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Herbers C, Zhang R, Erdman A, Johnson MD. Distinguishing features of Parkinson's disease fallers based on wireless insole plantar pressure monitoring. NPJ Parkinsons Dis 2024; 10:67. [PMID: 38503777 PMCID: PMC10951221 DOI: 10.1038/s41531-024-00678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
Postural instability is one of the most disabling motor signs of Parkinson's disease (PD) and often underlies an increased likelihood of falling and loss of independence. Current clinical assessments of PD-related postural instability are based on a retropulsion test, which introduces human error and only evaluates reactive balance. There is an unmet need for objective, multi-dimensional assessments of postural instability that directly reflect activities of daily living in which individuals may experience postural instability. In this study, we trained machine-learning models on insole plantar pressure data from 111 participants (44 with PD and 67 controls) as they performed simulated static and active postural tasks of activities that often occur during daily living. Models accurately classified PD from young controls (area under the curve (AUC) 0.99+/- 0.00), PD from age-matched controls (AUC 0.99+/- 0.01), and PD fallers from PD non-fallers (AUC 0.91+/- 0.08). Utilizing features from both static and active postural tasks significantly improved classification performances, and all tasks were useful for separating PD from controls; however, tasks with higher postural threats were preferred for separating PD fallers from PD non-fallers.
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Affiliation(s)
- Cara Herbers
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, 55455, MN, USA
| | - Raymond Zhang
- Department of Biomedical Engineering, University of Minnesota, 312 Church Street SE, Minneapolis, 55455, MN, USA
| | - Arthur Erdman
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, 55455, MN, USA
| | - Matthew D Johnson
- Department of Biomedical Engineering, University of Minnesota, 312 Church Street SE, Minneapolis, 55455, MN, USA.
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Heß T, Themann P, Oehlwein C, Milani TL. Does Impaired Plantar Cutaneous Vibration Perception Contribute to Axial Motor Symptoms in Parkinson's Disease? Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation. Brain Sci 2023; 13:1681. [PMID: 38137129 PMCID: PMC10742284 DOI: 10.3390/brainsci13121681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To investigate whether impaired plantar cutaneous vibration perception contributes to axial motor symptoms in Parkinson's disease (PD) and whether anti-parkinsonian medication and subthalamic nucleus deep brain stimulation (STN-DBS) show different effects. METHODS Three groups were evaluated: PD patients in the medication "on" state (PD-MED), PD patients in the medication "on" state and additionally "on" STN-DBS (PD-MED-DBS), as well as healthy subjects (HS) as reference. Motor performance was analyzed using a pressure distribution platform. Plantar cutaneous vibration perception thresholds (VPT) were investigated using a customized vibration exciter at 30 Hz. RESULTS Motor performance of PD-MED and PD-MED-DBS was characterized by greater postural sway, smaller limits of stability ranges, and slower gait due to shorter strides, fewer steps per minute, and broader stride widths compared to HS. Comparing patient groups, PD-MED-DBS showed better overall motor performance than PD-MED, particularly for the functional limits of stability and gait. VPTs were significantly higher for PD-MED compared to those of HS, which suggests impaired plantar cutaneous vibration perception in PD. However, PD-MED-DBS showed less impaired cutaneous vibration perception than PD-MED. CONCLUSIONS PD patients suffer from poor motor performance compared to healthy subjects. Anti-parkinsonian medication in tandem with STN-DBS seems to be superior for normalizing axial motor symptoms compared to medication alone. Plantar cutaneous vibration perception is impaired in PD patients, whereas anti-parkinsonian medication together with STN-DBS is superior for normalizing tactile cutaneous perception compared to medication alone. Consequently, based on our results and the findings of the literature, impaired plantar cutaneous vibration perception might contribute to axial motor symptoms in PD.
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Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Peter Themann
- Department of Neurology and Parkinson, Clinic at Tharandter Forest, 09633 Halsbruecke, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L. Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
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Legutke BR, Gobbi LTB, Orcioli-Silva D, Santos PCRD, Moraca GAG, Vitório R, Beretta VS. Transcranial direct current stimulation suggests not improving postural control during adapted tandem position in people with Parkinson's disease: A pilot study. Behav Brain Res 2023; 452:114581. [PMID: 37453515 DOI: 10.1016/j.bbr.2023.114581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Balance impairments in people with Parkinson's disease (PD) demonstrated mainly in challenging postural tasks, such as increased body oscillation may be attributed to the deficits in the brain structures functionality involved in postural control (e.g., motor cortex, midbrain, and brainstem). Although promising results, the effect of transcranial direct current stimulation (tDCS) on postural control in people with PD is unclear, especially in objective measures such as the center of pressure (CoP) parameters. Thus, we analyzed the effects of a single session of tDCS on the CoP parameters during the adapted tandem position in people with PD. METHODS Nineteen people with PD participated in this crossover, randomized, and double-blind study. Anodal tDCS was applied over the primary motor cortex in two conditions of stimulation (2 mA/active and sham) on two different days for 20 min immediately before the postural control evaluation. Participants remained standing in an adapted tandem position for the postural control assessment for 30 s (three trials). CoP parameters were acquired by a force plate. RESULTS No significant differences were demonstrated between stimulation conditions (p-value range = 0.15-0.89). CONCLUSIONS Our results suggested that a single session of tDCS with 2 mA does not improve the postural control of people with PD during adapted tandem.
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Affiliation(s)
- Beatriz Regina Legutke
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Campinas (UNICAMP), School of Applied Sciences (FCA), Laboratory of Applied Sport Physiology (LAFAE), Limeira, Brazil
| | - Paulo Cezar Rocha Dos Santos
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Israel; The Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel
| | - Gabriel Antonio Gazziero Moraca
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Rodrigo Vitório
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil; São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, São Paulo, Brazil.
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Heß T, Oehlwein C, Milani TL. Anticipatory Postural Adjustments and Compensatory Postural Responses to Multidirectional Perturbations-Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease. Brain Sci 2023; 13:brainsci13030454. [PMID: 36979264 PMCID: PMC10046463 DOI: 10.3390/brainsci13030454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Postural instability is one of the most restricting motor symptoms for patients with Parkinson's disease (PD). While medication therapy only shows minor effects, it is still unclear whether medication in conjunction with deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves postural stability. Hence, the aim of this study was to investigate whether PD patients treated with medication in conjunction with STN-DBS have superior postural control compared to patients treated with medication alone. METHODS Three study groups were tested: PD patients on medication (PD-MED), PD patients on medication and on STN-DBS (PD-MED-DBS), and healthy elderly subjects (HS) as a reference. Postural performance, including anticipatory postural adjustments (APA) prior to perturbation onset and compensatory postural responses (CPR) following multidirectional horizontal perturbations, was analyzed using force plate and electromyography data. RESULTS Regardless of the treatment condition, both patient groups showed inadequate APA and CPR with early and pronounced antagonistic muscle co-contractions compared to healthy elderly subjects. Comparing the treatment conditions, study group PD-MED-DBS only showed minor advantages over group PD-MED. In particular, group PD-MED-DBS showed faster postural reflexes and tended to have more physiological co-contraction ratios. CONCLUSION medication in conjunction with STN-DBS may have positive effects on the timing and amplitude of postural control.
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Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
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Sebastia-Amat S, Tortosa-Martínez J, Pueo B. The Use of the Static Posturography to Assess Balance Performance in a Parkinson's Disease Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:981. [PMID: 36673738 PMCID: PMC9859212 DOI: 10.3390/ijerph20020981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 06/17/2023]
Abstract
The literature has shown contradictory results so far about the use of posturography, especially static posturography, to evaluate balance performance in Parkinson’s disease (PD) populations. This study aimed to investigate the use of static posturography as a valid method to evaluate balance in a PD population. Fifty-two participants diagnosed with PD (Hoehn & Yahr stage: 1−3) were included in this cross-sectional study. All participants completed the following assessments: Hoehn and Yahr scale, Movement Disorder Society-Unified Parkinson’s Disease Rating Scale, Tinetti Scale, Berg Balance Scale, Activities-specific Balance Confidence scale, Timed Up and Go test, and Functional Reach Test. Sway parameters were analyzed with a baropodometric platform, under eyes open (EO) and eyes closed (EC) conditions, in a bipodal stance. Small to large correlations were observed between clinical balance tests and static posturography parameters, although the majority of these parameters correlated moderately. Considering posturographic variables, the highest correlation values were detected for total excursion (TE), mean velocity (MV), mean (X-mean), and root-mean-square (X-RMS) displacements in the medio-lateral directions. It was observed that posturographic parameters worsened as the disease progresses, although differences were only significant between the stages 1 and 3 in the H&Y scale (p < 0.05). Regarding the test condition, the visual deprivation worsened significantly all the static posturography parameters (p < 0.05), except the antero-posterior mean displacement (Y-Mean). Comparing visual conditions, the EC presented slightly higher correlation values with the clinical balance tests. Static posturography could be used as an objective complementary tool to clinical balance tests in order to assess and control balance performance, mainly to detect postural instability problems.
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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.
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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,
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Costa EDC, Santinelli FB, Moretto GF, Figueiredo C, von Ah Morano AE, Barela JA, Barbieri FA. A multiple domain postural control assessment in people with Parkinson's disease: traditional, non-linear, and rambling and trembling trajectories analysis. Gait Posture 2022; 97:130-136. [PMID: 35932689 DOI: 10.1016/j.gaitpost.2022.07.250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/06/2022] [Accepted: 07/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postural impairment is one of the most debilitating symptoms in people with Parkinson's disease (PD), which show faster and more variable oscillation during quiet stance than neurologically healthy individuals. Despite the center of pressure parameters can characterize PD's body sway, they are limited to uncover underlying mechanisms of postural stability and instability. RESEARCH QUESTION Do a multiple domain analysis, including postural adaptability and rambling and trembling components, explain underlying postural stability and instability mechanisms in people with PD? METHOD Twenty-four individuals (12 people with PD and 12 neurologically healthy peers) performed three 60-s trials of upright quiet standing on a force platform. Traditional and non-linear parameters (Detrended Fluctuation Analysis- DFA and Multiscale Entropy- MSE) and rambling and trembling trajectories were calculated for anterior-posterior (AP) and medial-lateral (ML) directions. RESULTS PDG's postural control was worse compared to CG, displaying longer displacement, higher velocity, and RMS. Univariate analyses revealed largely longer displacement and RMS only for the AP direction and largely higher velocity for both AP and ML directions. Also, PD individuals showed lower AP complexity, higher AP and ML DFA, and increased AP and ML displacement, velocity, and RMS of rambling and trembling components compared to neurologically healthy individuals. SIGNIFICANCE Based upon these results, people with PD have a lower capacity to adapt posture and impaired both rambling and trembling components compared to neurologically healthy individuals. These findings provide new insights to explain the larger, faster, and more variable sway in people with PD.
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Affiliation(s)
- Elisa de Carvalho Costa
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - Felipe Balistieri Santinelli
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Gabriel Felipe Moretto
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil
| | - Caique Figueiredo
- São Paulo State University (Unesp), School of Technology and Sciences, Department of Physical Education, Physical Education, Exercise and Immunometabolism Research Group, Presidente Prudente, SP, Brazil
| | - Ana Elisa von Ah Morano
- São Paulo State University (Unesp), School of Technology and Sciences, Department of Physical Education, Physical Education, Exercise and Immunometabolism Research Group, Presidente Prudente, SP, Brazil
| | - José Angelo Barela
- São Paulo State University (Unesp) - Institute of Biosciences, Department of Physical Education, Campus Rio Claro, SP, Brazil
| | - Fabio Augusto Barbieri
- São Paulo State University (Unesp), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, SP, Brazil.
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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.
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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.
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Mafra M, Lenzi OMW, Silveira FS, Schmitt MV, Oliveira JFD, Sousa CAD. Multimodal exercise program contributes to balance and motor functions in men and women with Parkinson's disease differently: an intervention study. MOTRIZ: REVISTA DE EDUCACAO FISICA 2022. [DOI: 10.1590/s1980-657420220015221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Comparing the applicability of temporal gait symmetry, variability and laterality in bilateral gait conditions: A feasibility study of healthy individuals and people with diabetic neuropathy. Clin Biomech (Bristol, Avon) 2022; 91:105530. [PMID: 34808428 DOI: 10.1016/j.clinbiomech.2021.105530] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 10/07/2021] [Accepted: 11/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gait symmetry is used to measure pathological gait but is usually applied to unilateral pathology. This study aims to investigate bilateral impairment using existing and new gait symmetry methods. METHODS 15 healthy volunteers and 14 people with diabetes and distal symmetrical polyneuropathy participated in this study. Three temporal parameters (combined step, stance phase and double stance), expressed as a percentage, were extracted for comparing gait symmetry between healthy volunteers and patients using in-shoe measurements (Pedar-X). Three indices were calculated, including the widely used Symmetry Index; the well-established Variability Index; and the newly developed Laterality Index, that calculates how well distributed a condition is across both legs. FINDINGS In all three parameters, Symmetry and Variability Index proved to be significantly greater in the diabetic cohort (p-values range < 0.001-0.0226). The Laterality Index was significantly greater in the diabetic cohort for the stance and double stance phases (p-values 0.03 and < 0.001), but not for the combined step (p-value 0.3953). In both cohorts, Laterality Index <1 (fractional laterality) was associated with small Symmetry Index data, whereas in large Symmetry Index data, the Laterality Index was 1 (unilateral condition). INTERPRETATIONS Gait symmetry and variability are useful tools for quantifying locomotion and the effects of aging and diseases. We have shown the ability of these two indices in differentiating two extreme groups of individuals. For cases with small Symmetry Index, the current method of using an arbitrary value is not ideal. The newly developed Laterality Index can be used to decide on the cut-off between symmetrical and asymmetrical gait.
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Araújo-Silva F, Santinelli FB, Felipe I Imaizumi L, Silveira APB, Vieira LHP, Alcock L, Barbieri FA. Temporal dynamics of cortical activity and postural control in response to the first levodopa dose of the day in people with Parkinson's disease. Brain Res 2021; 1775:147727. [PMID: 34788638 DOI: 10.1016/j.brainres.2021.147727] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Our understanding of how balance control responds to levodopa over the course of a single day in people with Parkinson's disease (PD) is limited with the majority of studies focused on isolated comparisons of ON vs. OFF levodopa medication. OBJECTIVE To evaluate the temporal dynamics of postural control following the first levodopa dose of the day during a challenging standing task in a group of people with PD. METHODS Changes in postural control were evaluated by monitoring cortical activity (covering frontal, motor, parietal and occipital areas), body sway parameters (force platform), and lower limb muscle activity (tibialis anterior and gastrocnemius medialis) in 15 individuals with PD during a semi-tandem standing task. Participants were assessed during two 60 second trials every 30 minutes (ON-30 ON-60 etc.) for 3 hours after the first matinal dose (ON-180). RESULTS Compared to when tested OFF-medication, cortical activity was increased across all four regions from ON-60 to ON-120 with early increases in alpha and beta band activity observed at ON-30. Levodopa was associated with increased gastrocnemius medialis activity (ON-30 to ON-120) and ankle co-contraction (ON-60 to ON-120). Changes in body sway outcomes (particularly in the anterior-posterior direction) were evident from ON-60 to ON-120. CONCLUSIONS Our results reveal a 60-minute window within which postural control outcomes may be obtained that are different compared to OFF-state and remain stable (from 60-minutes to 120-minutes after levodopa intake). Identifying a window of opportunity for measurement when individuals are optimally medicated is important for observations in a clinical and research setting.
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Affiliation(s)
- Fabiana Araújo-Silva
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Felipe B Santinelli
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Luis Felipe I Imaizumi
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Aline P B Silveira
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Luiz H P Vieira
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University Newcastle upon Tyne, UK
| | - Fabio A Barbieri
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil.
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Beretta VS, Carpenter MG, Barbieri FA, Santos PCR, Orcioli-Silva D, Pereira MP, Gobbi LTB. Does the impaired postural control in Parkinson's disease affect the habituation to non-sequential external perturbation trials? Clin Biomech (Bristol, Avon) 2021; 85:105363. [PMID: 33932865 DOI: 10.1016/j.clinbiomech.2021.105363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND How people with Parkinson's disease habituate their postural response to unpredictable translation perturbation is not totally understood. We compared the capacity to change the postural responses after unexpected external perturbation and investigated the habituation plateaus of postural responses to non-sequential perturbation trials in people with Parkinson's disease and healthy older adults. METHODS In people with Parkinson's disease (n = 37) and older adults (n = 20), sudden posterior support-surface translational were applied in 7 out of 17 randomized trials to ensure perturbation unpredictability. Electromyography and center of pressure parameters of postural response were analyzed by ANOVAs (Group vs. Trials). Two simple planned contrasts were performed to determine at which trial the responses first significantly habituate, and by which trials the habituation plateaus. FINDINGS Older adults demonstrated a first response change in trial 5 and habituation plateaus after trial 4, while for people with Parkinson's disease, the first change occurred in trial 2 and habituation plateau after trial 5 observed by center of pressure range. People with Parkinson's disease demonstrated a greater center of pressure range in trial 1 compared to older adults. Independent of trial, people with Parkinson's disease vs. older adults demonstrated a greater ankle muscle co-activation and recovery time. INTERPRETATION Despite the greater center of pressure range in the first trial, people with Parkinson's disease can habituate to unpredictable perturbations. This is reflected by little, to no difference in the time-course of adaptation for all but 2 parameters that showed only marginal differences between people with Parkinson's disease and older adults.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Mark Gregory Carpenter
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabio Augusto Barbieri
- São Paulo State University (Unesp), School of Sciences, Graduate Program in Movement Sciences, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Paulo Cezar Rocha Santos
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Marcelo Pinto Pereira
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
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13
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Kamieniarz A, Michalska J, Marszałek W, Stania M, Słomka KJ, Gorzkowska A, Juras G, Okun MS, Christou EA. Detection of postural control in early Parkinson's disease: Clinical testing vs. modulation of center of pressure. PLoS One 2021; 16:e0245353. [PMID: 33434235 PMCID: PMC7802937 DOI: 10.1371/journal.pone.0245353] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Little is known about the early stage balance changes in PD. Many clinicians assume that there are no postural issues in early PD because of failure to identify them on bedside and clinical testing. Here, we quantify balance changes in early and moderate stage PD and compared these values to healthy controls (HC) using clinical assessments of balance and posturography. METHODS We compared 15 HC with 15 early PD (PD-II; Hoehn and Yahr stage II) and 15 moderate PD (PD-III; H&Y stage III). Participants performed various clinical tests of balance and a standing postural task on a force platform. We quantified the spatiotemporal parameters of the center of pressure (COP), the sample entropy and power spectral density (PSD) of the COP. RESULTS The PSD of the COP differentiated PD-II from HC from 0-0.5 Hz and PD-II from PD-III from 0.5-1 Hz. Specifically, PD-II and PD-III manifested greater power than HC from 0-0.5 Hz, whereas PD-III exhibited greater power than PD-II and HC from 0.5-1.0 Hz (p<0.05). However, there were no significant differences between PD-II and HC in all clinical tests and in spatiotemporal parameters of the COP (p>0.05). Although the sample entropy was significantly lower in the PD groups (p<0.05), entropy failed to differentiate PD-II from PD-III. CONCLUSION The low-frequency modulation of the COP in this small cohort differentiated early PD from HC and from moderate PD. Clinicians should be aware that there are early balance deficits in PD. A larger sample size is needed to confirm these findings.
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Affiliation(s)
- Anna Kamieniarz
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Justyna Michalska
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Wojciech Marszałek
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Magdalena Stania
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Kajetan J. Słomka
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Agnieszka Gorzkowska
- Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Juras
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States of America
| | - Evangelos A. Christou
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States of America
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States of America
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14
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Delafontaine A, Hansen C, Marolleau I, Kratzenstein S, Gouelle A. Effect of a Concurrent Cognitive Task, with Stabilizing Visual Information and Withdrawal, on Body Sway Adaptation of Parkinsonian's Patients in an Off-Medication State: A Controlled Study. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5059. [PMID: 32899926 PMCID: PMC7571225 DOI: 10.3390/s20185059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 12/23/2022]
Abstract
Background: In persons with Parkinson's disease (pwPD) any additional somatosensory or distractor interference can influence the posture. When deprivation of vision and dual-task are associated, the effect on biomechanical performance is less consistent. The aim of this study was to evaluate the role of the visual deprivation and a cognitive task on the static balance in earlier stage PD subjects. Methods: Fifteen off-medication state pwPD (9 women and 6 men), 67.7 ± 7.3 years old, diagnosed PD since 5.4 ± 3.4 years, only Hoehn and Yahr state 2 and fifteen young control adults (7 women and 8 men) aged 24.9 ± 4.9 years, performed semi-tandem task under four randomized experimental conditions: eyes opened single-task, eyes closed single-task, eyes opened dual-task and eyes closed dual-task. The center of pressure (COP) was measured using a force plate and electromyography signals (EMG) of the ankle/hip muscles were recorded. Traditional parameters, including COP pathway length, ellipse area, mediolateral/anteroposterior root-mean-square and non-linear measurements were computed. The effect of vision privation, cognitive task, and vision X cognitive was investigated by a 2 (eyes opened/eyes closed) × 2 (postural task alone/with cognitive task) repeated-measures ANOVA after application of a Bonferroni pairwise correction for multiple comparisons. Significant interactions were further analyzed using post-hoc tests. Results: In pwPD, both COP pathway length (p < 0.01), ellipse area (p < 0.01) and mediolateral/anteroposterior root-mean-square (p < 0.01) were increased with the eyes closed, while the dual-task had no significant effect when compared to the single-task condition. Comparable results were observed in the control group for who COP pathway was longer in all conditions compared to eyes opened single-task (p < 0.01) and longer in conditions with eyes closed compared to eyes opened dual-task (p < 0.01). Similarly, all differences in EMG activity of pwPD were exclusively observed between eyes opened vs. eyes closed conditions, and especially for the forward leg's soleus (p < 0.01) and backward tibialis anterior (p < 0.01). Conclusions: These results in pwPD without noticeable impairment of static balance encourage the assessment of both visual occlusion and dual-task conditions when the appearance of significant alteration during the dual-task could reveal the subtle worsening onset of the balance control.
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Affiliation(s)
- Arnaud Delafontaine
- CIAMS, University Paris-Sud, Université Paris-Saclay, 91405 Orsay, France;
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, 24098 Kiel, Germany;
| | - Iris Marolleau
- CIAMS, University Paris-Sud, Université Paris-Saclay, 91405 Orsay, France;
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Stefan Kratzenstein
- CAU Motion Lab, Kiel University, Olshausenstraße 74, 24098 Kiel, Germany;
- Institute of Sport Science, Kiel University, Olshausenstraße 74, 24098 Kiel, Germany
| | - Arnaud Gouelle
- ProtoKinetics, Havertown, PA 19083, USA;
- Laboratory Performance, Santé, Métrologie, Société (PSMS), UFR STAPS, 51100 Reims, France
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Cancela JM, Mollinedo I, Montalvo S, Vila Suárez ME. Effects of a High-Intensity Progressive-Cycle Program on Quality of Life and Motor Symptomatology in a Parkinson's Disease Population: A Pilot Randomized Controlled Trial. Rejuvenation Res 2020; 23:508-515. [PMID: 32336211 DOI: 10.1089/rej.2019.2267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The benefits of aerobic exercise in persons with Parkinson's disease (PD) have been widely studied. Recent studies support the use of high-intensity aerobic exercise to improve oxidative stress values and functional performance in PD patients. The aim of this study is ascertain whether high-intensity aerobic training with lower extremity cycle ergometers and balance training can improve motor symptoms and quality of life in a PD population of Hoehn and Yahr disability score 1-3. The intervention took place in rehabilitation centers in secondary care. A pilot randomized controlled trial was carried out with 14 outpatients participated in the 8-week study. They were composed of a control group (CG; n = 7) that followed a balance protocol and an experimental group (EG; n = 7) that performed high-intensity (70% heart rate reserve) aerobic workout using a lower extremity cycle ergometer and a balance protocol once a week. The primary outcome measures included the 8-Foot Up-and-Go test, 6-Minute Walk test, 2-Minute Step test, Parkinson's Disease Questionnaire (PDQ39), Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Tinetti test. Significant improvements in the PDQ39 (F1.23 = 3.102; sig = 0.036), the MDS-UPDRS III (F1.23 = 4.723; sig = 0.033), and MDS-UPDRS Total (F1.23 = 4.117; sig = 0.047) were observed in the EG as against the CG. After taking into account the number of subjects in each group, the results suggest that the PD population can withstand high-intensity aerobic workouts with a lower extremity cycle ergometer. This exercise is a beneficial therapy for them because it reduces motor symptoms of the disease and furthermore increases and improves patient's quality of life.
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Affiliation(s)
- José M Cancela
- Faculty of Education and Sport Science, University of Vigo, Pontevedra, Spain.,Galicia Sur Health Research Institute (IIS Galicia Sur), HealthyFit Research Group, Sergas-UVIGO, Pontevedra, Spain
| | - Irimia Mollinedo
- Faculty of Education and Sport Science, University of Vigo, Pontevedra, Spain.,Galicia Sur Health Research Institute (IIS Galicia Sur), HealthyFit Research Group, Sergas-UVIGO, Pontevedra, Spain
| | - Sandro Montalvo
- Faculty of Education and Sport Science, University of Vigo, Pontevedra, Spain
| | - María Elena Vila Suárez
- Faculty of Education and Sport Science, University of Vigo, Pontevedra, Spain.,Galicia Sur Health Research Institute (IIS Galicia Sur), HealthyFit Research Group, Sergas-UVIGO, Pontevedra, Spain
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16
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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]
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17
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Kamieniarz A, Michalska J, Brachman A, Pawłowski M, Słomka KJ, Juras G. A posturographic procedure assessing balance disorders in Parkinson's disease: a systematic review. Clin Interv Aging 2018; 13:2301-2316. [PMID: 30519012 PMCID: PMC6237244 DOI: 10.2147/cia.s180894] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Postural instability is common in Parkinson's disease (PD), often contributing to falls, injuries, and reduced mobility. In the clinical setting, balance disorder is commonly diagnosed using clinical tests and balance scales, but it is suggested that the most sensitive measurement is the force platform. The aim of this systematic review was to summarize the methods and various posturographic procedures used to assess the body balance and gait in PD. A systematic review was conducted of papers published from 2000 to 2017. Databases searched were PubMed and EBSCO. Studies must have involved patients with PD, used force platform or motion analysis system as a measurement tool, and described posturographic procedure. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. A total of 32 studies met the inclusion criteria. The PEDro scores ranged from 5 to 7 points. The analysis of the objective methods assessing balance disorders revealed a large discrepancy in the duration and procedures of measurements. The number of repetitions of each trial fluctuated between 1 and 8, and the duration of a single trial ranged from 10 to 60 seconds. Overall, there are many scales and tests used to assess the balance disorders and disabilities of people with PD. Although in many included studies the authors have used posturography as a method to evaluate the postural instability of PD patients, the results are contradictory. To solve this issue, it is indicated to establish a "gold standard" of procedures of measures of balance.
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Affiliation(s)
- Anna Kamieniarz
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Justyna Michalska
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Anna Brachman
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Michał Pawłowski
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Kajetan J Słomka
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Grzegorz Juras
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
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18
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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.
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19
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Barbieri FA, Polastri PF, Gobbi LTB, Simieli L, Pereira VIA, Baptista AM, Moretto GF, Fiorelli CM, Imaizumi LFI, Rodrigues ST. Obstacle circumvention and eye coordination during walking to least and most affected side in people with Parkinson's disease. Behav Brain Res 2018; 346:105-114. [PMID: 29180136 DOI: 10.1016/j.bbr.2017.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The mechanisms that contribute to gait asymmetry in people with Parkinson's disease (PD) are unclear, mainly during gait with greater environmental demand, such as when an obstacle is circumvented while walking. OBJECTIVE The aim of this study was to investigate the effects of obstacle circumvention of the least and most affected side on motor and gaze behavior in people with PD under/without the effects of dopaminergic medication. METHODS Fifteen people with PD and 15 matched-control individuals were instructed to walk along a pathway, at a self-selected velocity, and to circumvent an obstacle, avoiding contact with it. Each participant performed five trials for each side. Kinematic parameters, mediolateral and horizontal body clearance to the obstacle, strategy to circumvent the obstacle, and gaze behavior were calculated. Parameters were grouped according to the side that the obstacle was circumvented and compared by three-way ANOVAs. RESULTS Both people with PD and the control group presented asymmetry to circumvent an obstacle during walking, however this was exacerbated in people with PD. Individuals with PD presented safe strategies (largest mediolateral and horizontal body clearance to the obstacle, "lead-out" strategy, and higher number and time of fixations on the obstacle) during obstacle circumvention for the least affected side compared to the most affected side. In addition, positive effects of dopaminergic medication on body clearance, spatial-temporal parameters, and gaze behavior were evidenced only when the obstacle was circumvented to the least affected side. CONCLUSIONS The obstacle circumvention to the most affected side is risky for people with PD.
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Affiliation(s)
- Fabio Augusto Barbieri
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil.
| | - Paula Favaro Polastri
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Campus Rio Claro, Posture and Gait Studies Laboratory (LEPLO), Department of Physical Education, Rio Claro, SP, Brazil
| | - Lucas Simieli
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Vinicius Ignácio Alota Pereira
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - André Macari Baptista
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Gabriel Felipe Moretto
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Carolina Menezes Fiorelli
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil; Universidade Sagrado Coração, Bauru, SP, Brazil
| | - Luis Felipe Itikawa Imaizumi
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
| | - Sérgio Tosi Rodrigues
- São Paulo State University (Unesp) - Campus Bauru, Scholl of Science, Human Movement Research Laboratory (MOVI-LAB) and Laboratory of Information, Vision and Action (LIVIA), Department of Physical Education, Bauru, SP, Brazil
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20
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Jehu DA, Cantù H, Hill A, Paquette C, Côté JN, Nantel J. Medication and trial duration influence postural and pointing parameters during a standing repetitive pointing task in individuals with Parkinson's disease. PLoS One 2018; 13:e0195322. [PMID: 29621320 PMCID: PMC5886485 DOI: 10.1371/journal.pone.0195322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/20/2018] [Indexed: 11/18/2022] Open
Abstract
We aimed to determine the effects of levodopa medication on the performance of a repetitive pointing task while standing, and to investigate the optimal trial duration in individuals with Parkinson’s disease, and older adults. Seventeen individuals with Parkinson’s disease (5 freezers) and 9 older adults stood on force platforms for 30 s and 120 s while performing a bilateral repetitive pointing task, tracked by motion capture. Participants with Parkinson’s disease were assessed on and off medication and older adults were also assessed on separate days. The main findings were that: 1) on medication, participants with Parkinson’s exhibited greater center of pressure root mean square in the medial-lateral direction, greater velocity in the medial-lateral and anterior-posterior directions, and greater range in the medial-lateral direction than off medication; 2) longer trial durations resulted in greater center of pressure range in the medial-lateral and anterior-posterior directions and greater coefficient of variation in finger pointing on the least affected side; 3) Parkinson’s participants exhibited larger range in the medial-lateral direction compared to older adults; 4) off medication, freezers presented with less range and root mean square in the anterior-posterior direction than non-freezers; and 5) a correlation emerged between the freezing of gait questionnaire and pointing asymmetry and the coefficient of variation of pointing on the most affected side. Therefore, Parkinson’s medication may increase instability during a repetitive pointing task. Longer trials may provide a better depiction of sway by discriminating between those with and without neurological impairment. Individuals with Parkinson’s were less stable than older adults, supporting that they are at a greater risk for falls. The greater restrictive postural strategy in freezers compared to non-freezers is likely a factor that augments fall-risk. Lastly, the link between freezing of gait and upper-limb movement indicates that freezing may manifest first in the lower-limbs.
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Affiliation(s)
- Deborah A. Jehu
- University of Ottawa, School of Human Kinetics, Ottawa, Ontario, Canada
| | - Hiram Cantù
- McGill University, Department of Kinesiology and Physical Education, Montréal, Québec, Canada
| | - Allen Hill
- University of Ottawa, School of Human Kinetics, Ottawa, Ontario, Canada
| | - Caroline Paquette
- McGill University, Department of Kinesiology and Physical Education, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montréal, Québec, Canada
| | - Julie N. Côté
- McGill University, Department of Kinesiology and Physical Education, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montréal, Québec, Canada
| | - Julie Nantel
- University of Ottawa, School of Human Kinetics, Ottawa, Ontario, Canada
- * E-mail:
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21
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Barbieri FA, Simieli L, Orcioli-Silva D, Baptista AM, Borkowske Pestana M, Spiandor Beretta V, Dos Santos PCR, Bucken Gobbi LT. Obstacle Avoidance Increases Asymmetry of Crossing Step in Individuals With Parkinson's Disease and Neurologically Healthy Individuals. J Mot Behav 2017. [PMID: 28632105 DOI: 10.1080/00222895.2016.1271303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The authors' aim was to investigate gait asymmetry of crossing step during obstacle avoidance while walking in people with Parkinson's disease (PD) under and without the effects of dopaminergic medication. Thirteen individuals with PD and 13 neurologically healthy individuals performed 5 trials of unobstructed gait and 10 trials of obstacle crossing during gait (5 trials with each leg) and spatiotemporal parameters were analyzed. Obstacle crossing increased step duration of the crossing step for the most-affected or nondominant limb compared to the crossing step with the least-affected or dominant limb. Individuals with PD without the effects of medication increased step duration for the step with the least-affected limb compared to the step with the most-affected limb during obstacle crossing.
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Affiliation(s)
- Fabio Augusto Barbieri
- a Human Movement Research Laboratory (MOVI-LAB), Faculty of Science, Department of Physical Education , Universidade Estadual Paulista-UNESP , Bauru , Brazil.,b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Lucas Simieli
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Diego Orcioli-Silva
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - André Macari Baptista
- a Human Movement Research Laboratory (MOVI-LAB), Faculty of Science, Department of Physical Education , Universidade Estadual Paulista-UNESP , Bauru , Brazil.,b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Mayara Borkowske Pestana
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Victor Spiandor Beretta
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Paulo Cezar Rocha Dos Santos
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
| | - Lilian Teresa Bucken Gobbi
- b Posture and Gait Studies Laboratory (LEPLO), Bioscience Institute, Department of Physical Education , Universidade Estadual Paulista-UNESP , Rio Claro , Brazil
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