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Kocer B, Soke F, Ataoglu NEE, Ersoy N, Gulsen C, Gulsen EO, Yasa ME, Uysal I, Comoglu SS, Bora HAT. The reliability and validity of the 3-m backward walk test in people with Parkinson's disease. Ir J Med Sci 2023; 192:3063-3071. [PMID: 37160569 DOI: 10.1007/s11845-023-03384-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND People with Parkinson's disease (PwPD) lose the ability in backward walking which is an important part of mobility in daily life. The 3-m backward walk test (3MBWT) evaluates backward walking; however, its reliability and validity have not been examined in PwPD yet. AIMS To examine (1) the test-retest reliability of the 3MBWT in PwPD; (2) the minimum detectable change in the 3MBWT times; (3) the concurrent and known-groups validity of the 3MBWT; and (4) the optimum cutoff time which best discriminates fallers from non-fallers with Parkinson's disease (PD). METHODS This cross-sectional study included 36 PwPD and 33 healthy people. The 3MBWT was conducted with the 10-m walk test, timed up and go test, Berg Balance Scale, four square step test, activity-specific balance confidence scale, Movement Disorders Society Sponsored Unified Parkinson's Disease Rating Scale, and Hoehn and Yahr Scale. RESULTS The 3MBWT demonstrated excellent test-retest reliability (ICC = 0.965). The MDC of 2.13 s was determined. The 3MBWT had moderate to high correlations with the other outcome measures (correlation coefficient ranged from -0.592 to 0.858). On the 3MBWT times, there were significant differences between PwPD and healthy people, and between fallers and non-fallers with PD (p < 0.001 and p < 0.001, respectively). A 3MBWT time of 10.31 s was found to best discriminate fallers from non-fallers with PD. CONCLUSIONS The 3MBWT is a reliable, valid, and easy to administer outcome measure to assess backward walking performance in PwPD, indicating it to be used in practice and research.
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Affiliation(s)
- Bilge Kocer
- Ankara Etlik City Hospital, Department of Neurology, University of Health Sciences, Varlik Neighborhood, Halil Sezai Erkut Street, Yenimahalle, Ankara, Turkey.
| | - Fatih Soke
- Gulhane Faculty of Physiotherapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | | | - Nursena Ersoy
- Faculty of Health Sciences, Department of Nutrition and Dietetic, Ankara University, Ankara, Turkey
| | - Cagri Gulsen
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Ankara, Turkey
| | - Elvan Ozcan Gulsen
- Vocational School of Health Services, Elderly Care Program, Anadolu University, Eskisehir, Turkey
| | - Mustafa Ertugrul Yasa
- Gulhane Faculty of Physiotherapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Ismail Uysal
- Fethiye Vocational School of Health Services, Department of Health Care Services, Mugla Sitki Kocman University, Ankara, Turkey
| | - Selim Selcuk Comoglu
- Ankara Etlik City Hospital, Department of Neurology, University of Health Sciences, Varlik Neighborhood, Halil Sezai Erkut Street, Yenimahalle, Ankara, Turkey
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Bao W, Li P, Yang Y, Chen K, Liu J. Dynamic postural balance indices can help discriminate between patients with multiple system atrophy and Parkinson's disease. Front Neurol 2023; 13:1089439. [PMID: 36698891 PMCID: PMC9868697 DOI: 10.3389/fneur.2022.1089439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Background Patients with Parkinson's disease (PD) and those with multiple system atrophy (MSA) show similar symptoms but have different clinical treatments. It will be helpful to discriminate between these two kinds of patients at an early or middle stage. The purpose of this study is to highlight the differences in posturographic characterization between patients with PD and those with MSA during quiet standing and perturbed standing. Methods A total of clinically diagnosed 42 patients with PD and 32 patients with MSA participated in the experiment. Patients were asked to first stand on a static balance force platform and then on a dynamic balance (medial-lateral rocker) force platform to measure the center of pressure (COP) trajectory during an eyes-open (EO) state. The posturographic parameters were obtained under the two standing conditions for statistical analysis. Results Four posturographic variables were calculated and analyzed, namely, the standard deviation of COP position (SD), sway path of COP position (SP), an elliptical area covering the 95% COP position trajectory (EA), sway path of COP position (SP), and integral area of the power spectral density at 0-0.5 Hz frequency band (PSD). Except for variable EA, the other three variables are all in the medial-lateral (ML) direction. In the static balance experiment, there were no significant differences between the four variables between patients with PD and those with MSA. However, in the dynamic balance experiment, the obtained four variables all presented significant differences between patients with PD and those with MSA. Conclusion The dynamic posturographic variables with significant differences between patients with PD and those with MSA imply that patients with MSA have worse postural control ability in the medial-lateral (ML) direction compared to patients with PD. The obtained dynamic indices may help supplemental clinical evaluation to discriminate between patients with MSA and those with PD.
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Affiliation(s)
- Wei Bao
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, Zhejiang, China
| | - Puyu Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Yang
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, Zhejiang, China
| | - Kai Chen
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, Zhejiang, China,*Correspondence: Kai Chen ✉
| | - Jun Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Jun Liu ✉
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ERDEM M, BALAL M, DEMİRKIRAN M. Postural stability in early Parkinson’s disease: effect of cognitive dual-tasking. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1126396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose: The primary aim of this study is to evaluate postural stability by using a static posturography in patients with early Parkinson’s disease (PD). Secondly, this paper addresses the need for illustrating the effect of dual-tasking on postural stability in early PD patients.
Materials and Methods: Twenty-nine early PD patients with maximum 5 years of disease duration were included in this study. The selected group had no clinical PI while their age- and sex-matched healthy controls were carried out. Neurological examination and mini-mental state examination (MMSE) were performed in all subjects. Unified Parkinson Disease Rating Scale (UPDRS) and modified Hoehn and Yahr (H&Y) scores were recorded in PD patients. Postural stability was assessed in all subjects on a static posturography platform under three different conditions: eyes open, eyes closed and a cognitive task of producing words with given letters.
Results: The mean age of the PD was 59.2±10.5 whereas the control groups mean age was 56.3±7.6 (p>0.05). The female-male ratio was 9/20 in the PD and 12/17 in the control group. There was no important difference between the two groups in terms of demographic characteristics. In the PD group, the mean UPDRS was 12.8±4.9. The patients were mostly receiving polytherapy.
Eye closure and cognitive task caused an increase in most sway parameters in both groups.
Conclusion: Early PD patients on medication, postural stability is preserved and cognitive dual-tasking does not affect postural stability in these patients in the early stage.
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Affiliation(s)
- Miray ERDEM
- ADANA CITY TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF NEUROLOGY
| | - Mehmet BALAL
- CUKUROVA UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NEUROLOGY
| | - Meltem DEMİRKIRAN
- CUKUROVA UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NEUROLOGY
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Wen J, Guo T, Wu J, Bai X, Zhou C, Wu H, Liu X, Chen J, Cao Z, Gu L, Pu J, Zhang B, Zhang M, Guan X, Xu X. Nigral Iron Deposition Influences Disease Severity by Modulating the Effect of Parkinson's Disease on Brain Networks. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2479-2492. [PMID: 36336939 PMCID: PMC9837680 DOI: 10.3233/jpd-223372] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In Parkinson's disease (PD), excessive iron deposition in the substantia nigra may exacerbate α-synuclein aggregation, facilitating the degeneration of dopaminergic neurons and their neural projection. OBJECTIVE To investigate the interaction effect between nigral iron deposition and PD status on brain networks. METHODS Eighty-five PD patients and 140 normal controls (NC) were included. Network function and nigral iron were measured using multi-modality magnetic resonance imaging. According to the median of nigral magnetic susceptibility of NC (0.095 ppm), PD and NC were respectively divided into high and low nigral iron group. The main and interaction effects were investigated by mixed effect analysis. RESULTS The main effect of disease was observed in basal ganglia network (BGN) and visual network (VN). The interaction effect between nigral iron and PD status was observed in left inferior frontal gyrus and left insular lobe in BGN, as well as right middle occipital gyrus, right superior temporal gyrus, and bilateral cuneus in VN. Furthermore, multiple mediation analysis revealed that the functional connectivity of interaction effect clusters in BGN and medial VN partially mediated the relationship between nigral iron and Unified Parkinson's Disease Rating Scale II score. CONCLUSION Our study demonstrates an interaction of nigral iron deposition and PD status on brain networks, that is, nigral iron deposition is associated with the change of brain network configuration exclusively when in PD. We identified a potential causal mediation pathway for iron to affect disease severity that was mediated by both BGN dysfunction and VN hyperfunction in PD.
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Affiliation(s)
- Jiaqi Wen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xueqin Bai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haoting Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaocao Liu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingwen Chen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhengye Cao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Luyan Gu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiali Pu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Correspondence to: Xiaojun Xu, MD, Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China. Tel.: +86 0571 87315255; Fax: +86 0571 87315255; E-mail: and Xiaojun Guan, PhD, Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou 310009, China. Tel.: +86 0571 87315255; Fax: +86 0571 87315255;
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Correspondence to: Xiaojun Xu, MD, Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou 310009, China. Tel.: +86 0571 87315255; Fax: +86 0571 87315255; E-mail: and Xiaojun Guan, PhD, Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou 310009, China. Tel.: +86 0571 87315255; Fax: +86 0571 87315255;
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Sringean J, Thanawattano C, Bhidayasiri R. Technological evaluation of strategies to get out of bed by people with Parkinson's disease: Insights from multisite wearable sensors. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:922218. [PMID: 36090600 PMCID: PMC9453393 DOI: 10.3389/fmedt.2022.922218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Difficulty getting out of bed is a common night-time and early morning manifestation of Parkinson's disease (PD), rated by 40% of the patients as their most concerning motor symptoms. However, current assessment methods are based on clinical interviews, video analysis, and clinical scales as objective outcome measures are not yet available. Objective To study the technical feasibility of multisite wearable sensors in the assessment of the supine-to-stand (STS) task as a determinant of the ability to get out of bed in patients with PD and age-matched control subjects, and develop relevant objective outcome measures. Methods The STS task was assessed in 32 patients with PD (mean Hoehn and Yahr; HY = 2.5) in the early morning before their first dopaminergic medication, and in 14 control subjects, using multisite wearable sensors (NIGHT-Recorder®; trunk, both wrists, and both ankles) in a sleep laboratory. Objective getting out of bed parameters included duration, onset, velocity and acceleration of truncal rotation, and angle deviation (a°) from the z-axis when subjects rose from the bed at different angles from the x-axis (10°, 15°, 30°, 45°, and 60°) as measures of truncal lateral flexion. Movement patterns were identified from the first body part or parts that moved. Correlation analysis was performed between these objective outcomes and standard clinical rating scales. Results Compared to control subjects, the duration of STS was significantly longer in patients with PD (p = 0.012), which is associated with a significantly slower velocity of truncal rotation (p = 0.003). Moderate and significant correlations were observed between the mean STS duration and age, and the Nocturnal Hypokinesia Questionnaire. The velocity of truncal rotation negatively and significantly correlated with HY staging. Any arm and leg moved together as the first movement significantly correlated with UPDRS-Axial and item #28. Several other correlations were also observed. Conclusion Our study was able to demonstrate the technical feasibility of using multisite wearable sensors to quantitatively assess early objective outcome measures of the ability of patients with PD to get out of bed, which significantly correlated with axial severity scores, suggesting that axial impairment could be a contributing factor in difficulty getting out of bed. Future studies are needed to refine these outcome measures for use in therapeutic trials related to nocturia or early morning akinesia in PD.
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Affiliation(s)
- Jirada Sringean
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Chusak Thanawattano
- National Science and Technology Development Agency (NSTDA), Pathumthani, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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Quantitative Analysis of Postural Instability in Patients with Parkinson's Disease. PARKINSONS DISEASE 2021; 2021:5681870. [PMID: 33936583 PMCID: PMC8060093 DOI: 10.1155/2021/5681870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022]
Abstract
Introduction Postural instability is commonly observed in Parkinson's disease, leading to an increasing risk of falling and worsening as the disease progresses. We found that limit of stability can be applied to reflect the dynamic evolution of postural instability in patients with Parkinson's disease. Methods Forty-three patients (9 of Hoehn and Yahr stage I, 12 of stage II, 14 of stage III, and 8 of stage IV) met the criteria for the diagnosis of idiopathic Parkinson's disease and could stand independently for at least 10 minutes. Twelve healthy controls with no sign of parkinsonism were also recruited. Postural instability was assessed by posturography in different directions (forward, backward, right, left, forward-right, forward-left, backward-right, and backward-left). This study trial was registered with the Chinese Clinical Trial Registry (no. ChiCTR1900022715). Results All participants were able to complete the limit of stability tasks without any complications. Patients in stages II to IV exhibited smaller end point excursion and slower time to complete than controls, suggesting an impaired limit of stability. The patients in stage II exhibited a remarkable decline in most directions compared to controls, except for right and left, and forward and backward decline occurred the earliest. For patients in stage III, right was the only direction with no significant difference from controls. In stage IV patients, the limit of stability declined significantly in all directions (p < 0.05). Conclusions The postural abnormalities of Parkinson's disease can occur at early stages, and the pattern of decline is more severe in the forward-backward direction. This trial is registered with ChiCTR1900022715.
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Ge W, Lueck CJ, Apthorp D, Suominen H. Which features of postural sway are effective in distinguishing Parkinson's disease from controls? A systematic review. Brain Behav 2021; 11:e01929. [PMID: 33145991 PMCID: PMC7821610 DOI: 10.1002/brb3.1929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Postural sway may be useful as an objective measure of Parkinson's disease (PD). Existing studies have analyzed many different features of sway using different experimental paradigms. We aimed to determine what features have been used to measure sway and then to assess which feature(s) best differentiate PD patients from controls. We also aimed to determine whether any refinements might improve discriminative power and so assist in standardizing experimental conditions and analysis of data. METHODS In this systematic review of the literature, effect size (ES) was calculated for every feature reported by each article and then collapsed across articles where appropriate. The influence of clinical medication status, visual state, and sampling rate on ES was also assessed. RESULTS Four hundred and forty-three papers were retrieved. 25 contained enough information for further analysis. The most commonly used features were not the most effective (e.g., PathLength, used 14 times, had ES of 0.47, while TotalEnergy, used only once, had ES of 1.78). Increased sampling rate was associated with increased ES (PathLength ES increased to 1.12 at 100 Hz from 0.40 at 10 Hz). Measurement during "OFF" clinical status was associated with increased ES (PathLength ES was 0.83 OFF compared to 0.21 ON). CONCLUSIONS This review identified promising features for analysis of postural sway in PD, recommending a sampling rate of 100 Hz and studying patients when OFF to maximize ES. ES complements statistical significance as it is clinically relevant and is easily compared across experiments. We suggest that machine learning is a promising tool for the future analysis of postural sway in PD.
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Affiliation(s)
- Wenbo Ge
- Research School of Computer Science, Australian National University, Canberra, ACT, Australia
| | - Christian J Lueck
- Department of Neurology, Canberra Hospital, Canberra, ACT, Australia.,Australian National University Medical School, Canberra, ACT, Australia
| | - Deborah Apthorp
- Research School of Computer Science, Australian National University, Canberra, ACT, Australia.,School of Psychology, University of New England, Armidale, NSW, Australia
| | - Hanna Suominen
- Research School of Computer Science, Australian National University, Canberra, ACT, Australia.,Machine Learning Research Group, Data61/CSIRO, Canberra, ACT, Australia.,Department of Future Technologies, University of Turku, Turku, Finland
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Cruz CF, Barela AMF, Doná F, Genoves GG, Ferraz HB, Silva SMCDA, Barela JA. Parkinson's disease delays predictable visual cue processing without affecting complex and unpredictable visual cue processing in postural control. Brain Res 2020; 1751:147209. [PMID: 33248062 DOI: 10.1016/j.brainres.2020.147209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022]
Abstract
This study examined the influence of visual information of different complexities and predictability on the body sway of individuals with Parkinson's disease (PD) during upright stance. Twenty-one individuals at initial stages of PD (62.1 ± 7.2 years), under dopaminergic medication, and 21 controls (62.3 ± 7.1 years) stood inside a moving room, performing 10 trials of 60 s. In the first trial, the room remained motionless. Then, the room oscillated in an anterior-posterior direction. There were three blocks of three trials. In the first block, the room oscillated at 0.2 Hz (periodic simple condition); in the second block, periodic frequencies of 0.1, 0.3, and 0.5 Hz were combined (periodic complex condition); in the third block, non-periodic frequencies of 0.1, 0.3, and 0.5 Hz were combined (non-periodic complex condition). Participants were not informed about the room movement. The displacement of the room and trunk were registered using an OPTOTRAK system. Postural sway was examined using mean sway amplitude, and the relationship between visual information and body sway used coherence, gain, and phase. There was no group difference when the room remained motionless. Upon visual manipulation, the PD group displayed larger sway magnitude in the non-periodic complex condition. Individuals with PD also lagged behind the moving room (lower phase values) compared to controls, only in the periodic simple condition. In the remaining measures, there was no group difference. These results suggest that individuals with PD use complex and unpredictable visual information, similar to controls, during upright stance. However, PD might affect the predictable visual cues processing.
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Affiliation(s)
- Caio Ferraz Cruz
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil.
| | - Ana Maria Forti Barela
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - Flávia Doná
- Movement Disorder Section, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Giovanna Gracioli Genoves
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil
| | | | | | - José Angelo Barela
- Institute of Biosciences, São Paulo State University, Rio Claro, SP, Brazil
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You S, Kim HA, Lee H. Association of Postural Instability with Autonomic Dysfunction in Early Parkinson’s Disease. J Clin Med 2020; 9:jcm9113786. [PMID: 33238599 PMCID: PMC7700469 DOI: 10.3390/jcm9113786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/14/2020] [Accepted: 11/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background: There have been several pathologic data that support an association between postural instability (PI) and autonomic dysfunction in Parkinson’s disease (PD). The purpose of this study was to investigate the correlation of PI and autonomic deficits in early PD. Methods: We collected 17 patients with a diagnosis of early PD. PI was assessed by computerized dynamic posturography (CDP). Standardized autonomic function test (AFT) and time and frequency domain spectral analysis of heart rate variability (HRV) were performed. CDP data obtained from the 21 patients were compared to that from age- and sex-matched healthy controls. We collected HRV data from 18 other age- and sex-matched controls. All patients were evaluated in the “OFF” state. We used Mann–Whitney U-test to compare parameters of CDP between the early PD and control groups. Spearman correlation was used for correlation analysis between parameters of CDP and autonomic function test in PD patients. Results: Most patients (76.5%) showed mild or moderate autonomic dysfunction in the standardized AFT. In CDP, sensory ratios of equilibrium score (e.g., visual and vestibular) and composite scores were significantly lower in PD patients than in controls. In HRV, the low-frequency/high-frequency ratio during the tilt and the gap of low- frequency/high-frequency ratio from supine to tilt were significantly different in both groups. The parameters of time and frequency domains of HRV reflecting parasympathetic function were correlated with equilibrium scores for somatosensory organization test in CDP. Discussion: PI was associated with parasympathetic autonomic dysfunction in early PD. This result was in accordance with a previous assumption that PI in PD is related to parasympathetic cholinergic neuron loss in the brainstem.
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Affiliation(s)
| | | | - Hyung Lee
- Correspondence: ; Tel.: +82-53-258-7831
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Degani AM, Cardoso VS, Magalhães AT, Assunção ALS, Soares EDC, Danna-Dos-Santos A. Postural Behavior in Medicated Parkinson Disease Patients: A Preliminary Study Searching for Indicators to Track Progress. J Cent Nerv Syst Dis 2020; 12:1179573520922645. [PMID: 32536782 PMCID: PMC7268163 DOI: 10.1177/1179573520922645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/16/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose: The establishment of early diagnostic methods for Parkinson disease (PD) is one of the key features to clinically control the rate of PD progression. This study aimed to give a first step toward recognizing the efficacy of multiple postural indices of balance control in differentiating medicated PD patients from health participants. Methods: Nine individuals with PD (Hoehn and Yahr Stage up to 2), 9 staged 2.5 and up, and 9 healthy age-matched Controls performed bipedal stances for 120 seconds with eyes either open or closed on a stable force platform. All participants with PD were under anti-Parkinsonian medication. Non-parametric tests investigated the effects of PD and visual input on postural indices extracted from the center of pressure coordinates. Results: Independent of the stage of the disease, individuals with PD presented faster and shakier body sway compared with Controls. Advanced stages of PD also revealed increased body sway length and variability. In addition, medio-lateral postural instability was more pronounced in all stages of PD when visual inputs were not allowed. Conclusion and Significance: Body sway velocity, jerkiness, length, and its variability revealed to be potential markers for subclinical signs of adjustments in the neuromechanisms of balance control and postural instability even at early stages of disease and under anti-Parkinsonian medication. Results produced here will direct future studies aiming to investigate the efficacy of these same indices on recognizing subclinical development of PD as well as those individuals susceptible to faster rates of progression.
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Affiliation(s)
- Adriana Menezes Degani
- Department of Physical Therapy, Western Michigan University, Kalamazoo, MI, USA.,Unified Clinics, Western Michigan University, Kalamazoo, MI, USA.,Synergy Applied Medical & Research, Missoula, MT, USA
| | - Vinicius Saura Cardoso
- BioSignal Laboratory, School of Physical Therapy, Federal University of Piauí, Parnaíba, Brazil
| | | | | | | | - Alessander Danna-Dos-Santos
- Department of Physical Therapy, Western Michigan University, Kalamazoo, MI, USA.,Synergy Applied Medical & Research, Missoula, MT, USA
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Evaluation of Visual Field and Balance Function Alterations in Patients Who Underwent Dermatochalasis Surgery. J Ophthalmol 2020; 2020:1310947. [PMID: 32377411 PMCID: PMC7180500 DOI: 10.1155/2020/1310947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 02/25/2020] [Accepted: 03/18/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To compare perioperative visual field (VF), balance functions (BF), and changes in the other ocular parameters in patients undergoing upper eyelid dermatochalasis (DC) surgery. Methods One hundred and fifty-eight eyes of 79 patients who underwent DC surgery were included in the study. The VF, BF, intraocular pressure (IOP), pachymetry (PM), macular, and optic nerve measurements were recorded. Measurements were repeated at postoperative month 1. The preoperative and postoperative ocular measurements and the balance data were compared. Results Nineteen of 79 (24.05%) patients were male and 60 of 79 (75.95%) were female, while the mean age of the patients was 58.65 ± 7.38 years. There were statistically significant differences in terms of VF and macular thickness between the preoperative and postoperative values. The improvements in mean defect, standard loss variance, and mean sensitivity values of global VF parameters in both eyes were statistically significant after surgery. Central macular thickness, mean macular thickness, and macular volume decreased significantly in all eyes after surgery (p < 0.05). Conclusions Although a marked improvement was observed in VF and peripheral vision after surgery, no significant change was found in BF parameters including primarily falling risk. The significant change in the macular parameters was only remarkable, and we think that the decrease was due to subtle vasospasm. There is a need for further comprehensive studies including especially patients older than 65 with a view to understanding the effect of DC surgery on BF.
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Rahmati Z, Schouten AC, Behzadipour S, Taghizadeh G, Firoozbakhsh K. Disentangling stability and flexibility degrees in Parkinson's disease using a computational postural control model. J Neuroeng Rehabil 2019; 16:104. [PMID: 31412926 PMCID: PMC6694532 DOI: 10.1186/s12984-019-0574-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/07/2019] [Indexed: 01/11/2023] Open
Abstract
Background Impaired postural control in Parkinson’s disease (PD) seriously compromises life quality. Although balance training improves mobility and postural stability, lack of quantitative studies on the neurophysiological mechanisms of balance training in PD impedes the development of patient-specific therapies. We evaluated the effects of a balance-training program using functional balance and mobility tests, posturography, and a postural control model. Methods Center-of-pressure (COP) data of 40 PD patients before and after a 12-session balance-training program, and 20 healthy control subjects were recorded in four conditions with two tasks on a rigid surface (R-tasks) and two on foam. A postural control model was fitted to describe the posturography data. The model comprises a neuromuscular controller, a time delay, and a gain scaling the internal disturbance torque. Results Patients’ axial rigidity before training resulted in slower COP velocity in R-tasks; which was reflected as lower internal torque gain. Furthermore, patients exhibited poor stability on foam, remarked by abnormal higher sway amplitude. Lower control parameters as well as higher time delay were responsible for patients’ abnormal high sway amplitude. Balance training improved all clinical scores on functional balance and mobility. Consistently, improved ‘flexibility’ appeared as enhanced sway velocity (increased internal torque gain). Balance training also helped patients to develop the ‘stability degree’ (increase control parameters), and to respond more quickly in unstable condition of stance on foam. Conclusions Projection of the common posturography measures on a postural control model provided a quantitative framework for unraveling the neurophysiological factors and different recovery mechanisms in impaired postural control in PD. Electronic supplementary material The online version of this article (10.1186/s12984-019-0574-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zahra Rahmati
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.,Djawad Movafaghian Research Center in Rehab Technologies, Sharif University of Technology, Tehran, Iran
| | - Alfred C Schouten
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Saeed Behzadipour
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran. .,Djawad Movafaghian Research Center in Rehab Technologies, Sharif University of Technology, Tehran, Iran.
| | - Ghorban Taghizadeh
- School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Panyakaew P, Anan C, Bhidayasiri R. Posturographic abnormalities in ambulatory atypical parkinsonian disorders: Differentiating characteristics. Parkinsonism Relat Disord 2019; 66:94-99. [PMID: 31337595 DOI: 10.1016/j.parkreldis.2019.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/26/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Postural instability is a common complaint in patients with Parkinson's disease (PD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). However, objective evaluation to identify posturographic characteristics to enable clinical differentiation is limited. METHOD Postural sway abnormalities in 35 atypical parkinsonian patients (19 PSP, 16 MSA), 35 matched PD patients, and healthy subjects were assessed under static posturography with eyes-open (EO) and eyes-closed (EC). RESULTS With EO, MSA patients showed a significantly greater mean ML sway than PD patients (p = 0.03), but with EC even more parameters were significantly different, including mean sway in both ML (p = 0.02) and AP directions (p = 0.01), sway area (p = 0.001), and sway path length (p = 0.003). While differences between MSA and PD were seen in both ML and AP directions, significant differences between PD and PSP were limited to greater mean ML sway (p = 0.01) with EO, greater mean (p = 0.002) and maximal AP sway (p = 0.02) amongst PSP patient with EC. Moderate and significant correlation was demonstrated between HY stage and mean AP sway amongst APD patients (r = 0.56, p < 0.01) and in PSP patients (r = 0.62, p < 0.01). CONCLUSION Our study identifies a number of objective sway measures assessed with EC that are potentially useful for clinical differentiation between APDs and PD. In comparison to PD, MSA showed greater sway area and a mean sway distance in both AP and ML directions, while the difference was limited to AP in PSP. Significant correlation between HY stage and sway parameters further supports postural sway as a potential disease progression marker in APDs.
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Affiliation(s)
- Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Chanawat Anan
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand.
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Cruz CF, Piemonte MEP, Okai-Nobrega LA, Okamoto E, Fortaleza ACDS, Mancini M, Horak FB, Barela JA. Parkinson's disease does not alter automatic visual-motor coupling in postural control. Neurosci Lett 2018; 686:47-52. [PMID: 30193795 DOI: 10.1016/j.neulet.2018.08.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/25/2018] [Accepted: 08/31/2018] [Indexed: 11/26/2022]
Abstract
This study examined the coupling between visual information and body sway in patients with Parkinson's disease (PD) compared with healthy controls. Postural control performance was compared between 14 patients with PD (age: 69.6 ± 8.8 years - stages 1-3 of the Hoehn and Yahr scale) and 14 healthy control participants (age: 68.6 ± 3.0 years). Participants stood upright in a moving room that remained motionless or continuously oscillated in the anterior-posterior direction. Ten trials were performed in the following conditions: no movement of the room (1 trial) and with the room moving at frequencies of 0.1, 0.17, and 0.5 Hz (3 trials each frequency). Body sway and moving room displacement were recorded. The results indicated that patients with PD displayed larger body sway magnitude in the stationary room condition. Body sway of patients with PD was induced by visual manipulation in all three visual stimulus frequencies, but body sway of patients with PD was less coherent compared to that of the control participants. However, no difference was observed in the visual-body sway coupling structure. These results indicate that patients with PD can unconsciously couple body sway to visual information in order to control postural sway in a similar manner to healthy participants with intact visual-motor coupling for posture control. However, this coupling is marked by greater variability, indicating that people with PD have a motor system with greater inherent noise leading to a more varied behavior.
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Affiliation(s)
- Caio Ferraz Cruz
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, São Paulo, SP, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil
| | - Maria Elisa Pimentel Piemonte
- Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil; Brazilian Parkinson Association, São Paulo, SP, Brazil
| | - Líria Akie Okai-Nobrega
- School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Erika Okamoto
- Brazilian Parkinson Association, São Paulo, SP, Brazil
| | | | - Martina Mancini
- Portland Veterans Affairs Health Care Service and Oregon Health and Sciences University, Portland, OR, USA
| | - Fay Bahling Horak
- Portland Veterans Affairs Health Care Service and Oregon Health and Sciences University, Portland, OR, USA
| | - José Angelo Barela
- Institute of Biosciences, São Paulo State University, Rio Claro, SP, Brazil.
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Paolucci T, Iosa M, Morone G, Fratte MD, Paolucci S, Saraceni VM, Villani C. Romberg ratio coefficient in quiet stance and postural control in Parkinson's disease. Neurol Sci 2018; 39:1355-1360. [PMID: 29737443 DOI: 10.1007/s10072-018-3423-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/21/2018] [Indexed: 11/25/2022]
Abstract
The aim of this study was to determine the function of visual afference in postural control in Parkinson patients. We enrolled 29 patients and 30 healthy controls. The stabilometry test was performed for posture and balance and Romberg ratio coefficients were calculated. In addition, the Berg Balance Scale and the 6-Minute Walking Test were administered to assess balance and functional exercise capacity; the Unified Parkinson's Disease Rating Scale was used to determine the stage of the disease; and the Short Form (SF)-36 Health Survey was given to collect information on quality of life. RESULTS significantly longer Center of Pressure (CoP) sway lengths were observed in the parkinson group. The Romberg index for CoP length of sway in parkinson patients was 94.3 ± 19.3%, versus 147.4 ± 120.6% for the control group. (p = 0.025). CONCLUSION Parkinson patients use the increase in CoP sway length and ellipse area to stabilize their balance and sight does not facilitate static postural control as in healthy subjects.
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Affiliation(s)
- Teresa Paolucci
- Complex Unit of Physical Medicine and Rehabilitation, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Matteo Delle Fratte
- Complex Unit of Physical Medicine and Rehabilitation, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Vincenzo M Saraceni
- Complex Unit of Physical Medicine and Rehabilitation, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Ciro Villani
- Universitary Department of Anatomic, Histologic, Forensic and Locomotor Apparatus Sciences - Section of Locomotor Apparatus Sciences, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
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Improving Dual-Task Control With a Posture-Second Strategy in Early-Stage Parkinson Disease. Arch Phys Med Rehabil 2018; 99:1540-1546.e2. [PMID: 29608901 DOI: 10.1016/j.apmr.2018.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/12/2018] [Accepted: 02/19/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the task prioritization effects on postural-suprapostural dual-task performance in patients with early-stage Parkinson disease (PD) without clinically observed postural symptoms. DESIGN Cross-sectional study. Participants performed a force-matching task while standing on a mobile platform, and were instructed to focus their attention on either the postural task (posture-first strategy) or the force-matching task (posture-second strategy). SETTING University research laboratory. PARTICIPANTS Individuals (N=16) with early-stage PD who had no clinically observed postural symptoms. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Dual-task change (DTC; percent change between single-task and dual-task performance) of posture error, posture approximate entropy (ApEn), force error, and reaction time (RT). Positive DTC values indicate higher postural error, posture ApEn, force error, and force RT during dual-task conditions compared with single-task conditions. RESULTS Compared with the posture-first strategy, the posture-second strategy was associated with smaller DTC of posture error and force error, and greater DTC of posture ApEn. In contrast, greater DTC of force RT was observed under the posture-second strategy. CONCLUSIONS Contrary to typical recommendations, our results suggest that the posture-second strategy may be an effective dual-task strategy in patients with early-stage PD who have no clinically observed postural symptoms in order to reduce the negative effect of dual tasking on performance and facilitate postural automaticity.
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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]
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Yang PH, Zhu JX, Huang YD, Zhang XY, Lei P, Bush AI, Xiang Q, Su ZJ, Zhang QH. Human Basic Fibroblast Growth Factor Inhibits Tau Phosphorylation via the PI3K/Akt-GSK3β Signaling Pathway in a 6-Hydroxydopamine-Induced Model of Parkinson's Disease. NEURODEGENER DIS 2016; 16:357-69. [PMID: 27228974 DOI: 10.1159/000445871] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Basic fibroblast growth factor (bFGF) has been increasingly investigated due to its neuroprotection in neurodegenerative disorders. Because there are still no cures for any of these disorders, it is crucial to identify new therapeutic targets and screen potential drugs. The increased phosphorylation of tau at Ser396 leads to intracellular tau accumulation, which forms neurofibrillary tangles in Parkinson's disease (PD). In this study, neuroprotection by bFGF was observed, and the mechanisms related to its regulation of phosphorylated tau were investigated. METHODS bFGF-loaded liposome carriers were intranasally administered to rats. The neuroprotective effects of bFGF were assessed in a PD model induced by 6-hydroxydopamine (6-OHDA) in vivo and in vitro. The phosphorylation of tau was measured, and the PI3K/Akt-GSK3β signaling pathway was investigated. RESULTS Our study demonstrated that liposomes markedly assisted in the delivery of bFGF to the striatum and substantia nigra of rats and enhanced the neuroprotective effects of bFGF on dopaminergic neurons. bFGF treatment significantly ameliorated the behavioral deficits induced by 6-OHDA, rescued the loss of tyrosine hydroxylase-positive neurons and increased the number of Nissl bodies. bFGF reduced the phosphorylation of tau and GSK3β and increased the phosphorylation of PI3K/Akt. CONCLUSION Liposomes markedly assisted in the delivery of bFGF to the brain and enhanced the neuroprotective effects of bFGF by inhibiting the phosphorylation of tau. bFGF down-regulated the phosphorylation of tau by increasing the phosphorylation of GSK3β via the PI3K/Akt signaling pathway. These findings provide a new vision of bFGF as a potential therapy for PD.
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Affiliation(s)
- Peng-Hui Yang
- Institute of Biomedicine and National Engineering Research Center of Genetic Medicine, Jinan University, Guangzhou, China
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Foongsathaporn C, Panyakaew P, Jitkritsadakul O, Bhidayasiri R. What daily activities increase the risk of falling in Parkinson patients? An analysis of the utility of the ABC-16 scale. J Neurol Sci 2016; 364:183-7. [DOI: 10.1016/j.jns.2016.03.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 11/29/2022]
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Mazzone P, Vilela Filho O, Viselli F, Insola A, Sposato S, Vitale F, Scarnati E. Our first decade of experience in deep brain stimulation of the brainstem: elucidating the mechanism of action of stimulation of the ventrolateral pontine tegmentum. J Neural Transm (Vienna) 2016; 123:751-767. [DOI: 10.1007/s00702-016-1518-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 01/28/2016] [Indexed: 12/19/2022]
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