntary interruptions of walking, is a debilitating motor symptom of Parkinson's disease that restricts people's autonomy. Previous brain imaging studies investigating the mechanisms underlying freezing were restricted to scan people in supine positions and yielded conflicting theories regarding the role of the supplementary motor area and other cortical regions. We used functional near-infrared spectroscopy to investigate cortical haemodynamics related to freezing in freely moving people. We measured functional near-infrared spectroscopy activity over multiple motor-related cortical areas in 23 persons with Parkinson's disease who experienced daily freezing ('freezers') and 22 age-matched controls during freezing-provoking tasks including turning and doorway passing, voluntary stops and actual freezing. Crucially, we corrected the measured signals for confounds of walking. We first compared cortical activity between freezers and controls during freezing-provoking tasks without freezing (i.e. turning and doorway passing) and during stops. Secondly, within the freezers, we compared cortical activity between freezing, stopping and freezing-provoking tasks without freezing. First, we show that turning and doorway passing (without freezing) resemble cortical activity during stopping in both groups involving activation of the supplementary motor area and prefrontal cortex, areas known for their role in inhibiting actions. During these freezing-provoking tasks, the freezers displayed higher activity in the premotor areas than controls. Secondly, we show that, during actual freezing events, activity in the prefrontal cortex was lower than during voluntary stopping. The cortical relation between the freezing-provoking tasks (turning and doorway passing) and stopping may explain their susceptibility to trigger freezing by activating a stopping mechanism. Besides, the stopping-related activity of the supplementary motor area and prefrontal cortex seems to be out of balance in freezers. In this paper, we postulate that freezing results from a paroxysmal imbalance between the supplementary motor area and prefrontal cortex, thereby extending upon the current role of the supplementary motor area in freezing pathophysiology.
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Affiliation(s)
- Helena M Cockx
- Department of Neurobiology, Faculty of Science, Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525AJ Nijmegen, The Netherlands
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525GC Nijmegen, The Netherlands
| | - Robert Oostenveld
- Donders Center for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525EN Nijmegen, The Netherlands
- NatMEG, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Yuli A Flórez R
- Department of Neurobiology, Faculty of Science, Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525AJ Nijmegen, The Netherlands
- Department of Psychiatry, Maastricht University Medical Center, 6229HX Maastricht, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525GC Nijmegen, The Netherlands
| | - Ian G M Cameron
- Department of Neurobiology, Faculty of Science, Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525AJ Nijmegen, The Netherlands
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, 7522NB Enschede, The Netherlands
- Domain Expert Precision Health, Nutrition & Behavior, OnePlanet Research Center, 6525EC Nijmegen, The Netherlands
| | - Richard J A van Wezel
- Department of Neurobiology, Faculty of Science, Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525AJ Nijmegen, The Netherlands
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente, 7522NB Enschede, The Netherlands
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Mezzarobba S, Bonassi G, Avanzino L, Pelosin E. Action Observation and Motor Imagery as a Treatment in Patients with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:S53-S64. [PMID: 38250785 PMCID: PMC11380291 DOI: 10.3233/jpd-230219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Action observation (AO) and motor imagery (MI) has emerged as promising tool for physiotherapy intervention in Parkinson's disease (PD). This narrative review summarizes why, how, and when applying AO and MI training in individual with PD. We report the neural underpinning of AO and MI and their effects on motor learning. We examine the characteristics and the current evidence regarding the effectiveness of physiotherapy interventions and we provide suggestions about their implementation with technologies. Neurophysiological data suggest a substantial correct activation of brain networks underlying AO and MI in people with PD, although the occurrence of compensatory mechanisms has been documented. Regarding the efficacy of training, in general evidence indicates that both these techniques improve mobility and functional activities in PD. However, these findings should be interpreted with caution due to variety of the study designs, training characteristics, and the modalities in which AO and MI were applied. Finally, results on long-term effects are still uncertain. Several elements should be considered to optimize the use of AO and MI in clinical setting, such as the selection of the task, the imagery or the video perspectives, the modalities of training. However, a comprehensive individual assessment, including motor and cognitive abilities, is essential to select which between AO and MI suite the best to each PD patients. Much unrealized potential exists for the use AO and MI training to provide personalized intervention aimed at fostering motor learning in both the clinic and home setting.
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Affiliation(s)
- Susanna Mezzarobba
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, and "RAISE Ecosystem", Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gaia Bonassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, and "RAISE Ecosystem", Genova, Italy
| | - Laura Avanzino
- IRCCS Ospedale Policlinico San Martino, 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, and "RAISE Ecosystem", Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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4
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Le DT, Tsuyuhara M, Kuwamura H, Kitano K, Nguyen TD, Duc Nguyen T, Fujita N, Watanabe T, Nishijo H, Mihara M, Urakawa S. Regional activity and effective connectivity within the frontoparietal network during precision walking with visual cueing: an fNIRS study. Cereb Cortex 2023; 33:11157-11169. [PMID: 37757479 DOI: 10.1093/cercor/bhad354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
Precision walking (PW) incorporates precise step adjustments into regular walking patterns to navigate challenging surroundings. However, the brain processes involved in PW control, which encompass cortical regions and interregional interactions, are not fully understood. This study aimed to investigate the changes in regional activity and effective connectivity within the frontoparietal network associated with PW. Functional near-infrared spectroscopy data were recorded from adult subjects during treadmill walking tasks, including normal walking (NOR) and PW with visual cues, wherein the intercue distance was either fixed (FIX) or randomly varied (VAR) across steps. The superior parietal lobule (SPL), dorsal premotor area (PMd), supplementary motor area (SMA), and dorsolateral prefrontal cortex (dlPFC) were specifically targeted. The results revealed higher activities in SMA and left PMd, as well as left-to-right SPL connectivity, in VAR than in FIX. Activities in SMA and right dlPFC, along with dlPFC-to-SPL connectivity, were higher in VAR than in NOR. Overall, these findings provide insights into the roles of different brain regions and connectivity patterns within the frontoparietal network in facilitating gait control during PW, providing a useful baseline for further investigations into brain networks involved in locomotion.
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Affiliation(s)
- Duc Trung Le
- Department of Musculoskeletal Functional Research and Regeneration, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8553, Japan
- Department of Neurology, Vietnam Military Medical University, No. 261 Phung Hung Street, Ha Dong District, Hanoi 12108, Vietnam
| | - Masato Tsuyuhara
- Department of Musculoskeletal Functional Research and Regeneration, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8553, Japan
| | - Hiroki Kuwamura
- Department of Musculoskeletal Functional Research and Regeneration, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8553, Japan
| | - Kento Kitano
- Department of Musculoskeletal Functional Research and Regeneration, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8553, Japan
| | - Thu Dang Nguyen
- Department of Musculoskeletal Functional Research and Regeneration, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8553, Japan
| | - Thuan Duc Nguyen
- Department of Neurology, Vietnam Military Medical University, No. 261 Phung Hung Street, Ha Dong District, Hanoi 12108, Vietnam
| | - Naoto Fujita
- Department of Musculoskeletal Functional Research and Regeneration, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8553, Japan
| | - Tatsunori Watanabe
- Faculty of Health Sciences, Aomori University of Health and Welfare, 58-1 Mase, Hamadate, Aomori-city, Aomori 030-8505, Japan
| | - Hisao Nishijo
- Department of System Emotional Science, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Sugitani 2630, Toyama 930-0194, Japan
- Faculty of Human Sciences, University of East Asia, 2-12-1 Ichinomiya Gakuen-cho, Shimonoseki City, Yamaguchi 751-8503, Japan
| | - Masahito Mihara
- Department of Neurology, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama 701-0192, Japan
| | - Susumu Urakawa
- Department of Musculoskeletal Functional Research and Regeneration, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8553, Japan
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5
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Shima A, Tanaka K, Ogawa A, Omae E, Miyake T, Nagamori Y, Miyata Y, Ohata K, Ono Y, Mima T, Takahashi R, Koganemaru S. Case report: Backward gait training combined with gait-synchronized cerebellar transcranial alternating current stimulation in progressive supranuclear palsy. Front Hum Neurosci 2023; 17:1082555. [PMID: 36908713 PMCID: PMC9992165 DOI: 10.3389/fnhum.2023.1082555] [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: 10/28/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
Progressive supranuclear palsy (PSP) is characterized by recurrent falls caused by postural instability, and a backward gait is considered beneficial for postural instability. Furthermore, a recent approach for rehabilitation combined with gait-oriented synchronized stimulation using non-invasive transcranial patterned stimulation could be promising for balance function. Here, we present a case of PSP with backward gait training combined with gait-synchronized transcranial alternating current stimulation (tACS). A 70-year-old woman with PSP-Richardson's syndrome underwent backward gait training combined with synchronized cerebellar tACS. Initially, she underwent short-term intervention with combined training of backward gait with synchronized cerebellar tACS, asynchronized, or sham stimulation according to the N-of-1 study design. Synchronized tACS training demonstrated a decrease in postural instability, whereas asynchronized or sham stimulation did not. The additional long-term interventions of combined backward gait training with synchronized cerebellar tACS demonstrated further decrease in postural instability with improvements in gait speed, balance function, and fall-related self-efficacy in daily life. The present case describes a novel approach for motor symptoms in a patient with PSP. Backward gait training with synchronized cerebellar tACS may be a promising therapeutic approach.
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Affiliation(s)
- Atsushi Shima
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuki Tanaka
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akari Ogawa
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Erika Omae
- Division of Neurobiology and Physiology, Department of Neuroscience, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoaki Miyake
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yui Nagamori
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Miyata
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Ohata
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yumie Ono
- Department of Electronics and Bioinformatics, Meiji University, Tokyo, Kanagawa, Japan
| | - Tatsuya Mima
- The Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoko Koganemaru
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Rehabilitation and Physical Medicine, Hokkaido University Hospital, Sapporo, Japan
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6
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Abstract
The frontal lobe is crucial and contributes to controlling truncal motion, postural responses, and maintaining equilibrium and locomotion. The rich repertoire of frontal gait disorders gives some indication of this complexity. For human walking, it is necessary to simultaneously achieve at least two tasks, such as maintaining a bipedal upright posture and locomotion. Particularly, postural control plays an extremely significant role in enabling the subject to maintain stable gait behaviors to adapt to the environment. To achieve these requirements, the frontal cortex (1) uses cognitive information from the parietal, temporal, and occipital cortices, (2) creates plans and programs of gait behaviors, and (3) acts on the brainstem and spinal cord, where the core posture-gait mechanisms exist. Moreover, the frontal cortex enables one to achieve a variety of gait patterns in response to environmental changes by switching gait patterns from automatic routine to intentionally controlled and learning the new paradigms of gait strategy via networks with the basal ganglia, cerebellum, and limbic structures. This chapter discusses the role of each area of the frontal cortex in behavioral control and attempts to explain how frontal lobe controls walking with special reference to postural control.
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Affiliation(s)
- Kaoru Takakusaki
- Department of Physiology, Division of Neuroscience, Asahikawa Medical University, Asahikawa, Japan.
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7
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Ogata T, Hashiguchi H, Hori K, Hirobe Y, Ono Y, Sawada H, Inaba A, Orimo S, Miyake Y. Foot Trajectory Features in Gait of Parkinson’s Disease Patients. Front Physiol 2022; 13:726677. [PMID: 35600314 PMCID: PMC9114796 DOI: 10.3389/fphys.2022.726677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
Parkinson’s disease (PD) is a progressive neurological disorder characterized by movement disorders, such as gait instability. This study investigated whether certain spatial features of foot trajectory are characteristic of patients with PD. The foot trajectory of patients with mild and advanced PD in on-state and healthy older and young individuals was estimated from acceleration and angular velocity measured by inertial measurement units placed on the subject’s shanks, just above the ankles. We selected six spatial variables in the foot trajectory: forward and vertical displacements from heel strike to toe-off, maximum clearance, and change in supporting leg (F1 to F3 and V1 to V3, respectively). Healthy young individuals had the greatest F2 and F3 values, followed by healthy older individuals, and then mild PD patients. Conversely, the vertical displacements of mild PD patients were larger than the healthy older individuals. Still, those of healthy older individuals were smaller than the healthy young individuals except for V3. All six displacements of the advanced PD patients were smaller than the mild PD patients. To investigate features in foot trajectories in detail, a principal components analysis and soft-margin kernel support vector machine was used in machine learning. The accuracy in distinguishing between mild PD patients and healthy older individuals and between mild and advanced PD patients was 96.3 and 84.2%, respectively. The vertical and forward displacements in the foot trajectory was the main contributor. These results reveal that large vertical displacements and small forward ones characterize mild and advanced PD patients, respectively.
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Affiliation(s)
- Taiki Ogata
- Department of Computer Science, Tokyo Institute of Technology, Yokohama, Japan
- *Correspondence: Taiki Ogata,
| | - Hironori Hashiguchi
- Department of Computational Intelligence and System Science, Tokyo Institute of Technology, Yokohama, Japan
| | - Koyu Hori
- Department of Computational Intelligence and System Science, Tokyo Institute of Technology, Yokohama, Japan
| | - Yuki Hirobe
- Department of Computer Science, Tokyo Institute of Technology, Yokohama, Japan
| | - Yumi Ono
- Department of Computer Science, Tokyo Institute of Technology, Yokohama, Japan
| | - Hiroyuki Sawada
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Akira Inaba
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Satoshi Orimo
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Yoshihiro Miyake
- Department of Computer Science, Tokyo Institute of Technology, Yokohama, Japan
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Bardakan MM, Fink GR, Zapparoli L, Bottini G, Paulesu E, Weiss PH. Imaging the neural underpinnings of freezing of gait in Parkinson’s disease. NEUROIMAGE: CLINICAL 2022; 35:103123. [PMID: 35917720 PMCID: PMC9421505 DOI: 10.1016/j.nicl.2022.103123] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/09/2022] [Accepted: 07/20/2022] [Indexed: 11/04/2022] Open
Abstract
Review of recent (after 2012) imaging studies on Parkinsonian freezing of gait. Virtual reality studies report functional decoupling of cortico-striatal circuits. Motor imagery studies reveal increased recruitment of parieto-occipital regions. fNIRS studies converge on reporting higher activity within prefrontal regions. Imaging findings support pathophysiological models of freezing of gait.
Freezing of gait (FoG) is a paroxysmal and sporadic gait impairment that severely affects PD patients’ quality of life. This review summarizes current neuroimaging investigations that characterize the neural underpinnings of FoG in PD. The review presents and discusses the latest advances across multiple methodological domains that shed light on structural correlates, connectivity changes, and activation patterns associated with the different pathophysiological models of FoG in PD. Resting-state fMRI studies mainly report cortico-striatal decoupling and disruptions in connectivity along the dorsal stream of visuomotor processing, thus supporting the ‘interference’ and the ‘perceptual dysfunction’ models of FoG. Task-based MRI studies employing virtual reality and motor imagery paradigms reveal a disruption in functional connectivity between cortical and subcortical regions and an increased recruitment of parieto-occipital regions, thus corroborating the ‘interference’ and ‘perceptual dysfunction’ models of FoG. The main findings of fNIRS studies of actual gait primarily reveal increased recruitment of frontal areas during gait, supporting the ‘executive dysfunction’ model of FoG. Finally, we discuss how identifying the neural substrates of FoG may open new avenues to develop efficient treatment strategies.
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Albrecht F, Pereira JB, Mijalkov M, Freidle M, Johansson H, Ekman U, Westman E, Franzén E. Effects of a Highly Challenging Balance Training Program on Motor Function and Brain Structure in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2021; 11:2057-2071. [PMID: 34511513 PMCID: PMC8673526 DOI: 10.3233/jpd-212801] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is characterized by motor deficits and brain alterations having a detrimental impact on balance, gait, and cognition. Intensive physical exercise can induce changes in the neural system, potentially counteracting neurodegeneration in PD and improving clinical symptoms. OBJECTIVE This randomized controlled trial investigated effects of a highly challenging, cognitively demanding, balance and gait training (HiBalance) program in participants with PD on brain structure. METHODS 95 participants were assigned to either the HiBalance or an active control speech training program. The group-based interventions were performed in 1-hour sessions, twice per week over a 10-week period. Participants underwent balance, gait, cognitive function, and structural magnetic resonance imaging assessments before and after the interventions. Voxel-based morphometry was analyzed in 34 HiBalance and 31 active controls. Additionally, structural covariance networks were assessed. RESULTS There was no significant time by group interaction between the HiBalance and control training in balance, gait, or brain volume. Within-HiBalance-group analyses showed higher left putamen volumes post-training. In repeated measures correlation a positive linear, non-significant relationship between gait speed and putamen volume was revealed. In the HiBalance group we found community structure changes and stronger thalamic-cerebellar connectivity in structural covariance networks. Neither brain volume changes nor topology changes were found for the active controls after the training. CONCLUSION Thus, subtle structural brain changes occur after balance and gait training. Future studies need to determine whether training modifications or other assessment methods lead to stronger effects.
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Affiliation(s)
- Franziska Albrecht
- Division of Physiotherapy, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Joana B. Pereira
- Division of Clinical Geriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Mite Mijalkov
- Division of Clinical Geriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Malin Freidle
- Division of Physiotherapy, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Johansson
- Division of Physiotherapy, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Urban Ekman
- Division of Clinical Geriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Medical Psychology, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Erika Franzén
- Division of Physiotherapy, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
- Stockholm’s Sjukhem Foundation, Stockholm, Sweden
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10
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Maidan I, Mirelman A, Hausdorff JM, Stern Y, Habeck CG. Distinct cortical thickness patterns link disparate cerebral cortex regions to select mobility domains. Sci Rep 2021; 11:6600. [PMID: 33758214 PMCID: PMC7988162 DOI: 10.1038/s41598-021-85058-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 02/19/2021] [Indexed: 01/03/2023] Open
Abstract
The cortical control of gait and mobility involves multiple brain regions. Therefore, one could speculate that the association between specific spatial patterns of cortical thickness may be differentially associated with different mobility domains. To test this possibility, 115 healthy participants aged 27–82 (mean 60.5 ± 13.8) underwent a mobility assessment (usual-walk, dual-task walk, Timed Up and Go) and MRI scan. Ten mobility domains of relatively simple (e.g., usual-walking) and complex tasks (i.e., dual task walking, turns, transitions) and cortical thickness of 68 ROIs were extracted. All associations between mobility and cortical thickness were controlled for age and gender. Scaled Subprofile Modelling (SSM), a PCA-regression, identified thickness patterns that were correlated with the individual mobility domains, controlling for multiple comparisons. We found that lower mean global cortical thickness was correlated with worse general mobility (r = − 0.296, p = 0.003), as measured by the time to complete the Timed Up and Go test. Three distinct patterns of cortical thickness were associated with three different gait domains during simple, usual-walking: pace, rhythm, and symmetry. In contrast, cortical thickness patterns were not related to the more complex mobility domains. These findings demonstrate that robust and topographically distinct cortical thickness patterns are linked to select mobility domains during relatively simple walking, but not to more complex aspects of mobility. Functional connectivity may play a larger role in the more complex aspects of mobility.
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Affiliation(s)
- Inbal Maidan
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel. .,Department of Neurology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Anat Mirelman
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.,Department of Neurology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Orthopaedic Surgery, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division of the Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain and G.H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Christian G Habeck
- Cognitive Neuroscience Division of the Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain and G.H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
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11
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Nishida D, Mizuno K, Yamada E, Hanakawa T, Liu M, Tsuji T. The neural correlates of gait improvement by rhythmic sound stimulation in adults with Parkinson's disease - A functional magnetic resonance imaging study. Parkinsonism Relat Disord 2021; 84:91-97. [PMID: 33607527 DOI: 10.1016/j.parkreldis.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/18/2020] [Accepted: 02/04/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Adults with Parkinson's disease (PD) experience gait disturbances that can sometimes be improved with rhythmic auditory stimulation (RAS); however, the underlying physiological mechanism for this improvement is not well understood. We investigated brain activation patterns in adults with PD and healthy controls (HC) using functional magnetic resonance imaging (fMRI) while participants imagined gait with or without RAS. METHODS Twenty-seven adults with PD who could walk independently and walked more smoothly with rhythmic auditory cueing than without it, and 25 age-matched HC participated in this study. Participants imagined gait in the presence of RAS or white noise (WN) during fMRI. RESULTS In the PD group, gait imagery with RAS activated cortical motor areas, including supplementary motor areas and the cerebellum, while gait imagery with WN additionally recruited the left parietal operculum. In HC, the induced activation was limited to cortical motor areas and the cerebellum for both the RAS and WN conditions. Within- and between-group analyses demonstrated that RAS reduced the activity of the left parietal operculum in the PD group but not in the HC group (condition-by-group interaction by repeated measures analysis of variance, p < 0.05). CONCLUSION During gait imagery in adults with PD, the left parietal operculum was less activated by RAS than by WN, while no change was observed in HC, suggesting that rhythmic auditory stimulation may support the sensory-motor networks involved in gait, thus alleviating the overload of the parietal operculum and compensating for its dysfunction in these patients.
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Affiliation(s)
- Daisuke Nishida
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Rehabilitation, Saiseikai Kanagawa-ken Hospital, Kanagawa, Japan; Department of Rehabilitation Medicine, School of Medicine Keio University, Tokyo, Japan
| | - Katsuhiro Mizuno
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Rehabilitation, Saiseikai Kanagawa-ken Hospital, Kanagawa, Japan; Department of Rehabilitation Medicine, School of Medicine Keio University, Tokyo, Japan.
| | - Emi Yamada
- Department of Clinical Physiology, School of Medicine Kyushu University, Fukuoka, Japan
| | - Takashi Hanakawa
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, School of Medicine Keio University, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, School of Medicine Keio University, Tokyo, Japan
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12
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Abraham A, Duncan RP, Earhart GM. The Role of Mental Imagery in Parkinson's Disease Rehabilitation. Brain Sci 2021; 11:brainsci11020185. [PMID: 33540883 PMCID: PMC7913152 DOI: 10.3390/brainsci11020185] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Parkinson’s disease (PD) is a disabling neurodegenerative disease whose manifestations span motor, sensorimotor, and sensory domains. While current therapies for PD include pharmacological, invasive, and physical interventions, there is a constant need for developing additional approaches for optimizing rehabilitation gains. Mental imagery is an emerging field in neurorehabilitation and has the potential to serve as an adjunct therapy to enhance patient function. Yet, the literature on this topic is sparse. The current paper reviews the motor, sensorimotor, and sensory domains impacted by PD using gait, balance, and pain as examples, respectively. Then, mental imagery and its potential for PD motor and non-motor rehabilitation is discussed, with an emphasis on its suitability for addressing gait, balance, and pain deficits in people with PD. Lastly, future research directions are suggested.
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Affiliation(s)
- Amit Abraham
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel 4077625, Israel
- Navigation and Accessibility Research Center of Ariel University (NARCA), Ariel University, Ariel 4077625, Israel
- Correspondence:
| | - Ryan P. Duncan
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO 63108, USA; (R.P.D.); (G.M.E.)
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Gammon M. Earhart
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO 63108, USA; (R.P.D.); (G.M.E.)
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
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13
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Boyne P, Doren S, Scholl V, Staggs E, Whitesel D, Maloney T, Awosika O, Kissela B, Dunning K, Vannest J. Functional magnetic resonance brain imaging of imagined walking to study locomotor function after stroke. Clin Neurophysiol 2020; 132:167-177. [PMID: 33291023 DOI: 10.1016/j.clinph.2020.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/25/2020] [Accepted: 11/08/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Imagined walking has yielded insights into normal locomotor control and could improve understanding of neurologic gait dysfunction. This study evaluated brain activation during imagined walking in chronic stroke. METHODS Ten persons with stroke and 10 matched controls completed a walking test battery and a magnetic resonance imaging session including imagined walking and knee extension tasks. Brain activations were compared between tasks and groups. Associations between activations and composite gait score were also calculated, while controlling for lesion load. RESULTS Stroke and worse gait score were each associated with lesser overall brain activation during knee extension but greater overall activation during imagined walking. During imagined walking, the stroke group significantly activated the primary motor cortex lower limb region and cerebellar locomotor region. Better walking function was associated with less activation of these regions and greater activation of medial superior frontal gyrus area 9. CONCLUSIONS Compared with knee extension, imagined walking was less sensitive to stroke-related deficits in brain activation but better at revealing compensatory changes, some of which could be maladaptive. SIGNIFICANCE The identified associations for imagined walking suggest potential neural mechanisms of locomotor adaptation after stroke, which could be useful for future intervention development and prognostication.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA.
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Victoria Scholl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Emily Staggs
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Dustyn Whitesel
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Thomas Maloney
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Oluwole Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, OH, USA
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, OH, USA
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer Vannest
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, OH, USA
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14
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Wang Q, Meng L, Pang J, Zhu X, Ming D. Characterization of EEG Data Revealing Relationships With Cognitive and Motor Symptoms in Parkinson's Disease: A Systematic Review. Front Aging Neurosci 2020; 12:587396. [PMID: 33240076 PMCID: PMC7683572 DOI: 10.3389/fnagi.2020.587396] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/06/2020] [Indexed: 01/08/2023] Open
Abstract
Recent research regards the electroencephalogram (EEG) as a promising method to study real-time brain dynamic changes in patients with Parkinson's disease (PD), but a deeper understanding is needed to discern coincident pathophysiology, patterns of changes, and diagnosis. This review summarized recent research on EEG characterization related to the cognitive and motor functions in PD patients and discussed its potential to be used as diagnostic biomarkers. Thirty papers out of 220 published from 2010 to 2020 were reviewed. Movement abnormalities and cognitive decline are related to changes in EEG spectrum and event-related potentials (ERPs) during typical oddball paradigms and/or combined motor tasks. Abnormalities in β and δ frequency bands are, respectively the main manifestation of dyskinesia and cognitive decline in PD. The review showed that PD patients have noteworthy changes in specific EEG characterizations, however, the underlying mechanism of the interrelation between gait and cognitive is still unclear. Understanding the specific nature of the relationship is essential for development of novel invasive clinical diagnostic and therapeutic methods.
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Affiliation(s)
- Qing Wang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Lin Meng
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Jun Pang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Xiaodong Zhu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
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15
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Virtual reality in research and rehabilitation of gait and balance in Parkinson disease. Nat Rev Neurol 2020; 16:409-425. [DOI: 10.1038/s41582-020-0370-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
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16
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Hoppe M, Chawla G, Browner N, Lewek MD. The effects of metronome frequency differentially affects gait on a treadmill and overground in people with Parkinson disease. Gait Posture 2020; 79:41-45. [PMID: 32344358 DOI: 10.1016/j.gaitpost.2020.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Treadmills and rhythmic auditory cueing can influence stepping rhythm for individuals with Parkinson disease (PD). Of concern, however, is that auditory cueing directly addresses the temporal features of gait, whereas adjusting step length may be more important for people with PD. Stepping to a faster cadence when walking overground may increase gait speed, but without requiring an increased step length. Furthermore, given the potentially valuable role of walking on a treadmill for individuals with PD, we are concerned that increasing cadence with rhythmic auditory cueing while walking at a constant treadmill speed will induce even shorter steps. RESEARCH QUESTION What is the effect of different metronome cue frequencies on spatiotemporal gait parameters when walking overground compared to walking on a treadmill in people with PD? METHODS Using a repeated-measures design, 21 people with PD (stage 1-3) walked overground and on a treadmill with and without metronome cues of 85 %, 100 %, and 115 % of their baseline cadence frequency for one minute each. We assessed step length, and cadence during all conditions. Gait speed was assessed during overground gait. RESULTS An interaction effect between cue frequency and walking environment revealed that participants took longer steps during the 85 % condition on the treadmill only. When walking overground, metronome cues of 85 % and 115 % of baseline cadence yielded decreases and increases, respectively, in both cadence and gait speed with no associated change in step length. SIGNIFICANCE These data suggest that people with PD are able to alter spatiotemporal gait parameters immediately when provided the appropriate metronome cue and walking environment. We propose to target shortened step lengths by stepping to the beat of slow frequency auditory cues while walking on a treadmill, whereas the use of fast frequency cues during overground walking can facilitate faster walking speeds.
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Affiliation(s)
- Madelon Hoppe
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Guneet Chawla
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nina Browner
- Department of Neurology University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael D Lewek
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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17
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Corticomuscular control of walking in older people and people with Parkinson's disease. Sci Rep 2020; 10:2980. [PMID: 32076045 PMCID: PMC7031238 DOI: 10.1038/s41598-020-59810-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/30/2020] [Indexed: 12/29/2022] Open
Abstract
Changes in human gait resulting from ageing or neurodegenerative diseases are multifactorial. Here we assess the effects of age and Parkinson’s disease (PD) on corticospinal activity recorded during treadmill and overground walking. Electroencephalography (EEG) from 10 electrodes and electromyography (EMG) from bilateral tibialis anterior muscles were acquired from 22 healthy young, 24 healthy older and 20 adults with PD. Event-related power, corticomuscular coherence (CMC) and inter-trial coherence were assessed for EEG from bilateral sensorimotor cortices and EMG during the double-support phase of the gait cycle. CMC and EMG power at low beta frequencies (13–21 Hz) was significantly decreased in older and PD participants compared to young people, but there was no difference between older and PD groups. Older and PD participants spent shorter time in the swing phase than young individuals. These findings indicate age-related changes in the temporal coordination of gait. The decrease in low-beta CMC suggests reduced cortical input to spinal motor neurons in older people during the double-support phase. We also observed multiple changes in electrophysiological measures at low-gamma frequencies during treadmill compared to overground walking, indicating task-dependent differences in corticospinal locomotor control. These findings may be affected by artefacts and should be interpreted with caution.
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18
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Hsiu-Chen C, Chiung-Chu C, Jiunn-Woei L, Wei-Da C, Yi-Hsin W, Ya-Ju C, Chin-Song L. The effects of dual-task in patients with Parkinson's disease performing cognitive-motor paradigms. J Clin Neurosci 2020; 72:72-78. [PMID: 31952973 DOI: 10.1016/j.jocn.2020.01.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/05/2020] [Indexed: 11/29/2022]
Abstract
Patients with Parkinson's disease (PD) exhibit impaired dual-task (DT) performance. A recent meta-analysis confirmed that dual tasking severely affects walking performance in PD patients. However, one report indicated that a cycling DT paradigm has facilitative effects on cognition. We investigated the effects of dual tasking by using walking and cycling as motor tasks and revealed the clinical determinants associated with DT performance. Twenty-seven eligible participants were enrolled for clinical, cognitive-walking, and cognitive-cycling DT paradigm investigations. The mean age and age at onset of the patients were 59.87 ± 6.3 and 53.11 ± 8.4 years, respectively. Both the off- and on-state akinesia subscores were worse on the more-affected side than on the less-affected side. However, the DT effects on the cycling and gait outcomes on both the more-affected and the less-affected side showed no significant differences. The DT effect on the two motor tasks and cognitive performance during a concurrent walking task declined. Nevertheless, the DT effect on cognition improved during cycling. The present study also revealed that the levodopa equivalent daily dosage was highly associated with cognitive-cycling performance and that the akinesia subscore was the most relevant factor that contributed to cognitive-walking performance. In conclusion, DT facilitation or interference might be mediated by the type of motor task applied. The cognitive-cycling DT paradigm had a facilitative effect on cognition. Cycling exercise may diminish motor dysfunction has been investigated. We suggest that cognitive-cycling DT training is a potential adjuvant therapeutic strategy for patients with PD to promote motor and cognitive functions.
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Affiliation(s)
- Chang Hsiu-Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taiwan; School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Professor Lu Neurological Clinic, Taoyuan, Taiwan
| | - Chen Chiung-Chu
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taiwan; Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Liaw Jiunn-Woei
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Mechanical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Chiou Wei-Da
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Physical Rehabilitation, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Weng Yi-Hsin
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taiwan; Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Chang Ya-Ju
- Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taiwan; School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Lu Chin-Song
- Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taiwan; Professor Lu Neurological Clinic, Taoyuan, Taiwan.
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19
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Marchal V, Sellers J, Pélégrini-Issac M, Galléa C, Bertasi E, Valabrègue R, Lau B, Leboucher P, Bardinet E, Welter ML, Karachi C. Deep brain activation patterns involved in virtual gait without and with a doorway: An fMRI study. PLoS One 2019; 14:e0223494. [PMID: 31634356 PMCID: PMC6802850 DOI: 10.1371/journal.pone.0223494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/22/2019] [Indexed: 11/23/2022] Open
Abstract
The human gait program involves many brain areas such as motor cortices, cerebellum, basal ganglia, brainstem, and spinal cord. The mesencephalic locomotor region (MLR), which contains the pedunculopontine (PPN) and cuneiform (CN) nuclei, is thought to be one of the key supraspinal gait generators. In daily life activities, gait primarily occurs in complex conditions, such as through narrow spaces, or while changing direction or performing motor or cognitive tasks. Here, we aim to explore the activity of these subcortical brain areas while walking through narrow spaces, using functional MRI in healthy volunteers and designing a virtual reality task mimicking walking down a hallway, without and with an open doorway to walk through. As a control, we used a virtual moving walkway in the same environment. Twenty healthy volunteers were scanned. Fifteen subjects were selected for second level analysis based on their ability to activate motor cortices. Using the contrast Gait versus Walkway, we found activated clusters in motor cortices, cerebellum, red nucleus, thalamus, and the left MLR including the CN and PPN. Using the contrast Gait with Doorway versus Walkway with Doorway, we found activated clusters in motor cortices, left putamen, left internal pallidum, left substantia nigra, right subthalamic area, and bilateral MLR involving the CN and PPN. Our results suggest that unobstructed gait involves a motor network including the PPN whereas gait through a narrow space requires the additional participation of basal ganglia and bilateral MLR, which may encode environmental cues to adapt locomotion.
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Affiliation(s)
- Véronique Marchal
- Sorbonne Universités, UPMC Univ Paris, CNRS, INSERM, AP HP GH Pitié Salpêtrière, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France
| | - Jason Sellers
- Sorbonne Universités, UPMC Univ Paris, CNRS, INSERM, AP HP GH Pitié Salpêtrière, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France
| | | | - Cécile Galléa
- Sorbonne Universités, UPMC Univ Paris, CNRS, INSERM, AP HP GH Pitié Salpêtrière, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France
| | - Eric Bertasi
- Sorbonne Universités, UPMC Univ Paris, CNRS, INSERM, AP HP GH Pitié Salpêtrière, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France
- Centre de Neuroimagerie de recherche (CENIR), ICM, Paris, France
| | - Romain Valabrègue
- Sorbonne Universités, UPMC Univ Paris, CNRS, INSERM, AP HP GH Pitié Salpêtrière, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France
- Centre de Neuroimagerie de recherche (CENIR), ICM, Paris, France
| | - Brian Lau
- Sorbonne Universités, UPMC Univ Paris, CNRS, INSERM, AP HP GH Pitié Salpêtrière, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France
| | - Pierre Leboucher
- Sorbonne Universités, UPMC Univ Paris, CNRS, INSERM, AP HP GH Pitié Salpêtrière, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France
- Plateforme PRISME, ICM, Paris, France
| | - Eric Bardinet
- Sorbonne Universités, UPMC Univ Paris, CNRS, INSERM, AP HP GH Pitié Salpêtrière, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France
- Centre de Neuroimagerie de recherche (CENIR), ICM, Paris, France
- * E-mail:
| | - Marie-Laure Welter
- Sorbonne Universités, UPMC Univ Paris, CNRS, INSERM, AP HP GH Pitié Salpêtrière, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France
- Service de Neurophysiologie, CHU Rouen, Université de Rouen, Rouen, France
| | - Carine Karachi
- Sorbonne Universités, UPMC Univ Paris, CNRS, INSERM, AP HP GH Pitié Salpêtrière, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France
- Service de Neurochirurgie, AP-HP, GH Pitié-Salpêtrière, Paris, France
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20
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Klempir O, Krupicka R, Mehnert J, Cejka V, Polakova K, Brozova H, Szabo Z, Ruzicka E, Jech R. Reshaping cortical activity with subthalamic stimulation in Parkinson's disease during finger tapping and gait mapped by near infrared spectroscopy. J Appl Biomed 2019; 17:157-166. [PMID: 34907697 DOI: 10.32725/jab.2019.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/19/2019] [Indexed: 11/05/2022] Open
Abstract
Exploration of motor cortex activity is essential to understanding the pathophysiology in Parkinson's Disease (PD), but only simple motor tasks can be investigated using a fMRI or PET. We aim to investigate the cortical activity of PD patients during a complex motor task (gait) to verify the impact of deep brain stimulation in the subthalamic nucleus (DBS-STN) by using Near-Infrared-Spectroscopy (NIRS). NIRS is a neuroimaging method of brain cortical activity using low-energy optical radiation to detect local changes in (de)oxyhemoglobin concentration. We used a multichannel portable NIRS during finger tapping (FT) and gait. To determine the signal activity, our methodology consisted of a pre-processing phase for the raw signal, followed by statistical analysis based on a general linear model. Processed recordings from 9 patients were statistically compared between the on and off states of DBS-STN. DBS-STN led to an increased activity in the contralateral motor cortex areas during FT. During gait, we observed a concentration of activity towards the cortex central area in the "stimulation-on" state. Our study shows how NIRS can be used to detect functional changes in the cortex of patients with PD with DBS-STN and indicates its future use for applications unsuited for PET and a fMRI.
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Affiliation(s)
- Ondrej Klempir
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Department of Biomedical Informatics, Kladno, Czech Republic
| | - Radim Krupicka
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Department of Biomedical Informatics, Kladno, Czech Republic
| | - Jan Mehnert
- University Medical Center Eppendorf, Department of Systems Neuroscience, Hamburg, Germany.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Vaclav Cejka
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Department of Biomedical Informatics, Kladno, Czech Republic.,Charles University, First Faculty of Medicine and General University Hospital, Department of Neurology, Prague, Czech Republic
| | - Kamila Polakova
- Charles University, First Faculty of Medicine and General University Hospital, Department of Neurology, Prague, Czech Republic
| | - Hana Brozova
- Charles University, First Faculty of Medicine and General University Hospital, Department of Neurology, Prague, Czech Republic
| | - Zoltan Szabo
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Department of Biomedical Informatics, Kladno, Czech Republic
| | - Evzen Ruzicka
- Charles University, First Faculty of Medicine and General University Hospital, Department of Neurology, Prague, Czech Republic
| | - Robert Jech
- Charles University, First Faculty of Medicine and General University Hospital, Department of Neurology, Prague, Czech Republic
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21
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Silva LPD, Duarte MPDS, Souza CDCBD, Lins CCDSA, Coriolano MDGWDS, Lins OG. Efeitos da prática mental associada à fisioterapia motora sobre a marcha e o risco de quedas na doença de Parkinson: estudo piloto. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/17012926022019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo deste estudo piloto, realizado em um hospital universitário de referência em Pernambuco, foi avaliar os efeitos da prática mental associada à fisioterapia motora sobre a marcha e o risco de queda em pessoas com doença de Parkinson. A amostra da pesquisa foi composta por 18 sujeitos, de ambos os sexos, com doença de Parkinson idiopática, divididos em grupo experimental (8 indivíduos) e controle (10 indivíduos). Ambos os grupos realizaram 15 sessões de 40 minutos de fisioterapia motora, duas vezes por semana. No grupo de intervenção, a fisioterapia foi associada a prática mental (15 minutos). Em relação às variáveis de desfecho primário, o tempo de execução do timed up and go e do teste de caminhada de 10 metros reduziu, mas a diferença não foi significativa. Em relação à velocidade, cadência e escore do dynamic gait index, houve aumento após a intervenção no grupo experimental, com diferença significativa (p=0,02). O número de passos foi mantido em ambos os grupos. Os resultados sugerem que a prática mental associada à fisioterapia motora reduz o risco de quedas em comparação com a fisioterapia motora aplicada isoladamente.
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Godi M, Giardini M, Schieppati M. Walking Along Curved Trajectories. Changes With Age and Parkinson's Disease. Hints to Rehabilitation. Front Neurol 2019; 10:532. [PMID: 31178816 PMCID: PMC6543918 DOI: 10.3389/fneur.2019.00532] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/03/2019] [Indexed: 01/11/2023] Open
Abstract
In this review, we briefly recall the fundamental processes allowing us to change locomotion trajectory and keep walking along a curved path and provide a review of contemporary literature on turning in older adults and people with Parkinson's Disease (PD). The first part briefly summarizes the way the body exploits the physical laws to produce a curved walking trajectory. Then, the changes in muscle and brain activation underpinning this task, and the promoting role of proprioception, are briefly considered. Another section is devoted to the gait changes occurring in curved walking and steering with aging. Further, freezing during turning and rehabilitation of curved walking in patients with PD is mentioned in the last part. Obviously, as the research on body steering while walking or turning has boomed in the last 10 years, the relevant critical issues have been tackled and ways to improve this locomotor task proposed. Rationale and evidences for successful training procedures are available, to potentially reduce the risk of falling in both older adults and patients with PD. A better understanding of the pathophysiology of steering, of the subtle but vital interaction between posture, balance, and progression along non-linear trajectories, and of the residual motor learning capacities in these cohorts may provide solid bases for new rehabilitative approaches.
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Affiliation(s)
- Marco Godi
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Pavia, Italy
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Pavia, Italy
| | - Marco Schieppati
- Department of Exercise and Sport Science, International University of Health, Exercise and Sports, LUNEX University, Differdange, Luxembourg
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Mirelman A, Bonato P, Camicioli R, Ellis TD, Giladi N, Hamilton JL, Hass CJ, Hausdorff JM, Pelosin E, Almeida QJ. Gait impairments in Parkinson's disease. Lancet Neurol 2019; 18:697-708. [PMID: 30975519 DOI: 10.1016/s1474-4422(19)30044-4] [Citation(s) in RCA: 319] [Impact Index Per Article: 63.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 12/19/2022]
Abstract
Gait impairments are among the most common and disabling symptoms of Parkinson's disease. Nonetheless, gait is not routinely assessed quantitatively but is described in general terms that are not sensitive to changes ensuing with disease progression. Quantifying multiple gait features (eg, speed, variability, and asymmetry) under natural and more challenging conditions (eg, dual-tasking, turning, and daily living) enhanced sensitivity of gait quantification. Studies of neural connectivity and structural network topology have provided information on the mechanisms of gait impairment. Advances in the understanding of the multifactorial origins of gait changes in patients with Parkinson's disease promoted the development of new intervention strategies, such as neurostimulation and virtual reality, aimed at alleviating gait impairments and enhancing functional mobility. For clinical applicability, it is important to establish clear links between specific gait impairments, their underlying mechanisms, and disease progression to foster the acceptance and usability of quantitative gait measures as outcomes in future disease-modifying clinical trials.
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Affiliation(s)
- Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | | | - Terry D Ellis
- Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, USA
| | - Nir Giladi
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jamie L Hamilton
- Michael J Fox Foundation for Parkinson's Research, New York, NY, USA
| | - Chris J Hass
- College of Health and Human Performance, Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Jeffrey M Hausdorff
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Elisa Pelosin
- Department of Neuroscience (DINOGMI), University of Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Quincy J Almeida
- Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, ON, Canada
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Speed and temporal adaptations during nonmotorized treadmill walking in Parkinson disease and nondisabled individuals. Int J Rehabil Res 2018; 42:126-132. [PMID: 30570519 DOI: 10.1097/mrr.0000000000000334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Few studies have explored the potential of gait analysis and training in nonmotorized treadmill (NMT) in Parkinson's disease (PD) patients. We investigated (a) the walking strategy adopted by patients with PD on NMT and (b) how balance may influence spatiotemporal gait parameters. We enrolled 12 patients with PD of modified Hoehn and Yahr stage 2-3 and 13 nondisabled individuals as controls. All participants were evaluated using Tinetti's performance oriented mobility assessment scale, freezing of gait questionnaire, modified falls efficacy scale, and the timed up and go test. They were asked to ambulate with comfortable and maximal speeds on the NMT. The gait parameters acquired on the NMT included walking speed, cadence (CAD), step length, and vertical ground reaction force, which were calculated for intragroup and intergroup comparisons. The PD group took on with higher contribution of CAD and less contribution of step length to increase walking speed as compared with control group. The postural stability is correlated significantly positively to the CAD at the setting of maximal speed in the PD group. Moreover, a significantly lower ratio of vertical ground reaction force/body weight was noted in the PD group during both comfortable and maximal walking speeds compared with the nondisabled controls. Our study outcomes clearly support the perceived benefits of NMT to differentiate spatiotemporal gait parameters between PD and controls. NMT may potentially be useful to evaluate the recovery of physical activities in PD receiving medications and/or rehabilitation.
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Maidan I, Fahoum F, Shustak S, Gazit E, Patashov D, Tchertov D, Giladi N, Hausdorff JM, Mirelman A. Changes in event-related potentials during dual task walking in aging and Parkinson's disease. Clin Neurophysiol 2018; 130:224-230. [PMID: 30580245 DOI: 10.1016/j.clinph.2018.11.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/16/2018] [Accepted: 11/10/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate EEG changes during an auditory odd-ball task while walking (dual-task) in young adults, older adults, and patients with Parkinson's disease. METHODS 11 young adults, 10 older adults, and 10 patients with Parkinson's disease (PD) performed an auditory oddball task during standing and walking on a treadmill, while wearing a wireless EEG cap. The amplitude and latency of P300 were compared between groups and within conditions using linear mix model analysis. Gait was evaluated using wearable sensors and cognition was assessed using the Color Trail Test. RESULTS P300 latency became longer during walking in all groups (p = 0.005). During walking, older adults (p = 0.005) and patients with PD (p = 0.001) showed prolonged P300 latency compared to young adults. Significant task by group interaction was found in P300 amplitude (p = 0.008). Patients with PD demonstrated reduced P300 amplitude during walking compared to standing (p = 0.023). Among all subjects, better motor and cognitive performance correlated with shorter P300 latency (r = 0.457, p = 0.014 and r = 0.431, p = 0.040, respectively). CONCLUSIONS These findings provide direct evidence of the physiological recruitment of attentional networks during walking and their impact by ageing and disease. SIGNIFICANCE This study is the first to report on changes in P300 latency and amplitude during dual-task oddball walking in older adults and patients with PD.
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Affiliation(s)
- Inbal Maidan
- Laboratory of Early Markers of Neurodegeneration, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Neurological Institute, Tel Aviv Medical Center, Tel-Aviv, Israel; Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Firas Fahoum
- Neurological Institute, Tel Aviv Medical Center, Tel-Aviv, Israel; Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel.
| | - Shiran Shustak
- Laboratory of Early Markers of Neurodegeneration, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Eran Gazit
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Dmitry Patashov
- Faculty of Science, Holon Institute of Technology, Holon, Israel; Faculty of Engineering, Holon Institute of Technology, Holon, Israel.
| | - Dmitry Tchertov
- Faculty of Engineering, Holon Institute of Technology, Holon, Israel.
| | - Nir Giladi
- Laboratory of Early Markers of Neurodegeneration, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Neurological Institute, Tel Aviv Medical Center, Tel-Aviv, Israel; Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Sieratzki Chair in Neurology Tel Aviv University, Israel.
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Neurological Institute, Tel Aviv Medical Center, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Anat Mirelman
- Laboratory of Early Markers of Neurodegeneration, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Neurological Institute, Tel Aviv Medical Center, Tel-Aviv, Israel; Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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26
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Allali G, Blumen HM, Devanne H, Pirondini E, Delval A, Van De Ville D. Brain imaging of locomotion in neurological conditions. Neurophysiol Clin 2018; 48:337-359. [PMID: 30487063 PMCID: PMC6563601 DOI: 10.1016/j.neucli.2018.10.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 01/20/2023] Open
Abstract
Impaired locomotion is a frequent and major source of disability in patients with neurological conditions. Different neuroimaging methods have been used to understand the brain substrates of locomotion in various neurological diseases (mainly in Parkinson's disease) during actual walking, and while resting (using mental imagery of gait, or brain-behavior correlation analyses). These studies, using structural (i.e., MRI) or functional (i.e., functional MRI or functional near infra-red spectroscopy) brain imaging, electrophysiology (i.e., EEG), non-invasive brain stimulation (i.e., transcranial magnetic stimulation, or transcranial direct current stimulation) or molecular imaging methods (i.e., PET, or SPECT) reveal extended brain networks involving both grey and white matters in key cortical (i.e., prefrontal cortex) and subcortical (basal ganglia and cerebellum) regions associated with locomotion. However, the specific roles of the various pathophysiological mechanisms encountered in each neurological condition on the phenotype of gait disorders still remains unclear. After reviewing the results of individual brain imaging techniques across the common neurological conditions, such as Parkinson's disease, dementia, stroke, or multiple sclerosis, we will discuss how the development of new imaging techniques and computational analyses that integrate multivariate correlations in "large enough datasets" might help to understand how individual pathophysiological mechanisms express clinically as an abnormal gait. Finally, we will explore how these new analytic methods could drive our rehabilitative strategies.
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Affiliation(s)
- Gilles Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
| | - Helena M Blumen
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA; Department of Medicine, Division of Geriatrics, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Hervé Devanne
- Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France; EA 7369, URePSSS, Unité de Recherche Pluridisciplinaire Sport Santé Société, Université du Littoral Côte d'Opale, Calais, France
| | - Elvira Pirondini
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland; Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Arnaud Delval
- Department of Clinical Neurophysiology, Lille University Medical Center, Lille, France; Unité Inserm 1171, Faculté de Médecine, Université de Lille, Lille, France
| | - Dimitri Van De Ville
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland; Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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27
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Avanzino L, Lagravinese G, Abbruzzese G, Pelosin E. Relationships between gait and emotion in Parkinson's disease: A narrative review. Gait Posture 2018; 65:57-64. [PMID: 30558947 DOI: 10.1016/j.gaitpost.2018.06.171] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Disturbance of gait is a key feature of Parkinson's disease (PD) and has a negative impact on quality of life. Deficits in cognition and sensorimotor processing impair the ability of people with PD to walk quickly, efficiently and safely. Recent evidence suggests that emotional disturbances may also affect gait in PD. RESEARCH QUESTION We explored if there were relationships between walking ability, emotion and cognitive impairment in people with PD. METHODS The literature was firstly reviewed for unimpaired individuals. The recent experimental evidence for the influence of emotion on gait in people with PD was then explored. The contribution of affective disorders to continuous gait disorders was investigated, particularly for bradykinetic and hypokinetic gait. In addition, we investigated the influence of emotional processing on episodic gait disturbances, such as freezing of gait. Potential effects of pharmacological, surgical and physical therapy interventions were also considered. RESULTS Emerging evidence showed that emotional disturbances arising from affective disorders such as anxiety and depression, in addition to cognitive impairment, could contribute to gait disorders in some people with PD. An analysis of the literature indicated mixed evidence that improvements in affective disorders induced by physical therapy, pharmacological management or surgery improve locomotion in PD. SIGNIFICANCE When assessing and treating gait disorders in people with PD, it is important to take into the account non-motor symptoms such as anxiety, depression and cognitive impairment, in addition to the motor sequalae of this progressive neurological condition.
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Affiliation(s)
- Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Giovanna Lagravinese
- Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy
| | - Giovanni Abbruzzese
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Unit, University of Genoa, Italy
| | - Elisa Pelosin
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Unit, University of Genoa, Italy.
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28
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Eddy CM, Cook JL. Emotions in action: The relationship between motor function and social cognition across multiple clinical populations. Prog Neuropsychopharmacol Biol Psychiatry 2018; 86:229-244. [PMID: 29857027 DOI: 10.1016/j.pnpbp.2018.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/17/2018] [Accepted: 05/25/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Clare M Eddy
- National Centre for Mental Health and College of Medical and Dental Sciences, BSMHFT, University of Birmingham, Birmingham, UK
| | - Jennifer L Cook
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.
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29
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Mahmoud LSED, Abu Shady NAELR, Hafez ES. Motor imagery training with augmented cues of motor learning on cognitive functions in patients with Parkinsonism. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.1.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lama Saad El-Din Mahmoud
- Assistant lecturer, Department of Neuromuscular Disorder and its surgery, Faculty of Physical Therapy, October 6 University, Egypt
| | | | - Ehab Shaker Hafez
- Professor of neurology, Faculty of Medicine, Cairo University, Egypt
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30
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Altered effective connectivity contributes to micrographia in patients with Parkinson’s disease and freezing of gait. J Neurol 2017; 265:336-347. [DOI: 10.1007/s00415-017-8709-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/08/2017] [Accepted: 12/09/2017] [Indexed: 02/06/2023]
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31
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Luu TP, Brantley JA, Nakagome S, Zhu F, Contreras-Vidal JL. Electrocortical correlates of human level-ground, slope, and stair walking. PLoS One 2017; 12:e0188500. [PMID: 29190704 PMCID: PMC5708801 DOI: 10.1371/journal.pone.0188500] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 11/08/2017] [Indexed: 01/29/2023] Open
Abstract
This study investigated electrocortical dynamics of human walking across different unconstrained walking conditions (i.e., level ground (LW), ramp ascent (RA), and stair ascent (SA)). Non-invasive active-electrode scalp electroencephalography (EEG) signals were recorded and a systematic EEG processing method was implemented to reduce artifacts. Source localization combined with independent component analysis and k-means clustering revealed the involvement of four clusters in the brain during the walking tasks: Left and Right Occipital Lobe (LOL, ROL), Posterior Parietal Cortex (PPC), and Central Sensorimotor Cortex (SMC). Results showed that the changes of spectral power in the PPC and SMC clusters were associated with the level of motor task demands. Specifically, we observed α and β suppression at the beginning of the gait cycle in both SA and RA walking (relative to LW) in the SMC. Additionally, we observed significant β rebound (synchronization) at the initial swing phase of the gait cycle, which may be indicative of active cortical signaling involved in maintaining the current locomotor state. An increase of low γ band power in this cluster was also found in SA walking. In the PPC, the low γ band power increased with the level of task demands (from LW to RA and SA). Additionally, our results provide evidence that electrocortical amplitude modulations (relative to average gait cycle) are correlated with the level of difficulty in locomotion tasks. Specifically, the modulations in the PPC shifted to higher frequency bands when the subjects walked in RA and SA conditions. Moreover, low γ modulations in the central sensorimotor area were observed in the LW walking and shifted to lower frequency bands in RA and SA walking. These findings extend our understanding of cortical dynamics of human walking at different level of locomotion task demands and reinforces the growing body of literature supporting a shared-control paradigm between spinal and cortical networks during locomotion.
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Affiliation(s)
- Trieu Phat Luu
- Noninvasive Brain-Machine Interface System Laboratory, Dept. of Electrical and Computer Engineering, University of Houston, Houston, TX, United States of America
| | - Justin A. Brantley
- Noninvasive Brain-Machine Interface System Laboratory, Dept. of Electrical and Computer Engineering, University of Houston, Houston, TX, United States of America
| | - Sho Nakagome
- Noninvasive Brain-Machine Interface System Laboratory, Dept. of Electrical and Computer Engineering, University of Houston, Houston, TX, United States of America
| | - Fangshi Zhu
- Noninvasive Brain-Machine Interface System Laboratory, Dept. of Electrical and Computer Engineering, University of Houston, Houston, TX, United States of America
| | - Jose L. Contreras-Vidal
- Noninvasive Brain-Machine Interface System Laboratory, Dept. of Electrical and Computer Engineering, University of Houston, Houston, TX, United States of America
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Lee KB, Kim JS, Hong BY, Sul B, Song S, Sung WJ, Hwang BY, Lim SH. Brain lesions affecting gait recovery in stroke patients. Brain Behav 2017; 7:e00868. [PMID: 29201557 PMCID: PMC5698874 DOI: 10.1002/brb3.868] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 09/26/2017] [Accepted: 09/30/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Gait recovery is an important goal in stroke patients. Several studies have sought to uncover relationships between specific brain lesions and the recovery of gait, but the effects of specific brain lesions on gait remain unclear. Thus, we investigated the effects of stroke lesions on gait recovery in stroke patients. MATERIALS AND METHODS In total, 30 subjects with stroke were assessed in a retrograde longitudinal observational study. To assess gait function, the functional ambulation category (FAC) was tested four times: initially (within 2 weeks) and 1, 3, and 6 months after the onset of the stroke. Brain lesions were analyzed via overlap, subtraction, and voxel-based lesion symptom mapping (VLSM). RESULTS Ambulation with FAC improved significantly with time. Subtraction analysis showed that involvement of the corona radiata, internal capsule, globus pallidus, and putamen were associated with poor recovery of gait throughout 6 months after onset. The caudate nucleus did influence poor recovery of gait at 6 months after onset. VLSM revealed that corona radiata, internal capsule, globus pallidus, putamen and cingulum were related with poor recovery of gait at 3 months after onset. Corona radiata, internal capsule, globus pallidus, putamen, primary motor cortex, and caudate nucleus were related with poor recovery of gait at 6 months after onset. CONCLUSION Results identified several important brain lesions for gait recovery in patients with stroke. These results may be useful for planning rehabilitation strategies for gait and understanding the prognosis of gait in stroke patients.
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Affiliation(s)
- Kyoung Bo Lee
- Department of Rehabilitation Medicine St. Vincent's Hospital College of Medicine The Catholic University of Korea Seoul Korea
| | - Joon Sung Kim
- Department of Rehabilitation Medicine St. Vincent's Hospital College of Medicine The Catholic University of Korea Seoul Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine St. Vincent's Hospital College of Medicine The Catholic University of Korea Seoul Korea
| | - Bomi Sul
- Department of Rehabilitation Medicine St. Vincent's Hospital College of Medicine The Catholic University of Korea Seoul Korea
| | - Seojin Song
- Department of Rehabilitation Medicine St. Vincent's Hospital College of Medicine The Catholic University of Korea Seoul Korea
| | - Won Jin Sung
- Department of Rehabilitation Medicine St. Vincent's Hospital College of Medicine The Catholic University of Korea Seoul Korea
| | | | - Seong Hoon Lim
- Department of Rehabilitation Medicine St. Vincent's Hospital College of Medicine The Catholic University of Korea Seoul Korea
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Maidan I, Rosenberg-Katz K, Jacob Y, Giladi N, Hausdorff JM, Mirelman A. Disparate effects of training on brain activation in Parkinson disease. Neurology 2017; 89:1804-1810. [PMID: 28954877 DOI: 10.1212/wnl.0000000000004576] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/20/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the effects of 2 forms of exercise, i.e., a 6-week trial of treadmill training with virtual reality (TT + VR) that targets motor and cognitive aspects of safe ambulation and a 6-week trial of treadmill training alone (TT), on brain activation in patients with Parkinson disease (PD). METHODS As part of a randomized controlled trial, patients were randomly assigned to 6 weeks of TT (n = 17, mean age 71.5 ± 1.5 years, disease duration 11.6 ± 1.6 years; 70% men) or TT + VR (n = 17, mean age 71.2 ± 1.7 years, disease duration 7.9 ± 1.4 years; 65% men). A previously validated fMRI imagery paradigm assessed changes in neural activation pretraining and post-training. Participants imagined themselves walking in 2 virtual scenes projected in the fMRI: (1) a clear path and (2) a path with virtual obstacles. Whole brain and region of interest analyses were performed. RESULTS Brain activation patterns were similar between training arms before the interventions. After training, participants in the TT + VR arm had lower activation than the TT arm in Brodmann area 10 and the inferior frontal gyrus (cluster level familywise error-corrected [FWEcorr] p < 0.012), while the TT arm had lower activation than TT + VR in the cerebellum and middle temporal gyrus (cluster level FWEcorr p < 0.001). Changes in fall frequency and brain activation were correlated in the TT + VR arm. CONCLUSIONS Exercise modifies brain activation patterns in patients with PD in a mode-specific manner. Motor-cognitive training decreased the reliance on frontal regions, which apparently resulted in improved function, perhaps reflecting increased brain efficiency.
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Affiliation(s)
- Inbal Maidan
- From the Center for the Study of Movement, Cognition, and Mobility, Neurological Institute (I.M., K.R.-K., Y.J., N.G., J.M.H., A.M.), and Laboratory of Early Markers of Neurodegeneration (A.M.), Tel Aviv Sourasky Medical Center; Sagol School of Neuroscience (N.G., J.M.H., A.M.) and Departments of Neurology & Neurosurgery (N.G., A.M.) and Physical Therapy (J.M.H.), Sackler Faculty of Medicine, Tel Aviv University, Israel; and Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery (J.M.H.), Rush University Medical Center, Chicago, IL
| | - Keren Rosenberg-Katz
- From the Center for the Study of Movement, Cognition, and Mobility, Neurological Institute (I.M., K.R.-K., Y.J., N.G., J.M.H., A.M.), and Laboratory of Early Markers of Neurodegeneration (A.M.), Tel Aviv Sourasky Medical Center; Sagol School of Neuroscience (N.G., J.M.H., A.M.) and Departments of Neurology & Neurosurgery (N.G., A.M.) and Physical Therapy (J.M.H.), Sackler Faculty of Medicine, Tel Aviv University, Israel; and Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery (J.M.H.), Rush University Medical Center, Chicago, IL
| | - Yael Jacob
- From the Center for the Study of Movement, Cognition, and Mobility, Neurological Institute (I.M., K.R.-K., Y.J., N.G., J.M.H., A.M.), and Laboratory of Early Markers of Neurodegeneration (A.M.), Tel Aviv Sourasky Medical Center; Sagol School of Neuroscience (N.G., J.M.H., A.M.) and Departments of Neurology & Neurosurgery (N.G., A.M.) and Physical Therapy (J.M.H.), Sackler Faculty of Medicine, Tel Aviv University, Israel; and Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery (J.M.H.), Rush University Medical Center, Chicago, IL
| | - Nir Giladi
- From the Center for the Study of Movement, Cognition, and Mobility, Neurological Institute (I.M., K.R.-K., Y.J., N.G., J.M.H., A.M.), and Laboratory of Early Markers of Neurodegeneration (A.M.), Tel Aviv Sourasky Medical Center; Sagol School of Neuroscience (N.G., J.M.H., A.M.) and Departments of Neurology & Neurosurgery (N.G., A.M.) and Physical Therapy (J.M.H.), Sackler Faculty of Medicine, Tel Aviv University, Israel; and Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery (J.M.H.), Rush University Medical Center, Chicago, IL
| | - Jeffrey M Hausdorff
- From the Center for the Study of Movement, Cognition, and Mobility, Neurological Institute (I.M., K.R.-K., Y.J., N.G., J.M.H., A.M.), and Laboratory of Early Markers of Neurodegeneration (A.M.), Tel Aviv Sourasky Medical Center; Sagol School of Neuroscience (N.G., J.M.H., A.M.) and Departments of Neurology & Neurosurgery (N.G., A.M.) and Physical Therapy (J.M.H.), Sackler Faculty of Medicine, Tel Aviv University, Israel; and Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery (J.M.H.), Rush University Medical Center, Chicago, IL
| | - Anat Mirelman
- From the Center for the Study of Movement, Cognition, and Mobility, Neurological Institute (I.M., K.R.-K., Y.J., N.G., J.M.H., A.M.), and Laboratory of Early Markers of Neurodegeneration (A.M.), Tel Aviv Sourasky Medical Center; Sagol School of Neuroscience (N.G., J.M.H., A.M.) and Departments of Neurology & Neurosurgery (N.G., A.M.) and Physical Therapy (J.M.H.), Sackler Faculty of Medicine, Tel Aviv University, Israel; and Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery (J.M.H.), Rush University Medical Center, Chicago, IL.
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Godde B, Voelcker-Rehage C. Cognitive Resources Necessary for Motor Control in Older Adults Are Reduced by Walking and Coordination Training. Front Hum Neurosci 2017; 11:156. [PMID: 28443006 PMCID: PMC5387041 DOI: 10.3389/fnhum.2017.00156] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/16/2017] [Indexed: 12/22/2022] Open
Abstract
We examined if physical exercise interventions were effective to reduce cognitive brain resources recruited while performing motor control tasks in older adults. Forty-three older adults (63-79 years of age) participated in either a walking (n = 17) or a motor coordination (n = 15) intervention (1 year, 3 times per week) or were assigned to a control group (n = 11) doing relaxation and stretching exercises. Pre and post the intervention period, we applied functional MRI to assess brain activation during imagery of forward and backward walking and during counting backwards from 100 as control task. In both experimental groups, activation in the right dorsolateral prefrontal cortex (DLPFC) during imagery of forward walking decreased from pre- to post-test (Effect size: -1.55 and -1.16 for coordination and walking training, respectively; Cohen's d). Regression analysis revealed a significant positive association between initial motor status and activation change in the right DLPFC (R2 = 0.243, F(3,39) = 4.18, p = 0.012). Participants with lowest motor status at pretest profited most from the interventions. Data suggest that physical training in older adults is effective to free up cognitive resources otherwise needed for the control of locomotion. Training benefits may become particularly apparent in so-called dual-task situations where subjects must perform motor and cognitive tasks concurrently.
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Affiliation(s)
- Ben Godde
- Department of Psychology and Methods, Jacobs University BremenBremen, Germany
- Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University BremenBremen, Germany
- Center for Cognitive Science, Bremen UniversityBremen, Germany
| | - Claudia Voelcker-Rehage
- Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University BremenBremen, Germany
- Center for Cognitive Science, Bremen UniversityBremen, Germany
- Institute of Human Movement Science and Health, Technische Universität ChemnitzChemnitz, Germany
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Labriffe M, Annweiler C, Amirova LE, Gauquelin-Koch G, Ter Minassian A, Leiber LM, Beauchet O, Custaud MA, Dinomais M. Brain Activity during Mental Imagery of Gait Versus Gait-Like Plantar Stimulation: A Novel Combined Functional MRI Paradigm to Better Understand Cerebral Gait Control. Front Hum Neurosci 2017; 11:106. [PMID: 28321186 PMCID: PMC5337483 DOI: 10.3389/fnhum.2017.00106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/20/2017] [Indexed: 01/27/2023] Open
Abstract
Human locomotion is a complex sensorimotor behavior whose central control remains difficult to explore using neuroimaging method due to technical constraints, notably the impossibility to walk with a scanner on the head and/or to walk for real inside current scanners. The aim of this functional Magnetic Resonance Imaging (fMRI) study was to analyze interactions between two paradigms to investigate the brain gait control network: (1) mental imagery of gait, and (2) passive mechanical stimulation of the plantar surface of the foot with the Korvit boots. The Korvit stimulator was used through two different modes, namely an organized (“gait like”) sequence and a destructured (chaotic) pattern. Eighteen right-handed young healthy volunteers were recruited (mean age, 27 ± 4.7 years). Mental imagery activated a broad neuronal network including the supplementary motor area-proper (SMA-proper), pre-SMA, the dorsal premotor cortex, ventrolateral prefrontal cortex, anterior insula, and precuneus/superior parietal areas. The mechanical plantar stimulation activated the primary sensorimotor cortex and secondary somatosensory cortex bilaterally. The paradigms generated statistically common areas of activity, notably bilateral SMA-proper and right pre-SMA, highlighting the potential key role of SMA in gait control. There was no difference between the organized and chaotic Korvit sequences, highlighting the difficulty of developing a walking-specific plantar stimulation paradigm. In conclusion, this combined-fMRI paradigm combining mental imagery and gait-like plantar stimulation provides complementary information regarding gait-related brain activity and appears useful for the assessment of high-level gait control.
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Affiliation(s)
- Matthieu Labriffe
- Laboratoire Angevin de Recherche en Ingénierie des Systèmes, EA7315, University of Angers - Université Nantes Angers Le MansAngers, France; Department of Radiology, Angers University Hospital, University of Angers - Université Nantes Angers Le MansAngers, France
| | - Cédric Annweiler
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic - Angers University Hospital; UPRES EA 4638 - University of Angers, Université Nantes Angers Le MansAngers, France; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, LondonON, Canada
| | - Liubov E Amirova
- Laboratoire de Biologie Neuro-Vasculaire et Mitochondriale Intégrée, UMR CNRS 6214 INSERM U1083, University of AngersAngers, France; Institute of Biomedical Problems, Russian Academy of SciencesMoscow, Russia
| | | | - Aram Ter Minassian
- Laboratoire Angevin de Recherche en Ingénierie des Systèmes, EA7315, University of Angers - Université Nantes Angers Le MansAngers, France; Department of Anesthesia and Critical Care, Angers University Hospital - University of Angers, Université Nantes Angers Le MansAngers, France
| | - Louis-Marie Leiber
- Laboratoire Angevin de Recherche en Ingénierie des Systèmes, EA7315, University of Angers - Université Nantes Angers Le MansAngers, France; Department of Radiology, Angers University Hospital, University of Angers - Université Nantes Angers Le MansAngers, France
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, MontrealQC, Canada; Dr. Joseph Kaufmann Chair in Geriatric Medicine, Faculty of Medicine, McGill University, MontrealQC, Canada
| | - Marc-Antoine Custaud
- Laboratoire de Biologie Neuro-Vasculaire et Mitochondriale Intégrée, UMR CNRS 6214 INSERM U1083, University of AngersAngers, France; Clinical Research Center, Angers University Hospital, University of Angers - Université Nantes Angers Le MansAngers, France
| | - Mickaël Dinomais
- Laboratoire Angevin de Recherche en Ingénierie des Systèmes, EA7315, University of Angers - Université Nantes Angers Le MansAngers, France; Department of Physical and Rehabilitation Medicine, Angers University Hospital, University of Angers - Université Nantes Angers Le MansAngers, France
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Caligiore D, Mustile M, Spalletta G, Baldassarre G. Action observation and motor imagery for rehabilitation in Parkinson's disease: A systematic review and an integrative hypothesis. Neurosci Biobehav Rev 2017; 72:210-222. [DOI: 10.1016/j.neubiorev.2016.11.005] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/26/2016] [Accepted: 11/07/2016] [Indexed: 12/18/2022]
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Metzger FG, Ehlis AC, Haeussinger FB, Schneeweiss P, Hudak J, Fallgatter AJ, Schneider S. Functional brain imaging of walking while talking - An fNIRS study. Neuroscience 2016; 343:85-93. [PMID: 27915210 DOI: 10.1016/j.neuroscience.2016.11.032] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/02/2016] [Accepted: 11/21/2016] [Indexed: 11/24/2022]
Abstract
Since functional imaging of whole body movements is not feasible with functional magnetic resonance imaging (fMRI), the present study presents in vivo functional near-infrared spectroscopy (fNIRS) as a suitable technique to measure body movement effects on fronto-temporo-parietal cortical activation in single- and dual-task paradigms. Previous fNIRS applications in studies addressing whole body movements were typically limited to the assessment of prefrontal brain areas. The current study investigated brain activation in the frontal, temporal and parietal cortex of both hemispheres using functional near-infrared spectroscopy (fNIRS) with two large 4×4 probe-sets with 24 channels each during single and dual gait tasks. 12 young healthy adults were measured using fNIRS walking on a treadmill: the participants performed two single-task (ST) paradigms (walking at different speeds, i.e. 3 and 5km/h) and a dual task (DT) paradigm where a verbal fluency task (VFT) had to be executed while walking at 3km/h. The results show an increase of activation in Broca's area during the more advanced conditions (ST 5km/h vs. ST 3km/h, DT vs. ST 3km/h, DT vs. 5km/h), while the corresponding area on the right hemisphere was also activated. DT paradigms including a cognitive task in conjunction with whole body movements elicit wide-spread cortical activation patterns across fronto-temporo-parietal areas. An elaborate assessment of these activation patterns requires more extensive fNIRS assessments than the traditional prefrontal investigations, e.g. as performed with portable fNIRS devices.
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Affiliation(s)
- Florian G Metzger
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Calwerstraße 14, 72076 Tuebingen, Germany; Geriatric Center, University Hospital of Tuebingen, Calwerstraße 14, 72076 Tuebingen, Germany.
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Calwerstraße 14, 72076 Tuebingen, Germany.
| | - Florian B Haeussinger
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Calwerstraße 14, 72076 Tuebingen, Germany.
| | - Patrick Schneeweiss
- Department of Sports Medicine, University Hospital of Tuebingen, Hoppe-Seyler-Straße 6, 72076 Tübingen, Germany.
| | - Justin Hudak
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Calwerstraße 14, 72076 Tuebingen, Germany.
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Calwerstraße 14, 72076 Tuebingen, Germany; Center of Integrative Neuroscience (CIN), Cluster of Excellence, University of Tuebingen, Otfried-Müller-Straße 25, 72076 Tübingen, Germany.
| | - Sabrina Schneider
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Calwerstraße 14, 72076 Tuebingen, Germany; Department of Psychology, HELP University Kuala Lumpur, Persiaran Cakerawala, Subang Bestari, Seksyen U4, 40150 Shah Alam, Selangor, Malaysia.
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Perruchoud D, Michels L, Piccirelli M, Gassert R, Ionta S. Differential neural encoding of sensorimotor and visual body representations. Sci Rep 2016; 6:37259. [PMID: 27883017 PMCID: PMC5121642 DOI: 10.1038/srep37259] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/26/2016] [Indexed: 12/13/2022] Open
Abstract
Sensorimotor processing specifically impacts mental body representations. In particular, deteriorated somatosensory input (as after complete spinal cord injury) increases the relative weight of visual aspects of body parts’ representations, leading to aberrancies in how images of body parts are mentally manipulated (e.g. mental rotation). This suggests that a sensorimotor or visual reference frame, respectively, can be relatively dominant in local (hands) versus global (full-body) bodily representations. On this basis, we hypothesized that the recruitment of a specific reference frame could be reflected in the activation of sensorimotor versus visual brain networks. To this aim, we directly compared the brain activity associated with mental rotation of hands versus full-bodies. Mental rotation of hands recruited more strongly the supplementary motor area, premotor cortex, and secondary somatosensory cortex. Conversely, mental rotation of full-bodies determined stronger activity in temporo-occipital regions, including the functionally-localized extrastriate body area. These results support that (1) sensorimotor and visual frames of reference are used to represent the body, (2) two distinct brain networks encode local or global bodily representations, and (3) the extrastriate body area is a multimodal region involved in body processing both at the perceptual and representational level.
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Affiliation(s)
- David Perruchoud
- The Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology and Department of Clinical Neurosciences, University Hospital Center (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Lars Michels
- Institute of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Marco Piccirelli
- Institute of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Silvio Ionta
- The Laboratory for Investigative Neurophysiology (The LINE), Department of Radiology and Department of Clinical Neurosciences, University Hospital Center (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
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Abstract
People with Parkinson's disease exhibit debilitating gait impairments, including gait slowness, increased step variability, and poor postural control. A widespread supraspinal locomotor network including the cortex, cerebellum, basal ganglia, and brain stem contributes to the control of human locomotion, and altered activity of these structures underlies gait dysfunction due to Parkinson's disease.
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Affiliation(s)
- D S Peterson
- Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon; and Oregon Health & Science University, Department of Neurology, Portland, Oregon
| | - F B Horak
- Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon; and Oregon Health & Science University, Department of Neurology, Portland, Oregon
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Maidan I, Rosenberg-Katz K, Jacob Y, Giladi N, Deutsch JE, Hausdorff JM, Mirelman A. Altered brain activation in complex walking conditions in patients with Parkinson's disease. Parkinsonism Relat Disord 2016; 25:91-6. [PMID: 26861167 DOI: 10.1016/j.parkreldis.2016.01.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Behavioral studies suggest that deficits in cognitive domains and sensory-motor processes associated with Parkinson's disease (PD) impair the ability to walk in complex environments. However, the neural correlates of locomotion in complex environments are still unclear. METHODS Twenty healthy older adults (mean age 69.7 ± 1.3 yrs) and 20 patients with PD (mean age 72.9 ± 1.6 yrs; disease duration: 6.8 ± 1.3 yrs; UPDRSIII: 29.8 ± 2.4) were asked to imagine themselves walking while in the MRI scanner. Three imagined walking tasks, i.e., usual walking, obstacle negotiation, and navigation were performed. Watching the same virtual scenes without imagining walking served as control tasks. Whole brain analyses were used. RESULTS Compared to usual walking, both groups had increased activation during obstacle negotiation in middle occipital gyrus (MOG) (pFWEcorr<0.001), middle frontal gyrus (MFG) (pFWEcorr<0.005), and cerebellum (pFWEcorr<0.001). Healthy older adults had higher activation in precuneus and MOG (pFWEcorr<0.023) during navigation, while no differences were observed in patients with PD. Between group comparisons revealed that patients with PD had a significantly higher activation in usual walking and obstacle negotiation (pFWEcorr<0.039) while during navigation task, healthy older adults had higher activation (pFWEcorr<0.047). CONCLUSIONS Patients with PD require greater activation during imagined usual walking and obstacle negotiation than healthy older adults. This increased activation may reflect a compensatory attempt to overcome inefficient neural activation in patients with PD. This increased activation may reduce the functional reserve needed during more demanding tasks such as during navigation which may contribute to the high prevalence of falls and dual tasking difficulties among patients with PD.
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Affiliation(s)
- I Maidan
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Rivers Lab, Department of Rehabilitation and Movement Science, Rutgers Biomedical and Health Sciences, Newark, USA
| | - K Rosenberg-Katz
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Y Jacob
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - N Giladi
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - J E Deutsch
- Rivers Lab, Department of Rehabilitation and Movement Science, Rutgers Biomedical and Health Sciences, Newark, USA
| | - J M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - A Mirelman
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Vervoort G, Alaerts K, Bengevoord A, Nackaerts E, Heremans E, Vandenberghe W, Nieuwboer A. Functional connectivity alterations in the motor and fronto-parietal network relate to behavioral heterogeneity in Parkinson's disease. Parkinsonism Relat Disord 2016; 24:48-55. [PMID: 26924603 DOI: 10.1016/j.parkreldis.2016.01.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Insight into the neural mechanisms of postural instability and gait disorder (PIGD) and tremor dominant (TD) subtypes in Parkinson's disease (PD) is indispensable for generating pathophysiology hypotheses underlying this phenotyping. This cross-sectional study aimed to gain insight in specific and brain-wide functional connectivity (FC) and its correlation with motor deterioration and preservation in PD subtypes. METHODS 68 PD patients classified as PIGD (n = 41), TD (n = 19) or indeterminate (n = 8) and 19 age-matched controls underwent resting-state fMRI while 'off' medication to assess FC between regions of interest (ROIs) in the motor and fronto-parietal network and on a whole-brain level using a parcellated template. FC alterations were correlated with quantitative behavioral measures. RESULTS ROI-analyses showed decreased FC between the caudate and putamen in PIGD compared to TD. This hypo-connectivity was correlated with behavioral impairment. In contrast, TD-specific hyper-connectivity between motor cortical areas and the inferior parietal lobule correlated with less behavioral impairment, suggesting compensatory mechanisms. Both subgroups showed hyper-connectivity between the left supplementary motor area and pedunculopontine nucleus, whereas PIGD-specific right lateralized hyper-connectivity was shown between this nucleus and the premotor cortex. Whole-brain analyses revealed 65% hypo-connectivity and 35% hyper-connectivity in PIGD compared to TD. TD also revealed primarily hypo-connectivity compared to controls, but had more pronounced hyper-connectivity involving temporo-occipital areas. CONCLUSION This multilevel analysis showed differential connectivity alterations in large scale neural networks and between motor and cognitive control areas that related to behavioral heterogeneity in PD, underscoring the classic TD-PIGD phenotypical classification.
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Affiliation(s)
- Griet Vervoort
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001 Leuven, Belgium.
| | - Kaat Alaerts
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001 Leuven, Belgium.
| | - Aniek Bengevoord
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001 Leuven, Belgium.
| | - Evelien Nackaerts
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001 Leuven, Belgium.
| | - Elke Heremans
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001 Leuven, Belgium.
| | - Wim Vandenberghe
- University Hospitals Leuven, Department of Neurology, Herestraat 49, 3000 Leuven, Belgium.
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101/1501, 3001 Leuven, Belgium.
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Vervoort G, Heremans E, Bengevoord A, Strouwen C, Nackaerts E, Vandenberghe W, Nieuwboer A. Dual-task-related neural connectivity changes in patients with Parkinson' disease. Neuroscience 2016; 317:36-46. [PMID: 26762801 DOI: 10.1016/j.neuroscience.2015.12.056] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/19/2015] [Accepted: 12/30/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Dual-task (DT) gait impairment in people with Parkinson's disease (PD) and specifically in those with freezing of gait (FOG), reflects attentional dependency of movement. This study aimed to elucidate resting-state brain connectivity alterations related to DT gait abnormalities in PD with and without FOG. METHODS PD patients (n=73) and healthy age-matched controls (n=20) underwent DT gait analysis and resting-state functional Magnetic Resonance Imaging (rs-MRI) while 'off' medication. Patients were classified as freezer (n=13) or non-freezer (n=60). Functional connectivity (FC) alterations between PD and controls and between patient subgroups were assessed in regions of interest (ROIs) within the fronto-parietal and motor network. RESULTS PD had longer stance times, shorter swing times and more step length asymmetry during DT gait and needed more time and steps during DT turning compared to controls. Additionally, freezers showed similar impairments and longer double support times compared to non-freezers during DT gait. PD demonstrated hyper-connectivity between the inferior parietal lobule and premotor cortex (PMC) and between the cerebellum and the PMC and M1. FOG-specific hypo-connectivity within the striatum and between the caudate and superior temporal lobe and hyper-connectivity between the dorsal putamen and precuneus was correlated with worse DT performance. CONCLUSION PD showed FC alterations in DT-related networks, which were not correlated to DT performance. However, FOG-specific FC alterations in DT-related regions involving the precuneus and striatum were correlated to worse DT performance, suggesting that the balance between cognitive and motor networks is altered.
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Affiliation(s)
- G Vervoort
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
| | - E Heremans
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
| | - A Bengevoord
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
| | - C Strouwen
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
| | - E Nackaerts
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
| | - W Vandenberghe
- University Hospitals Leuven, Department of Neurology, Leuven, Belgium.
| | - A Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
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Iosa M, Morone G, Fusco A, Marchetti F, Caltagirone C, Paolucci S, Peppe A. Loss of fractal gait harmony in Parkinson's Disease. Clin Neurophysiol 2015; 127:1540-1546. [PMID: 26679417 DOI: 10.1016/j.clinph.2015.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/21/2015] [Accepted: 11/21/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Recently, an intrinsic fractal harmonic structure was found underlying the rhythm of physiological walking, but it has not yet been investigated in subjects with a neurological disease. The aim of this study was to determine if and how this harmonic structure is altered in patients with Parkinson's Disease. METHODS Gait analysis of 70 patients with Parkinson's Disease in pharmacological phase on was performed, the findings of which we compared with reference data of age-matched healthy subjects. Fifteen patients were retested after a washout period of 12 h. RESULTS Alterations in all spatio-temporal gait parameters and gait indices with regard to symmetry, coordination, and harmony were noted, but after correction for multicollinearity bias, only the latter correlated significantly with Unified Parkinson's Disease Rating Scale motor score (p=0.001). The fractal gait structure underwent even more extensive alterations in pharmacological off phase (p<0.05). CONCLUSIONS The intrinsic gait harmony was altered in patients with Parkinson's Disease and significantly correlated to motor severity. It could be partially recovered by assumption of L-dopa. SIGNIFICANCE Loss of harmony is a quantitatively assessable gait benchmark in Parkinson's Disease. It seems to be dependent on dopaminergic but also on non-dopaminergic networks.
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Affiliation(s)
- Marco Iosa
- Santa Lucia Foundation, I.R.C.C.S., via Ardeatina 306, 00179 Rome, Italy.
| | - Giovanni Morone
- Santa Lucia Foundation, I.R.C.C.S., via Ardeatina 306, 00179 Rome, Italy
| | - Augusto Fusco
- Santa Lucia Foundation, I.R.C.C.S., via Ardeatina 306, 00179 Rome, Italy
| | - Fabio Marchetti
- Santa Lucia Foundation, I.R.C.C.S., via Ardeatina 306, 00179 Rome, Italy
| | - Carlo Caltagirone
- Santa Lucia Foundation, I.R.C.C.S., via Ardeatina 306, 00179 Rome, Italy; Tor Vergata University of Rome, via Montpellier 1, 00133 Rome, Italy
| | - Stefano Paolucci
- Santa Lucia Foundation, I.R.C.C.S., via Ardeatina 306, 00179 Rome, Italy
| | - Antonella Peppe
- Santa Lucia Foundation, I.R.C.C.S., via Ardeatina 306, 00179 Rome, Italy
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Delval A, Tard C, Rambour M, Defebvre L, Moreau C. Characterization and quantification of freezing of gait in Parkinson's disease: Can detection algorithms replace clinical expert opinion? Neurophysiol Clin 2015; 45:305-13. [PMID: 26547546 DOI: 10.1016/j.neucli.2015.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 10/22/2022] Open
Abstract
Freezing of gait is a paroxysmal phenomenon that is frequently reported by the parkinsonian patients or their entourage. The phenomenon significantly alters quality of life but is often difficult to characterize in the physician's office. In the present review, we focus on the clinical characterization and quantification of freezing of gait. Various biomechanical methods (based mainly on time-frequency analysis) can be used to determine time-domain characteristics of freezing of gait. Methods already used to study non-gait freezing of other effectors (the lower limbs, upper limbs and orofacial area) are also being developed for the analysis of freezing in functional magnetic resonance imaging protocols. Here, we review the reliability of these methods and compare them with reliability of information obtained from physical examination and detailed analysis of the patient's medical history.
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Affiliation(s)
- A Delval
- U1171, Université de Lille, Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, Lille, France.
| | - C Tard
- U1171, Université de Lille, Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, Lille, France
| | - M Rambour
- U1171, Université de Lille, Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, Lille, France
| | - L Defebvre
- U1171, Université de Lille, Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, Lille, France
| | - C Moreau
- U1171, Université de Lille, Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, Lille, France
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45
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Abbruzzese G, Avanzino L, Marchese R, Pelosin E. Action Observation and Motor Imagery: Innovative Cognitive Tools in the Rehabilitation of Parkinson's Disease. PARKINSON'S DISEASE 2015; 2015:124214. [PMID: 26495150 PMCID: PMC4606219 DOI: 10.1155/2015/124214] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/23/2015] [Indexed: 12/20/2022]
Abstract
Parkinson's disease (PD) is characterized by a progressive impairment of motor skills with deterioration of autonomy in daily living activities. Physiotherapy is regarded as an adjuvant to pharmacological and neurosurgical treatment and may provide small and short-lasting clinical benefits in PD patients. However, the development of innovative rehabilitation approaches with greater long-term efficacy is a major unmet need. Motor imagery (MI) and action observation (AO) have been recently proposed as a promising rehabilitation tool. MI is the ability to imagine a movement without actual performance (or muscle activation). The same cortical-subcortical network active during motor execution is engaged in MI. The physiological basis of AO is represented by the activation of the "mirror neuron system." Both MI and AO are involved in motor learning and can induce improvements of motor performance, possibly mediated by the development of plastic changes in the motor cortex. The review of available evidences indicated that MI ability and AO feasibility are substantially preserved in PD subjects. A few preliminary studies suggested the possibility of using MI and AO as parts of rehabilitation protocols for PD patients.
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Affiliation(s)
- Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, 16132 Genoa, Italy
| | - Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, 16132 Genoa, Italy
| | - Roberta Marchese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, 16132 Genoa, Italy
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, 16132 Genoa, Italy
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46
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Tard C, Delval A, Devos D, Lopes R, Lenfant P, Dujardin K, Hossein-Foucher C, Semah F, Duhamel A, Defebvre L, Le Jeune F, Moreau C. Brain metabolic abnormalities during gait with freezing in Parkinson’s disease. Neuroscience 2015; 307:281-301. [DOI: 10.1016/j.neuroscience.2015.08.063] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 08/25/2015] [Accepted: 08/25/2015] [Indexed: 11/28/2022]
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47
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Brain activity during walking: A systematic review. Neurosci Biobehav Rev 2015; 57:310-27. [PMID: 26306029 DOI: 10.1016/j.neubiorev.2015.08.002] [Citation(s) in RCA: 194] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/27/2015] [Accepted: 08/02/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND This systematic review provides an overview of the literature deducing information about brain activation during (1) imagined walking using MRI/fMRI or (2) during real walking using measurement systems as fNIRS, EEG and PET. METHODS Three independent reviewers undertook an electronic database research browsing six databases. The search request consisted of three search fields. The first field comprised common methods to evaluate brain activity. The second search field comprised synonyms for brain responses to movements. The third search field comprised synonyms for walking. RESULTS 48 of an initial yield of 1832 papers were reviewed. We found differences in cortical activity regarding young vs. old individuals, physically fit vs. physically unfit cohorts, healthy people vs. patients with neurological diseases, and between simple and complex walking tasks. CONCLUSIONS We summarize that the dimension of brain activity in different brain areas during walking is highly sensitive to task complexity, age and pathologies supporting previous assumptions underpinning the significance of cortical control. Many compensation mechanisms reflect the brain's plasticity which ensures stable walking.
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48
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Niccolini F, Foltynie T, Reis Marques T, Muhlert N, Tziortzi AC, Searle GE, Natesan S, Kapur S, Rabiner EA, Gunn RN, Piccini P, Politis M. Loss of phosphodiesterase 10A expression is associated with progression and severity in Parkinson's disease. Brain 2015. [PMID: 26210536 DOI: 10.1093/brain/awv219] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The mechanisms underlying neurodegeneration and loss of dopaminergic signalling in Parkinson's disease are still only partially understood. Phosphodiesterase 10A (PDE10A) is a basal ganglia expressed dual substrate enzyme, which regulates cAMP and cGMP signalling cascades, thus having a key role in the regulation of dopaminergic signalling in striatal pathways, and in promoting neuronal survival. This study aimed to assess in vivo the availability of PDE10A in patients with Parkinson's disease using positron emission tomography molecular imaging with (11)C-IMA107, a highly selective PDE10A radioligand. We studied 24 patients with levodopa-treated, moderate to advanced Parkinson's disease. Their positron emission tomography imaging data were compared to those from a group of 12 healthy controls. Parametric images of (11)C-IMA107 binding potential relative to non-displaceable binding (BPND) were generated from the dynamic (11)C-IMA107 scans using the simplified reference tissue model with the cerebellum as the reference tissue. Corresponding region of interest analysis showed lower mean (11)C-IMA107 BPND in the caudate (P < 0.001), putamen (P < 0.001) and globus pallidus (P = 0.025) in patients with Parkinson's disease compared to healthy controls, which was confirmed with voxel-based analysis. Longer Parkinson's duration correlated with lower (11)C-IMA107 BPND in the caudate (r = -0.65; P = 0.005), putamen (r = -0.51; P = 0.025), and globus pallidus (r = -0.47; P = 0.030). Higher Unified Parkinson's Disease Rating Scale part-III motor scores correlated with lower (11)C-IMA107 BPND in the caudate (r = -0.54; P = 0.011), putamen (r = -0.48; P = 0.022), and globus pallidus (r = -0.70; P < 0.001). Higher Unified Dyskinesia Rating Scale scores in those Parkinson's disease with levodopa-induced dyskinesias (n = 12), correlated with lower (11)C-IMA107 BPND in the caudate (r = -0.73; P = 0.031) and putamen (r = -0.74; P = 0.031). Our findings demonstrate striatal and pallidal loss of PDE10A expression, which is associated with Parkinson's duration and severity of motor symptoms and complications. PDE10A is an enzyme that could be targeted with novel pharmacotherapy, and this may help improve dopaminergic signalling and striatal output, and therefore alleviate symptoms and complications of Parkinson's disease.
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Affiliation(s)
- Flavia Niccolini
- 1 Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK 2 Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Thomas Foltynie
- 3 Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK
| | - Tiago Reis Marques
- 4 Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nils Muhlert
- 5 School of Psychology and Cardiff University Brain Research Imaging Centre, Cardiff University, UK 6 School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Andri C Tziortzi
- 7 Imanova Ltd., Centre for Imaging Sciences, Hammersmith Hospital, London, UK
| | - Graham E Searle
- 7 Imanova Ltd., Centre for Imaging Sciences, Hammersmith Hospital, London, UK
| | - Sridhar Natesan
- 4 Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Shitij Kapur
- 4 Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eugenii A Rabiner
- 7 Imanova Ltd., Centre for Imaging Sciences, Hammersmith Hospital, London, UK 8 Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Roger N Gunn
- 2 Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK 2 Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Paola Piccini
- 2 Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Marios Politis
- 1 Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK 2 Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
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Maillet A, Thobois S, Fraix V, Redouté J, Le Bars D, Lavenne F, Derost P, Durif F, Bloem BR, Krack P, Pollak P, Debû B. Neural substrates of levodopa-responsive gait disorders and freezing in advanced Parkinson's disease: a kinesthetic imagery approach. Hum Brain Mapp 2015; 36:959-80. [PMID: 25411130 PMCID: PMC6869751 DOI: 10.1002/hbm.22679] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 07/18/2014] [Accepted: 10/21/2014] [Indexed: 11/06/2022] Open
Abstract
Gait disturbances, including freezing of gait, are frequent and disabling symptoms of Parkinson's disease. They often respond poorly to dopaminergic treatments. Although recent studies have shed some light on their neural correlates, their modulation by dopaminergic treatment remains quite unknown. Specifically, the influence of levodopa on the networks involved in motor imagery (MI) of parkinsonian gait has not been directly studied, comparing the off and on medication states in the same patients. We therefore conducted an [H2 (15) 0] Positron emission tomography study in eight advanced parkinsonian patients (mean disease duration: 12.3 ± 3.8 years) presenting with levodopa-responsive gait disorders and FoG, and eight age-matched healthy subjects. All participants performed three tasks (MI of gait, visual imagery and a control task). Patients were tested off, after an overnight withdrawal of all antiparkinsonian treatment, and on medication, during consecutive mornings. The order of conditions was counterbalanced between subjects and sessions. Results showed that imagined gait elicited activations within motor and frontal associative areas, thalamus, basal ganglia and cerebellum in controls. Off medication, patients mainly activated premotor-parietal and pontomesencephalic regions. Levodopa increased activation in motor regions, putamen, thalamus, and cerebellum, and reduced premotor-parietal and brainstem involvement. Areas activated when patients are off medication may represent compensatory mechanisms. The recruitment of these accessory circuits has also been reported for upper-limb movements in Parkinson's disease, suggesting a partly overlapping pathophysiology between imagined levodopa-responsive gait disorders and appendicular signs. Our results also highlight a possible cerebellar contribution in the pathophysiology of parkinsonian gait disorders through kinesthetic imagery.
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Affiliation(s)
- Audrey Maillet
- Université Joseph FourierGrenoble UniversitésGrenobleFrance
- INSERM‐UJF‐CEA‐CHU U836 Grenoble Institut des NeurosciencesGrenobleFrance
- Centre de Neuroscience CognitiveUMR 5229 CNRSLyonFrance
| | - Stéphane Thobois
- Centre de Neuroscience CognitiveUMR 5229 CNRSLyonFrance
- Hospices Civils de LyonHôpital Neurologique Pierre WertheimerLyonFrance
- Faculté de médecine Lyon Sud Charles MérieuxUniversité Lyon ILyonFrance
| | - Valérie Fraix
- Université Joseph FourierGrenoble UniversitésGrenobleFrance
- INSERM‐UJF‐CEA‐CHU U836 Grenoble Institut des NeurosciencesGrenobleFrance
- Centre Hospitalier UniversitairePavillon de NeurologieGrenobleFrance
| | | | - Didier Le Bars
- Hospices Civils de LyonHôpital Neurologique Pierre WertheimerLyonFrance
- CERMEPImagerie du VivantBronFrance
- Institut de Chimie et Biochimie Moléculaires et SupramoléculairesUniversité Claude BernardLyon ILyonFrance
| | | | - Philippe Derost
- Hôpital Gabriel MontpiedService de NeurologieClermont‐FerrandFrance
| | - Franck Durif
- Hôpital Gabriel MontpiedService de NeurologieClermont‐FerrandFrance
| | - Bastiaan R. Bloem
- Radboud University Medical CenterDonders Institute for BrainCognition and BehaviorDepartment of NeurologyNijmegenNetherlands
| | - Paul Krack
- Université Joseph FourierGrenoble UniversitésGrenobleFrance
- INSERM‐UJF‐CEA‐CHU U836 Grenoble Institut des NeurosciencesGrenobleFrance
- Centre Hospitalier UniversitairePavillon de NeurologieGrenobleFrance
| | - Pierre Pollak
- Université Joseph FourierGrenoble UniversitésGrenobleFrance
- INSERM‐UJF‐CEA‐CHU U836 Grenoble Institut des NeurosciencesGrenobleFrance
- Centre Hospitalier UniversitairePavillon de NeurologieGrenobleFrance
- Hôpitaux Universitaires de GenèveGenevaSwitzerland
| | - Bettina Debû
- Université Joseph FourierGrenoble UniversitésGrenobleFrance
- INSERM‐UJF‐CEA‐CHU U836 Grenoble Institut des NeurosciencesGrenobleFrance
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50
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Earhart GM, Duncan RP, Huang JL, Perlmutter JS, Pickett KA. Comparing interventions and exploring neural mechanisms of exercise in Parkinson disease: a study protocol for a randomized controlled trial. BMC Neurol 2015; 15:9. [PMID: 25652002 PMCID: PMC4326476 DOI: 10.1186/s12883-015-0261-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/08/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Effective treatment of locomotor dysfunction in Parkinson disease (PD) is essential, as gait difficulty is an early and major contributor to disability. Exercise is recommended as an adjunct to traditional treatments for improving gait, balance, and quality of life. Among the exercise approaches known to improve walking, tango and treadmill training have recently emerged as two promising therapies for improving gait, disease severity and quality of life, yet these two interventions have not been directly compared to each other. Prior studies have been helpful in identifying interventions effective in improving gait function, but have done little to elucidate the neural mechanisms underlying functional improvements. The primary objective of the proposed work is to compare the effects of three community-based exercise programs, tango, treadmill training and stretching, on locomotor function in individuals with PD. In addition, we aim to determine whether and how these interventions alter functional connectivity of locomotor control networks in the brain. METHODS/DESIGN One hundred and twenty right-handed individuals with idiopathic PD who are at least 30 years of age will be assigned in successive waves to one of three community-based exercise groups: tango dancing, treadmill training or stretching (control). Each group will receive three months of exercise training with twice weekly one-hour group classes. Each participant will be evaluated at three time points: pre-intervention (baseline), post-intervention (3 months), and follow-up (6 months). All evaluations will include assessment of gait, balance, disease severity, and quality of life. Baseline and post-intervention evaluations will also include task-based functional magnetic resonance imaging (fMRI) and resting state functional connectivity MRI. All MRI and behavioral measures will be conducted with participants OFF anti-Parkinson medication, with behavioral measures also assessed ON medication. DISCUSSION This study will provide important insights regarding the effects of different modes of exercise on locomotor function in PD. The protocol is innovative because it: 1) uses group exercise approaches for all conditions including treadmill training, 2) directly compares tango to treadmill training and stretching, 3) tests participants OFF medication, and 4) utilizes two distinct neuroimaging approaches to explore mechanisms of the effects of exercise on the brain. TRIAL REGISTRATION ClinicalTrials.gov NCT01768832 .
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Affiliation(s)
- Gammon M Earhart
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA. .,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA. .,Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Ryan P Duncan
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA. .,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
| | - John L Huang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.
| | - Joel S Perlmutter
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA. .,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA. .,Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Kristen A Pickett
- Occupational Therapy Program, University of Wisconsin, Madison, WI, USA.
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