1
|
Faria MH, Simieli L, Rietdyk S, Penedo T, Santinelli FB, Barbieri FA. (A)symmetry during gait initiation in people with Parkinson's disease: A motor and cortical activity exploratory study. Front Aging Neurosci 2023; 15:1142540. [PMID: 37139089 PMCID: PMC10150081 DOI: 10.3389/fnagi.2023.1142540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Background Gait asymmetry and deficits in gait initiation (GI) are among the most disabling symptoms in people with Parkinson's disease (PwPD). Understanding if PwPD with reduced asymmetry during GI have higher asymmetry in cortical activity may provide support for an adaptive mechanism to improve GI, particularly in the presence of an obstacle. Objective This study quantified the asymmetry of anticipatory postural adjustments (APAs), stepping parameters and cortical activity during GI, and tested if the presence of an obstacle regulates asymmetry in PwPD. Methods Sixteen PwPD and 16 control group (CG) performed 20-trials in two conditions: unobstructed and obstructed GI with right and left limbs. We measured, through symmetry index, (i) motor parameters: APAs and stepping, and (ii) cortical activity: the PSD of the frontal, sensorimotor and occipital areas during APA, STEP-I (moment of heel-off of the leading foot in the GI until the heel contact of the same foot); and STEP-II (moment of the heel-off of the trailing foot in the GI until the heel contact of the same foot) phases. Results Parkinson's disease showed higher asymmetry in cortical activity during APA, STEP-I and STEP-II phases and step velocity (STEP-II phase) during unobstructed GI than CG. However, unexpectedly, PwPD reduced the level of asymmetry of anterior-posterior displacement (p < 0.01) and medial-lateral velocity (p < 0.05) of the APAs. Also, when an obstacle was in place, PwPD showed higher APAs asymmetry (medial-lateral velocity: p < 0.002), with reduced and increased asymmetry of the cortical activity during APA and STEP-I phases, respectively. Conclusion Parkinson's disease were not motor asymmetric during GI, indicating that higher cortical activity asymmetry can be interpreted as an adaptive behavior to reduce motor asymmetry. In addition, the presence of obstacle did not regulate motor asymmetry during GI in PwPD.
Collapse
Affiliation(s)
- Murilo Henrique Faria
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
| | - Lucas Simieli
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
| | - Shirley Rietdyk
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Tiago Penedo
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
| | - Felipe Balistieri Santinelli
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Fabio Augusto Barbieri
- Human Movement Research Laboratory (MOVI-LAB), School of Sciences, Department of Physical Education, São Paulo State University (Unesp), Bauru, São Paulo, Brazil
- *Correspondence: Fabio Augusto Barbieri,
| |
Collapse
|
2
|
da Conceição NR, de Souza CR, Júlia ÁDO, de Lima-Pardini AC, Silva-Batista C, Teixeira LA, Coelho DB. Between-leg asymmetry in automatic postural responses to stance perturbations in people with Parkinson's disease. Gait Posture 2022; 97:40-42. [PMID: 35872481 DOI: 10.1016/j.gaitpost.2022.07.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND People with Parkinson's disease (PwPD) showed impairments of balance control which can be aggravated by the presence of higher interlateral postural asymmetry caused by a distinct dopaminergic loss in the substantia nigra between cerebral hemispheres. RESEARCH QUESTION We evaluate asymmetries between the more and the less affected leg in PwPD in responses to unanticipated stance perturbations. METHODS Sixteen 16 PwPD participated in the experiment that consisted of recovering a stable upright stance, keeping the feet in place, in response to a perturbation caused by a sudden release of a load equivalent to 7 % of the participant's body mass. Anterior displacement and velocity of the center of pressure (CoP), the latency of gastrocnemius medialis muscle (GM) activation onset, rate of GM activation, and normalized magnitude of muscular activation were analyzed. RESULTS Analysis revealed significantly rate (p = 0.04) and magnitude (p = 0.02) higher activation of GM in the less affected limb. No significant effects of the leg were found for GM activation latency or CoP-related variables. SIGNIFICANCE There is a higher contribution of the less affected leg in automatic postural responses in PwPD.
Collapse
Affiliation(s)
- Núbia Ribeiro da Conceição
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Caroline Ribeiro de Souza
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Ávila de Oliveira Júlia
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | - Carla Silva-Batista
- Exercise Neuroscience Research Group, School of Arts, Sciences, and Humanities, University of São Paulo, São Paulo, Brazil
| | - Luis Augusto Teixeira
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - 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 Bernardo do Campo, São Paulo, Brazil.
| |
Collapse
|
3
|
Engel D, Student J, Schwenk JCB, Morris AP, Waldthaler J, Timmermann L, Bremmer F. Visual perturbation of balance suggests impaired motor control but intact visuomotor processing in Parkinson's disease. J Neurophysiol 2021; 126:1076-1089. [PMID: 34469704 DOI: 10.1152/jn.00183.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Postural instability marks one of the most disabling features of Parkinson's disease (PD), but it only reveals itself after affected brain areas have already been significantly damaged. Thus there is a need to detect deviations in balance and postural control before visible symptoms occur. In this study, we visually perturbed balance in the anterior-posterior direction using sinusoidal oscillations of a moving room in virtual reality at different frequencies. We tested three groups: individuals with PD under dopaminergic medication, an age-matched control group, and a group of young healthy adults. We tracked their center of pressure and their full-body motion, from which we also extracted the center of mass. We investigated sway amplitudes and applied newly introduced phase-locking analyses to investigate responses across participants' bodies. Patients exhibited significantly higher sway amplitudes as compared with the control subjects. However, their sway was phase locked to the visual motion like that of age-matched and young healthy adults. Furthermore, all groups successfully compensated for the visual perturbation by phase locking their sway to the stimulus. As frequency of the perturbation increased, distribution of phase locking (PL) across the body revealed a shift of the highest PL values from the upper body toward the hip region for young healthy adults, which could not be observed in patients and elderly healthy adults. Our findings suggest an impaired motor control, but intact visuomotor processing in early stages of PD, while less flexibility to adapt postural strategy to different perturbations revealed to be an effect of age rather than disease.NEW & NOTEWORTHY A better understanding of visuomotor control in Parkinson's disease (PD) potentially serves as a tool for earlier diagnosis, which is crucial for improving patient's quality of life. In our study, we assess body sway responses to visual perturbations of the balance control system in patients with early-to-mid stage PD, using motion tracking along with recently established phase-locking techniques. Our findings suggest patients at this stage have an impaired muscular stability but intact visuomotor control.
Collapse
Affiliation(s)
- David Engel
- Department of Neurophysics, Philipps-Universität Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior (CMBB), Philipps-Universität Marburg and Justus-Liebig-Universität Giessen, Germany
| | - Justus Student
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Jakob C B Schwenk
- Department of Neurophysics, Philipps-Universität Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior (CMBB), Philipps-Universität Marburg and Justus-Liebig-Universität Giessen, Germany
| | - Adam P Morris
- Neuroscience Program, Biomedicine Discovery Institute, Department of Physiology, Monash University, Clayton, Victoria, Australia.,Data Science and Artificial Intellegience Platform, Monash eResearch Centre, Monash University, Clayton, Victoria, Australia
| | - Josefine Waldthaler
- Center for Mind, Brain and Behavior (CMBB), Philipps-Universität Marburg and Justus-Liebig-Universität Giessen, Germany.,Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Lars Timmermann
- Center for Mind, Brain and Behavior (CMBB), Philipps-Universität Marburg and Justus-Liebig-Universität Giessen, Germany.,Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Frank Bremmer
- Department of Neurophysics, Philipps-Universität Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior (CMBB), Philipps-Universität Marburg and Justus-Liebig-Universität Giessen, Germany
| |
Collapse
|
4
|
Moretto GF, Santinelli FB, Penedo T, Mochizuki L, Rinaldi NM, Barbieri FA. Prolonged Standing Task Affects Adaptability of Postural Control in People With Parkinson's Disease. Neurorehabil Neural Repair 2020; 35:58-67. [PMID: 33241729 DOI: 10.1177/1545968320971739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies on short-term upright quiet standing tasks have presented contradictory findings about postural control in people with Parkinson's disease (pwPD). Prolonged trial durations might better depict body sway and discriminate pwPD and controls. OBJECTIVE The aim of this study was to investigate postural control in pwPD during a prolonged standing task. METHODS A total of 26 pwPD and 25 neurologically healthy individuals performed 3 quiet standing trials (60 s) before completing a constrained prolonged standing task for 15 minutes. Motion capture was used to record body sway (Vicon, 100 Hz). To investigate the body sway behavior during the 15 minutes of standing, the analysis was divided into three 5-minute-long phases: early, middle, and late. The following body sway parameters were calculated for the anterior-posterior (AP) and medial-lateral (ML) directions: velocity, root-mean-square, and detrended fluctuations analysis (DFA). The body sway area was also calculated. Two-way ANOVAs (group and phases) and 1-way ANOVA (group) were used to compare these parameters for the prolonged standing and quiet standing, respectively. RESULTS pwPD presented smaller sway area (P < .001), less complexity (DFA; AP: P < .009; ML: P < .01), and faster velocity (AP: P < .002; ML: P < .001) of body sway compared with the control group during the prolonged standing task. Although the groups swayed similarly (no difference for sway area) during quiet standing, they presented differences in sway area during the prolonged standing task (P < .001). CONCLUSIONS Prolonged standing task reduced adaptability of the postural control system in pwPD. In addition, the prolonged standing task may better analyze the adaptability of the postural control system in pwPD.
Collapse
Affiliation(s)
| | | | - Tiago Penedo
- São Paulo State University (UNESP), Bauru, Brazil
| | | | | | | |
Collapse
|
5
|
Park H, Youm C, Lee M, Noh B, Cheon SM. Turning Characteristics of the More-Affected Side in Parkinson's Disease Patients with Freezing of Gait. SENSORS 2020; 20:s20113098. [PMID: 32486303 PMCID: PMC7309092 DOI: 10.3390/s20113098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/16/2022]
Abstract
This study investigated the turning characteristics of the more-affected limbs in Parkinson's disease (PD) patients in comparison with that of a control group, and in PD patients with freezing of gait (FOG; freezers) in comparison with those without FOG (non-freezers) for 360° and 540° turning tasks at the maximum speed. A total of 12 freezers, 12 non-freezers, and 12 controls participated in this study. The PD patients showed significantly longer total durations, shorter inner and outer step lengths, and greater anterior-posterior (AP) root mean square (RMS) center of mass (COM) distances compared to those for the controls. The freezers showed significantly greater AP and medial-lateral (ML) RMS COM distances compared to those of non-freezers. The turning task toward the inner step of the more-affected side (IMA) in PD patients showed significantly greater step width, total steps, and AP and ML RMS COM distances than that toward the outer step of the more-affected side (OMA). The corresponding results for freezers revealed significantly higher total steps and shorter inner step length during the 540° turn toward the IMA than that toward the OMA. Therefore, PD patients and freezers exhibited greater turning difficulty in performing challenging turning tasks such as turning with an increased angle and speed and toward the more-affected side.
Collapse
Affiliation(s)
- Hwayoung Park
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Busan 49315, Korea; (H.P.); (M.L.)
| | - Changhong Youm
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Busan 49315, Korea; (H.P.); (M.L.)
- Department of Healthcare and Science, College of Health Sciences, Dong-A University, Busan 49315, Korea;
- Correspondence: ; Tel.: +82-51-200-7830; Fax: +82-51-200-7505
| | - Myeounggon Lee
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Busan 49315, Korea; (H.P.); (M.L.)
| | - Byungjoo Noh
- Department of Healthcare and Science, College of Health Sciences, Dong-A University, Busan 49315, Korea;
| | - Sang-Myung Cheon
- Department of Neurology, School of Medicine, Dong-A University, Dongdaesin-dong 3-ga, Seo-gu, Busan 49315, Korea;
| |
Collapse
|
6
|
Kuhner A, Wiesmeier IK, Cenciarini M, Maier TL, Kammermeier S, Coenen VA, Burgard W, Maurer C. Motion Biomarkers Showing Maximum Contrast Between Healthy Subjects and Parkinson's Disease Patients Treated With Deep Brain Stimulation of the Subthalamic Nucleus. A Pilot Study. Front Neurosci 2020; 13:1450. [PMID: 32116488 PMCID: PMC7020741 DOI: 10.3389/fnins.2019.01450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 12/30/2019] [Indexed: 11/18/2022] Open
Abstract
Background: Classic motion abnormalities in Parkinson's disease (PD), such as tremor, bradykinesia, or rigidity, are well-covered by standard clinical assessments such as the Unified Parkinson's Disease Rating Scale (UPDRS). However, PD includes motor abnormalities beyond the symptoms and signs as measured by UPDRS, such as the lack of anticipatory adjustments or compromised movement smoothness, which are difficult to assess clinically. Moreover, PD may entail motor abnormalities not yet known. All these abnormalities are quantifiable via motion capture and may serve as biomarkers to diagnose and monitor PD. Objective: In this pilot study, we attempted to identify motion features revealing maximum contrast between healthy subjects and PD patients with deep brain stimulation (DBS) of the nucleus subthalamicus (STN) switched off and on as the first step to develop biomarkers for detecting and monitoring PD patients' motor symptoms. Methods: We performed 3D gait analysis in 7 out of 26 PD patients with DBS switched off and on, and in 25 healthy control subjects. We computed feature values for each stride, related to 22 body segments, four time derivatives, left–right mean vs. difference, and mean vs. variance across stride time. We then ranked the feature values according to their distinguishing power between PD patients and healthy subjects. Results: The foot and lower leg segments proved better in classifying motor anomalies than any other segment. Higher degrees of time derivatives were superior to lower degrees (jerk > acceleration > velocity > displacement). The averaged movements across left and right demonstrated greater distinguishing power than left–right asymmetries. The variability of motion was superior to motion's absolute values. Conclusions: This small pilot study identified the variability of a smoothness measure, i.e., jerk of the foot, as the optimal signal to separate healthy subjects' from PD patients' gait. This biomarker is invisible to clinicians' naked eye and is therefore not included in current motor assessments such as the UPDRS. We therefore recommend that more extensive investigations be conducted to identify the most powerful biomarkers to characterize motor abnormalities in PD. Future studies may challenge the composition of traditional assessments such as the UPDRS.
Collapse
Affiliation(s)
- Andreas Kuhner
- Department of Computer Science, University of Freiburg, Freiburg im Breisgau, Germany.,BrainLinks BrainTools, Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany
| | - Isabella Katharina Wiesmeier
- BrainLinks BrainTools, Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Neurology and Neurophysiology, University Medical Center Freiburg, Medical Faculty, Freiburg im Breisgau, Germany
| | - Massimo Cenciarini
- BrainLinks BrainTools, Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Neurology and Neurophysiology, University Medical Center Freiburg, Medical Faculty, Freiburg im Breisgau, Germany
| | - Timo Leon Maier
- BrainLinks BrainTools, Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Neurology and Neurophysiology, University Medical Center Freiburg, Medical Faculty, Freiburg im Breisgau, Germany
| | - Stefan Kammermeier
- Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Neurologische Klinik und Poliklinik, Munich, Germany
| | - Volker Arnd Coenen
- BrainLinks BrainTools, Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Stereotactic and Functional Neurosurgery, University Medical Center Freiburg, Medical Faculty, Freiburg im Breisgau, Germany
| | - Wolfram Burgard
- Department of Computer Science, University of Freiburg, Freiburg im Breisgau, Germany.,BrainLinks BrainTools, Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christoph Maurer
- BrainLinks BrainTools, Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Neurology and Neurophysiology, University Medical Center Freiburg, Medical Faculty, Freiburg im Breisgau, Germany
| |
Collapse
|
7
|
Barbieri FA, Carpenter M, Beretta VS, Orcioli-Silva D, Simieli L, Vitório R, Gobbi LTB. Postural control, falls and Parkinson’s disease: Are fallers more asymmetric than non-fallers? Hum Mov Sci 2019; 63:129-137. [DOI: 10.1016/j.humov.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 10/10/2018] [Accepted: 10/17/2018] [Indexed: 10/27/2022]
|
8
|
Harro CC, Kelch A, Hargis C, DeWitt A. Comparing Balance Performance on Force Platform Measures in Individuals with Parkinson's Disease and Healthy Adults. PARKINSON'S DISEASE 2018; 2018:6142579. [PMID: 30687494 PMCID: PMC6304814 DOI: 10.1155/2018/6142579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/23/2018] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Postural instability is a known contributing factor to balance dysfunction and increased fall risk in those with Parkinson's disease (PD). Computerized posturography employing a force platform system provides objective, quantitative assessments of postural control impairments. This study examines balance performance as measured by force platform (FP) tests in persons with PD compared to age-matched healthy adults. Secondarily, we examine if these FP measures provide diagnostic and clinically meaningful information about the underlying balance impairments in the PD population. METHODS Participants-42 individuals with PD (Hoehn and Yahr stage = 2.33 ± 0.77) and 55 age-matched healthy adults-were assessed on three standardized balance measures on a computerized force platform system. Between groups, comparisons of FP performance were analyzed using independent t-test. Within the group, comparisons for the PD cohort were analyzed using ANOVA for comparing disease stage and Mann-Whitney U test for PD subtypes. RESULTS The PD cohort demonstrated significantly greater postural instability on the sensory organization test (SOT) measures (P=0.013, CI-95% = 1.286 to 10.37) and slower movement velocity on the limits of stability (LOS) test (P=0.001, CI-95% = 0.597 to 1.595) than the healthy cohort, suggesting that these tests were sensitive to detect sensory integration and voluntary postural control deficits in the PD cohort. Within the PD group, the SOT differentiated between H&Y stages 1-3. The motor control test (MCT) detected changes in reactive postural control mainly in later disease stages. All three FP tests distinguished between PD subtypes, with the Posture Gait Instability subtype demonstrating poorer balance performance than Tremor Dominant subtype. CONCLUSION These findings suggest FP measures provide clinically meaningful, diagnostic information in the examination of balance impairments in individuals with PD. FP measures may inform clinicians regarding intrinsic balance deficits and guide them in designing targeted balance interventions to reduce fall risk in persons with PD.
Collapse
Affiliation(s)
- Cathy C. Harro
- Assistance Professor, Physical Therapy, College of Health Professions, Grand Valley State University, Cook DeVos Center for Health Sciences, 301 Michigan Street NE, Suite 268, Grand Rapids, MI 49503, USA
| | - Amanda Kelch
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy Street SE, Grand Rapids, MI 49503, USA
| | - Cora Hargis
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy Street SE, Grand Rapids, MI 49503, USA
| | - Abigail DeWitt
- PT Solutions, 1321 Tusculum Blvd., Greeneville, TN 37743, USA
| |
Collapse
|
9
|
Abstract
This study aimed to determine the relationship between postural asymmetry and falls in Parkinson's disease (PD). In total, 28 patients with PD were included. Postural control was analyzed in bipedal, tandem, and unipedal standing. Center of pressure (CoP) parameters were calculated for both limbs, and asymmetry was assessed using the asymmetry index. Logistic regression was used to predict/classify fallers through postural asymmetry. The Spearman correlation was performed to relate asymmetry and falls number. Poisson regression models were created to predict the number of falls in each condition. The results demonstrated that asymmetry can classify 75% of fallers and nonfallers. Asymmetry in anteroposterior-mean velocity of CoP in unipedal standing was related to the number of falls. Poisson regression showed that anteroposterior-mean velocity of CoP predicts falls in PD, indicating that increased asymmetry results in a greater number of falls. Anteroposterior-mean velocity of CoP seems to be a sensitive parameter to detect falls in PD, mainly during a postural challenging task.
Collapse
|
10
|
Sutter EN, Seidler KJ, Duncan RP, Earhart GM, McNeely ME. Low to moderate relationships between gait and postural responses in Parkinson disease. J Rehabil Med 2018; 49:505-511. [PMID: 28553677 DOI: 10.2340/16501977-2238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between spatiotemporal parameters of forward and backward gait and quality of compensatory stepping responses in forward and backward directions in people with Parkinson's disease with and without freezing of gait. DESIGN Cross-sectional analysis. SUBJECTS A total of 111 individuals with mild to moderate Parkinson's disease. METHODS Forward and backward gait velocity and step length were evaluated using a GAITRite walkway. Forward and backward postural responses were evaluated using items from the Mini Balance Evaluation Systems Test and the Movement Disorders Society Unified Parkinson Disease Rating Scale motor subsection. Relationships between gait and postural responses were examined for the full sample and for sub-groups with and without freezing of gait. RESULTS There were significant (p < 0.05) low to moderate correlations between postural responses and gait overall. Correlations were similar in the freezer and non-freezer sub-groups. Freezers performed worse than non-freezers on all gait parameters and backward postural response items (p < 0.05). CONCLUSION Low to moderate relationships between gait and postural responses indicate the complexity of postural control and the potential involvement of different neural circuitry across these tasks. Better understanding of the relationships between gait and postural deficits in Parkinson's disease may inform the future development of targeted interventions to address these impairments.
Collapse
Affiliation(s)
- Ellen N Sutter
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, USA
| | | | | | | | | |
Collapse
|
11
|
An Overview of the Physiology and Pathophysiology of Postural Control. BIOSYSTEMS & BIOROBOTICS 2018. [DOI: 10.1007/978-3-319-72736-3_1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
12
|
Long-term effects of exercise and physical therapy in people with Parkinson disease. Nat Rev Neurol 2017; 13:689-703. [DOI: 10.1038/nrneurol.2017.128] [Citation(s) in RCA: 219] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
13
|
Bonora G, Mancini M, Carpinella I, Chiari L, Ferrarin M, Nutt JG, Horak FB. Investigation of Anticipatory Postural Adjustments during One-Leg Stance Using Inertial Sensors: Evidence from Subjects with Parkinsonism. Front Neurol 2017; 8:361. [PMID: 28790972 PMCID: PMC5524831 DOI: 10.3389/fneur.2017.00361] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 07/07/2017] [Indexed: 11/22/2022] Open
Abstract
The One-Leg Stance (OLS) test is a widely adopted tool for the clinical assessment of balance in the elderly and in subjects with neurological disorders. It was previously showed that the ability to control anticipatory postural adjustments (APAs) prior to lifting one leg is significantly impaired by idiopathic Parkinson’s disease (iPD). However, it is not known how APAs are affected by other types of parkinsonism, such as frontal gait disorders (FGD). In this study, an instrumented OLS test based on wearable inertial sensors is proposed to investigate both the initial anticipatory phase and the subsequent unipedal balance. The sensitivity and the validity of the test have been evaluated. Twenty-five subjects with iPD presenting freezing of gait (FOG), 33 with iPD without FOG, 13 with FGD, and 32 healthy elderly controls were recruited. All subjects wore three inertial sensors positioned on the posterior trunk (L4–L5), and on the left and right frontal face of the tibias. Participants were asked to lift a foot and stand on a single leg as long as possible with eyes open, as proposed by the mini-BESTest. Temporal parameters and trunk acceleration were extracted from sensors and compared among groups. The results showed that, regarding the anticipatory phase, the peak of mediolateral trunk acceleration was significantly reduced compared to healthy controls (p < 0.05) in subjects with iPD with and without FOG, but not in FGD group (p = 0.151). Regarding the balance phase duration, a significant shortening was found in the three parkinsonian groups compared to controls (p < 0.001). Moreover, balance was significantly longer (p < 0.001) in iPD subjects without FOG compared to subjects with FGD and iPD subjects presenting FOG. Strong correlations between balance duration extracted by sensors and clinical mini-BESTest scores were found (ρ > 0.74), demonstrating the method’s validity. Our findings support the validity of the proposed method for assessing the OLS test and its sensitivity in distinguishing among the tested groups. The instrumented test discriminated between healthy controls and people with parkinsonism and among the three groups with parkinsonism. The objective characterization of the initial anticipatory phase represents an interesting improvement compared to most clinical OLS tests.
Collapse
Affiliation(s)
- Gianluca Bonora
- Biomedical Technology Department, IRCCS Foundation Don Gnocchi Onlus, Milan, Italy
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Ilaria Carpinella
- Biomedical Technology Department, IRCCS Foundation Don Gnocchi Onlus, Milan, Italy
| | - Lorenzo Chiari
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Maurizio Ferrarin
- Biomedical Technology Department, IRCCS Foundation Don Gnocchi Onlus, Milan, Italy
| | - John G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States.,VA Portland Healthcare Systems, VAPORHCS, Portland, OR, United States
| |
Collapse
|