1
|
Wodarski P, Jurkojć J, Chmura M, Warmerdam E, Romijnders R, Hobert MA, Maetzler W, Cygoń K, Hansen C. Trend change analysis of postural balance in Parkinson's disease discriminates between medication state. J Neuroeng Rehabil 2024; 21:112. [PMID: 38943208 PMCID: PMC11212256 DOI: 10.1186/s12984-024-01411-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/20/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Maintaining static balance is relevant and common in everyday life and it depends on a correct intersegmental coordination. A change or reduction in postural capacity has been linked to increased risk of falls. People with Parkinson's disease (pwPD) experience motor symptoms affecting the maintenance of a stable posture. The aim of the study is to understand the intersegmental changes in postural sway and to apply a trend change analysis to uncover different movement strategies between pwPD and healthy adults. METHODS In total, 61 healthy participants, 40 young (YO), 21 old participants (OP), and 29 pwPD (13 during medication off, PDoff; 23 during medication on, PDon) were included. Participants stood quietly for 10 s as part of the Short Physical Performance Battery. Inertial measurement units (IMU) at the head, sternum, and lumbar region were used to extract postural parameters and a trend change analysis (TCA) was performed to compare between groups. OBJECTIVE This study aims to explore the potential application of TCA for the assessment of postural stability using IMUs, and secondly, to employ this analysis within the context of neurological diseases, specifically Parkinson's disease. RESULTS Comparison of sensors locations revealed significant differences between head, sternum and pelvis for almost all parameters and cohorts. When comparing PDon and PDoff, the TCA revealed differences that were not seen by any other parameter. CONCLUSIONS While all parameters could differentiate between sensor locations, no group differences could be uncovered except for the TCA that allowed to distinguish between the PD on/off. The potential of the TCA to assess disease progression, response to treatment or even the prodromal PD phase should be explored in future studies. TRIAL REGISTRATION The research procedure was approved by the ethical committee of the Medical Faculty of Kiel University (D438/18). The study is registered in the German Clinical Trials Register (DRKS00022998).
Collapse
Affiliation(s)
- Piotr Wodarski
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, Gliwice, Poland
| | - Jacek Jurkojć
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, Gliwice, Poland
| | - Marta Chmura
- Faculty of Biomedical Engineering, Department of Biomechatronics, Silesian University of Technology, Gliwice, Poland
| | - Elke Warmerdam
- Division of Surgery, Saarland University, 66421, Homburg, Germany
| | | | - Markus A Hobert
- Department of Neurology, Kiel University, 24105, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, Kiel University, 24105, Kiel, Germany
| | | | - Clint Hansen
- Department of Neurology, Kiel University, 24105, Kiel, Germany.
| |
Collapse
|
2
|
O'Neal SK, Miller SA, Eikenberry MC, Moore ES. A backward cycling programme for people with Parkinson's disease: a feasibility and preliminary results study. J Rehabil Med 2024; 56:jrm17738. [PMID: 38860715 PMCID: PMC11182036 DOI: 10.2340/jrm.v56.17738] [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: 07/11/2023] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE To assess the feasibility of backward cycling for people with Parkinson's disease. Secondary objectives were to assess changes in gait and balance following a 6-week program. DESIGN A single-group prospective pre-test, post-test study with 1-month follow-up. SUBJECTS/PATIENTS Twenty-six people with Parkinson's disease (mean age: 69 (7.74) years, gender: 83% males, time since diagnosis: 6 (4.44) years). METHODS Participants pedaled backward on a stationary bicycle for 30 minutes at moderate intensity twice a week for 6 weeks. Feasibility was assessed by acceptability, suitability, and burden. Data collected at pre- and post-intervention with 1-month follow-up included backward stepping response variables, forward/backward gait variables, Mini-Balance Evaluation Systems Test (MBT), and 6 Minute Walk Test. RESULTS There was a high retention rate (95.8%) and adherence rate (100%) with one adverse event and minimal burden. Significant improvements were seen in step count and excursion distance during backward stepping responses, forward and backward gait velocity, forward step length, and the Mini-BESTest. CONCLUSION Backward cycling was a feasible intervention for people with Parkinson's disease, demonstrating low burden with high retention and adherence rates, and it is a safe exercise with the potential for benefits in gait and balance variables.
Collapse
Affiliation(s)
| | - Stephanie A Miller
- University of Indianapolis, Indianapolis, Indiana, USA
- Marian University, Indianapolis, IN, USA
| | | | | |
Collapse
|
3
|
Taniuchi R, Kanai S, Hara A, Monden K, Nagatani H, Torii T, Harada T. Extraction of the pull force from inertial sensors during the pull test for Parkinson's disease: A reliability study. J Mov Disord 2024; 17:150-157. [PMID: 38098205 PMCID: PMC11082607 DOI: 10.14802/jmd.23185] [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: 09/17/2023] [Revised: 11/10/2023] [Accepted: 12/15/2023] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE To examine the inter- and intra-rater reliability of the pull test in patients with Parkinson's disease (PD) using the extracted pull force. METHODS In this inter- and intra-rater reliability study, two raters performed a pull test on 30 patients with PD. The pull force was quantified using inertial sensors attached to the rater's right hand and the patient's lower trunk. In this study, the pull force was calculated as an extracted three-dimensional vector quantity, the resultant acceleration, and was expressed in m/s2. Inter- and intra-rater reliabilities were analyzed using the interclass correlation coefficient (ICC) for the pull force and Cohen's weighted kappa (κw) for the pull test score. Furthermore, Bland-Altman analysis was used to investigate systematic errors. RESULTS The inter- and intra-rater reliability of the pull force was very poor (ICC = 0.033-0.214). Bland-Altman analysis revealed no systematic errors in the pull forces between the two test points. Conversely, κw for the pull test scores ranged from 0.763 to 0.920, indicating substantial to almost perfect agreement. CONCLUSION The pull test score was reliable despite variations in the quantified pull force for inter- and intra-rater reliability. Our findings suggest that the pull test is a robust tool for evaluating postural instability in patients with PD and that the pull force probably does not affect scoring performance.
Collapse
Affiliation(s)
- Ryoma Taniuchi
- Department of Rehabilitation, National Hospital Organization Hiroshima-Nishi Medical Center, Hiroshima, Japan
- Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Shusaku Kanai
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Amane Hara
- Department of Rehabilitation, National Hospital Organization Hiroshima-Nishi Medical Center, Hiroshima, Japan
| | - Kazuya Monden
- Department of Rehabilitation, National Hospital Organization Hiroshima-Nishi Medical Center, Hiroshima, Japan
| | - Hiroaki Nagatani
- Department of Rehabilitation, National Hospital Organization Hiroshima-Nishi Medical Center, Hiroshima, Japan
| | - Tsuyoshi Torii
- Department of Neurology, National Hospital Organization Hiroshima-Nishi Medical Center, Hiroshima, Japan
| | - Toshihide Harada
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima, Japan
| |
Collapse
|
4
|
Pugh RJ, Higgins RD, Min H, Wutzke CJ, Guccione AA. Turns while walking among individuals with Parkinson's disease following overground locomotor training: A pilot study. Clin Biomech (Bristol, Avon) 2024; 114:106234. [PMID: 38582028 DOI: 10.1016/j.clinbiomech.2024.106234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/12/2024] [Accepted: 03/26/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Individuals with Parkinson's disease are challenged in making turns while walking, evidenced by reduced intersegmental coordination and reduced dynamic postural stability. Although overground locomotor training previously improved ambulation among people with Parkinson's disease, its effect on walking turns remained unknown. We sought to understand the effects of overground locomotor training on walking turns among individuals with mild-Parkinson's disease. METHODS Twelve participants with Parkinson's (7 Males/5 Females; Age: 68.5 ± 6.4 years) completed twenty-four sessions lasting approximately 60 min and over 12-15 weeks. Baseline and follow-up assessments included the ten-minute walk test using wearable sensors. Primary outcomes included changes to intersegmental coordination, measured by peak rotation and normalized peak rotation, and dynamic postural stability, measured by peak turn velocities in the frontal and transverse planes. Statistical analysis included one-tailed paired t-tests and Cohen's d effect sizes with α = 0.05. FINDINGS No effects of overground locomotor training on mean peak thoracic rotation (+0.23 ± 4.24°; Cohen's d = 0.05; P = 0.45) or mean normalized peak thoracic rotation (-0.59 ± 5.52 (unitless); Cohen's d = 0.10; P = 0.45) were observed. Moderate and small effects of overground locomotor training were observed on mean peak turn velocities in the frontal (+1.59 ± 2.18°/s; Cohen's d = 0.43; P = 0.01) and transverse planes (+0.88 ± 3.18°/s; Cohen's d = 0.25; P = 0.18). INTERPRETATION This pilot study provides preliminary evidence suggesting that individuals with mild-Parkinson's moderately improved frontal plane dynamic postural stability after overground locomotor training, likely attenuating the perturbations experienced while turning. CLINICAL TRIAL REGISTRATION NCT03864393.
Collapse
Affiliation(s)
- R Jamil Pugh
- George Mason University, College of Public Health, 4400 University Drive, Fairfax, VA 22030, USA; Washington DC VA Medical Center, Skeletal Muscle Laboratory, 50 Irving Street NW, Washington, DC 20422, USA.
| | - Rosemary D Higgins
- Florida Gulf Coast University, Office of Provost & Executive VP for Academic Affairs, 10501 FGCU Blvd. S., Fort Myers, FL 3965, USA
| | - Hua Min
- George Mason University, College of Public Health, 4400 University Drive, Fairfax, VA 22030, USA
| | - Clinton J Wutzke
- Gonzaga University, School of Nursing and Human Physiology, 502 East Boone Avenue, Spokane, WA 99258-0102, USA
| | - Andrew A Guccione
- George Mason University, College of Public Health, 4400 University Drive, Fairfax, VA 22030, USA
| |
Collapse
|
5
|
Camargo CHF, Ferreira-Peruzzo SA, Ribas DIR, Franklin GL, Teive HAG. Imbalance and gait impairment in Parkinson's disease: discussing postural instability and ataxia. Neurol Sci 2024; 45:1377-1388. [PMID: 37985635 DOI: 10.1007/s10072-023-07205-w] [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: 09/26/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
Gait and balance difficulties pose significant clinical challenges in Parkinson's disease (PD). The impairment of physiological mechanisms responsible for maintaining natural orthostatism plays a central role in the pathophysiology of postural instability observed in PD. In addition to the well-known rigidity and abnormalities in muscles and joints, various brain regions involved in the regulation of posture, balance, and gait, such as the basal ganglia, cerebellum, and brainstem regions like the pontine peduncle nucleus, are affected in individuals with PD. The recognition of the cerebellum's role in PD has been increasingly acknowledged. Cortical areas and their connections are associated with freezing of gait, a type of frontal lobe ataxia commonly observed in PD. Furthermore, impairments in the peripheral nervous system, including those caused by levodopatherapy, can contribute to gait impairment and imbalance in PD patients. Consequently, individuals with PD may exhibit frontal ataxia, sensory ataxia, and even cerebellar ataxia as underlying causes of gait disturbances and imbalance, starting from the early stages of the disease. The complex interplay between dysfunctional brain regions, impaired cortical connections, and peripheral nervous system abnormalities contributes to the multifaceted nature of gait and balance difficulties in PD. Understanding the intricate mechanisms is crucial for the development of effective therapeutic approaches targeting these specific deficits in PD.
Collapse
Affiliation(s)
- Carlos Henrique F Camargo
- Neurological Diseases Group, Postgraduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, 80060-900, Brazil.
| | - Silvia Aparecida Ferreira-Peruzzo
- Neurological Diseases Group, Postgraduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, 80060-900, Brazil
- School of Health Sciences, Autonomous University of Brazil, Curitiba, Paraná, Brazil
| | - Danieli Isabel Romanovitch Ribas
- Neurological Diseases Group, Postgraduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, 80060-900, Brazil
- School of Health Sciences, Autonomous University of Brazil, Curitiba, Paraná, Brazil
| | - Gustavo L Franklin
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - Hélio A G Teive
- Neurological Diseases Group, Postgraduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, 80060-900, Brazil
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Paraná, Brazil
| |
Collapse
|
6
|
Bath JE, Wang DD. Unraveling the threads of stability: A review of the neurophysiology of postural control in Parkinson's disease. Neurotherapeutics 2024; 21:e00354. [PMID: 38579454 PMCID: PMC11000188 DOI: 10.1016/j.neurot.2024.e00354] [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: 11/30/2023] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/07/2024] Open
Abstract
Postural instability is a detrimental and often treatment-refractory symptom of Parkinson's disease. While many existing studies quantify the biomechanical deficits among various postural domains (static, anticipatory, and reactive) in this population, less is known regarding the neural network dysfunctions underlying these phenomena. This review will summarize current studies on the cortical and subcortical neural activities during postural responses in healthy subjects and those with Parkinson's disease. We will also review the effects of current therapies, including neuromodulation and feedback-based wearable devices, on postural instability symptoms. With recent advances in implantable devices that allow chronic, ambulatory neural data collection from patients with Parkinson's disease, combined with sensors that can quantify biomechanical measurements of postural responses, future work using these devices will enable better understanding of the neural mechanisms of postural control. Bridging this knowledge gap will be the critical first step towards developing novel neuromodulatory interventions to enhance the treatment of postural instability in Parkinson's disease.
Collapse
Affiliation(s)
- Jessica E Bath
- Department of Physical Therapy & Rehabilitation Science, University of California, San Francisco, USA; Department of Neurological Surgery, University of California, San Francisco, USA
| | - Doris D Wang
- Department of Neurological Surgery, University of California, San Francisco, USA.
| |
Collapse
|
7
|
Mangalam M, Kelty-Stephen DG, Seleznov I, Popov A, Likens AD, Kiyono K, Stergiou N. Older adults and individuals with Parkinson's disease control posture along suborthogonal directions that deviate from the traditional anteroposterior and mediolateral directions. Sci Rep 2024; 14:4117. [PMID: 38374371 PMCID: PMC10876602 DOI: 10.1038/s41598-024-54583-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/14/2024] [Indexed: 02/21/2024] Open
Abstract
A rich and complex temporal structure of variability in postural sway characterizes healthy and adaptable postural control. However, neurodegenerative disorders such as Parkinson's disease, which often manifest as tremors, rigidity, and bradykinesia, disrupt this healthy variability. This study examined postural sway in young and older adults, including individuals with Parkinson's disease, under different upright standing conditions to investigate the potential connection between the temporal structure of variability in postural sway and Parkinsonism. A novel and innovative method called oriented fractal scaling component analysis was employed. This method involves decomposing the two-dimensional center of pressure (CoP) planar trajectories to pinpoint the directions associated with minimal and maximal temporal correlations in postural sway. As a result, it facilitates a comprehensive assessment of the directional characteristics within the temporal structure of sway variability. The results demonstrated that healthy young adults control posture along two orthogonal directions closely aligned with the traditional anatomical anteroposterior (AP) and mediolateral (ML) axes. In contrast, older adults and individuals with Parkinson's disease controlled posture along suborthogonal directions that significantly deviate from the AP and ML axes. These findings suggest that the altered temporal structure of sway variability is evident in individuals with Parkinson's disease and underlies postural deficits, surpassing what can be explained solely by the natural aging process.
Collapse
Affiliation(s)
- Madhur Mangalam
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA.
| | - Damian G Kelty-Stephen
- Department of Psychology, State University of New York at New Paltz, New Paltz, NY, 12561, USA
| | - Ivan Seleznov
- Graduate School of Engineering Science, Osaka University, Osaka, 560-8531, Japan
| | - Anton Popov
- Department of Electronic Engineering, Igor Sikorsky Kyiv Polytechnic Institute, Kyiv, 03056, Ukraine
- Faculty of Applied Sciences, Ukrainian Catholic University, Lviv, 79011, Ukraine
| | - Aaron D Likens
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Ken Kiyono
- Graduate School of Engineering Science, Osaka University, Osaka, 560-8531, Japan
| | - Nick Stergiou
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
- Department of Department of Physical Education, and Sport Science, Aristotle University, 570 01, Thessaloniki, Greece
| |
Collapse
|
8
|
Vermette MJ, Prince F, Bherer L, Messier J. Concentrating to avoid falling: interaction between peripheral sensory and central attentional demands during a postural stability limit task in sedentary seniors. GeroScience 2024; 46:1181-1200. [PMID: 37482601 PMCID: PMC10828328 DOI: 10.1007/s11357-023-00860-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/25/2023] [Indexed: 07/25/2023] Open
Abstract
Evidence suggests falls and postural instabilities among seniors are attributed to a decline in both the processing of afferent signals (e.g., proprioceptive, vestibular) and attentional resources. We investigated the interaction between the non-visual and attentional demands of postural control in sedentary seniors. Old and young adults performed a postural stability limit task involving a maximal voluntary leaning movement with and without vision as well as a cognitive-attentional subtraction task. These tasks were performed alone (single-task) or simultaneously (dual-task) to vary the sensory-attentional demands. The functional limits of stability were quantified as the maximum center of pressure excursion during voluntary leaning. Seniors showed significantly smaller limits of postural stability compared to young adults in all sensory-attentional conditions. However, surprisingly, both groups of subjects reduced their stability limits by a similar amount when vision was removed. Furthermore, they similarly decreased their anterior-posterior stability limits when concurrently performing the postural and the cognitive-attentional tasks with vision. The overall average cognitive performance of young adults was higher than seniors and was only slightly affected during dual-tasking. In contrast, older adults markedly degraded their cognitive performance from the single- to the dual-task situations, especially when vision was unavailable. Thus, their dual-task costs were higher than those of young adults and increased in the eyes-closed condition, when postural control relied more heavily on non-visual sensory signals. Our findings provide the first evidence that as posture approaches its stability limits, sedentary seniors allot increasingly large cognitive attentional resources to process critical sensory inputs.
Collapse
Affiliation(s)
- Marie Julie Vermette
- École de Kinésiologie et des Sciences de l'Activité Physique (EKSAP), Université de Montréal, 2100 Boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Chemin Queen Mary, Montréal, QC, H3W 1W5, Canada
| | - François Prince
- Département de Chirurgie, Faculté de Médecine, Université de Montréal, CP6128, Succursale Centre-Ville, Montréal, QC, H3C 3J7, Canada
| | - Louis Bherer
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Chemin Queen Mary, Montréal, QC, H3W 1W5, Canada
- Département de Médecine, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
- Institut de Cardiologie de Montréal, Montréal, QC, Canada
| | - Julie Messier
- École de Kinésiologie et des Sciences de l'Activité Physique (EKSAP), Université de Montréal, 2100 Boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada.
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Chemin Queen Mary, Montréal, QC, H3W 1W5, Canada.
| |
Collapse
|
9
|
Heß T, Themann P, Oehlwein C, Milani TL. Does Impaired Plantar Cutaneous Vibration Perception Contribute to Axial Motor Symptoms in Parkinson's Disease? Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation. Brain Sci 2023; 13:1681. [PMID: 38137129 PMCID: PMC10742284 DOI: 10.3390/brainsci13121681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To investigate whether impaired plantar cutaneous vibration perception contributes to axial motor symptoms in Parkinson's disease (PD) and whether anti-parkinsonian medication and subthalamic nucleus deep brain stimulation (STN-DBS) show different effects. METHODS Three groups were evaluated: PD patients in the medication "on" state (PD-MED), PD patients in the medication "on" state and additionally "on" STN-DBS (PD-MED-DBS), as well as healthy subjects (HS) as reference. Motor performance was analyzed using a pressure distribution platform. Plantar cutaneous vibration perception thresholds (VPT) were investigated using a customized vibration exciter at 30 Hz. RESULTS Motor performance of PD-MED and PD-MED-DBS was characterized by greater postural sway, smaller limits of stability ranges, and slower gait due to shorter strides, fewer steps per minute, and broader stride widths compared to HS. Comparing patient groups, PD-MED-DBS showed better overall motor performance than PD-MED, particularly for the functional limits of stability and gait. VPTs were significantly higher for PD-MED compared to those of HS, which suggests impaired plantar cutaneous vibration perception in PD. However, PD-MED-DBS showed less impaired cutaneous vibration perception than PD-MED. CONCLUSIONS PD patients suffer from poor motor performance compared to healthy subjects. Anti-parkinsonian medication in tandem with STN-DBS seems to be superior for normalizing axial motor symptoms compared to medication alone. Plantar cutaneous vibration perception is impaired in PD patients, whereas anti-parkinsonian medication together with STN-DBS is superior for normalizing tactile cutaneous perception compared to medication alone. Consequently, based on our results and the findings of the literature, impaired plantar cutaneous vibration perception might contribute to axial motor symptoms in PD.
Collapse
Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Peter Themann
- Department of Neurology and Parkinson, Clinic at Tharandter Forest, 09633 Halsbruecke, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L. Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| |
Collapse
|
10
|
Naseri A, Lee IC, Huang H, Liu M. Investigating the Association of Quantitative Gait Stability Metrics With User Perception of Gait Interruption Due to Control Faults During Human-Prosthesis Interaction. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4693-4702. [PMID: 37906490 DOI: 10.1109/tnsre.2023.3328877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
This study aims to compare the association of different gait stability metrics with the prosthesis users' perception of their own gait stability. Lack of perceived confidence on the device functionality can influence the gait pattern, level of daily activities, and overall quality of life for individuals with lower limb motor deficits. However, the perception of gait stability is subjective and difficult to acquire online. The quantitative gait stability metrics can be objectively measured and monitored using wearable sensors; however, objective measurements of gait stability associated with human's perception of their own gait stability has rarely been reported. By identifying quantitative measurements that associate with users' perceptions, we can gain a more accurate and comprehensive understanding of an individual's perceived functional outcomes of assistive devices such as prostheses. To achieve our research goal, experiments were conducted to artificially apply internal disturbances in the powered prosthesis while the prosthetic users performed level ground walking. We monitored and compared multiple gait stability metrics and a local measurement to the users' reported perception of their own gait stability. The results showed that the center of pressure progression in the sagittal plane and knee momentum (i.e., residual thigh and prosthesis shank angular momentum about prosthetic knee joint) can potentially estimate the users' perceptions of gait stability when experiencing disturbances. The findings of this study can help improve the development and evaluation of gait stability control algorithms in robotic prosthetic devices.
Collapse
|
11
|
Kocer B, Soke F, Ataoglu NEE, Ersoy N, Gulsen C, Gulsen EO, Yasa ME, Uysal I, Comoglu SS, Bora HAT. The reliability and validity of the 3-m backward walk test in people with Parkinson's disease. Ir J Med Sci 2023; 192:3063-3071. [PMID: 37160569 DOI: 10.1007/s11845-023-03384-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND People with Parkinson's disease (PwPD) lose the ability in backward walking which is an important part of mobility in daily life. The 3-m backward walk test (3MBWT) evaluates backward walking; however, its reliability and validity have not been examined in PwPD yet. AIMS To examine (1) the test-retest reliability of the 3MBWT in PwPD; (2) the minimum detectable change in the 3MBWT times; (3) the concurrent and known-groups validity of the 3MBWT; and (4) the optimum cutoff time which best discriminates fallers from non-fallers with Parkinson's disease (PD). METHODS This cross-sectional study included 36 PwPD and 33 healthy people. The 3MBWT was conducted with the 10-m walk test, timed up and go test, Berg Balance Scale, four square step test, activity-specific balance confidence scale, Movement Disorders Society Sponsored Unified Parkinson's Disease Rating Scale, and Hoehn and Yahr Scale. RESULTS The 3MBWT demonstrated excellent test-retest reliability (ICC = 0.965). The MDC of 2.13 s was determined. The 3MBWT had moderate to high correlations with the other outcome measures (correlation coefficient ranged from -0.592 to 0.858). On the 3MBWT times, there were significant differences between PwPD and healthy people, and between fallers and non-fallers with PD (p < 0.001 and p < 0.001, respectively). A 3MBWT time of 10.31 s was found to best discriminate fallers from non-fallers with PD. CONCLUSIONS The 3MBWT is a reliable, valid, and easy to administer outcome measure to assess backward walking performance in PwPD, indicating it to be used in practice and research.
Collapse
Affiliation(s)
- Bilge Kocer
- Ankara Etlik City Hospital, Department of Neurology, University of Health Sciences, Varlik Neighborhood, Halil Sezai Erkut Street, Yenimahalle, Ankara, Turkey.
| | - Fatih Soke
- Gulhane Faculty of Physiotherapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | | | - Nursena Ersoy
- Faculty of Health Sciences, Department of Nutrition and Dietetic, Ankara University, Ankara, Turkey
| | - Cagri Gulsen
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Ankara, Turkey
| | - Elvan Ozcan Gulsen
- Vocational School of Health Services, Elderly Care Program, Anadolu University, Eskisehir, Turkey
| | - Mustafa Ertugrul Yasa
- Gulhane Faculty of Physiotherapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Ismail Uysal
- Fethiye Vocational School of Health Services, Department of Health Care Services, Mugla Sitki Kocman University, Ankara, Turkey
| | - Selim Selcuk Comoglu
- Ankara Etlik City Hospital, Department of Neurology, University of Health Sciences, Varlik Neighborhood, Halil Sezai Erkut Street, Yenimahalle, Ankara, Turkey
| | | |
Collapse
|
12
|
Palmer JA, Payne AM, Mirdamadi JL, Ting LH, Borich MR. Delayed cortical engagement associated with balance dysfunction after stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.28.23299035. [PMID: 38076827 PMCID: PMC10705625 DOI: 10.1101/2023.11.28.23299035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Cortical resources are typically engaged for balance and mobility in older adults, but these resources are impaired post-stroke. Although slowed balance and mobility after stroke have been well-characterized, the effects of unilateral cortical lesions due to stroke on neuromechanical control of balance is poorly understood. Our central hypothesis is that stroke impairs the ability to rapidly and effectively engage the cerebral cortex during balance and mobility behaviors, resulting in asymmetrical contributions of each limb to balance control. Using electroencephalography (EEG), we assessed cortical N1 responses evoked over fronto-midline regions (Cz) during balance recovery in response to backward support-surface perturbations loading both legs, as well as posterior-lateral directions that preferentially load the paretic or nonparetic leg. Cortical N1 responses were smaller and delayed in the stroke group. While older adults exhibited weak or absent relationships between cortical responses and clinical function, stroke survivors exhibited strong associations between slower N1 latencies and slower walking, lower clinical mobility, and lower balance function. We further assessed kinetics of balance recovery during perturbations using center of pressure rate of rise. During backward support-surface perturbations that loaded the legs bilaterally, balance recovery kinetics were not different between stroke and control groups and were not associated with cortical response latency. However, lateralized perturbations revealed slower kinetic reactions during paretic loading compared to controls, and to non-paretic loading within stroke participants. Individuals post stroke had similar nonparetic-loaded kinetic reactions to controls implicating that they effectively compensate for impaired paretic leg kinetics when relying on the non-paretic leg. In contrast, paretic-loaded balance recovery revealed time-synchronized associations between slower cortical responses and slower kinetic reactions only in the stroke group, potentially reflecting the limits of cortical engagement for balance recovery revealed within the behavioral context of paretic motor capacity. Overall, our results implicate individuals after stroke may be uniquely limited in their balance ability by the slowed speed of their cortical engagement, particularly under challenging balance conditions that rely on the paretic leg. We expect this neuromechanical insight will enable progress toward an individualized framework for the assessment and treatment of balance impairments based on the interaction between neuropathology and behavioral context.
Collapse
Affiliation(s)
- Jacqueline A Palmer
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322 USA
| | - Aiden M Payne
- Department of Psychology, College of Arts and Sciences, Florida State University, Tallahassee, FL, USA
| | - Jasmine L Mirdamadi
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322 USA
| | - Lena H Ting
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322 USA
- Department of Biomedical Engineering, Emory and Georgia Tech, 1760 Haygood Road, Atlanta, GA, 30322, USA
| | - Michael R Borich
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322 USA
| |
Collapse
|
13
|
Rahmati Z, Behzadipour S, Taghizadeh G. Margins of postural stability in Parkinson's disease: an application of control theory. Front Bioeng Biotechnol 2023; 11:1226876. [PMID: 37781528 PMCID: PMC10539597 DOI: 10.3389/fbioe.2023.1226876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction: Postural instability is a restrictive feature in Parkinson's disease (PD), usually assessed by clinical or laboratory tests. However, the exact quantification of postural stability, using stability theorems that take into account human dynamics, is still lacking. We investigated the feasibility of control theory and the Nyquist stability criterion-gain margin (GM) and phase margin (PM)-in discriminating postural instability in PD, as well as the effects of a balance-training program. Methods: Center-of-pressure (COP) data of 40 PD patients before and after a 4-week balance-training program, and 20 healthy control subjects (HCs) (Study1) as well as COP data of 20 other PD patients at four time points during a 6-week balance-training program (Study2), collected in two earlier studies, were used. COP was recorded in four tasks, two on a rigid surface and two on foam, both with eyes open and eyes closed. A postural control model (an inverted pendulum with a Proportional-integral-derivative (PID) controller and time delay) was fitted to the COP data to subject-specifically identify the model parameters thereby calculating |GM| and PM for each subject in each task. Results: PD patients had a smaller margin of stability (|GM| and PM) compared with HCs. Particularly, patients, unlike HCs, showed a drastic drop in PM on foam. Clinical outcomes and margins of stability improved in patients after balance training. |GM| improved early in week 4, followed by a plateau during the rest of the training. In contrast, PM improved late (week 6) in a relatively continuous-progression form. Conclusion: Using fundamental stability theorems is a promising technique for the standardized quantification of postural stability in various tasks.
Collapse
Affiliation(s)
- Zahra Rahmati
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Saeed Behzadipour
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
- Djawad Movafaghian Research Center in Neurorehab Technologies, Sharif University of Technology, Tehran, Iran
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
14
|
Leodori G, Santilli M, Modugno N, D’Avino M, De Bartolo MI, Fabbrini A, Rocchi L, Conte A, Fabbrini G, Belvisi D. Postural Instability and Risk of Falls in Patients with Parkinson's Disease Treated with Deep Brain Stimulation: A Stabilometric Platform Study. Brain Sci 2023; 13:1243. [PMID: 37759844 PMCID: PMC10526843 DOI: 10.3390/brainsci13091243] [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: 08/03/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Postural instability (PI) in Parkinson's disease (PD) exposes patients to an increased risk of falls (RF). While dopaminergic therapy and deep brain stimulation (DBS) improve motor performance in advanced PD patients, their effects on PI and RF remain elusive. PI and RF were assessed using a stabilometric platform in six advanced PD patients. Patients were evaluated in OFF and ON dopaminergic medication and under four DBS settings: with DBS off, DBS bilateral, and unilateral DBS of the more- or less-affected side. Our findings indicate that dopaminergic medication by itself exacerbated PI and RF, and DBS alone led to a decline in RF. No combination of medication and DBS yielded a superior improvement in postural control compared to the baseline combination of OFF medication and the DBS-off condition. Yet, for ON medication, DBS significantly improved both PI and RF. Among DBS conditions, DBS bilateral provided the most favorable outcomes, improving PI and RF in the ON medication state and presenting the smallest setbacks in the OFF state. Conversely, the more-affected side DBS was less beneficial. These preliminary results could inform therapeutic strategies for advanced PD patients experiencing postural disorders.
Collapse
Affiliation(s)
- Giorgio Leodori
- IRCCS Neuromed, 86077 Pozzilli, Italy; (G.L.); (M.S.); (N.M.); (M.D.); (A.C.); (D.B.)
- Department of Human Neuroscience, University of Rome “Sapienza”, 00185 Rome, Italy; (M.I.D.B.); (A.F.)
| | - Marco Santilli
- IRCCS Neuromed, 86077 Pozzilli, Italy; (G.L.); (M.S.); (N.M.); (M.D.); (A.C.); (D.B.)
| | - Nicola Modugno
- IRCCS Neuromed, 86077 Pozzilli, Italy; (G.L.); (M.S.); (N.M.); (M.D.); (A.C.); (D.B.)
| | - Michele D’Avino
- IRCCS Neuromed, 86077 Pozzilli, Italy; (G.L.); (M.S.); (N.M.); (M.D.); (A.C.); (D.B.)
| | - Maria Ilenia De Bartolo
- Department of Human Neuroscience, University of Rome “Sapienza”, 00185 Rome, Italy; (M.I.D.B.); (A.F.)
| | - Andrea Fabbrini
- Department of Human Neuroscience, University of Rome “Sapienza”, 00185 Rome, Italy; (M.I.D.B.); (A.F.)
| | - Lorenzo Rocchi
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy;
| | - Antonella Conte
- IRCCS Neuromed, 86077 Pozzilli, Italy; (G.L.); (M.S.); (N.M.); (M.D.); (A.C.); (D.B.)
- Department of Human Neuroscience, University of Rome “Sapienza”, 00185 Rome, Italy; (M.I.D.B.); (A.F.)
| | - Giovanni Fabbrini
- IRCCS Neuromed, 86077 Pozzilli, Italy; (G.L.); (M.S.); (N.M.); (M.D.); (A.C.); (D.B.)
- Department of Human Neuroscience, University of Rome “Sapienza”, 00185 Rome, Italy; (M.I.D.B.); (A.F.)
| | - Daniele Belvisi
- IRCCS Neuromed, 86077 Pozzilli, Italy; (G.L.); (M.S.); (N.M.); (M.D.); (A.C.); (D.B.)
- Department of Human Neuroscience, University of Rome “Sapienza”, 00185 Rome, Italy; (M.I.D.B.); (A.F.)
| |
Collapse
|
15
|
Legutke BR, Gobbi LTB, Orcioli-Silva D, Santos PCRD, Moraca GAG, Vitório R, Beretta VS. Transcranial direct current stimulation suggests not improving postural control during adapted tandem position in people with Parkinson's disease: A pilot study. Behav Brain Res 2023; 452:114581. [PMID: 37453515 DOI: 10.1016/j.bbr.2023.114581] [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: 01/19/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Balance impairments in people with Parkinson's disease (PD) demonstrated mainly in challenging postural tasks, such as increased body oscillation may be attributed to the deficits in the brain structures functionality involved in postural control (e.g., motor cortex, midbrain, and brainstem). Although promising results, the effect of transcranial direct current stimulation (tDCS) on postural control in people with PD is unclear, especially in objective measures such as the center of pressure (CoP) parameters. Thus, we analyzed the effects of a single session of tDCS on the CoP parameters during the adapted tandem position in people with PD. METHODS Nineteen people with PD participated in this crossover, randomized, and double-blind study. Anodal tDCS was applied over the primary motor cortex in two conditions of stimulation (2 mA/active and sham) on two different days for 20 min immediately before the postural control evaluation. Participants remained standing in an adapted tandem position for the postural control assessment for 30 s (three trials). CoP parameters were acquired by a force plate. RESULTS No significant differences were demonstrated between stimulation conditions (p-value range = 0.15-0.89). CONCLUSIONS Our results suggested that a single session of tDCS with 2 mA does not improve the postural control of people with PD during adapted tandem.
Collapse
Affiliation(s)
- Beatriz Regina Legutke
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Campinas (UNICAMP), School of Applied Sciences (FCA), Laboratory of Applied Sport Physiology (LAFAE), Limeira, Brazil
| | - Paulo Cezar Rocha Dos Santos
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Israel; The Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel
| | - Gabriel Antonio Gazziero Moraca
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Rodrigo Vitório
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil; São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, São Paulo, Brazil.
| |
Collapse
|
16
|
Martino G, Beck ON, Ting LH. Voluntary muscle coactivation in quiet standing elicits reciprocal rather than coactive agonist-antagonist control of reactive balance. J Neurophysiol 2023; 129:1378-1388. [PMID: 37162064 PMCID: PMC10259861 DOI: 10.1152/jn.00458.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/04/2023] [Accepted: 05/06/2023] [Indexed: 05/11/2023] Open
Abstract
Muscle coactivation increases in challenging balance conditions as well as with advanced age and mobility impairments. Increased muscle coactivation can occur both in anticipation of (feedforward) and in reaction to (feedback) perturbations, however, the causal relationship between feedforward and feedback muscle coactivation remains elusive. Here, we hypothesized that feedforward muscle coactivation would increase both the body's initial mechanical resistance due to muscle intrinsic properties and the later feedback-mediated muscle coactivation in response to postural perturbations. Young adults voluntarily increased leg muscle coactivation using visual biofeedback before support-surface perturbations. In contrast to our hypothesis, feedforward muscle coactivation did not increase the body's initial intrinsic resistance to perturbations, nor did it increase feedback muscle coactivation. Rather, perturbations with feedforward muscle coactivation elicited a medium- to long-latency increase of feedback-mediated agonist activity but a decrease of feedback-mediated antagonist activity. This reciprocal rather than coactivation effect on ankle agonist and antagonist muscles enabled faster reactive ankle torque generation, reduced ankle dorsiflexion, and reduced center of mass (CoM) motion. We conclude that in young adults, voluntary feedforward muscle coactivation can be independently modulated with respect to feedback-mediated muscle coactivation. Furthermore, our findings suggest feedforward muscle coactivation may be useful for enabling quicker joint torque generation through reciprocal, rather than coactivated, agonist-antagonist feedback muscle activity. As such our results suggest that behavioral context is critical to whether muscle coactivation functions to increase agility versus stability.NEW & NOTEWORTHY Feedforward and feedback muscle coactivation are commonly observed in older and mobility impaired adults and are considered strategies to improve stability by increasing body stiffness prior to and in response to perturbations. In young adults, voluntary feedforward coactivation does not necessarily increase feedback coactivation in response to perturbations. Instead, feedforward coactivation enabled faster ankle torques through reciprocal agonist-antagonist muscle activity. As such, coactivation may promote either agility or stability depending on the behavioral context.
Collapse
Affiliation(s)
- Giovanni Martino
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, Georgia, United States
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Owen N Beck
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, Georgia, United States
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas, United States
| | - Lena H Ting
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, Georgia, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia, United States
| |
Collapse
|
17
|
Korkusuz S, Seçkinoğulları B, Özcan A, Demircan EN, Çakmaklı GY, Armutlu K, Yavuz F, Elibol B. Effects of freezing of gait on balance in patients with Parkinson's disease. Neurol Res 2023; 45:407-414. [PMID: 36413435 DOI: 10.1080/01616412.2022.2149510] [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: 07/07/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the effects of freezing of gait (FOG) on static and dynamic balance. METHODS Twenty patients with Parkinson's disease with and without FOG [PD+FOG (68,6±6,39 years) and PD-FOG group (70,6±4,57 years)] and 10 healthy individuals (68,4±4,92 years) with similar demographic characteristics were included in the study. Balance was compared between the three groups. Balance was evaluated with clinical tests Limits of stability (LoS) and body sway were measured using the E-LINK FP3 Force Plate and the Korebalance Balance Evaluation System, which measure the balance in static and dynamic conditions. Center of pressure (COP) change and average sway velocity were evaluated with the Zebris RehaWalk system. RESULTS Total and subscale scores of the Unified Parkinson's Disease Rating Scale were significantly higher in the PD+FOG group (p<0.05). The balance test results for both groups were similar (p>0.05). The PD+FOG group performed worse on the computerized static balance tests, the COP analysis, and the dynamic balance total score than the other two groups (p<0.05). The PD+FOG group had significantly greater sustained weight deviation than the healthy controls (p<0.05). Patients with Parkinson's disease had a lower LoS in the posterior direction than healthy controls (p<0.05). DISCUSSION FOG affects the dynamic balance more negatively than the static balance. In addition, FOG reduces LoS in the posterior direction and increases body sway in the anterior-posterior direction, which can lead to falls.
Collapse
Affiliation(s)
- Süleyman Korkusuz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Büşra Seçkinoğulları
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ayşenur Özcan
- Department of Physical Therapy and Rehabilitation, Çankırı Karatekin University, Çankırı, Turkey
| | - Emine Nur Demircan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Gül Yalçın Çakmaklı
- School of Medicine, Neurology Department, Hacettepe University, Ankara, Turkey
| | - Kadriye Armutlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ferdi Yavuz
- Faculty of Health Sciences, European University of Lefke, Lefke, Cyprus
| | - Bülent Elibol
- School of Medicine, Neurology Department, Hacettepe University, Ankara, Turkey
| |
Collapse
|
18
|
Moya-Jofré C, Valencia O, León-Barrera M, Araneda Valenzuela O, Guzmán-Venegas R. [Muscle activation times facing to a perturbation in patients with early-stage Parkinson's disease]. Rehabilitacion (Madr) 2023; 57:100755. [PMID: 35999122 DOI: 10.1016/j.rh.2022.07.004] [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: 02/21/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Parkinson's disease (PD) generates a high incidence of falls, however, there is little evidence of instabilities in the initial stages. This investigation sought to compare the muscle activation times in patients with initial PD against a postural disturbance vs. a control group. MATERIALS AND METHODS The electromyographic activity (EMG) of 10 patients with PD in early stages (61.3 ±3.8 years) and a control group of 10 adults (62.2 ±3.0 year) was evaluated. The participants were subjected to a surface disturbance, which generated a stabilization response. The test was performed under 2conditions: eyes open (OA) v/s eyes closed (OC). Trunk (spinal erector) and lower extremity (soleus, tibialis anterior, femoral biceps, femoral rectus, adductor magnus, gluteus medius) muscle activation time was analyzed using surface EMG. RESULTS The PD group showed faster response times compared to the control group in the soleus muscle in OC (P=.04). This same muscle showed differences when comparing OA vs. OC only in the PD group (P=.04), showing a shorter response time in the OC condition. When comparing the spinal erector muscle, the PD group showed slower response times in the OA (P=.02) and OC (P=.04) conditions compared to the control group. CONCLUSIONS Muscle activation times show that people with PD respond slower in the trunk muscles, while activation times decrease at the distal level. In the early stages, the slower responses at the trunk level could explain the onset of instability postural in these patients.
Collapse
Affiliation(s)
- C Moya-Jofré
- Laboratorio de Biomecánica Hospital del Trabajador (Achs), Santiago, Chile; Laboratorio de Biomecánica Centro de Alto Rendimiento, Santiago, Chile.
| | - O Valencia
- Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo, Escuela de Kinesiología, Universidad de los Andes, Chile
| | - M León-Barrera
- Centro de Trastornos del Movimiento (CETRAM), Santiago, Chile
| | - O Araneda Valenzuela
- Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo, Escuela de Kinesiología, Universidad de los Andes, Chile
| | - R Guzmán-Venegas
- Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo, Escuela de Kinesiología, Universidad de los Andes, Chile
| |
Collapse
|
19
|
Heß T, Oehlwein C, Milani TL. Anticipatory Postural Adjustments and Compensatory Postural Responses to Multidirectional Perturbations-Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease. Brain Sci 2023; 13:brainsci13030454. [PMID: 36979264 PMCID: PMC10046463 DOI: 10.3390/brainsci13030454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Postural instability is one of the most restricting motor symptoms for patients with Parkinson's disease (PD). While medication therapy only shows minor effects, it is still unclear whether medication in conjunction with deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves postural stability. Hence, the aim of this study was to investigate whether PD patients treated with medication in conjunction with STN-DBS have superior postural control compared to patients treated with medication alone. METHODS Three study groups were tested: PD patients on medication (PD-MED), PD patients on medication and on STN-DBS (PD-MED-DBS), and healthy elderly subjects (HS) as a reference. Postural performance, including anticipatory postural adjustments (APA) prior to perturbation onset and compensatory postural responses (CPR) following multidirectional horizontal perturbations, was analyzed using force plate and electromyography data. RESULTS Regardless of the treatment condition, both patient groups showed inadequate APA and CPR with early and pronounced antagonistic muscle co-contractions compared to healthy elderly subjects. Comparing the treatment conditions, study group PD-MED-DBS only showed minor advantages over group PD-MED. In particular, group PD-MED-DBS showed faster postural reflexes and tended to have more physiological co-contraction ratios. CONCLUSION medication in conjunction with STN-DBS may have positive effects on the timing and amplitude of postural control.
Collapse
Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| |
Collapse
|
20
|
Mostile G, Contrafatto F, Terranova R, Terravecchia C, Luca A, Sinitò M, Donzuso G, Cicero CE, Sciacca G, Nicoletti A, Zappia M. Turning and Sitting in Early Parkinsonism: Differences Between Idiopathic Normal Pressure Hydrocephalus Associated with Parkinsonism and Parkinson's Disease. Mov Disord Clin Pract 2023; 10:466-471. [PMID: 36949785 PMCID: PMC10026280 DOI: 10.1002/mdc3.13638] [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: 09/12/2022] [Revised: 11/10/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022] Open
Abstract
Background Differential diagnosis between idiopathic normal pressure hydrocephalus (iNPH) associated with parkinsonism (iNPH-P) and Parkinson's disease (PD) may prove difficult when evaluating patients with early parkinsonism. The objective of this study was to evaluate differences in mobility during standardized tasks between iNPH-P and PD. Methods We selected 21 iNPH-P and 21 pharmacologically untreated PD patients. They all performed the instrumented Timed Up and Go test at the time of diagnosis. Results Turning tasks showed longer duration and lower speed in iNPH-P than in PD. Vertical variation in acceleration during the sit-to-stand phase was lower in iNPH-P patients, whereas the duration of the stand-to-sit phase was longer. On walking, iNPH-P showed smaller stride length and a longer gait cycle duration. In multivariate analysis adjusting for age and cognitive status as potential confounders, average angular speed on turning before sitting was the discriminating parameter between the two groups. Conclusions Patients with iNPH-P showed specific abnormal mobility performances with respect to untreated PD, specifically during the turning-to-sitting transition.
Collapse
Affiliation(s)
- Giovanni Mostile
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
- Oasi Research Institute‐IRCCSTroinaItaly
| | - Federico Contrafatto
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Roberta Terranova
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Claudio Terravecchia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Antonina Luca
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Martina Sinitò
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Giulia Donzuso
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Calogero E. Cicero
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Giorgia Sciacca
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Mario Zappia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| |
Collapse
|
21
|
Doshi KB, Moon SH, Whitaker MD, Lockhart TE. Assessment of gait and posture characteristics using a smartphone wearable system for persons with osteoporosis with and without falls. Sci Rep 2023; 13:538. [PMID: 36631544 PMCID: PMC9834330 DOI: 10.1038/s41598-023-27788-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
We used smartphone technology to differentiate the gait characteristics of older adults with osteoporosis with falls from those without falls. We assessed gait mannerism and obtained activities of daily living (ADLs) with wearable sensor systems (smartphones and inertial measurement units [IMUs]) to identify fall-risk characteristics. We recruited 49 persons with osteoporosis: 14 who had a fall within a year before recruitment and 35 without falls. IMU sensor signals were sampled at 50 Hz using a customized smartphone app (Lockhart Monitor) attached at the pelvic region. Longitudinal data was collected using MoveMonitor+ (DynaPort) IMU over three consecutive days. Given the close association between serum calcium, albumin, PTH, Vitamin D, and musculoskeletal health, we compared these markers in individuals with history of falls as compared to nonfallers. For the biochemical parameters fall group had significantly lower calcium (P = 0.01*) and albumin (P = 0.05*) and higher parathyroid hormone levels (P = 0.002**) than nonfall group. In addition, persons with falls had higher sway area (P = 0.031*), lower dynamic stability (P < 0.001***), gait velocity (P = 0.012*), and were less able to perform ADLs (P = 0.002**). Thus, persons with osteoporosis with a history of falls can be differentiated by using dynamic real-time measurements that can be easily captured by a smartphone app, thus avoiding traditional postural sway and gait measures that require individuals to be tested in a laboratory setting.
Collapse
Affiliation(s)
- Krupa B. Doshi
- grid.417468.80000 0000 8875 6339Division of Endocrinology, Mayo Clinic, Scottsdale, AZ 85259 USA
| | - Seong Hyun Moon
- grid.215654.10000 0001 2151 2636School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85281 USA
| | - Michael D. Whitaker
- grid.417468.80000 0000 8875 6339Division of Endocrinology, Mayo Clinic, Scottsdale, AZ 85259 USA
| | - Thurmon E. Lockhart
- grid.215654.10000 0001 2151 2636School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85281 USA
| |
Collapse
|
22
|
Kataoka H, Matsugi A, Nikaido Y, Hasegawa N, Kawasaki T, Okada Y. Editorial: Advances in rehabilitation for motor symptoms in neurodegenerative disease. Front Hum Neurosci 2023; 17:1107061. [PMID: 36875240 PMCID: PMC9978808 DOI: 10.3389/fnhum.2023.1107061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Affiliation(s)
- Hiroshi Kataoka
- Department of Neurology, Nara Medical University, Kashihara, Nara, Japan
| | - Akiyoshi Matsugi
- Faculty of Rehabilitation, Shijonawate Gakuen University, Osaka, Japan
| | - Yasutaka Nikaido
- Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Naoya Hasegawa
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Tsubasa Kawasaki
- Department of Physical Therapy, School of Health, Institute of Sports Medicine and Science, Tokyo International University, Saitama, Japan
| | - Yohei Okada
- Graduate School of Health Sciences, Kio University, Nara, Japan
| |
Collapse
|
23
|
Lu C, Louie KH, Stutz AM, MacKinnon CD, Cooper SE. Postural instability in Parkinson's disease assessed with clinical "pull test" and standardized postural perturbations: effect of medication and body weight support. J Neurol 2023; 270:386-393. [PMID: 36100730 DOI: 10.1007/s00415-022-11375-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This experiment tested if balance performance differed between a standardized treadmill surface perturbation task and a clinical pull test and was affected by medication or the presence of body weight support in people with Parkinson's disease (PD). METHODS Twenty-seven individuals were tested (14 PD in both ON- and OFF-medication states). Clinical pull test and rapid forward (backward fall) translations of the support surface were applied to induce postural reactions requiring at least 1 step to restore balance. The effects of pull type (clinical vs. treadmill), partial bodyweight support (0 vs 20% body weight) and group (control, PD ON-meds and PD OFF-meds) on reactive stepping as well as practice/learning effect were examined. The number of steps taken and the first step duration were entered in linear repeated-measures mixed-effect models separately. RESULTS The effects of pull type, group, and bodyweight support were all significant in both metrics, as was ON- vs. OFF-medication. A significant interaction term (group x pull type) was found in the first step duration, showing that the group difference was greater in treadmill compared to the clinical pull test. A significant practice effect was also observed within and across testing sessions. CONCLUSIONS A standardized treadmill perturbation performed slightly better than the classical pull test in distinguishing between groups, and partial weight support did not substantially degrade the test's performance to detect the balance deficits in people with PD.
Collapse
Affiliation(s)
- Chiahao Lu
- Department of Neurology, University of Minnesota, 516E. 717 Delaware Building. 717 Delaware St. SE, Minneapolis, MN, 55414, USA.
| | - Kenneth H Louie
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55414, USA
- Department of Neurological Surgery, University of California, San Francisco, CA, 94143, USA
| | - Amber M Stutz
- Department of Neurology, University of Minnesota, 516E. 717 Delaware Building. 717 Delaware St. SE, Minneapolis, MN, 55414, USA
- Neurology, Sanford Brain and Spine Center, Fargo, ND, 58103, USA
| | - Colum D MacKinnon
- Department of Neurology, University of Minnesota, 516E. 717 Delaware Building. 717 Delaware St. SE, Minneapolis, MN, 55414, USA
| | - Scott E Cooper
- Department of Neurology, University of Minnesota, 516E. 717 Delaware Building. 717 Delaware St. SE, Minneapolis, MN, 55414, USA
| |
Collapse
|
24
|
Gomez NG, Foreman KB, Hunt M, Merryweather AS. Upper-extremity kinematics and interlimb movement correlation in persons with Parkinson Disease on irregular terrain, cross-slope, and under dual-task condition. Heliyon 2022; 8:e11223. [PMCID: PMC9637754 DOI: 10.1016/j.heliyon.2022.e11223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/05/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
Background A defining clinical characteristics of Parkinson disease is reduced upper-extremity movements. Irregular terrain, the presence of a cross slope, and dual-task conditions have been found to alter the lower-limb gait characteristics of persons with Parkinson disease but there is little information how different environmental and cognitive conditions impact upper-limb kinematics as well as interlimb movement correlation. Research question Do environmental conditions, such as irregular terrain and the presence of cross slope, as well as dual-task condition impact the upper-extremity kinematics and interlimb movement correlation of persons with Parkinson disease compared to healthy, age-matched controls? Methods Three-dimensional whole-body gait data were collected for nine participants with mild-to-moderate Parkinson disease and nine healthy age-matched control participants. All participants ambulated on a regular terrain, irregular terrain, with and without cross slope, and under dual and single-task conditions. The primary outcomes were arm swing magnitude, arm swing asymmetry, and normalized cross-correlation between the ipsilateral arms and contralateral legs, which characterized movement correlation. Results For all conditions, persons with Parkinson disease exhibited reduced arm swing magnitude and greater arm swing asymmetry compared to the healthy controls. All participants increased their arm swing magnitude on the irregular surface and under the dual-task condition. In the healthy group, the arm swing asymmetry was invariant to terrain but declined under the dual-task condition while the persons with Parkinson disease exhibited increased asymmetry on the cross slope, on the irregular terrain, and under the dual-task condition. Interlimb movement correlation decreased on the irregular terrain for the persons with Parkinson disease while the healthy group exhibited decreased interlimb movement correlation on the cross slope as well as under the dual-task condition. Significance Persons with Parkinson disease were able to increase their arm swing magnitude when their balance was challenged and the most significant threat to their safety as defined by the greatest reduction in the interlimb movement correlation was the irregular terrain. Persons with PD had reduced arm swing magnitude compared to healthy participants. Persons with PD increased arm swing magnitude when their balance was challenged. The irregular terrain was the condition that impacted both health groups the most. Dual-task increased arm swing magnitude and reduced interlimb movement correlation.
Collapse
Affiliation(s)
- Nicholas G. Gomez
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - K. Bo Foreman
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA
| | - MaryEllen Hunt
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Andrew S. Merryweather
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA,Corresponding author.
| |
Collapse
|
25
|
Imbesi S, Corzani M, Lopane G, Mincolelli G, Chiari L. User-Centered Design Methodologies for the Prototype Development of a Smart Harness and Related System to Provide Haptic Cues to Persons with Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2022; 22:8095. [PMID: 36365792 PMCID: PMC9654762 DOI: 10.3390/s22218095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
This paper describes the second part of the PASSO (Parkinson smart sensory cues for older users) project, which designs and tests an innovative haptic biofeedback system based on a wireless body sensor network using a smartphone and different smartwatches specifically designed to rehabilitate postural disturbances in persons with Parkinson's disease. According to the scientific literature on the use of smart devices to transmit sensory cues, vibrotactile feedback (particularly on the trunk) seems promising for improving people's gait and posture performance; they have been used in different environments and are well accepted by users. In the PASSO project, we designed and developed a wearable device and a related system to transmit vibrations to a person's body to improve posture and combat impairments like Pisa syndrome and camptocormia. Specifically, this paper describes the methodologies and strategies used to design, develop, and test wearable prototypes and the mHealth system. The results allowed a multidisciplinary comparison among the solutions, which led to prototypes with a high degree of usability, wearability, accessibility, and effectiveness. This mHealth system is now being used in pilot trials with subjects with Parkinson's disease to verify its feasibility among patients.
Collapse
Affiliation(s)
- Silvia Imbesi
- Department of Architecture, University of Ferrara, 44121 Ferrara, Italy
| | - Mattia Corzani
- Department of Electrical, Electronic, and Information Engineering, University of Bologna, 40126 Bologna, Italy
| | - Giovanna Lopane
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UO Medicina Riabilitativa e Neuroriabilitazione, 40139 Bologna, Italy
| | | | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering, University of Bologna, 40126 Bologna, Italy
| |
Collapse
|
26
|
Ünlüer NÖ, Ozkan T, Sari YA, Karadağ YS. Investigation of the relationship between trunk position sense and balance, functional mobility, fear of falling, and disease stage in Parkinson's disease. Ir J Med Sci 2022:10.1007/s11845-022-03192-7. [PMID: 36251108 DOI: 10.1007/s11845-022-03192-7] [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: 08/24/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Parameters related to trunk control such as balance disorders, mobility problems, and falling are frequently observed in patients with Parkinson's disease (PD). However, to provide a stable foundation for movement, trunk stability requires appropriate adequate position sense. The aim of the study was to examine the relationship between trunk position sense, balance, functional mobility, fear of falling, and disease stage in patients with PD. METHODS The study was conducted in 41 patients with PD (16 female and 25 male). Trunk position sense was assessed with a digital inclinometer, balance with functional reach test, Berg balance scale and one-leg stand test, functional mobility with timed up and go test, fear of falling with activity-specific balance confidence scale, and disease stage with Modified Hoehn and Yahr Scale (MHYS). All patients were tested during the "on" phase following drug therapy. RESULTS Repositioning error degree was related with MHYS, Berg balance scale, right and left one-leg stand test, forward functional reach test, timed up and go test, timed up and go test-cognitive and activity-specific balance confidence scale results in patients with PD (r = - 0.363/ - 0.609, p < 0.05 for all). CONCLUSION It was shown in the study that trunk position sense was associated with disease stage, balance level, functional mobility, and fear of falling in patients with PD. These results suggest that trunk position sense is more important to plan effective rehabilitation program for development and protection of disease stage, balance level, functional mobility, and fear of falling in patients with PD.
Collapse
Affiliation(s)
- Nezehat Özgül Ünlüer
- Faculty of Health Science, Physiotherapy and Rehabilitation, Ankara Yıldırım Beyazıt University, 06760, Ankara, Turkey.
| | - Taskin Ozkan
- Physiotherapy Program, Vocational School of Health Services, Giresun University, Giresun, Turkey
| | - Yasemin Ateş Sari
- Faculty of Health Science, Physiotherapy and Rehabilitation, Ankara Yıldırım Beyazıt University, 06760, Ankara, Turkey
| | - Yesim Sücüllü Karadağ
- Department of Neurology, Health Science University, Ankara City Hospital, Ankara, Turkey
| |
Collapse
|
27
|
Zawadka-Kunikowska M, Klawe JJ, Tafil-Klawe M, Bejtka M, Rzepiński Ł, Cieślicka M. Cognitive Function and Postural Control Strategies in Relation to Disease Progression in Patients with Parkinson's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912694. [PMID: 36231994 PMCID: PMC9566250 DOI: 10.3390/ijerph191912694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 06/01/2023]
Abstract
AIM This study assessed the influence of performing an additional cognitive task on center of pressure (COP) displacement in the early and advanced stages of patients with Parkinson's disease (PD) compared to age-matched healthy controls (HCs). METHODS The study included 40 HCs and 62 patients with PD: early PD (n = 38) and advanced PD (n = 24). COP parameters were determined by static posturography during quiet standing with open eyes (ST, single task) and simultaneous performance of a cognitive task (DT, dual task). Cognitive functioning was examined with a Mini Mental State Examination, number-counting-backward test, and number of enunciated words during DT. RESULTS In the advanced-PD group, DT significantly reduced the sway radius (p = 0.009), area of stabilogram (p = 0.034), medio-lateral length (p = 0.027), and velocity (p = 0.033) compared to ST. In HCs, DT showed a significant increase in the sway radius (p = 0.006), total length (p = 0.039), sway velocity (p = 0.037), anterior-posterior length, and sway velocity. Both PD groups showed worse cognitive performance compared to HCs. CONCLUSIONS Both early and advanced patients with PD showed significant delay in cognitive performance associated with executive function compared to the HCs. During additional cognitive tasks, patients with advanced stages of PD may reduce stabilographic parameters in medio-lateral direction, and this is probably an adaptive strategy to restore balance.
Collapse
Affiliation(s)
- Monika Zawadka-Kunikowska
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Jacek J. Klawe
- Department of Hygiene, Epidemiology, Ergonomy and Postgraduate Education, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Małgorzata Tafil-Klawe
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Monika Bejtka
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Łukasz Rzepiński
- Department of Neurology, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
- Sanitas-Neurology Outpatient Clinic, Dworcowa 110, 85-010 Bydgoszcz, Poland
| | - Mirosława Cieślicka
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
| |
Collapse
|
28
|
Beretta VS, Santos PCR, Orcioli-Silva D, Jaimes DAR, Pereira MP, Barbieri FA, Gobbi LTB. Cumulative additional information does not improve the neuromuscular control during postural responses to perturbations in postural instability/gait disorders subtype of Parkinson's disease. Exp Gerontol 2022; 166:111892. [PMID: 35811017 DOI: 10.1016/j.exger.2022.111892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/15/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Postural response impairments in postural instability and gait disorders (PIGD) subtype patients may be attributed to Parkinson's disease (PD)-deterioration in central-set (programing/modulating of central outputs during motor responses). Although additional information improves some PD motor impairments, an unanswered question is whether additional information can benefit postural response in PIGD subtype. OBJECTIVE To analyze the effect of cumulative additional information on postural responses after perturbation in PIGD and neurologically healthy older adults (CG). METHODS Perturbations were applied in 16 PIGD and 19 CG by the support-base translation. Participants performed 3 blocks of 5 trials without additional information (B1-B3, Day 1) and 5 trials of each cumulative additional information (C1-C4, Day 2): information about perturbation (C1), visual (C2), verbal (C3), and somatosensory information (C4). Electromyography and center of pressure (CoP) parameters were analyzed by ANOVAs with Group (PIGD × CG) and Block (B1 × B2 × B3) and with Group (PIGD × CG) and Condition (B3 × C1 × C2 × C3 × C4). RESULTS PIGD decreased the range of CoP in B3 while CG decreased both range of CoP and the integral of antagonist's muscle activity (iEMG) in B2. Also, PIGD decreased the recovery time in C4 while CG increased the iEMG of agonist's muscle in C2 and antagonist's muscle in all conditions except C2. CONCLUSION Additional information provided before postural control assessment influences the postural response in PIGD and CG differently. PIGD demonstrated inflexibility of central-set in modulating the neuromuscular control regardless of additional information. CG presents a flexible system evidenced by the increase of agonist muscle iEMG when provided visual information.
Collapse
Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Paulo Cezar Rocha Santos
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Israel
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Campinas (UNICAMP), School of Applied Sciences (FCA), Laboratory of Applied Sport Physiology (LAFAE), Limeira, Brazil
| | - Diego Alejandro Rojas Jaimes
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of San Buenaventura Medellin, Graduate Program in Physical Education and Sports, Medellín, Colombia
| | - Marcelo Pinto Pereira
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Fabio Augusto Barbieri
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
| |
Collapse
|
29
|
Galaz Z, Drotar P, Mekyska J, Gazda M, Mucha J, Zvoncak V, Smekal Z, Faundez-Zanuy M, Castrillon R, Orozco-Arroyave JR, Rapcsak S, Kincses T, Brabenec L, Rektorova I. Comparison of CNN-Learned vs. Handcrafted Features for Detection of Parkinson's Disease Dysgraphia in a Multilingual Dataset. Front Neuroinform 2022; 16:877139. [PMID: 35722168 PMCID: PMC9198652 DOI: 10.3389/fninf.2022.877139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Parkinson's disease dysgraphia (PDYS), one of the earliest signs of Parkinson's disease (PD), has been researched as a promising biomarker of PD and as the target of a noninvasive and inexpensive approach to monitoring the progress of the disease. However, although several approaches to supportive PDYS diagnosis have been proposed (mainly based on handcrafted features (HF) extracted from online handwriting or the utilization of deep neural networks), it remains unclear which approach provides the highest discrimination power and how these approaches can be transferred between different datasets and languages. This study aims to compare classification performance based on two types of features: features automatically extracted by a pretrained convolutional neural network (CNN) and HF designed by human experts. Both approaches are evaluated on a multilingual dataset collected from 143 PD patients and 151 healthy controls in the Czech Republic, United States, Colombia, and Hungary. The subjects performed the spiral drawing task (SDT; a language-independent task) and the sentence writing task (SWT; a language-dependent task). Models based on logistic regression and gradient boosting were trained in several scenarios, specifically single language (SL), leave one language out (LOLO), and all languages combined (ALC). We found that the HF slightly outperformed the CNN-extracted features in all considered evaluation scenarios for the SWT. In detail, the following balanced accuracy (BACC) scores were achieved: SL—0.65 (HF), 0.58 (CNN); LOLO—0.65 (HF), 0.57 (CNN); and ALC—0.69 (HF), 0.66 (CNN). However, in the case of the SDT, features extracted by a CNN provided competitive results: SL—0.66 (HF), 0.62 (CNN); LOLO—0.56 (HF), 0.54 (CNN); and ALC—0.60 (HF), 0.60 (CNN). In summary, regarding the SWT, the HF outperformed the CNN-extracted features over 6% (mean BACC of 0.66 for HF, and 0.60 for CNN). In the case of the SDT, both feature sets provided almost identical classification performance (mean BACC of 0.60 for HF, and 0.58 for CNN).
Collapse
Affiliation(s)
- Zoltan Galaz
- Department of Telecommunications, Brno University of Technology, Brno, Czechia
| | - Peter Drotar
- Intelligent Information Systems Laboratory, Faculty of Electrical Engineering and Informatics, Technical University of Kosice, Košice, Slovakia
| | - Jiri Mekyska
- Department of Telecommunications, Brno University of Technology, Brno, Czechia
| | - Matej Gazda
- Intelligent Information Systems Laboratory, Faculty of Electrical Engineering and Informatics, Technical University of Kosice, Košice, Slovakia
| | - Jan Mucha
- Department of Telecommunications, Brno University of Technology, Brno, Czechia
| | - Vojtech Zvoncak
- Department of Telecommunications, Brno University of Technology, Brno, Czechia
| | - Zdenek Smekal
- Department of Telecommunications, Brno University of Technology, Brno, Czechia
| | | | - Reinel Castrillon
- Faculty of Engineering, Universidad de Antioquia—UdeA, Medellín, Colombia
- Faculty of Engineering, Universidad Católica de Oriente, Rionegro, Colombia
| | - Juan Rafael Orozco-Arroyave
- Faculty of Engineering, Universidad de Antioquia—UdeA, Medellín, Colombia
- Pattern Recognition Lab, Friedrich-Alexander-Universität, Erlangen, Germany
| | - Steven Rapcsak
- Department of Neurology, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Tamas Kincses
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Lubos Brabenec
- Applied Neuroscience Research Group, Central European Institute of Technology—CEITEC, Masaryk University, Brno, Czechia
| | - Irena Rektorova
- Applied Neuroscience Research Group, Central European Institute of Technology—CEITEC, Masaryk University, Brno, Czechia
- First Department of Neurology, Faculty of Medicine and St. Anne's University Hospital, Masaryk University, Brno, Czechia
- *Correspondence: Irena Rektorova
| |
Collapse
|
30
|
The effect of body mass reduction on functional stability in young obese women. Sci Rep 2022; 12:8876. [PMID: 35614189 PMCID: PMC9132994 DOI: 10.1038/s41598-022-12959-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/16/2022] [Indexed: 11/08/2022] Open
Abstract
Functional stability is necessary for everyday activities. The studies have indicated the deterioration of functional stability during standing in the obese adults. This study aimed to determine whether the 3-month weight-loss program that resulted in body mass reduction equal to or greater than 5% of the initial body mass would improve functional stability in young obese women. For the purpose of this study, the data of 30 females were included. Their mean age was 35.8 ± 9.2. The women performed the anterior limit of stability test on the force platform twice: before and after weight-loss program. Their BMI at two sessions was 36.1 ± 5.1 and 32.3 ± 5, respectively. After the weight loss program, the COP velocities were increased in both phases of the anterior limit of stability test: the dynamic transition from standing to maximal forward-leaning and the maintenance of maximal forward-leaning position (p < 0.05). No significant changes in the values of the COP parameters were found in the eyes-closed trial (p > 0.05). The results suggest that body mass reduction in young obese women led to improved mobility and postural control when visual cuing was available. The longer-lasting weight-loss program might be necessary to observe this effect under visual deprivation conditions. Body mass should be reduced in obese patients to improve their mobility and functional stability; it may prevent unexpected falls.
Collapse
|
31
|
Schmidle S, de Crignis AC, Stürzer M, Hermsdörfer J, Jahn K, Krewer C. Influence of stance width on standing balance in healthy older adults. J Neurol 2022; 269:6228-6236. [DOI: 10.1007/s00415-022-11144-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/07/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
AbstractPosturography is an objective way to systematically interpret postural control. Recent evidence suggests self-selected stance width when conducting posturography in healthy young participants, as it is easy to perform yet standardized. It is unclear, if this is similarly applicable to healthy older adults which can better serve as comparison group for persons with specific impairments, like Parkinson’s disease, who might have problems with set foot distances. The aim of this study was to investigate the influence of different stance widths on a set of parameters in healthy older adults. Twenty-four healthy elderly (65.6 ± 5.0 years, BMI 26.2 ± 4.5 kg/m2) participated in the study. Posturographic measurement consisted of two tests (body sway, BS; limits of stability, LoS) each assessed in five stance widths on a force platform. A series of time domain and frequency domain parameters, such as BS and LoS range, sample entropy, mean velocity, and balance functional reserve were calculated. Anthropometric parameters and self-selected stance width (mean 17.7 ± 4.7 cm) showed positive correlation. One-way repeated measures MANOVA revealed significant differences between all parameters and foot positions. Except for sample entropy in A-P dimension, univariate analysis showed significant effects of stance widths on the parameters with stronger effects on M-L dimensions. Outcomes acquired in self-selected stance width provide comparable results to standardized stance widths 20 and 30 cm. The recommendation of self-selected stance width can be adopted to older healthy subjects. Furthermore, it reflects a natural stance and includes individual body composition.
Collapse
|
32
|
Son M, Cheon SM, Youm C, Kim JW. Turning reveals the characteristics of gait freezing better than walking forward and backward in Parkinson's disease. Gait Posture 2022; 94:131-137. [PMID: 35306381 DOI: 10.1016/j.gaitpost.2022.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/27/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUNDS People with Parkinson's disease (PD) experiences walking disturbances and freezing of gait (FoG) is one of the most distressing symptoms. RESEARCH QUESTION This study aimed to comprehensively analyze the walking characteristics of patients with PD, including forward and backward walking and turning, in order to define the characteristics of FoG. METHODS A total of 68 patients with PD and 14 control subjects were enrolled in this study. Forward and backward walking and 360-degree turning were recorded at preferred speed in "off" state using three-dimensional motion analysis system. RESULTS PD patients showed a narrower step length, slower walking speed, and higher asymmetry index (AI) of step length during forward and backward walking. During turning, the PD patients had more turning steps, longer turning time, and shorter step length than the control subjects. No difference was observed in the characteristics of forward walking according to the FoG status, but the freezer group showed a narrower step length and decreased range of motion in the ankle joints during backward walking. Freezer group showed longer step time and higher AI of step length at turning. The severity of FoG was correlated with step length and walking speed during forward and backward walking, total step count, total step time, and walking speed during turning. SIGNIFICANCE The characteristics and impacts of FoG in PD were most prominent during turning, followed by backward and forward walking. Further comprehensive analyses of walking including turning might contribute to the understanding of the pathophysiology of walking disturbances in PD.
Collapse
Affiliation(s)
- Minji Son
- Department of Health Care and Science, College of Health Sciences, Dong-A University, Busan, Republic of Korea
| | - Sang-Myung Cheon
- Department of Neurology, School of Medicine, Dong-A University, Busan, Republic of Korea.
| | - Changhong Youm
- Department of Health Care and Science, College of Health Sciences, Dong-A University, Busan, Republic of Korea
| | - Jae Woo Kim
- Department of Neurology, School of Medicine, Dong-A University, Busan, Republic of Korea
| |
Collapse
|
33
|
Warmerdam E, Schumacher M, Beyer T, Nerdal PT, Schebesta L, Stürner KH, Zeuner KE, Hansen C, Maetzler W. Postural Sway in Parkinson's Disease and Multiple Sclerosis Patients During Tasks With Different Complexity. Front Neurol 2022; 13:857406. [PMID: 35422747 PMCID: PMC9001932 DOI: 10.3389/fneur.2022.857406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Neurological diseases are associated with static postural instability. Differences in postural sway between neurological diseases could include "conceptual" information about how certain symptoms affect static postural stability. This information might have the potential to become a helpful aid during the process of finding the most appropriate treatment and training program. Therefore, this study investigated static postural sway performance of Parkinson's disease (PD) and multiple sclerosis (MS) patients, as well as of a cohort of healthy adults. Three increasingly difficult static postural tasks were performed, in order to determine whether the postural strategies of the two disease groups differ in response to the increased complexity of the balance task. Participants had to perform three stance tasks (side-by-side, semi-tandem and tandem stance) and maintain these positions for 10 s. Seven static sway parameters were extracted from an inertial measurement unit that participants wore on the lower back. Data of 47 healthy adults, 14 PD patients and 8 MS patients were analyzed. Both healthy adults and MS patients showed a substantial increase in several static sway parameters with increasingly complex stance tasks, whereas PD patients did not. In the MS patients, the observed substantial change was driven by large increases from semi-tandem and tandem stance. This study revealed differences in static sway adaptations between PD and MS patients to increasingly complex stance tasks. Therefore, PD and MS patients might require different training programs to improve their static postural stability. Moreover, this study indicates, at least indirectly, that rigidity/bradykinesia and spasticity lead to different adaptive processes in static sway.
Collapse
Affiliation(s)
- Elke Warmerdam
- Department of Neurology, Kiel University, Kiel, Germany
- Innovative Implant Development (Fracture Healing), Division of Surgery, Saarland University, Homburg, Germany
| | | | - Thorben Beyer
- Department of Neurology, Kiel University, Kiel, Germany
| | | | | | | | | | - Clint Hansen
- Department of Neurology, Kiel University, Kiel, Germany
| | | |
Collapse
|
34
|
Student J, Engel D, Timmermann L, Bremmer F, Waldthaler J. Visual Perturbation Suggests Increased Effort to Maintain Balance in Early Stages of Parkinson’s to be an Effect of Age Rather Than Disease. Front Hum Neurosci 2022; 16:762380. [PMID: 35308620 PMCID: PMC8924037 DOI: 10.3389/fnhum.2022.762380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/02/2022] [Indexed: 12/01/2022] Open
Abstract
Postural instability marks a prevalent symptom of Parkinson’s disease (PD). It often manifests in increased body sway, which is commonly assessed by tracking the Center of Pressure (CoP). Yet, in terms of postural control, the body’s Center of Mass (CoM), and not CoP is what is regulated in a gravitational field. The aim of this study was to explore the effect of early- to mid-stage PD on these measures of postural control in response to unpredictable visual perturbations. We investigated three cohorts: (i) 18 patients with early to mid-stage PD [Hoehn & Yahr stage (1–3); 1.94 ± 0.70]; (ii) a group of 15 age-matched controls (ECT); and (iii) a group of 12 young healthy adults (YCT). Participants stood on a force plate to track their CoP, while the movement of their entire body was recorded with a video-based motion tracking system to monitor their CoM. A moving room paradigm was applied through a head-mounted virtual reality headset. The stimulus consisted of a virtual tunnel that stretched in the anterior-posterior direction which either remained static or moved back and forth in an unpredictable fashion.We found differences in mean sway amplitude (MSA) and mean velocities of CoP and CoM between the groups under both conditions, with higher MSA of CoP and CoM for PD and higher mean velocities of both variables for PD and ECT when compared with YCT. Visual perturbation increased mean CoP velocity in all groups but did not have effects on mean CoM velocity or MSA. While being significantly lower for the young adults, the net effect of visual perturbation on mean CoP velocity was similar between patients with PD and age-matched controls. There was no effect of the visual perturbation on mean CoM velocity for any of the groups.Our simultaneous assessment of CoP and CoM revealed that postural control is reflected differently in CoM and CoP. As the motion of CoM remained mostly unaffected, all groups successfully counteracted the perturbation and maintained their balance. Higher CoP velocity for PD and ECT revealed increased corrective motion needed to achieve this, which however was similar in both groups. Thus, our results suggest increased effort, expressed in CoP velocity, to be an effect of age rather than disease in earlier stages of PD.
Collapse
Affiliation(s)
- Justus Student
- Department of Neurophysics, University of Marburg, Marburg, Germany
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
- *Correspondence: Justus Student
| | - David Engel
- Department of Neurophysics, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University of Gießen, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University of Gießen, Marburg, Germany
| | - Frank Bremmer
- Department of Neurophysics, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University of Gießen, Marburg, Germany
| | - Josefine Waldthaler
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus-Liebig-University of Gießen, Marburg, Germany
| |
Collapse
|
35
|
Boerger TF, McGinn L, Wang MC, Schmit BD, Hyngstrom AS. Degenerative cervical myelopathy delays responses to lateral balance perturbations regardless of predictability. J Neurophysiol 2022; 127:673-688. [PMID: 35080466 PMCID: PMC8897012 DOI: 10.1152/jn.00159.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to quantify balance impairments in standing in people with degenerative cervical myelopathy (PwDCM) in response to external perturbations. PwDCM have damage to their spinal cord due to degeneration of the cervical vertebral column, but little is known about balance. Balance was quantified by capturing kinetics, kinematic, and electromyographic data during standing in response to lateral waist pulls. Participants received pulls during predictable and unpredictable contexts in three stance widths at two magnitudes. In response to lateral waist pulls, PwDCM had larger center of mass excursion (P < 0.001) and delayed gluteus medius electromyography onset (P < 0.001) and peak (P < 0.001) timing. These main effects of history of myelopathy were consistent across predictability, stance width, and magnitude. A multilinear regression determined that gluteus medius peak timing + tibialis anterior peak timing most strongly predicted center of mass excursion (R2 = 0.50, P < 0.001). These data suggest that PwDCM have delays in generating voluntary and reactive motor commands, contributing to balance impairments. Future rehabilitation strategies should focus on generating rapid muscular contractions. Additionally, frontal plane postural control is regulated by the gluteus medius and the tibialis anterior, whereas other muscles (e.g. gluteus minimus, ankle invertors/evertors) not studied here may also contribute.NEW & NOTEWORTHY Frontal plane reactive postural control is impaired in persons with degenerative cervical myelopathy because of delayed muscle responses. Additionally, postural control varies across stance width, predictability, and perturbation magnitude.
Collapse
Affiliation(s)
- T. F. Boerger
- 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - L. McGinn
- 2Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
| | - M. C. Wang
- 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - B. D. Schmit
- 3Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
| | - A. S. Hyngstrom
- 2Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
| |
Collapse
|
36
|
Nikaido Y, Okada Y, Urakami H, Ishida N, Akisue T, Kawami Y, Kuroda K, Kajimoto Y, Saura R. Dynamic stability during gait in idiopathic normal pressure hydrocephalus and Parkinson's disease. Acta Neurol Scand 2022; 145:215-222. [PMID: 34633069 DOI: 10.1111/ane.13537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/14/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To clarify a characteristic of dynamic stability during gait in idiopathic normal pressure hydrocephalus (iNPH) and Parkinson's disease (PD), and to explore the association between dynamic stability and disease severity in each disease. MATERIALS AND METHODS The 5-m gait of 36 iNPH (precerebrospinal fluid drainage), 20 PD (medicated state), and 25 healthy controls (HC) were evaluated using three-dimensional motion analysis. Ambulatory dynamic stability was defined as the ability to maintain the extrapolated center of mass within the base of support at heel contact, with the distance between the two referred to as the margin of stability (MOS). RESULTS Anteroposterior direction (AP) MOS was significantly larger in the iNPH and PD groups than in the HC group; no significant difference was found between the iNPH and PD groups. Mediolateral direction (ML) MOS was significantly larger in the iNPH and PD groups than in the HC group and significantly larger in the iNPH group than in the PD group. In the iNPH group, the disease severity was positively correlated with only ML MOS. In the PD group, the disease severity was positively correlated with the AP MOS and ML MOS. CONCLUSIONS Dynamic stability in iNPH increases in AP and ML, and it may be associated with not only iNPH-associated gait disturbance but also with a voluntarily cautious gait strategy. Dynamic stability in PD only increased in AP, and this may be associated with PD symptoms. These findings will help physicians understand the difference in pathological gait including dynamic stability between patients with iNPH and PD.
Collapse
Affiliation(s)
- Yasutaka Nikaido
- Clinical Department of Rehabilitation Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Yohei Okada
- Graduate School of Health Sciences Kio University Nara Japan
- Neurorehabilitation Research Center of Kio University Nara Japan
| | - Hideyuki Urakami
- Clinical Department of Rehabilitation Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Naoya Ishida
- Clinical Department of Rehabilitation Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Sciences, Graduate School of Health Sciences Kobe University Kobe Japan
| | - Yuki Kawami
- Department of Rehabilitation Sciences, Graduate School of Health Sciences Kobe University Kobe Japan
- Department of Physical Therapy, Faculty of Rehabilitation Hyogo Prefectural Rehabilitation Hospital at Nishi‐Harima Hyogo Japan
| | - Kenji Kuroda
- Clinical Department of Rehabilitation Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Yoshinaga Kajimoto
- Department of Neurosurgery, Division of Surgery Osaka Medical and Pharmaceutical University Osaka Japan
| | - Ryuichi Saura
- Department of Physical and Rehabilitation Medicine, Division of Comprehensive Medicine Osaka Medical and Pharmaceutical University Osaka Japan
| |
Collapse
|
37
|
Taniuchi R, Harada T, Nagatani H, Makino T, Watanabe C, Kanai S. The power of instruction on retropulsion: A pilot randomized controlled trial of therapeutic exercise focused on ankle joint movement in Parkinson’s disease. Clin Park Relat Disord 2022; 7:100151. [PMID: 35856046 PMCID: PMC9287626 DOI: 10.1016/j.prdoa.2022.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/12/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022] Open
Abstract
Retropulsion in PD may involve the lack of push-off for a backward step. Exercise with ankle-movement instruction can improve backward response. Toe-landing instruction may facilitate treatment of retropulsion in PD.
Introduction Although retropulsion is a serious complication of Parkinson’s disease (PD), it is unknown whether ankle joint movement patterns can be targeted to treat retropulsion. The primary aim of this study was to investigate the effectiveness of therapeutic exercise focused on instructions regarding ankle joint movement on retropulsion in PD. Methods Twenty patients with moderate PD were randomly allocated to the experimental intervention (INSTR) or control groups. The INSTR group received a 2-week therapeutic exercise program (40 min/day, five times/week) that involved repeated backward pulls on the shoulders with instructions to land on the toes as a response, and the control group received the same intervention without the instructions. The primary outcome was the difference in changes from baseline in the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS part III) score between the study groups at weeks 1 and 2. Results The improvement in the MDS-UPDRS part III scores was significantly greater for the INSTR group in the week 1 (p = 0.033, pη2 = 0.241) and week 2 (p = 0.004, pη2 = 0.401) assessments. However, the provision of instructions to land on the toes as a backward response induced improvement in the only scores related to the backward response, and no significant between-group differences were observed in the other outcomes. Conclusion The 2-week therapeutic exercise program with instructions to treat retropulsion improved the backward response. Trial registration UMIN-CTR, UMIN000042722.
Collapse
|
38
|
Staying UpRight in Parkinson's disease: A pilot study of a novel wearable postural intervention. Gait Posture 2022; 91:86-93. [PMID: 34656009 DOI: 10.1016/j.gaitpost.2021.09.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This interventional pilot study aimed to 1) examine whether a novel wearable vibro-tactile feedback device ('UpRight Go') is effective and feasible to improve postural alignment in Parkinson's disease (PD); 2) explore relationships between postural alignment and attention in PD; 3) explore effect of vibro-tactile device on balance and gait; and 4) gain initial feedback on the use of the vibro-tactile device in the laboratory and at home. METHODS 25 people with PD sat, stood and walked for two-minutes without and with the UpRight device attached to their upper backs to provide feedback on postural alignment in the laboratory. A sub-group (n = 12) wore the UpRight device at home for 60 min. per day for 7-days of postural feedback. Subjective feedback on use of the device was obtained in the laboratory and at the end of the 7-day period. The primary outcome for this study was posture measured by verticality of inertial measurement units (IMUs) at the neck, trunk and low back, which was done with and without the UpRight device. Secondary outcomes included clinical measures of posture, subjective feedback on the device, computerized attention measures, gait and balance. RESULTS Neck postural alignment in PD was significantly improved (reduced neck flexion) with the UpRight during sitting and standing in both clinical measures (p = 0.005) and IMU outcomes (p = 0.046), but trunk and low back posture did not change. There was no change in postural alignment during walking with the UpRight. Postural alignment response was related to attentional capabilities. Many subjects (68 %) reported that they felt a benefit from the UpRight and most participants reported that the device was acceptable (Lab use; 72 %, Home use; 75 %). CONCLUSION The UpRight Go feedback device may improve neck/upper-back posture in PD during sitting and standing, but not during walking. Postural alignment response to the device may depend on attentional mechanisms.
Collapse
|
39
|
Kawami Y, Nikaido Y, Nose S, Unekawa M, Marumoto K, Kawami M, Matsugashita S, Kozuki T, Akisue T. Mediolateral Postural Control during Gait in Parkinson’s Disease. Prog Rehabil Med 2022; 7:20220048. [PMID: 36160027 PMCID: PMC9470496 DOI: 10.2490/prm.20220048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: Balance in the mediolateral direction is usually maintained in patients with
early-stage Parkinson’s disease (PD), but not in moderate-stage PD as revealed by the
Tandem Gait Test. Although mediolateral postural control in PD patients remains
controversial, previous studies have shown that the Tandem Gait Test may predict the
risk of future falls in patients with PD. This study aimed to clarify postural control
differences among PD patients with and without mediolateral balance impairments (MLBI:
mediolateral balance impairments, nMLBI: non-mediolateral balance impairments,
respectively) and healthy controls (HCs). Methods: We recruited 40 PD patients and 20 HCs. According to the Tandem Gait Test score, PD
patients were divided into MLBI and nMLBI groups. Primary outcome measures were the
ambulatory movement trajectory amplitude of the center of mass and its coefficient of
variation (CV) during gait. Results: Mediolateral movement trajectory amplitudes and CV were not significantly different
between the nMLBI group and HCs, whereas the mediolateral movement trajectory amplitude
in the MLBI group was significantly higher than that in the nMLBI group. Moreover, the
CV of the mediolateral movement trajectory amplitude in the MLBI group was significantly
lower than that in the nMLBI group. The mediolateral movement trajectory amplitude was
significantly correlated with the fall score. Conclusions: The current results suggest that PD patients with mediolateral balance impairments
showed mediolateral postural sway during gait compared with PD patients without
mediolateral balance impairments. It is necessary to focus on the instabilities in the
mediolateral direction to avoid falls in PD patients.
Collapse
Affiliation(s)
- Yuki Kawami
- Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan
| | - Yasutaka Nikaido
- Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Shoma Nose
- Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan
| | - Maya Unekawa
- Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan
| | - Kohei Marumoto
- Department of Physical Medicine and Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan
| | - Mika Kawami
- Department of Occupational Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan
| | - So Matsugashita
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Tsuyoshi Kozuki
- Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Tatsuno, Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| |
Collapse
|
40
|
Patel M, Nilsson MH, Rehncrona S, Tjernström F, Magnusson M, Johansson R, Fransson PA. Strategic alterations of posture are delayed in Parkinson's disease patients during deep brain stimulation. Sci Rep 2021; 11:23550. [PMID: 34876604 PMCID: PMC8651728 DOI: 10.1038/s41598-021-02813-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 11/22/2021] [Indexed: 11/09/2022] Open
Abstract
Parkinson’s disease (PD) is characterized by rigidity, akinesia, postural instability and tremor. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) reduces tremor but the effects on postural instability are inconsistent. Another component of postural control is the postural strategy, traditionally referred to as the ankle or hip strategy, which is determined by the coupling between the joint motions of the body. We aimed to determine whether DBS STN and vision (eyes open vs. eyes closed) affect the postural strategy in PD in quiet stance or during balance perturbations. Linear motion was recorded from the knee, hip, shoulder and head in 10 patients with idiopathic PD with DBS STN (after withdrawal of other anti-PD medication), 25 younger adult controls and 17 older adult controls. Correlation analyses were performed on anterior–posterior linear motion data to determine the coupling between the four positions measured. All participants were asked to stand for a 30 s period of quiet stance and a 200 s period of calf vibration. The 200 s vibration period was subdivided into four 50 s periods to study adaptation between the first vibration period (30–80 s) and the last vibration period (180–230 s). Movement was recorded in patients with PD with DBS ON and DBS OFF, and all participants were investigated with eyes closed and eyes open. DBS settings were randomized and double-blindly programmed. Patients with PD had greater coupling of the body compared to old and young controls during balance perturbations (p ≤ 0.046). Controls adopted a strategy with greater flexibility, particularly using the knee as a point of pivot, whereas patients with PD adopted an ankle strategy, i.e., they used the ankle as the point of pivot. There was higher flexibility in patients with PD with DBS ON and eyes open compared to DBS OFF and eyes closed (p ≤ 0.011). During balance perturbations, controls quickly adopted a new strategy that they retained throughout the test, but patients with PD were slower to adapt. Patients with PD further increased the coupling between segmental movement during balance perturbations with DBS ON but retained a high level of coupling with DBS OFF throughout balance perturbations. The ankle strategy during balance perturbations in patients with PD was most evident with DBS OFF and eyes closed. The increased coupling with balance perturbations implies a mechanism to reduce complexity at a cost of exerting more energy. Strategic alterations of posture were altered by DBS in patients with PD and were delayed. Our findings therefore show that DBS does not fully compensate for disease-related effects on posture.
Collapse
Affiliation(s)
- Mitesh Patel
- Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, WV1 1LY, UK
| | - Maria H Nilsson
- Department of Health Sciences, Lund University, 221 85, Lund, Sweden.,Memory Clinic, Skåne University Hospital, 212 24, Malmö, Sweden.,Clinical Memory Research Unit, Faculty of Medicine, Lund University, 221 85, Lund, Sweden
| | - Stig Rehncrona
- Department of Neurosurgery, Lund University, 221 85, Lund, Sweden
| | | | - Måns Magnusson
- Department of Clinical Sciences, Lund University, 221 85, Lund, Sweden
| | - Rolf Johansson
- Department of Automatic Control, Lund University, 221 00, Lund, Sweden
| | | |
Collapse
|
41
|
Payne AM, Palmer JA, McKay JL, Ting LH. Lower Cognitive Set Shifting Ability Is Associated With Stiffer Balance Recovery Behavior and Larger Perturbation-Evoked Cortical Responses in Older Adults. Front Aging Neurosci 2021; 13:742243. [PMID: 34938171 PMCID: PMC8685437 DOI: 10.3389/fnagi.2021.742243] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022] Open
Abstract
The mechanisms underlying associations between cognitive set shifting impairments and balance dysfunction are unclear. Cognitive set shifting refers to the ability to flexibly adjust behavior to changes in task rules or contexts, which could be involved in flexibly adjusting balance recovery behavior to different contexts, such as the direction the body is falling. Prior studies found associations between cognitive set shifting impairments and severe balance dysfunction in populations experiencing frequent falls. The objective of this study was to test whether cognitive set shifting ability is expressed in successful balance recovery behavior in older adults with high clinical balance ability (N = 19, 71 ± 7 years, 6 female). We measured cognitive set shifting ability using the Trail Making Test and clinical balance ability using the miniBESTest. For most participants, cognitive set shifting performance (Trail Making Test B-A = 37 ± 20 s) was faster than normative averages (46 s for comparable age and education levels), and balance ability scores (miniBESTest = 25 ± 2/28) were above the threshold for fall risk (23 for people between 70 and 80 years). Reactive balance recovery in response to support-surface translations in anterior and posterior directions was assessed in terms of body motion, muscle activity, and brain activity. Across participants, lower cognitive set shifting ability was associated with smaller peak center of mass displacement during balance recovery, lower directional specificity of late phase balance-correcting muscle activity (i.e., greater antagonist muscle activity 200-300 ms after perturbation onset), and larger cortical N1 responses (100-200 ms). None of these measures were associated with clinical balance ability. Our results suggest that cognitive set shifting ability is expressed in balance recovery behavior even in the absence of profound clinical balance disability. Specifically, our results suggest that lower flexibility in cognitive task performance is associated with lower ability to incorporate the directional context into the cortically mediated later phase of the motor response. The resulting antagonist activity and stiffer balance behavior may help explain associations between cognitive set shifting impairments and frequent falls.
Collapse
Affiliation(s)
- Aiden M. Payne
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, GA, United States
| | - Jacqueline A. Palmer
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - J. Lucas McKay
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, United States,Jean and Paul Amos PD and Movement Disorders Program, Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
| | - Lena H. Ting
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, GA, United States,Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States,*Correspondence: Lena H. Ting,
| |
Collapse
|
42
|
Clinical Usefulness of Retropulsion Tests in Persons with Mild to Moderate Parkinson's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312325. [PMID: 34886051 PMCID: PMC8656501 DOI: 10.3390/ijerph182312325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/16/2022]
Abstract
People with Parkinson's disease (PwPD) have an increased risk for falls and near falls. They have particular difficulties with maintaining balance against an external perturbation, and several retropulsion tests exist. The Unified PD Rating Scale item 30 (UPDRS30) is the most common, involving an expected shoulder pull. Others recommend using an unexpected shoulder pull, e.g., the Nutt Retropulsion Test (NRT). We aimed to evaluate the clinical usefulness of these tests for detecting future fallers. By using two different golden standards related to self-reported prospective falls and near falls over 6 months following two different time points with 3.5 years between, we estimated sensitivity/specificity, Youden index, predictive values, and likelihood ratios for each test. The different time points yielded a different prevalence of falls and near falls, as well as different predictive values. When comparing the performance of the NRT and UPDRS30 for detecting future fallers, we found that the NRT consistently performed better than UPDRS30. However, neither test exhibited optimal performance in terms of predictive values and associated likelihood ratios. Our findings speak against using either of these tests as a single assessment for this purpose and support previous recommendations of using a multifactorial approach when targeting balance problems in PwPD.
Collapse
|
43
|
Çoban F, Belgen Kaygısız B, Selcuk F. Effect of clinical Pilates training on balance and postural control in patients with Parkinson's disease: a randomized controlled trial. J Comp Eff Res 2021; 10:1373-1383. [PMID: 34726472 DOI: 10.2217/cer-2021-0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Clinical pilates exercises have been shown to improve balance. Our study aims to compare effects of clinical Pilates and conventional physiotherapy exercises on balance and postural control in Parkinson's disease patients. Materials & methods: Forty patients were randomly assigned into either clinical Pilates (CLP) or conventional physiotherapy (COP) group. Exercises were performed twice a week for 8 weeks. Balance, lower-extremity strength, fall risk and functional mobility were assessed at the beginning and end of the exercise period. Results: All measurements indicated significant increase in two groups (p < 0.05). Compared with the COP group, the CLP group showed significant improvement in dynamic balance values (p < 0.05). Conclusion: CLP was as effective as COP, with better dynamic balance results, and could be used in rehabilitation for patients with Parkinson's disease. Clinical trial registration number: NCT04063605.
Collapse
Affiliation(s)
- Fahriye Çoban
- European University of Lefke, Faculty of Health Sciences, Physiotherapy & Rehabilitation Department, Lefke, Northern Cyprus TR-10 Mersin, Turkey
| | - Beliz Belgen Kaygısız
- European University of Lefke, Faculty of Health Sciences, Physiotherapy & Rehabilitation Department, Lefke, Northern Cyprus TR-10 Mersin, Turkey
| | - Ferda Selcuk
- Dr. Burhan Nalbantoğlu State Hospital, Neurology Department, Nicosia, Northern Cyprus TR-10 Mersin, Turkey
| |
Collapse
|
44
|
Moreira GM, Tesser IM, Scrok ND, Boumer TC, Manffra EF. Estabilidade dinâmica de pessoas com AVE durante o movimento de cabeceio simulado em um jogo digital. FISIOTERAPIA E PESQUISA 2021. [DOI: 10.1590/1809-2950/19027628042021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A estabilidade postural é um objetivo de tratamento na fisioterapia que pode ser alcançado por meio de exercícios de transferência de peso bilateral. Os jogos digitais surgem como alternativa para execução desses exercícios, mas sua avaliação ainda necessita de aprimoramento. Propõe-se aqui o uso de variáveis biomecânicas para verificar o comportamento da estabilidade postural dinâmica durante um movimento de cabeceio, simulado por um jogo digital com diferentes exigências de velocidades. Para isso, 16 voluntários pós-acidente vascular encefálico (AVE) - 12 homens e 4 mulheres, com idade média de 56 anos - e 16 hígidos pareados por sexo e idade participaram da coleta experimental, na qual eles foram submetidos ao jogo digital “cabeceio”, que tem cinco níveis de velocidade, do mais lento ao mais rápido, com duração de 30 segundos cada. A partir dos sinais cinemáticos foi possível calcular os indicadores de interesse, a área da base de suporte e a margem de estabilidade, definida como a menor distância entre as bordas da base de suporte e a projeção vertical do centro de massa (CM) extrapolado, que considera a velocidade do CM. Os valores da base de suporte não apresentaram diferenças entre os níveis de velocidade do jogo, mas sim entre grupos. A margem de estabilidade não diferiu entre níveis e grupos. Os níveis de velocidade do jogo, possivelmente, não estimularam os voluntários a buscar estratégias diferentes para manter a estabilidade, como dar um passo, mas os fizeram adotar bases de suporte diferentes, sendo que indivíduos com AVE adotaram uma base de suporte menor do que a dos hígidos.
Collapse
|
45
|
Zampogna A, Mileti I, Martelli F, Paoloni M, Del Prete Z, Palermo E, Suppa A. Early balance impairment in Parkinson's Disease: Evidence from Robot-assisted axial rotations. Clin Neurophysiol 2021; 132:2422-2430. [PMID: 34454269 DOI: 10.1016/j.clinph.2021.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/27/2021] [Accepted: 06/06/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Early postural instability (PI) is a red flag for the diagnosis of Parkinson's disease (PD). Several patients, however, fall within the first three years of disease, particularly when turning. We investigated whether PD patients, without clinically overt PI, manifest abnormal reactive postural responses to ecological perturbations resembling turning. METHODS Fifteen healthy subjects and 20 patients without clinically overt PI, under and not under L-Dopa, underwent dynamic posturography during axial rotations around the longitudinal axis, provided by a robotic mechatronic platform. We measured reactive postural responses, including body displacement and reciprocal movements of the head, trunk, and pelvis, by using a network of three wearable inertial sensors. RESULTS Patients showed higher body displacement of the head, trunk and pelvis, and lower joint movements at the lumbo-sacral junction than controls. Conversely, movements at the cranio-cervical junction were normal in PD. L-Dopa left reactive postural responses unchanged. CONCLUSIONS Patients with PD without clinically overt PI manifest abnormal reactive postural responses to axial rotations, unresponsive to L-Dopa. The biomechanical model resulting from our experimental approach supports novel pathophysiological hypotheses of abnormal axial rotations in PD. SIGNIFICANCE PD patients without clinically overt PI present subclinical balance impairment during axial rotations, unresponsive to L-Dopa.
Collapse
Affiliation(s)
- Alessandro Zampogna
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Ilaria Mileti
- Mechanical Measurements and Microelectronics (M3Lab) Lab, Engineering Department, University Niccolò Cusano, 00166 Rome, Italy
| | - Francesca Martelli
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, 00184 Rome, Italy
| | - Marco Paoloni
- Department of Physical Medicine and Rehabilitation, Sapienza University of Rome, 00161 Rome, Italy
| | - Zaccaria Del Prete
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, 00184 Rome, Italy
| | - Eduardo Palermo
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, 00184 Rome, Italy
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; IRCCS Neuromed, 86077 Pozzilli, IS, Italy.
| |
Collapse
|
46
|
Papa EV, Patterson RM, Bugnariu N. "Going Backward": Effects of age and fatigue on posterior-directed falls in Parkinson disease. NeuroRehabilitation 2021; 49:151-159. [PMID: 34180424 DOI: 10.3233/nre-210040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nearly half of persons with Parkinson disease (PD) report fatigue as a factor in their fall history. However, it is unknown whether these self-reported falls are caused by a sensation of fatigue or performance fatigue. OBJECTIVE We sought to investigate the influences of performance fatigue and age on postural control in persons with PD. METHODS Individuals with PD (n = 14) underwent postural control assessments before (T0) and immediately after (T1) fatiguing exercise. Biomechanical data were gathered on participants completing a treadmill-induced, posterior-directed fall. Performance fatigue was produced using lower extremity resistance exercise on an isokinetic ergometer. Repeated measures ANCOVAs were used with age as a covariate to determine the effects of performance fatigue on biomechanical variables. RESULTS After adjustment for age, there was a statistically significant difference in peak center of pressure (COP) latency during the support phase of recovery. Pairwise comparisons demonstrated a decrease in peak ankle displacement from T0 to T1. Age was also found to be significantly related to reaction time and peak knee displacement while participants were fatigued. CONCLUSIONS The decreased peak COP latency, along with decreased ankle angular displacement, suggest that persons with PD adopt a stiffening strategy in response to backward directed falls. Postural stiffening is not uncommon in persons with PD and could be a risk factor for falls. Older individuals with PD demonstrate slower mobility scores and decreased reaction times in the setting of fatigue, suggesting a combined effect of the aging and fatigue processes.
Collapse
Affiliation(s)
- Evan V Papa
- School of Rehabilitation and Communication Sciences, Idaho State University, Meridian, ID, USA
| | - Rita M Patterson
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | | |
Collapse
|
47
|
Cano Porras D, Jacobs JV, Inzelberg R, Bahat Y, Zeilig G, Plotnik M. Patterns of whole-body muscle activations following vertical perturbations during standing and walking. J Neuroeng Rehabil 2021; 18:75. [PMID: 33957953 PMCID: PMC8101216 DOI: 10.1186/s12984-021-00836-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls commonly occur due to losses of balance associated with vertical body movements (e.g. reacting to uneven ground, street curbs). Research, however, has focused on horizontal perturbations, such as forward and backward translations of the standing surface. This study describes and compares muscle activation patterns following vertical and horizontal perturbations during standing and walking, and investigates the role of vision during standing postural responses. METHODS Fourteen healthy participants (ten males; 27±4 years-old) responded to downward, upward, forward, and backward perturbations while standing and walking in a virtual reality (VR) facility containing a moveable platform with an embedded treadmill; participants were also exposed to visual perturbations in which only the virtual scenery moved. We collected bilateral surface electromyography (EMG) signals from 8 muscles (tibialis anterior, rectus femoris, rectus abdominis, external oblique, gastrocnemius, biceps femoris, paraspinals, deltoids). Parameters included onset latency, duration of activation, and activation magnitude. Standing perturbations comprised dynamic-camera (congruent), static-camera (incongruent) and eyes-closed sensory conditions. ANOVAs were used to compare the effects of perturbation direction and sensory condition across muscles. RESULTS Vertical perturbations induced longer onset latencies and shorter durations of activation with lower activation magnitudes in comparison to horizontal perturbations (p<0.0001). Downward perturbations while standing generated earlier activation of anterior muscles to facilitate flexion (for example, p=0.0005 and p=0.0021 when comparing the early activators, rectus femoris and tibialis anterior, to a late activator, the paraspinals), whereas upward perturbations generated earlier activation of posterior muscles to facilitate extension (for example, p<0.0001 and p=0.0004, when comparing the early activators, biceps femoris and gastrocnemius, to a late activator, the rectus abdominis). Static-camera conditions induced longer onset latencies (p=0.0085 and p<0.0001 compared to eyes-closed and dynamic-camera conditions, respectively), whereas eyes-closed conditions induced longer durations of activation (p=0.0001 and p=0.0008 compared to static-camera and dynamic-camera, respectively) and larger activation magnitudes. During walking, downward perturbations promptly activated contralateral trunk and deltoid muscles (e.g., p=0.0036 for contralateral deltoid versus a late activator, the ipsilateral tibialis anterior), and upward perturbations triggered early activation of trunk flexors (e.g., p=0.0308 for contralateral rectus abdominis versus a late activator, the ipsilateral gastrocnemius). Visual perturbations elicited muscle activation in 67.7% of trials. CONCLUSION Our results demonstrate that vertical (vs. horizontal) perturbations generate unique balance-correcting muscle activations, which were consistent with counteracting vertical body extension induced by downward perturbations and vertical body flexion induced by upward perturbations. Availability of visual input appears to affect response efficiency, and incongruent visual input can adversely affect response triggering. Our findings have clinical implications for the design of robotic exoskeletons (to ensure user safety in dynamic balance environments) and for perturbation-based balance and gait rehabilitation.
Collapse
Affiliation(s)
- Desiderio Cano Porras
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Perception and Action in Complex Environments, Marie Curie International Training Network, European Union's Horizons 2020 Research and Innovation Program, Brussels, Belgium.,Brightlands Institute for Smart Society-BISS, Maastricht University, Maastricht, The Netherlands
| | - Jesse V Jacobs
- Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | - Rivka Inzelberg
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Applied Mathematics and Computer Science, The Weizmann Institute of Science, Rehovot, Israel
| | - Yotam Bahat
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Gabriel Zeilig
- Department of Neurological Rehabilitation, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel.,Department of Physical and Rehabilitation Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel. .,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel. .,Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
48
|
Spectral analysis of body movement during deep brain stimulation in Parkinson's disease. Gait Posture 2021; 86:217-225. [PMID: 33765547 DOI: 10.1016/j.gaitpost.2021.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 02/15/2021] [Accepted: 03/15/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The characteristics of Parkinson's disease (PD) include postural instability and resting tremor. However, reductions of tremor amplitude do not always improve postural stability. RESEARCH QUESTION What is the effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on spectral analysis of body movement in patients with PD when tested without anti-PD medication? The effect of visual cues was also studied. METHODS Ten patients with PD (mean age 64.3 years, range 59-69 years) and 17 control participants (mean age 71.2 years, range 65-79 years) were recruited. Spectral power following a period of quiet stance (35 s) was analysed in three different spectral power bands (0-4 Hz, 4-7 Hz and 7-25 Hz). Motion markers were secured to the head, shoulder, hip, and knee, which recorded movements in two directions, the anteroposterior and lateral. RESULTS DBS STN significantly changed the spectral distribution pattern across the body in the anteroposterior (p = 0.029) and lateral directions (p ≤ 0.003). DBS predominantly reduced spectral power at the head (p ≤ 0.037) and shoulder (p ≤ 0.031) in the lateral direction. The spectral power of the lower and upper body in patients with PD, with DBS ON, were more similar to the control group, than to DBS OFF. Visual cues mainly reduced spectral power in the anteroposterior direction at the shoulder (p ≤ 0.041) in controls and in patients with PD with DBS ON. SIGNIFICANCE There is an altered postural strategy in patients with PD with DBS ON as shown by an altered spectral power distribution pattern across body segments and a reduction of spectral power in the lateral direction at the head and shoulder. A reduction of spectral power in controls and in patients with PD with DBS ON suggests that visual cues are able to reduce spectral power to some extent, but not with DBS OFF where postural sway and power are larger.
Collapse
|
49
|
Beretta VS, Carpenter MG, Barbieri FA, Santos PCR, Orcioli-Silva D, Pereira MP, Gobbi LTB. Does the impaired postural control in Parkinson's disease affect the habituation to non-sequential external perturbation trials? Clin Biomech (Bristol, Avon) 2021; 85:105363. [PMID: 33932865 DOI: 10.1016/j.clinbiomech.2021.105363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND How people with Parkinson's disease habituate their postural response to unpredictable translation perturbation is not totally understood. We compared the capacity to change the postural responses after unexpected external perturbation and investigated the habituation plateaus of postural responses to non-sequential perturbation trials in people with Parkinson's disease and healthy older adults. METHODS In people with Parkinson's disease (n = 37) and older adults (n = 20), sudden posterior support-surface translational were applied in 7 out of 17 randomized trials to ensure perturbation unpredictability. Electromyography and center of pressure parameters of postural response were analyzed by ANOVAs (Group vs. Trials). Two simple planned contrasts were performed to determine at which trial the responses first significantly habituate, and by which trials the habituation plateaus. FINDINGS Older adults demonstrated a first response change in trial 5 and habituation plateaus after trial 4, while for people with Parkinson's disease, the first change occurred in trial 2 and habituation plateau after trial 5 observed by center of pressure range. People with Parkinson's disease demonstrated a greater center of pressure range in trial 1 compared to older adults. Independent of trial, people with Parkinson's disease vs. older adults demonstrated a greater ankle muscle co-activation and recovery time. INTERPRETATION Despite the greater center of pressure range in the first trial, people with Parkinson's disease can habituate to unpredictable perturbations. This is reflected by little, to no difference in the time-course of adaptation for all but 2 parameters that showed only marginal differences between people with Parkinson's disease and older adults.
Collapse
Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Mark Gregory Carpenter
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabio Augusto Barbieri
- São Paulo State University (Unesp), School of Sciences, Graduate Program in Movement Sciences, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Paulo Cezar Rocha Santos
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Marcelo Pinto Pereira
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
| |
Collapse
|
50
|
Genoves GG, Cruz CF, Doná F, Andrade TAM, Ferraz HB, Barela JA. Detection of passive movement in lower limb joints is impaired in individuals with Parkinson's disease. Neurophysiol Clin 2021; 51:279-285. [PMID: 33934993 DOI: 10.1016/j.neucli.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Sensory information is crucial when performing daily activities, and Parkinson's disease may diminish sensitivity to sensory cues. This study aimed to examine the detection threshold of passive motion of knee and ankle joints in individuals with Parkinson's disease. METHODS Eighteen individuals in the early stages of idiopathic Parkinson's disease (age: 62.7 ± 7.3 years) and 18 healthy matched controls (age: 62.5 ± 7.1 years) first performed a simple reaction time test. Participants were asked to perform ten trials, during which they had to watch a square on a screen and press a button as quickly as possible when the square lit up. Thereafter, the participants were tested for their detection threshold of passive motion of their lower limb joints. Participants were seated in a specially designed chair and their knee or ankle joint was passively moved at a velocity of 0.5º/s. Participants kept their eyes closed and were instructed to press a button as quickly as possible when any joint motion was detected. RESULTS Individuals with Parkinson's disease needed more time to perform the reaction time test than did the control participants. Individuals with Parkinson's disease also needed larger angular displacement, even when reaction time was used as a covariate measure, to detect any passive motion, in both knee (0.70º ± 0.20º) and ankle (1.03º ± 0.23º) joints than did the control participants [(0.57º ± 0.20º) and (0.84º ± 0.27º), respectively]. CONCLUSION Impaired joint proprioception can be observed in the early stages of Parkinson's disease, which may compromise the use of proprioception cues from lower limbs.
Collapse
Affiliation(s)
- Giovanna Gracioli Genoves
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - Caio Ferraz Cruz
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil
| | - Flávia Doná
- Federal University of São Paulo, São Paulo, SP, Brazil
| | | | | | - José Angelo Barela
- Institute of Biosciences, São Paulo State University, Rio Claro, SP, Brazil.
| |
Collapse
|