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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.
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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.)
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Palmisano C, Beccaria L, Haufe S, Volkmann J, Pezzoli G, Isaias IU. Gait Initiation Impairment in Patients with Parkinson's Disease and Freezing of Gait. Bioengineering (Basel) 2022; 9:639. [PMID: 36354550 PMCID: PMC9687939 DOI: 10.3390/bioengineering9110639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 08/03/2023] Open
Abstract
Freezing of gait (FOG) is a sudden episodic inability to produce effective stepping despite the intention to walk. It typically occurs during gait initiation (GI) or modulation and may lead to falls. We studied the anticipatory postural adjustments (imbalance, unloading, and stepping phase) at GI in 23 patients with Parkinson's disease (PD) and FOG (PDF), 20 patients with PD and no previous history of FOG (PDNF), and 23 healthy controls (HCs). Patients performed the task when off dopaminergic medications. The center of pressure (CoP) displacement and velocity during imbalance showed significant impairment in both PDNF and PDF, more prominent in the latter patients. Several measurements were specifically impaired in PDF patients, especially the CoP displacement along the anteroposterior axis during unloading. The pattern of segmental center of mass (SCoM) movements did not show differences between groups. The standing postural profile preceding GI did not correlate with outcome measurements. We have shown impaired motor programming at GI in Parkinsonian patients. The more prominent deterioration of unloading in PDF patients might suggest impaired processing and integration of somatosensory information subserving GI. The unaltered temporal movement sequencing of SCoM might indicate some compensatory cerebellar mechanisms triggering time-locked models of body mechanics in PD.
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Affiliation(s)
- Chiara Palmisano
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Würzburg, Germany
| | - Laura Beccaria
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Würzburg, Germany
| | - Stefan Haufe
- Uncertainty, Inverse Modeling and Machine Learning Group, Faculty IV Electrical Engineering and Computer Science, Technical University of Berlin, 10623 Berlin, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Würzburg, Germany
| | - Gianni Pezzoli
- Centro Parkinson, ASST Gaetano Pini-CTO, 20122 Milano, Italy
| | - Ioannis U. Isaias
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Würzburg, Germany
- Centro Parkinson, ASST Gaetano Pini-CTO, 20122 Milano, Italy
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Luna NMS, Brech GC, Canonica A, Ernandes RDC, Bocalini DS, Greve JMD, Alonso AC. Effects of treadmill training on gait of elders with Parkinson's disease: a literature review. EINSTEIN-SAO PAULO 2020; 18:eRW5233. [PMID: 33263679 PMCID: PMC7687915 DOI: 10.31744/einstein_journal/2020rw5233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 02/01/2020] [Indexed: 12/11/2022] Open
Abstract
Parkinson's disease is the second most common neurodegenerative disorder in old age. Aging process for elders with Parkinson's disease can induce gait disturbances with more functional disabilities than for elders without the disease. Treadmill training as a therapy has resulted in notable effects on the gait of patients with Parkinson's disease and may be a resource for geriatric neurological rehabilitation. This review aimed to study the effects on gait after treadmill training in elderly patients with Parkinson's disease. The search was performed in the databases PubMed®, LILACS, PEDro and EMBASE, with the following keywords: “Parkinson's disease”, “elderly”, “treadmill training” and “gait evaluation”. The quality of the studies included was assessed by PEDro Scale. Eleven studies met the inclusion and exclusion criteria. Eight studies were randomized, and only one did a follow-up. One can observe in this review that treadmill training with or without weight support (at least 20 minutes, two to three times a week, with progressive increase of loads, for minimum of 6 weeks) in elderly patients with the Parkinson's disease was effective to improve gait. In addition, both were considered safe (since some studies described the use of belts, even in unsupported training) and can be associated with therapies complementary to gait, such as repetitive transcranial magnetic stimulation, visual cues or anodal transcranial direct current stimulation. Treadmill training in elderly patients with Parkinson's disease is an intervention that improves gait outcomes, but further studies are required for better proofs.
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Affiliation(s)
- Natália Mariana Silva Luna
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Guilherme Carlos Brech
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alexandra Canonica
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Julia Maria D'Andréa Greve
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Eyigoz E, Courson M, Sedeño L, Rogg K, Orozco-Arroyave JR, Nöth E, Skodda S, Trujillo N, Rodríguez M, Rusz J, Muñoz E, Cardona JF, Herrera E, Hesse E, Ibáñez A, Cecchi G, García AM. From discourse to pathology: Automatic identification of Parkinson's disease patients via morphological measures across three languages. Cortex 2020; 132:191-205. [PMID: 32992069 DOI: 10.1016/j.cortex.2020.08.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 06/02/2020] [Accepted: 08/25/2020] [Indexed: 01/11/2023]
Abstract
Embodied cognition research on Parkinson's disease (PD) points to disruptions of frontostriatal language functions as sensitive targets for clinical assessment. However, no existing approach has been tested for crosslinguistic validity, let alone by combining naturalistic tasks with machine-learning tools. To address these issues, we conducted the first classifier-based examination of morphological processing (a core frontostriatal function) in spontaneous monologues from PD patients across three typologically different languages. The study comprised 330 participants, encompassing speakers of Spanish (61 patients, 57 matched controls), German (88 patients, 88 matched controls), and Czech (20 patients, 16 matched controls). All subjects described the activities they perform during a regular day, and their monologues were automatically coded via morphological tagging, a computerized method that labels each word with a part-of-speech tag (e.g., noun, verb) and specific morphological tags (e.g., person, gender, number, tense). The ensuing data were subjected to machine-learning analyses to assess whether differential morphological patterns could classify between patients and controls and reflect the former's degree of motor impairment. Results showed robust classification rates, with over 80% of patients being discriminated from controls in each language separately. Moreover, the most discriminative morphological features were associated with the patients' motor compromise (as indicated by Pearson r correlations between predicted and collected motor impairment scores that ranged from moderate to moderate-to-strong across languages). Taken together, our results suggest that morphological patterning, an embodied frontostriatal domain, may be distinctively affected in PD across languages and even under ecological testing conditions.
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Affiliation(s)
- Elif Eyigoz
- IBM Research, T. J. Watson Research Center, New York, USA
| | - Melody Courson
- Department of Psychology, Université de Montréal, CRIUGM Research Center, Montréal, Canada
| | - Lucas Sedeño
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Katharina Rogg
- Department of Social Psychology, University of Würzburg, Würzburg, Germany
| | - Juan Rafael Orozco-Arroyave
- Pattern Recognition Lab, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany; GITA Lab, Faculty of Engineering, University of Antioquia (UdeA), Medellín, Colombia
| | - Elmar Nöth
- Pattern Recognition Lab, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
| | - Sabine Skodda
- Department of Neurology, Knappschaftskrankenhaus, Ruhr-University, Bochum, Germany
| | - Natalia Trujillo
- Neuroscience Group, Faculty of Medicine, University of Antioquia (UdeA), Medellín, Colombia; School of Public Health, University of Antioquia (UdeA), Medellín, Colombia
| | - Mabel Rodríguez
- National Institute of Mental Health, Prague, Czech Republic; Department of Psychology, Faculty of Arts, Charles University in Prague, Prague, Czech Republic
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic
| | - Edinson Muñoz
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
| | - Juan F Cardona
- Instituto de Psicología, Universidad del Valle, Cali, Colombia
| | - Eduar Herrera
- Departamento de Estudios Psicológicos, Universidad Icesi, Cali, Colombia
| | - Eugenia Hesse
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Universidad de San Andrés, Buenos Aires, Argentina
| | - Agustín Ibáñez
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Universidad de San Andrés, Buenos Aires, Argentina; Universidad Autónoma del Caribe, Barranquilla, Colombia; Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile; Global Brain Health Institute, University of California, San Francisco, United States
| | | | - Adolfo M García
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile; Universidad de San Andrés, Buenos Aires, Argentina; Global Brain Health Institute, University of California, San Francisco, United States; Faculty of Education, National University of Cuyo (UNCuyo), Mendoza, Argentina.
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5
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Brandmeir NJ, Brandmeir CL, Carr D, Kuzma K, McInerney J. Deep Brain Stimulation for Parkinson Disease Does not Worsen or Improve Postural Instability: A Prospective Cohort Trial. Neurosurgery 2019; 83:1173-1182. [PMID: 29444300 DOI: 10.1093/neuros/nyx602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 11/25/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Falls and postural instability (PI) are major sources of morbidity in Parkinson disease (PD). Deep brain stimulation (DBS) is a major therapy for PD. The effects of DBS on PI and falls remain controversial. OBJECTIVE To study if DBS worsens PI, validated measures of PI (Timed Up and Go, Berg Balance Scale, Unified Parkinson's Disease Rating Scale 3.12 [Pull Test], and the Biodex Sway Index with eyes closed on a firm and soft surface) and reported falls were used to prospectively evaluate the effect of DBS on PI at 3 and 12 mo postoperatively compared to baseline measurements. The primary outcomes were a positive result on 4 out of the 5 PI tests and falls. METHODS Patients presenting for DBS were prospectively enrolled and evaluated at presentation and, 3 and 12 mo postoperatively. All tests were performed at each visit. RESULTS At 3 mo 4 of 5 positive showed noninferiority to baseline, with a rate of 28% vs 41% (relative risk [RR] 0.8 [0.5-1.3]). At 12 mo, 4 of 5 positive had a rate of 35% vs 30% (RR 1.2 [0.8-1.8]) and falls had a rate of 54% vs 46% (RR 1.2 [0.6-2.3]). These did not meet criteria to prove noninferiority. Sensitivity analysis at 12 mo showed noninferiority for 4 of 5 (RR 0.9 [0.6-1.5]) but not falls (RR 1.1 [0.5-2.3]). CONCLUSION This evidence is consistent with the hypothesis that DBS does not worsen PI when measured at 3 and 12 mo postoperatively.
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Affiliation(s)
- Nicholas J Brandmeir
- Blanchette Rockefeller Neuroscience Institute.,West Virginia University Department of Neurosurgery, Morgantown, WV
| | - Cheryl L Brandmeir
- West Virginia University Department of Neurosurgery, Morgantown, WV.,West Virginia University Department of Human Performance, Morgantown, WV
| | - David Carr
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Kristine Kuzma
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - James McInerney
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Heilbronn M, Scholten M, Schlenstedt C, Mancini M, Schöllmann A, Cebi I, Pötter-Nerger M, Gharabaghi A, Weiss D. Anticipatory postural adjustments are modulated by substantia nigra stimulation in people with Parkinson's disease and freezing of gait. Parkinsonism Relat Disord 2019; 66:34-39. [DOI: 10.1016/j.parkreldis.2019.06.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/17/2019] [Accepted: 06/26/2019] [Indexed: 01/17/2023]
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de Lima-Pardini AC, Coelho DB, Souza CP, Souza CO, Ghilardi MGDS, Garcia T, Voos M, Milosevic M, Hamani C, Teixeira LA, Fonoff ET. Effects of spinal cord stimulation on postural control in Parkinson's disease patients with freezing of gait. eLife 2018; 7:37727. [PMID: 30070204 PMCID: PMC6092115 DOI: 10.7554/elife.37727] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/28/2018] [Indexed: 12/12/2022] Open
Abstract
Freezing of gait (FoG) in Parkinson’s disease (PD) is an incapacitating transient phenomenon, followed by continuous postural disorders. Spinal cord stimulation (SCS) is a promising intervention for FoG in patients with PD, however, its effects on distinct domains of postural control is not well known. The aim of this study is to assess the effects of SCS on FoG and distinct domains of postural control. Four patients with FoG were implanted with SCS systems in the upper thoracic spine. Anticipatory postural adjustment (APA), reactive postural responses, gait and FoG were biomechanically assessed. In general, the results showed that SCS improved FoG and APA. However, SCS failed to improve reactive postural responses. SCS seems to influence cortical motor circuits, involving the supplementary motor area. On the other hand, reactive posture control to external perturbation that mainly relies on neuronal circuitries involving the brainstem and spinal cord, is less influenced by SCS.
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Affiliation(s)
| | - Daniel Boari Coelho
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.,Biomedical Engineering, Federal University of ABC, São Paulo, Brazil
| | - Carolina Pinto Souza
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - Tiago Garcia
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Mariana Voos
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Matija Milosevic
- Department of Life Sciences, Graduate School of Arts and Sciences, University of Tokyo, Tokyo, Japan
| | - Clement Hamani
- Division of Neurosurgery, Sunnybrook Research Institute, Harquail Centre for Neuromodulation, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Luis Augusto Teixeira
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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Gallese V, Cuccio V. The neural exploitation hypothesis and its implications for an embodied approach to language and cognition: Insights from the study of action verbs processing and motor disorders in Parkinson's disease. Cortex 2018; 100:215-225. [PMID: 29455947 DOI: 10.1016/j.cortex.2018.01.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 12/31/2017] [Accepted: 01/23/2018] [Indexed: 11/29/2022]
Abstract
As it is widely known, Parkinson's disease is clinically characterized by motor disorders such as the loss of voluntary movement control, including resting tremor, postural instability, and bradykinesia (Bocanegra et al., 2015; Helmich, Hallett, Deuschl, Toni, & Bloem, 2012; Liu et al., 2006; Rosin, Topka, & Dichgans, 1997). In the last years, many empirical studies (e.g., Bocanegra et al., 2015; Spadacenta et al., 2012) have also shown that the processing of action verbs is selectively impaired in patients affected by this neurodegenerative disorder. In the light of these findings, it has been suggested that Parkinson disorder can be interpreted within an embodied cognition framework (e.g., Bocanegra et al., 2015). The central tenet of any embodied approach to language and cognition is that high order cognitive functions are grounded in the sensory-motor system. With regard to this point, Gallese (2008) proposed the neural exploitation hypothesis to account for, at the phylogenetic level, how key aspects of human language are underpinned by brain mechanisms originally evolved for sensory-motor integration. Glenberg and Gallese (2012) also applied the neural exploitation hypothesis to the ontogenetic level. On the basis of these premises, they developed a theory of language acquisition according to which, sensory-motor mechanisms provide a neurofunctional architecture for the acquisition of language, while retaining their original functions as well. The neural exploitation hypothesis is here applied to interpret the profile of patients affected by Parkinson's disease. It is suggested that action semantic impairments directly tap onto motor disorders. Finally, a discussion of what theory of language is needed to account for the interactions between language and movement disorders is presented.
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Affiliation(s)
- Vittorio Gallese
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Italy; Institute of Philosophy, School of Advanced Study, University of London, UK.
| | - Valentina Cuccio
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Italy
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Mancini M, Chiari L, Holmstrom L, Salarian A, Horak FB. Validity and reliability of an IMU-based method to detect APAs prior to gait initiation. Gait Posture 2016; 43:125-31. [PMID: 26433913 PMCID: PMC4758510 DOI: 10.1016/j.gaitpost.2015.08.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 07/23/2015] [Accepted: 08/31/2015] [Indexed: 02/02/2023]
Abstract
Anticipatory postural adjustments (APAs) prior to gait initiation have been largely studied in traditional, laboratory settings using force plates under the feet to characterize the displacement of the center of pressure. However clinical trials and clinical practice would benefit from a portable, inexpensive method for characterizing APAs. Therefore, the main objectives of this study were (1) to develop a novel, automatic IMU-based method to detect and characterize APAs during gait initiation and (2) to measure its test-retest reliability. Experiment I was carried out in the laboratory to determine the validity of the IMU-based method in 10 subjects with PD (OFF medication) and 12 control subjects. Experiment II was carried out in the clinic, to determine test-retest reliability of the IMU-based method in a different set of 17 early-to-moderate, treated subjects with PD (tested ON medication) and 17 age-matched control subjects. Results showed that gait initiation characteristics (both APAs and 1st step) detected with our novel method were significantly correlated to the characteristics calculated with a force plate and motion analysis system. The size of APAs measured with either inertial sensors or force plate was significantly smaller in subjects with PD than in control subjects (p<0.05). Test-retest reliability for the gait initiation characteristics measured with inertial sensors was moderate-to-excellent (0.56<ICC<0.82) for both groups. Our findings support the feasibility of automatically characterizing postural preparation and gait initiation with body-worn inertial sensors that would be practical for unsupervised clinical and home settings.
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Affiliation(s)
- Martina Mancini
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR 97239-3098, USA. Tel: +1 503 418 2602. Fax: +1 503 418 2701
| | - Lorenzo Chiari
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, University of Bologna, Bologna, Italy
| | | | - Arash Salarian
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR 97239-3098, USA. Tel: +1 503 418 2602. Fax: +1 503 418 2701
| | - Fay B. Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR 97239-3098, USA. Tel: +1 503 418 2602. Fax: +1 503 418 2701,APDM Inc, Portland, OR, USA,Department of Research, Portland VA Medical Center, 3710 SW US Veterans Hospital Rd, Portland, OR 97239-9264
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10
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Effects of deep brain stimulation on balance and gait in patients with Parkinson's disease: A systematic neurophysiological review. Neurophysiol Clin 2015; 45:371-88. [DOI: 10.1016/j.neucli.2015.07.001] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 06/23/2015] [Accepted: 07/16/2015] [Indexed: 12/17/2022] Open
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Vieira MF, Sacco IDCN, Nora FGDSA, Rosenbaum D, Lobo da Costa PH. Footwear and Foam Surface Alter Gait Initiation of Typical Subjects. PLoS One 2015; 10:e0135821. [PMID: 26270323 PMCID: PMC4536224 DOI: 10.1371/journal.pone.0135821] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 07/27/2015] [Indexed: 11/18/2022] Open
Abstract
Gait initiation is the task commonly used to investigate the anticipatory postural adjustments necessary to begin a new gait cycle from the standing position. In this study, we analyzed whether and how foot-floor interface characteristics influence the gait initiation process. For this purpose, 25 undergraduate students were evaluated while performing a gait initiation task in three experimental conditions: barefoot on a hard surface (barefoot condition), barefoot on a soft surface (foam condition), and shod on a hard surface (shod condition). Two force plates were used to acquire ground reaction forces and moments for each foot separately. A statistical parametric mapping (SPM) analysis was performed in COP time series. We compared the anterior-posterior (AP) and medial-lateral (ML) resultant center of pressure (COP) paths and average velocities, the force peaks under the right and left foot, and the COP integral x force impulse for three different phases: the anticipatory postural adjustment (APA) phase (Phase 1), the swing-foot unloading phase (Phase 2), and the support-foot unloading phase (Phase 3). In Phase 1, significantly smaller ML COP paths and velocities were found for the shod condition compared to the barefoot and foam conditions. Significantly smaller ML COP paths were also found in Phase 2 for the shod condition compared to the barefoot and foam conditions. In Phase 3, increased AP COP velocities were found for the shod condition compared to the barefoot and foam conditions. SPM analysis revealed significant differences for vector COP time series in the shod condition compared to the barefoot and foam conditions. The foam condition limited the impulse-generating capacity of COP shift and produced smaller ML force peaks, resulting in limitations to body-weight transfer from the swing to the support foot. The results suggest that footwear and a soft surface affect COP and impose certain features of gait initiation, especially in the ML direction of Phase 1.
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Affiliation(s)
- Marcus Fraga Vieira
- Bioengineering and Biomechanics Laboratory, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
- * E-mail:
| | - Isabel de Camargo Neves Sacco
- Physical Therapy, Speech, and Occupational Therapy Department, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | | | - Dieter Rosenbaum
- Institute for Experimental Musculoskeletal Medicine, Movement Analysis Lab, University Hospital, Münster, Germany
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12
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Syntax, action verbs, action semantics, and object semantics in Parkinson's disease: Dissociability, progression, and executive influences. Cortex 2015; 69:237-54. [DOI: 10.1016/j.cortex.2015.05.022] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 03/25/2015] [Accepted: 05/18/2015] [Indexed: 12/14/2022]
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Fasano A, Aquino CC, Krauss JK, Honey CR, Bloem BR. Axial disability and deep brain stimulation in patients with Parkinson disease. NATURE REVIEWS. NEUROLOGY 2015. [PMID: 25582445 DOI: 10.1038/nrneurol.2014.252.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Axial motor signs-including gait impairment, postural instability and postural abnormalities-are common and debilitating symptoms in patients with advanced Parkinson disease. Dopamine replacement therapy and physiotherapy provide, at best, partial relief from axial motor symptoms. In carefully selected candidates, deep brain stimulation (DBS) of the subthalamic nucleus or globus pallidus internus is an established treatment for 'appendicular' motor signs (limb tremor, bradykinesia and rigidity). However, the effects of DBS on axial signs are much less clear, presumably because motor control of axial and appendicular functions is mediated by different anatomical-functional pathways. Here, we discuss the successes and failures of DBS in managing axial motor signs. We systematically address a series of common clinical questions associated with the preoperative phase, during which patients presenting with prominent axial signs are considered for DBS implantation surgery, and the postoperative phase, in particular, the management of axial motor signs that newly develop as postoperative complications, either acutely or with a delay. We also address the possible merits of new targets-including the pedunculopontine nucleus area, zona incerta and substantia nigra pars reticulata-to specifically alleviate axial symptoms. Supported by a rapidly growing body of evidence, this practically oriented Review aims to support decision-making in the management of axial symptoms.
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Affiliation(s)
- Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst Street, 7 Mc412, Toronto, ON M5T 2S8, Canada
| | - Camila C Aquino
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Toronto Western Hospital, UHN, University of Toronto, 399 Bathurst Street, 7 Mc412, Toronto, ON M5T 2S8, Canada
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Christopher R Honey
- Division of Neurosurgery at the University of British Columbia, 8105-2775 Laurel Street, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, PO Box 9101, 6500 HB Nijmegen, Netherlands
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Abstract
Axial motor signs-including gait impairment, postural instability and postural abnormalities-are common and debilitating symptoms in patients with advanced Parkinson disease. Dopamine replacement therapy and physiotherapy provide, at best, partial relief from axial motor symptoms. In carefully selected candidates, deep brain stimulation (DBS) of the subthalamic nucleus or globus pallidus internus is an established treatment for 'appendicular' motor signs (limb tremor, bradykinesia and rigidity). However, the effects of DBS on axial signs are much less clear, presumably because motor control of axial and appendicular functions is mediated by different anatomical-functional pathways. Here, we discuss the successes and failures of DBS in managing axial motor signs. We systematically address a series of common clinical questions associated with the preoperative phase, during which patients presenting with prominent axial signs are considered for DBS implantation surgery, and the postoperative phase, in particular, the management of axial motor signs that newly develop as postoperative complications, either acutely or with a delay. We also address the possible merits of new targets-including the pedunculopontine nucleus area, zona incerta and substantia nigra pars reticulata-to specifically alleviate axial symptoms. Supported by a rapidly growing body of evidence, this practically oriented Review aims to support decision-making in the management of axial symptoms.
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Vallabhajosula S, Haq IU, Hwynn N, Oyama G, Okun M, Tillman MD, Hass CJ. Low-frequency Versus High-frequency Subthalamic Nucleus Deep Brain Stimulation on Postural Control and Gait in Parkinson's Disease: A Quantitative Study. Brain Stimul 2015; 8:64-75. [DOI: 10.1016/j.brs.2014.10.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/13/2014] [Accepted: 10/20/2014] [Indexed: 11/17/2022] Open
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Delval A, Moreau C, Bleuse S, Tard C, Ryckewaert G, Devos D, Defebvre L. Auditory cueing of gait initiation in Parkinson’s disease patients with freezing of gait. Clin Neurophysiol 2014; 125:1675-81. [DOI: 10.1016/j.clinph.2013.12.101] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 11/04/2013] [Accepted: 12/17/2013] [Indexed: 01/05/2023]
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17
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Pötter-Nerger M, Volkmann J. Deep brain stimulation for gait and postural symptoms in Parkinson's disease. Mov Disord 2014; 28:1609-15. [PMID: 24132849 DOI: 10.1002/mds.25677] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 08/16/2013] [Indexed: 11/06/2022] Open
Abstract
In patients with Parkinson's disease, gait and balance difficulties have emerged as some of the main therapeutic concerns. During earlier stages of the disease, the dopamine-responsive aspects of gait disorder can be treated initially with dopaminergic drugs or deep brain stimulation. However, certain temporal aspects of parkinsonian gait disorder remain therapeutically resistant in both the short term and the long term. In this review, we summarize the effects of deep brain stimulation on gait and postural symptoms in the five currently available targets (subthalamic nucleus, globus pallidus, ventralis intermedius thalamic nucleus, pedunculopontine nucleus, and substantia nigra) and describe programming strategies for patients who are mainly disabled by gait problems.
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Cardona JF, Kargieman L, Sinay V, Gershanik O, Gelormini C, Amoruso L, Roca M, Pineda D, Trujillo N, Michon M, García AM, Szenkman D, Bekinschtein T, Manes F, Ibáñez A. How embodied is action language? Neurological evidence from motor diseases. Cognition 2014; 131:311-22. [PMID: 24594627 DOI: 10.1016/j.cognition.2014.02.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 01/15/2014] [Accepted: 02/04/2014] [Indexed: 11/25/2022]
Abstract
Although motor-language coupling is now being extensively studied, its underlying mechanisms are not fully understood. In this sense, a crucial opposition has emerged between the non-representational and the representational views of embodiment. The former posits that action language is grounded on the non-brain motor system directly engaged by musculoskeletal activity - i.e., peripheral involvement of ongoing actions. Conversely, the latter proposes that such grounding is afforded by the brain's motor system - i.e., activation of neural areas representing motor action. We addressed this controversy through the action-sentence compatibility effect (ACE) paradigm, which induces a contextual coupling of motor actions and verbal processing. ACEs were measured in three patient groups - early Parkinson's disease (EPD), neuromyelitis optica (NMO), and acute transverse myelitis (ATM) patients - as well as their respective healthy controls. NMO and ATM constitute models of injury to non-brain motor areas and the peripheral motor system, whereas EPD provides a model of brain motor system impairment. In our study, EPD patients exhibited impaired ACE and verbal processing relative to healthy participants, NMO, and ATM patients. These results indicate that the processing of action-related words is mainly subserved by a cortico-subcortical motor network system, thus supporting a brain-based embodied view on action language. More generally, our findings are consistent with contemporary perspectives for which action/verb processing depends on distributed brain networks supporting context-sensitive motor-language coupling.
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Affiliation(s)
- Juan F Cardona
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; School of Psychology, Catholic University of Pereira (UCP), Risaralda, Colombia
| | - Lucila Kargieman
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Vladimiro Sinay
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina
| | - Oscar Gershanik
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Carlos Gelormini
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Lucia Amoruso
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - María Roca
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina
| | - David Pineda
- Neuroscience Research Programme, University of Antioquia, Medellin, Colombia
| | - Natalia Trujillo
- Neuroscience Research Programme, University of Antioquia, Medellin, Colombia
| | - Maëva Michon
- UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile
| | - Adolfo M García
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Daniela Szenkman
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Tristán Bekinschtein
- Cognition and Brain Sciences Unit, Medical Research Council, Cambridge CB2 7EF, United Kingdom
| | - Facundo Manes
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Australian Research Council (ARC) Centre of Excellence in Cognition and its Disorders, NSW, Australia
| | - Agustín Ibáñez
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile; Universidad Autónoma del Caribe, Barranquilla, Colombia.
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Kenney C, Fernandez HH, Okun MS. Role of deep brain stimulation targeted to the pedunculopontine nucleus in Parkinson’s disease. Expert Rev Neurother 2014; 7:585-9. [PMID: 17563240 DOI: 10.1586/14737175.7.6.585] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
AbstractA growing body of evidence indicates that neurodegenerative motor disorders involved high-order cognitive dysfunctions. Crucially, evidence obtained in multiple behavioral, neuroimaging, and electrophysiological studies points to selective impairments of action language -that is, processing of linguistic stimuli denoting motor actions, including idioms (e.g., cut a rug) and action verbs (e.g., clap). Action-verb deficits (with relative preservation of noun processing) have been repeatedly documented in Parkinson’s disease (PD). However, research on relevant biomarkers is still scant, and clinical implications of these findings have not yet been formally discussed. Relevant insights may be obtained through the assessment of motor-language coupling (i.e., the behavioral and neural integration of action-verb processing and ongoing motor actions). We propose that motorlanguage coupling deficits, as indexed by a cortical-subcortical network, may constitute an early neurocognitive marker of PD. Specifically, deficits in this domain at the prodromal stage may be detected through the actionsentence compatibility (ACE) paradigm, which induces a contextual coupling of ongoing motor actions and action-verb processing. Our translational proposal is supported and illustrated by recent studies demonstrating the sensitivity of the ACE technique as well as its potential to assist in differential diagnosis and interventionprogram design.
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Delval A, Tard C, Defebvre L. Why we should study gait initiation in Parkinson's disease. Neurophysiol Clin 2013; 44:69-76. [PMID: 24502907 DOI: 10.1016/j.neucli.2013.10.127] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 10/14/2013] [Accepted: 10/14/2013] [Indexed: 11/28/2022] Open
Abstract
The gait initiation process is of particular interest in Parkinson's disease because it combines motor and cognitive components of movement preparation (referred to as anticipatory postural adjustments) and movement execution (the step by itself). Moreover, gait initiation in Parkinson's disease is often affected by motor blocks (a subtype of the "freezing of gait" phenomenon). Gait initiation disturbances in Parkinson's disease include delayed release of anticipatory postural adjustments, hypokinetic anticipatory postural adjustments (reduced scaling) and bradykinetic anticipatory postural adjustments (abnormal timing). The most extreme form is freezing of gait with sometimes the absence of anticipatory postural adjustments. Other phenomena can be also described in some freezing patients (such as multiple anticipatory postural adjustments, described clinically as "knee trembling"). The fact that emotion, attention, external triggers and dopaminergic drugs can all modify this motor program suggests the existence of a complex pathophysiological mechanism that involves not only locomotor networks but also cortical areas and the basal ganglia system. Abnormal coupling between standing posture and anticipatory postural adjustments and between the latter and step execution appears to be a crucial part of the pathophysiological mechanism. Although external cueing appears to be of interest, few studies have provided evidence of the efficacy of various rehabilitation methods in routine care.
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Affiliation(s)
- A Delval
- Université Lille Nord de France, UDSL, Lille, France; Laboratoire de Neurosciences Fonctionnelles et Pathologies, EA 4559, Lille 2, Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, Lille, France.
| | - C Tard
- Université Lille Nord de France, UDSL, Lille, France; Laboratoire de Neurosciences Fonctionnelles et Pathologies, EA 4559, Lille 2, Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, Lille, France
| | - L Defebvre
- Université Lille Nord de France, UDSL, Lille, France; Laboratoire de Neurosciences Fonctionnelles et Pathologies, EA 4559, Lille 2, Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, Lille, France
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Zitella LM, Mohsenian K, Pahwa M, Gloeckner C, Johnson MD. Computational modeling of pedunculopontine nucleus deep brain stimulation. J Neural Eng 2013; 10:045005. [PMID: 23723145 DOI: 10.1088/1741-2560/10/4/045005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) near the pedunculopontine nucleus (PPN) has been posited to improve medication-intractable gait and balance problems in patients with Parkinson's disease. However, clinical studies evaluating this DBS target have not demonstrated consistent therapeutic effects, with several studies reporting the emergence of paresthesia and oculomotor side effects. The spatial and pathway-specific extent to which brainstem regions are modulated during PPN-DBS is not well understood. APPROACH Here, we describe two computational models that estimate the direct effects of DBS in the PPN region for human and translational non-human primate (NHP) studies. The three-dimensional models were constructed from segmented histological images from each species, multi-compartment neuron models and inhomogeneous finite element models of the voltage distribution in the brainstem during DBS. MAIN RESULTS The computational models predicted that: (1) the majority of PPN neurons are activated with -3 V monopolar cathodic stimulation; (2) surgical targeting errors of as little as 1 mm in both species decrement activation selectivity; (3) specifically, monopolar stimulation in caudal, medial, or anterior PPN activates a significant proportion of the superior cerebellar peduncle (up to 60% in the human model and 90% in the NHP model at -3 V); (4) monopolar stimulation in rostral, lateral or anterior PPN activates a large percentage of medial lemniscus fibers (up to 33% in the human model and 40% in the NHP model at -3 V) and (5) the current clinical cylindrical electrode design is suboptimal for isolating the modulatory effects to PPN neurons. SIGNIFICANCE We show that a DBS lead design with radially-segmented electrodes may yield improved functional outcome for PPN-DBS.
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Affiliation(s)
- Laura M Zitella
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
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Seri-Fainshtat E, Israel Z, Weiss A, Hausdorff JM. Impact of sub-thalamic nucleus deep brain stimulation on dual tasking gait in Parkinson's disease. J Neuroeng Rehabil 2013; 10:38. [PMID: 23587168 PMCID: PMC3637536 DOI: 10.1186/1743-0003-10-38] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 04/10/2013] [Indexed: 11/25/2022] Open
Abstract
Background The beneficial effects of bilateral sub-thalamic nucleus deep brain stimulation on motor function and gait in advanced Parkinson’s disease are established. Less is known about the effect of stimulation on cognitive function and the capacity to walk while dual tasking, an ability that has been related to fall risk. Everyday walking takes place in complex environments that often require multi-tasking. Hence, dual tasking gait performance reflects everyday ambulation as well as gait automaticity. The purpose of this study was to examine the impact of sub-thalamic nucleus deep brain stimulation on dual task walking in patients with advanced Parkinson’s disease. Methods Gait was assessed using a performance-based test and by quantifying single-task and dual task walking conditions in 28 patients with advanced Parkinson’s disease. These tests were conducted in 4 conditions: “OFF” medication, with the stimulator turned on and off, and “ON” medication, with the stimulator turned on and off. A previously validated, computerized neuro-psychological battery assessed executive function, attention and memory “OFF” and “ON” deep brain stimulation, after subjects took their anti-Parkinsonian medications. Results Stimulation improved motor function and the spatiotemporal parameters of gait (e.g., gait speed) during both single-task and dual task walking conditions. Attention improved, but executive function did not. The dual task effect on gait did not change in response to stimulation. For example, during serial 3 subtractions, gait speed was reduced by -0.20 ± 0.14 m/sec while OFF DBS and OFF meds and by -0.22 ± 0.14 m/sec when the DBS was turned on (p = 0.648). Similarly, ON medication, serial 3 subtractions reduced gait speed by -0.20 ± 0.16 m/sec OFF DBS and by -0.22 ± 0.09 m/sec ON DBS (p = 0.543). Conclusions Bilateral sub-thalamic nucleus deep brain stimulation improves motor symptoms, certain features of gait and even some aspects of cognitive function. However, stimulation apparently fails to reduce the negative impact of a dual task on walking abilities. These findings provide new insight into the effects of deep brain stimulation on gait during cognitively challenging conditions and everyday walking.
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Sander K, Rosenbaum D, Böhm H, Layher F, Lindner T, Wegener R, Wolf SI, Seehaus F. [Instrumented gait and movement analysis of musculoskeletal diseases]. DER ORTHOPADE 2013; 41:802-19. [PMID: 23052847 DOI: 10.1007/s00132-012-1947-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Instrumented 3-dimensional gait analysis is increasingly being used for the evaluation of movement disorders in orthopedic and neurological musculoskeletal diseases. Due to the high reliability of the measurements the procedures are appropriate for diagnostic purposes as well as for outcome assessment after conservative or surgical interventions. Contrary to conventional clinical assessments gait analysis parameters are able to demonstrate a normal physiological gait pattern that can be achieved with improved kinematic and kinetic parameters. For a suitable application in clinically relevant problems the limitations of the procedures should be taken into account. Due to the high instrumental involvement combined with time and cost expenditure instrumented gait analysis will probably not develop to a clinical routine procedure. Nevertheless, an excellent set of information for answering clinical questions is provided. The present contribution presents selected measurement procedures and technologies and illustrates the wide variety of possibilities with the use of selected clinical examples.
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Affiliation(s)
- K Sander
- Abt. Biomechanik, Lehrstuhl für Orthopädie des Universitätsklinikums Jena, Waldkrankenhaus Rudolf Elle GmbH, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland.
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25
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Action-verb processing in Parkinson’s disease: new pathways for motor–language coupling. Brain Struct Funct 2013; 218:1355-73. [DOI: 10.1007/s00429-013-0510-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
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26
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Rocchi L, Carlson-Kuhta P, Chiari L, Burchiel KJ, Hogarth P, Horak FB. Effects of deep brain stimulation in the subthalamic nucleus or globus pallidus internus on step initiation in Parkinson disease: laboratory investigation. J Neurosurg 2012; 117:1141-9. [PMID: 23039143 DOI: 10.3171/2012.8.jns112006] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Difficulty with step initiation, called "start hesitation," is related to gait bradykinesia and is an early hallmark of gait freezing in Parkinson disease (PD). Authors of this study investigated the effects of deep brain stimulation (DBS) and levodopa on step initiation before and 6 months after DBS surgery in 29 patients with PD who were randomized to either the bilateral subthalamic nucleus (STN) or globus pallidus internus (GPi) as the DBS site. METHODS The authors measured the amplitude and duration of anticipatory postural adjustments (APAs), the feed-forward postural preparation that precedes the onset of voluntary step initiation, based on center-of-pressure displacements on a force plate. They also measured the length and velocity of the first step using a motion analysis system to study kinematics. Some of the patients (22) were from a large, multicenter, double-blind clinical trial, and all patients in the study (29, PD-DBS group) were randomized to DBS in either the bilateral STN (15 patients) or bilateral GPi (14 patients). Differences in step initiation were investigated in 2 conditions before surgery (off/on levodopa) and in 4 conditions after surgery (off/on levodopa combined with off/on DBS). Twenty-eight elderly healthy control volunteers (CTRL group) were also tested, and 9 control volunteers with PD who met the criteria for DBS (PD-C group) were tested at baseline and 6 months later. RESULTS Patients in the PD-DBS group had smaller amplitudes and longer durations of APAs compared with those in the 28 healthy control volunteers in all conditions. Before surgery, APAs improved with levodopa. After surgery, the APAs were significantly worse than in the best-treatment state before surgery (DOPA condition), and responsiveness to levodopa decreased. No differences in APAs were detected between the STN and GPi groups. A comparison with PD control volunteers who did not undergo DBS surgery confirmed that a deterioration in step preparation was not related to disease progression. Step length and velocity were smaller in the PD-DBS group than in controls in all conditions. Before surgery, levodopa improved the length and velocity of the first step. Both step length and velocity were unchanged in the best-treatment state before surgery (DOPA condition) as compared with after surgery (DBS+DOPA), with only step velocity in the STN group getting worse after surgery. CONCLUSIONS Six months of DBS in the STN or GPi impaired anticipatory postural preparation for step initiation, the opposite effect as with levodopa. Deep brain stimulation disrupted postural preparation more than step execution, suggesting independent motor pathways for preparation and execution of gait. Although turning the stimulators on after surgery combined with levodopa benefited the postural preparation to step, a comparison of pre- and postsurgery conditions suggests that either the surgery itself or 6 months of continuous stimulation may lead to an alteration of circuits or plastic changes that impair step initiation.
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Affiliation(s)
- Laura Rocchi
- Department of Electronics, Computer Science & Systems, University of Bologna, Bologna, Italy.
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Emotional state affects gait initiation in individuals with Parkinson's disease. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2012; 12:207-19. [PMID: 22194236 DOI: 10.3758/s13415-011-0071-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of the present study was to determine the impact of manipulating emotional state on gait initiation in persons with Parkinson's disease (PD) and healthy older adults. Following the presentation of pictures that are known to elicit specific emotional responses, participants initiated gait and continued to walk for several steps at their normal pace. Reaction time, the displacement and velocity of the center of pressure (COP) trajectory during the preparatory postural adjustments, and length and velocity of the first two steps were measured. Analysis of the gait initiation measures revealed that exposure to (1) threatening pictures, relative to all other pictures, speeded the initiation of gait for PD patients and healthy older adults; (2) approach-oriented emotional pictures (erotic and happy people), relative to withdrawal-oriented pictures, facilitated the anticipatory postural adjustments of gait initiation for PD patients and healthy older adults, as evidenced by greater displacement and velocity of the COP movement; and (3) emotional pictures modulated gait initiation parameters in PD patients to the same degree as in healthy older adults. Collectively, these findings hold significant implications for understanding the circuitry underlying the manner by which emotions modulate movement and for the development of emotion-based interventions designed to maximize improvements in gait initiation for individuals with PD.
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Hass CJ, Buckley TA, Pitsikoulis C, Barthelemy EJ. Progressive resistance training improves gait initiation in individuals with Parkinson's disease. Gait Posture 2012; 35:669-73. [PMID: 22266107 DOI: 10.1016/j.gaitpost.2011.12.022] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 12/19/2011] [Accepted: 12/21/2011] [Indexed: 02/02/2023]
Abstract
An impaired ability to initiate walking is a common feature of postural instability and gait impairment in Parkinson's disease. While progressive resistance training (PRT) has been proposed to be an effective modality to improve balance and gait function in people with Parkinson's disease, there are a limited number of randomized trials and no studies have evaluated gait initiation performance. Thus, the purpose of this study was to examine the potential benefits PRT on GI performance in people with Parkinson's disease. Eighteen individuals with idiopathic PD were randomly assigned to either a twice weekly PRT program or a non-contact control group for 10 weeks. Biomechanical analysis of GI was performed pre- and post-intervention. Dependent variables of interest included the displacement of the center-of-pressure (COP) during the anticipatory postural phase of GI as well as the initial stride length and velocity. The PRT group demonstrated improvements in the posterior displacement of the COP and the initial stride length and velocity. There were no improvements in any variables for the control subjects. These results suggest that PRT may be an effective non-pharmacological and nonsurgical treatment to improve GI performance in PWP.
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Affiliation(s)
- Chris J Hass
- Department of Applied Physiology and Kinesiology and Movement Disorders Center, University of Florida, Gainesville, FL 32611, United States.
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Ibáñez A, Cardona JF, Dos Santos YV, Blenkmann A, Aravena P, Roca M, Hurtado E, Nerguizian M, Amoruso L, Gómez-Arévalo G, Chade A, Dubrovsky A, Gershanik O, Kochen S, Glenberg A, Manes F, Bekinschtein T. Motor-language coupling: direct evidence from early Parkinson's disease and intracranial cortical recordings. Cortex 2012; 49:968-84. [PMID: 22482695 DOI: 10.1016/j.cortex.2012.02.014] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 02/28/2012] [Accepted: 02/28/2012] [Indexed: 11/24/2022]
Abstract
Language and action systems are functionally coupled in the brain as demonstrated by converging evidence using Functional magnetic resonance imaging (fMRI), electroencephalography (EEG), transcranial magnetic stimulation (TMS), and lesion studies. In particular, this coupling has been demonstrated using the action-sentence compatibility effect (ACE) in which motor activity and language interact. The ACE task requires participants to listen to sentences that described actions typically performed with an open hand (e.g., clapping), a closed hand (e.g., hammering), or without any hand action (neutral); and to press a large button with either an open hand position or closed hand position immediately upon comprehending each sentence. The ACE is defined as a longer reaction time (RT) in the action-sentence incompatible conditions than in the compatible conditions. Here we investigated direct motor-language coupling in two novel and uniquely informative ways. First, we measured the behavioural ACE in patients with motor impairment (early Parkinson's disease - EPD), and second, in epileptic patients with direct electrocorticography (ECoG) recordings. In experiment 1, EPD participants with preserved general cognitive repertoire, showed a much diminished ACE relative to non-EPD volunteers. Moreover, a correlation between ACE performance and action-verb processing (kissing and dancing test - KDT) was observed. Direct cortical recordings (ECoG) in motor and language areas (experiment 2) demonstrated simultaneous bidirectional effects: motor preparation affected language processing (N400 at left inferior frontal gyrus and middle/superior temporal gyrus), and language processing affected activity in movement-related areas (motor potential at premotor and M1). Our findings show that the ACE paradigm requires ongoing integration of preserved motor and language coupling (abolished in EPD) and engages motor-temporal cortices in a bidirectional way. In addition, both experiments suggest the presence of a motor-language network which is not restricted to somatotopically defined brain areas. These results open new pathways in the fields of motor diseases, theoretical approaches to language understanding, and models of action-perception coupling.
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Affiliation(s)
- Agustín Ibáñez
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO); Favaloro University, Buenos Aires, Argentina.
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Muniz AMS, Nadal J, Lyons KE, Pahwa R, Liu W. Long-term evaluation of gait initiation in six Parkinson's disease patients with bilateral subthalamic stimulation. Gait Posture 2012; 35:452-7. [PMID: 22154114 DOI: 10.1016/j.gaitpost.2011.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 09/09/2011] [Accepted: 11/03/2011] [Indexed: 02/02/2023]
Abstract
Defined as the transient state between standing and walking, gait initiation is negatively affected in Parkinson's disease (PD), which often results in significant disability. Although deep brain stimulation (DBS) is the most common surgical procedure for PD, the long-term effects of DBS on gait initiation are not well studied. The present study evaluated the long-term effects of subthalamic nucleus (STN) DBS on the preparation phase of gait initiation using principal component (PC) analysis. Six patients with PD who had undergone STN DBS and 24 healthy control subjects were evaluated. PD subjects were assessed 11.3±10.3 (P1) and 78.9±10.6 (P2) months after surgery. PD subjects were tested with STN DBS in two conditions: without medication and with medication. PC analysis was applied separately for the vertical, anterior-posterior and medial-lateral components of ground reaction force (GRF) recorded during gait initiation. Three PC scores were chosen by the scree test for each GRF component and all these PC scores were used for calculating a standard distance between healthy controls and PD subjects. The Friedman test showed a significant difference in standard distance among conditions (P=0.004), with the post-hoc test recognizing differences among P1 conditions and P2 medication-on condition. The eigenvector loading factors pointed to major differences between PD conditions surrounding the maximum amplitude of vertical and anterior-posterior GRF. For the studied sample, all distances increased in the follow-up evaluation (P2) with and without medications, indicating a worsening in gait initiation after seven years.
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Affiliation(s)
- A M S Muniz
- Department of Post-graduation, Physical Education Collage of Brazilian Army, Rio de Janeiro, RJ, Brazil.
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Bleuse S, Delval A, Blatt J, Derambure P, Destée A, Defebvre L. Effect of bilateral subthalamic nucleus deep brain stimulation on postural adjustments during arm movement. Clin Neurophysiol 2011; 122:2032-5. [DOI: 10.1016/j.clinph.2011.02.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 02/21/2011] [Accepted: 02/24/2011] [Indexed: 12/01/2022]
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Stins JF, Beek PJ. Organization of voluntary stepping in response to emotion-inducing pictures. Gait Posture 2011; 34:164-8. [PMID: 21549605 DOI: 10.1016/j.gaitpost.2011.04.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 01/28/2011] [Accepted: 04/05/2011] [Indexed: 02/02/2023]
Abstract
The present experiment was conducted to examine the expectation that emotion stimuli influence the initiation and execution of voluntary stepping, a highly coordinated activity involving a sequence of medio-lateral and anterio-posterior weight shifts. Thirty participants made forward (approach) or backward (avoidance) steps on a forceplate in response to the valence of visual stimuli. Posturographic parameters of the steps, related to automatic stimulus evaluation, step initiation and step execution, were determined and analyzed as a function of stimulus valence and stimulus-response mapping. The results revealed marked effects of emotion on the step parameters of interest; unpleasant images caused an initial "freezing" response, and a tendency to move away from the stimuli. Pleasant stimuli, in contrast, were not found to induce approach tendencies. The results demonstrated that affect, especially negative emotions, and whole-body movements such as voluntary stepping are coupled.
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Affiliation(s)
- J F Stins
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands.
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Muniz AS, Liu W, Liu H, Lyons KE, Pahwa R, Nadal J. Gait initiation evaluation after deep brain stimulation for Parkinson's disease: A 7-year follow-up. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:3650-3. [PMID: 21096853 DOI: 10.1109/iembs.2010.5627419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study evaluated the long-term effects of deep brain stimulation of the subthalamic nucleus (DBS-STN) on gait initiation. Six Parkinson's disease (PD) patients who had undergone DBS-STN and 31 control subjects were evaluated. PD subjects were assessed at two different time periods: 11.3 ± 10.3 (P1) and 78.9 ± 10.6 (P2) months after surgery. Subjects under stimulation were tested in two conditions: without medication and with medication. Principal components (PC) analysis was separately applied on vertical, anterior-posterior and medial-lateral ground reaction force (GRF) from gait initiation, during the anticipatory postural adjustment (APA) phase. Three PC scores were chosen by the scree test for each GRF component. The higher loading factors pointed to major differences between controls and PD patients on maximum APA amplitude for vertical and anterior-posterior GRF. Friedman test showed a significant difference in standard distance among conditions (P = 0.006), with the post-hoc test recognizing differences only between P1 and P2 in the medication-on condition. All distances increased in the follow-up evaluation (P2), when considering the same medication condition, indicating a worsening in gait initiation after 7 years of follow-up.
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Affiliation(s)
- A S Muniz
- Department of Post-graduation, Physical Education Collage of Brazilian Army, Rio de Janeiro, BRAZIL.
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Peppe A, Pierantozzi M, Chiavalon C, Marchetti F, Caltagirone C, Musicco M, Stanzione P, Stefani A. Deep brain stimulation of the pedunculopontine tegmentum and subthalamic nucleus: effects on gait in Parkinson's disease. Gait Posture 2010; 32:512-8. [PMID: 20727761 DOI: 10.1016/j.gaitpost.2010.07.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 07/14/2010] [Accepted: 07/16/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study examines the effects of subthalamic nucleus (STN) deep brain stimulation (DBS) and pedunculopontine tegmentum (PPTg) DBS in advanced Parkinson's disease using gait analysis. METHODS Five people underwent bilateral DBS in both the STN and PPTg. Gait analysis was performed one year after neurosurgery using an optoelectronic system. The effects of DBS (STN, PPTg and STN+PPTg) were studied in two clinical conditions: without (Off) and during (On) antiparkinsonian therapy. RESULTS PPTg and STN DBS were associated with changes in spatio-temporal and kinematics variables. CONCLUSIONS Although experimental data cannot be generalized widely due to the small sample, PPTg DBS appears to affect the neuronal circuits subserving gait.
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Affiliation(s)
- A Peppe
- IRCCS, Santa Lucia Foundation, Via Ardeatina 309, 00179 Rome, Italy.
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Hausdorff JM, Gruendlinger L, Scollins L, O'Herron S, Tarsy D. Deep brain stimulation effects on gait variability in Parkinson's disease. Mov Disord 2009; 24:1688-92. [DOI: 10.1002/mds.22554] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Booth JR, Wood L, Lu D, Houk JC, Bitan T. The role of the basal ganglia and cerebellum in language processing. Brain Res 2006; 1133:136-44. [PMID: 17189619 PMCID: PMC2424405 DOI: 10.1016/j.brainres.2006.11.074] [Citation(s) in RCA: 218] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 11/14/2006] [Accepted: 11/18/2006] [Indexed: 11/24/2022]
Abstract
The roles of the cerebellum and basal ganglia have typically been confined in the literature to motor planning and control. However, mounting evidence suggests that these structures are involved in more cognitive domains such as language processing. In the current study, we looked at effective connectivity (the influence that one brain region has on another) of the cerebellum and basal ganglia with regions thought to be involved in phonological processing, i.e. left inferior frontal gyrus and left lateral temporal cortex. We analyzed functional magnetic resonance imaging data (fMRI) obtained during a rhyming judgment task in adults using dynamic causal modeling (DCM). The results showed that the cerebellum has reciprocal connections with both left inferior frontal gyrus and left lateral temporal cortex, whereas the putamen has unidirectional connections into these two brain regions. Furthermore, the connections between cerebellum and these phonological processing areas were stronger than the connections between putamen and these areas. This pattern of results suggests that the putamen and cerebellum may have distinct roles in language processing. Based on research in the motor planning and control literature, we argue that the putamen engages in cortical initiation while the cerebellum amplifies and refines this signal to facilitate correct decision making.
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Affiliation(s)
- James R Booth
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA.
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