Asymmetric dynamic center-of-pressure in Parkinson's disease

Spatiotemporal, kinematic and kinetic gait characteristics in Parkinson's disease compared to healthy individuals: A systematic review with meta-analysis

BACKGROUND

Gait disorders are frequently reported in individuals with Parkinson's disease (PD). Despite extensive research, the specific gait features affected by PD remain inadequately defined. Therefore, this study aimed to investigate kinematic, kinetic, and spatiotemporal parameters of gait in individuals with PD compared to healthy controls.

METHODS

We conducted a systematic review in PubMed, CINAHL, and EMBASE up to March 2024 to retrieve studies assessing adults with PD, which examined gait compared to healthy controls. Two reviewers independently performed the screening process, extrapolation data and quality assessment. Studies were meta-analyzed using original units of measurement (mean difference, MD) to enhance the clinical understanding of the gait characteristics. The level of evidence was provided.

FINDINGS

Thirty-four studies were included (n = 1533 participants with PD and n = 1093 healthy controls). Moderate-to-strong evidence was found for reduced speed (MD:-0.21 m/s, 95 %CI: -0.27; -0.15), stride length (MD:-0.17 m, 95 %CI: -0.25; -0.09), swing time (MD:-1.16 % of gait cycle, 95 %CI: -2.30; -0.02), and sagittal range of motion of the lower limb joints in individuals with PD (hip: MD:-5.39°, 95 %CI: -10.42; -0.37; knee: MD:-11.05°, 95 %CI: -21.88; -0.22; ankle: MD:-4.03°, 95 %CI: -6.37; -1.69). An increase in double support time (MD:0.07 s, 95 %CI: 0.05; 0.10) and a decrease in cadence (MD: -4.93 steps/min, 95 %CI: -7.89; -1.98) were observed. Kinetic data showed diverse outcomes, making a meta-analysis not possible.

INTERPRETATION

PD is associated with changes in gait kinematics and spatiotemporal parameters, while kinetic aspects remain under investigated. Future research should focus on kinetics, joint angular velocity, and push-off parameters. PROSPERO registration: CRD42022347368.

Force-sensing treadmill gait analysis system can detect gait abnormalities in haemophilia patients without arthropathy

BACKGROUND

Joint damage in patients with haemophilia (PwH) is commonly assessed by imaging, but few reports have described how structural changes in joints, for example, haemophilic arthropathy (HA)-affect gait ability.

OBJECTIVES

We evaluated gait function among PwH with HA, PwH without HA, and people without haemophilia (non-PwH) using a Zebris FDM-T treadmill (FDM-T), an easy-to-use gait assessment instrument with a force sensor matrix.

METHODS

The following gait parameters were collected: centre of pressure trajectory intersection (COPi) anterior/posterior variability, COPi lateral variability, COPi anterior/posterior symmetry, COPi lateral symmetry, single-limb support line (SLSL) length, and SLSL variability. Participants walked at their typical gait speed. The physical function of the PwH was assessed by the Hemophilia Joint Health Score (HJHS). Parameters were compared among the three groups.

RESULTS

Twelve PwH with HA, 28 PwH without HA, and 12 non-PwH were enrolled. Gait speed significantly differed between groups (non-PwH, 3.1 ± 0.7; PwH without HA, 2.0 ± 0.7; PwH with HA; 1.5 ± 0.4). The COPi anterior/posterior variability, COPi lateral variability, SLSL length, and SLSL variability were greater in the PwH groups than in the non-PwH group. The COPi lateral symmetry differed between PwH with HA and the other groups. The HJHS was not correlated with gait parameters among PwH with HA.

CONCLUSIONS

Gait parameters and speed were abnormal in both PwH with HA and PwH without HA. The FDM-T can be used to identify early stages of physical dysfunction that cannot be detected by conventional functional assessments such as the HJHS.

Distinguishing features of Parkinson's disease fallers based on wireless insole plantar pressure monitoring

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.

Laser-light cueing shoes with integrated foot pressure and inertial sensing for investigating the impact of visual cueing on gait characteristics in Parkinson's disease individuals

Gait disorders are a fundamental challenge in Parkinson's disease (PD). The use of laser-light visual cues emitted from shoes has demonstrated effective in improving freezing of gait within less restrictive environments. However, the effectiveness of shoes-based laser-light cueing may vary among individuals with PD who have different types of impairments. We introduced an innovative laser-light visual shoes system capable of producing alternating visual cues for the left and right feet through one-side cueing at a time, while simultaneously recording foot inertial data and foot pressures. The effects of this visual cueing system on gait patterns were assessed in individuals with PD, both those with well-gait and those with worse-gait. Our device successfully quantified gait characteristics, including the asymmetry in the center of pressure trajectory, in individuals with PD. Furthermore, visual cueing prolonged stride times and increased the percentage of stance phase, while concurrently reducing stride length in PD individuals with well-gait. Conversely, in PD individuals with worse-gait, visual cueing resulted in a decreased freeze index and a reduction in the proportion of intervals prone to freezing episodes. The effects of visual cueing varied between PD individuals with well-gait and those with worse-gait. Visual cueing slowed down gait in the well-gait group while it appeared to mitigate freezing episodes in worse-gait group. Future researches, including enhancements to extend the projection distance of visual cues and clinical assessments conducted in real-world settings, will help establish the clinical utility of our proposed visual cueing system.

Effects of wearable visual cueing on gait pattern and stability in patients with Parkinson’s disease

The present study examined the effects of wearable visual cues, provided by a wearable laser device, on the gait pattern and stability in patients with Parkinson’s disease (PD). In total, 18 patients with a clinical diagnosis of idiopathic PD (Hoehn and Yahr stage II-III) and 18 healthy controls were included. The main outcome measures included spatiotemporal parameters, sagittal plane kinematic parameters of joints in lower limbs, and dynamic center of pressure (COP) parameters. Significant intra-group improvement in gait parameters was observed in PD patients. Compared with that at baseline, the gait pattern improved in PD patients under the cued condition, with longer stride length and higher toe clearance, as well as shortening of double stance phase, especially the stride length, double stance phase and toe clearance were not significantly different between cued condition and healthy control groups. In kinematics, the ankle peak dorsiflexion in swing phase and the hip range of motion (ROM) in gait cycle was significantly improved in PD patients with visual cues and close to healthy controls. Decreased anteroposterior (AP) position of COP improved gait stability in patients with PD under the cued condition. Multiple linear regression analysis showed that the AP position has a negative correlation with ankle peak dorsiflexion in swing phase. Pearson’s correlation coefficients showed that the minimum toe clearance (Mini TC) was positively correlated with the ankle peak dorsiflexion in swing phase. The immediate effect of wearable visual cues improved the gait pattern and stability in PD patients, suggesting that it may be effective when applied as an alternative technique in rehabilitation training for PD patients.

Centre of pressure during walking after unilateral transfemoral amputation

Lower-limb amputation imposes a health burden on amputees; thus, gait assessments are required prophylactically and clinically, particularly for individuals with unilateral transfemoral amputation (UTFA). The centre of pressure (COP) during walking is one of the most useful parameters for evaluating gait. Although superimposed COP trajectories reflect the gait characteristics of individuals with neurological disorders, the quantitative characteristics based on the COP trajectories of individuals with UTFA remain unclear. Thus, these COP trajectories were investigated across a range of walking speeds in this study. The COP trajectories were recorded on a split-belt force-instrumented treadmill at eight walking speeds. Asymmetry and variability parameters were compared based on the COP trajectories of 25 individuals with UTFA and 25 able-bodied controls. The COP trajectories of the individuals with UTFA were significantly larger in lateral asymmetry and variability but did not show significant differences in anterior-posterior variability compared with those of the able-bodied controls. Further, the individuals with UTFA demonstrated larger lateral asymmetry at lower speeds. These results suggest that (1) individuals with UTFA adopt orientation-specific balance control strategies during gait and (2) individuals with UTFA could also be exposed to a higher risk of falling at lower walk speeds.

Impact of Parkinson’s Disease on Functional Mobility at Different Stages

Introduction

Specific functional assessments to determine the progression of Parkinson’s Disease (PD) are important to slow down such progression and better plan rehabilitation. This study aimed to explore possible differences in the performance of different functional tasks included in a mobility test using sensors embedded in an Android device, in people at different PD stages.

Materials and Methods

Eighty-seven participants with PD agreed to participate in this cross-sectional study. They were assessed once using an inertial sensor and variables related to functional status were recorded (i.e., MLDisp, APDisp, DispA, Vrange, MLRange, PTurnSit, PStand, TTime, and RTime).

Results

There was significant impairment of the vertical range during gait between stages I and II. Further, when stages II and III were compared, the sit-to-stand power was significantly impaired, and the total time required to complete the test increased significantly (p < 0.05). Even more significant differences were obtained when stages I and III were compared, in particular, dysfunction in postural control, vertical range, sit to stand power and total time. Finally, there were no significant differences between stages in the medial-lateral displacements and reaction time (p > 0.05).

Conclusion

Functional mobility becomes more significantly impaired in the PD population as the PD stages progress. This implies impaired postural control, decreased ability to sit down or stand up from a chair, increased metabolic cost during walking, and overall slowing-down of motor function.

Fall Risk Assessment for the Elderly Based on Weak Foot Features of Wearable Plantar Pressure

The high fall rate of the elderly brings enormous challenges to families and the medical system; therefore, early risk assessment and intervention are quite necessary. Compared to other sensor-based technologies, in-shoe plantar pressure sensors, effectiveness and low obtrusiveness are widely used for long-term fall risk assessments because of their portability. While frequently-used bipedal center-of-pressure (COP) features are derived from a pressure sensing platform, they are not suitable for the shoe system or pressure insole owing to the lack of relative position information. Therefore, in this study, a definition of "weak foot" was proposed to solve the sensitivity problem of single foot features and facilitate the extraction of temporal consistency related features. Forty-four multi-dimensional weak foot features based on single foot COP were correspondingly extracted; notably, the relationship between the fall risk and temporal inconsistency in the weak foot were discussed in this study, and probability distribution method was used to analyze the symmetry and temporal consistency of gait lines. Though experiments, foot pressure data were collected from 48 subjects with 24 high risk (HR) and 24 low risk (LR) ones obtained by the smart footwear system. The final models with 87.5% accuracy and 100% sensitivity on test data outperformed the base line models using bipedal COP. The results and feature space shown the novel features of wearable plantar pressure could comprehensively evaluate the difference between HR and LR groups. Our fall risk assessment models based on these features had good generalization performance, and showed practicability and reliability in real-life monitoring situations.

Chiropractic care for low back pain, gait and posture in a patient with Parkinson's disease: a case report and brief review

Parkinson's disease (PD) is a progressive neurological disorder with cardinal motor features of tremor, bradykinesia, muscle rigidity, impaired gait and posture. Muscular pain or arthralgia is a common non-motor symptom in PD. The PD-related pain is probably attributed to a combination of altered posture, abnormal muscle tone, and truncal dystonia. A 59-year-old male taxi-driver with PD treated with levodopa for 18 months complained of progressive low back pain and gait difficulties that prevented him from normal activities in the past 2 months. Magnetic resonance imaging showed degenerative disc disease with multiple levels of bulging discs in the lumbar spine. After 35 chiropractic sessions, there was a significant improvement in various aspects of well-being, including pain resolution measured by a numeric rating scale, physical and mental improvement measured by the Parkinson's Disease Questionnaire, gait stability depicted by gait cyclogram, and better postural alignment and stability assessed by radiographic parameters. The current study may serve as an example of spinal manipulation showing the potential to address gait and posture problems associated with pain in a patient with PD. Aging changes in the muscles, bones and joints may accompany PD. Although PD itself is an incurable neurodegenerative disease, functional capacity of the musculoskeletal system can be enhanced by different types of manual therapy, by means of improving muscle strength, joint mobility, and postural balance. The actual duration in sustaining improved outcomes following a course of manipulative intervention remains to be determined.

Diagnostic usefulness of 10-step tandem gait test for the patient with degenerative cervical myelopathy

Tandem gait is considered one of the most useful screening tools for gait impairment. The aim of this study is to evaluate diagnostic usefulness of 10-step tandem gait test for the patients with degenerative cervical myelopathy (DCM). Sixty-two DCM patients were compared to 55 persons without gait abnormalities as control. We counted the number of consecutive steps and graded into five according the number of steps and stability. Five grades of tandem gait were investigated for association with clinical parameters including qualitative Japanese orthopedic association (JOA) sub-score for lower extremities and Nurick scale and quantitative balance and gait assessments. The number of tandem steps were reduced and the grades of tandem gait were differently distributed in the DCM patients compared to controls (steps, 7.1 ± 3.6 versus 9.9 ± 0.4, p < 0.001; grades of 0/1/2/3/4/5, 1/13/14/15/19 versus 0/0/2/15/38, p < 0.001 in patients with DCM and control respectively). Patients with DCM showed more unstable balance and abnormal gait features including slower velocity, shorter strides, wider bases with increased stance phase of a gait cycle compared to the control group. The grades of tandem gait were correlated with JOA sub-score (r = 0.553, p < 0.001) and the Nurick scale (r = - 0.652, p < 0.001) as well as both balance and gait parameters. In DCM patients, tandem gait was impaired and correlated with severity of gait abnormality. The authors believe that 10-step tandem gait test is an objective and useful screening test for evaluating gait disturbance in patients with DCM.