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Jovanovic L, Damaševičius R, Matic R, Kabiljo M, Simic V, Kunjadic G, Antonijevic M, Zivkovic M, Bacanin N. Detecting Parkinson's disease from shoe-mounted accelerometer sensors using convolutional neural networks optimized with modified metaheuristics. PeerJ Comput Sci 2024; 10:e2031. [PMID: 38855236 PMCID: PMC11157549 DOI: 10.7717/peerj-cs.2031] [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: 01/19/2024] [Accepted: 04/09/2024] [Indexed: 06/11/2024]
Abstract
Neurodegenerative conditions significantly impact patient quality of life. Many conditions do not have a cure, but with appropriate and timely treatment the advance of the disease could be diminished. However, many patients only seek a diagnosis once the condition progresses to a point at which the quality of life is significantly impacted. Effective non-invasive and readily accessible methods for early diagnosis can considerably enhance the quality of life of patients affected by neurodegenerative conditions. This work explores the potential of convolutional neural networks (CNNs) for patient gain freezing associated with Parkinson's disease. Sensor data collected from wearable gyroscopes located at the sole of the patient's shoe record walking patterns. These patterns are further analyzed using convolutional networks to accurately detect abnormal walking patterns. The suggested method is assessed on a public real-world dataset collected from parents affected by Parkinson's as well as individuals from a control group. To improve the accuracy of the classification, an altered variant of the recent crayfish optimization algorithm is introduced and compared to contemporary optimization metaheuristics. Our findings reveal that the modified algorithm (MSCHO) significantly outperforms other methods in accuracy, demonstrated by low error rates and high Cohen's Kappa, precision, sensitivity, and F1-measures across three datasets. These results suggest the potential of CNNs, combined with advanced optimization techniques, for early, non-invasive diagnosis of neurodegenerative conditions, offering a path to improve patient quality of life.
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Affiliation(s)
- Luka Jovanovic
- Faculty of Technical Sciences, Singidunum University, Belgrade, Serbia
| | | | - Rade Matic
- Department for Information Systems and Technologies, Belgrade Academy for Business and Arts Applied Studies, Belgrade, Serbia
| | - Milos Kabiljo
- Department for Information Systems and Technologies, Belgrade Academy for Business and Arts Applied Studies, Belgrade, Serbia
| | - Vladimir Simic
- Faculty of Transport and Traffic Engineering, University of Belgrade, Belgrade, Serbia
- College of Engineering, Department of Industrial Engineering and Management, Yuan Ze University, Taoyuan City, Taiwan
| | - Goran Kunjadic
- Higher Colleges of Technology, Abu Dhabi, United Arab Emirates
| | - Milos Antonijevic
- Faculty of Informatics and Computing, Singidunum University, Belgrade, Serbia
| | - Miodrag Zivkovic
- Faculty of Informatics and Computing, Singidunum University, Belgrade, Serbia
| | - Nebojsa Bacanin
- Faculty of Informatics and Computing, Singidunum University, Belgrade, Serbia
- MEU Research Unit, Middle East University, Amman, Jordan
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Harro CC, Horak I, Valley K, Wagner D. Nordic walking training in persons with Parkinson's disease: Individualized prescription-A case series. Physiother Theory Pract 2023; 39:2208-2222. [PMID: 35451933 DOI: 10.1080/09593985.2022.2063211] [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: 08/18/2021] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Physical therapy interventions for patients with Parkinson's disease prioritize task-specific exercise to address gait and motor dysfunction. Nordic walking (NW) is a moderate intensity exercise promoting walking speed and rhythm. This case series describes the application of customized NW training in individuals with varied severity of Parkinson's gait dysfunction and the outcomes specific to gait, motor and non-motor symptoms; and NW engagement and retention in the follow-up phase. CASE DESCRIPTION Three individuals with idiopathic PD (two males and one female; ages 59-69; Hoehn & Yahr stages II-III) participated. Supervised NW training phase included 15 one-hour sessions over 6-weeks, individually progressed for each participant. During the 3-month follow-up phase independent NW exercise was prescribed 3 times a week. Primary outcome measures examined gait function and impairment-based measures assessed Parkinson's motor and nonmotor symptoms. OUTCOMES Participants improved in: 10-Meter walk-fast speed (0.13, 0.18, 0.15 m/s; respectively); 6-Minute Walk distance (137.5, 56.4, 129.4 m, respectively); Unified Parkinson's Disease Rating Scale-Motor Score (-6, -7, -14, respectively); and all Timed-Up-Go subtests. Participant 2 had 44.4% decline in freezing episodes and reduced fall rate. Participants' gains were retained at the 3-month follow-up. DISCUSSION This case series suggests that NW has therapeutic benefits for three individuals with varied Parkinson's gait dysfunction. Independent NW exercise was sustained post-training and motor and gait function gains were retained.
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Affiliation(s)
- Cathy C Harro
- Department of Physical Therapy, Cook-DeVos Center for Health Sciences, Grand Valley State University, Grand Rapids, MI, USA
| | - Ian Horak
- Department of Physical Therapy, Cook-DeVos Center for Health Sciences, Grand Valley State University, Grand Rapids, MI, USA
| | - Karlee Valley
- Department of Physical Therapy, Cook-DeVos Center for Health Sciences, Grand Valley State University, Grand Rapids, MI, USA
| | - Drew Wagner
- Department of Physical Therapy, Cook-DeVos Center for Health Sciences, Grand Valley State University, Grand Rapids, MI, USA
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Liu M, Kang N, Wang D, Mei D, Wen E, Qian J, Chen G. Analysis of Lower Extremity Motor Capacity and Foot Plantar Pressure in Overweight and Obese Elderly Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3112. [PMID: 36833807 PMCID: PMC9965343 DOI: 10.3390/ijerph20043112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Overweight, obesity and falls are major public health problems and old people are the biggest group suffering falls. METHODS 92 females were divided into the overweight or obesity (O) group (68.85 ± 3.85) and regular-weight (R) group (67.90 ± 4.02). Lower extremity motor capacity and plantar pressure were compared between the two groups. The IRB approval number is 20190804. RESULTS (1) Functional Movement Screen and Fugl-Meyer Assessment scores in the O group were significantly lower than in the R group. The time to complete the Timed Up and Go test in the O group was significantly longer than in the R group. (2) Foot flat phase, double support distance, and left foot axis angle in the O group were significantly higher than in the R group. Distance and velocity, left-foot minimum subtalar joint angle and right-foot maximum subtalar joint angle in the O group were significantly shorter than in the R group. (3) Peak force, average force and pressure of metatarsal 1-4, mid-foot, heel medial and lateral, peak pressure of metatarsal l, midfoot, heel medial and lateral in the O group were significantly higher than in the R group. (p < 0.05). CONCLUSIONS Overweight and obese elderly women have a lower sensorimotor function, flexibility and stability in functional movements, but higher loads on the foot.
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Affiliation(s)
- Min Liu
- Institute of Population Research, Peking University, Beijing 100871, China
| | - Ning Kang
- Institute of Population Research, Peking University, Beijing 100871, China
| | - Dongmin Wang
- Department of Physical Education, Peking University, Beijing 100871, China
| | - Donghui Mei
- College of Psychology, Capital Normal University, Beijing 100048, China
| | - Erya Wen
- Department of Physical Education, Peking University, Beijing 100871, China
| | - Junwei Qian
- Department of Physical Education, Peking University, Beijing 100871, China
| | - Gong Chen
- Institute of Population Research, Peking University, Beijing 100871, China
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Harro CC, Shoemaker MJ, Coatney CM, Lentine VE, Lieffers LR, Quigley JJ, Rollins SG, Stewart JD, Hall J, Khoo SK. Effects of nordic walking exercise on gait, motor/non-motor symptoms, and serum brain-derived neurotrophic factor in individuals with Parkinson's disease. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1010097. [PMID: 36311206 PMCID: PMC9614339 DOI: 10.3389/fresc.2022.1010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
Objective The primary purpose of this study was to investigate the immediate and long-term effects of Nordic Walking (NW) exercise on walking function, motor/non-motor Parkinson's Disease (PD) symptoms, and serum brain-derived neurotrophic factor (BDNF) in persons with idiopathic PD. Methods Twelve community-dwelling participants with mild to moderate idiopathic PD and varied degrees of gait dysfunction were recruited for this prospective, repeated measures design that examined clinical measures and BDNF levels at baseline (T0), post-intervention (T1) and 3-month follow-up (T2). Participants engaged in 6 weeks of supervised NW exercise training with individualized instruction, followed by 14 weeks of independent NW exercise with remote coaching. Outcome measurements included daily step counts, 6-Minute Walk Test (6-MinWT), 10-Meter Walk Test (10MWT), spatiotemporalparameters, Timed Up and Go Test (TUG), dual-task TUG, Revised-Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Revised-Freezing of Gait Questionnaire, MDS-Nonmotor Symptom scale (NMS), Parkinson's Fatigue Scale, and serum BDNF levels. The Friedman test with post hoc Wilcoxon sign-ranked pairwise comparisons were used to compare baseline to T1, baseline to T2, and T1 to T2 timepoints with a Benjamini-Hockberg correction applied. Results Statistically significant improvements found post-training and retained at 3-month follow-up included 6-MinWT, daily step count, 10mWT, MDS-UPDRS, and TUG with effect sizes of 0.57 to 1.03. Serum BDNF at T2 was significantly greater than T0 and T1. Although no statistically significant improvements were observed in the MDS-NMS, 9 of 12 participants had improved non-motor symptoms. There was good adherence, sustained independent exercise engagement, and no adverse events over the 5-month study duration. Conclusions This study demonstrated that NW exercise was a safe, feasible, and sustainable mode of aerobic exercise for this sample of participants with varied Parkinson's disease duration and severity. Following an individualized and progressive NW training intervention, significant improvements in walking function, daily activity level, and motor function were observed. Following the supervised NW training phase, independent three-month engagement in NW exercise was sustained with long-term retention of these clinical improvements and an increase in serum BDNF levels over this five-month NW exercise trial. Impact Nordic walking exercise may be a safe, feasible and sustainable mode of independent exercise for improving daily ambulatory activity, gait and motor function, and serum BDNF in individuals with mild to moderate PD with varied gait abilities. Clinical Trials Registry ID 20-101-H.
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Affiliation(s)
- Cathy C. Harro
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States,Correspondence: Cathy Harro
| | - Michael J Shoemaker
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Cassandra M. Coatney
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Valerie E. Lentine
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Lillian R. Lieffers
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Jessica J. Quigley
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Shannon G. Rollins
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Jonathan D. Stewart
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, MI, United States
| | - Julie Hall
- Department of Medical Laboratory Science, Grand Valley State University, Grand Rapids, MI, United States
| | - Sok Kean Khoo
- Department of Cell and Molecular Biology, Grand Valley State University, Grand Rapids, MI, United States
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Wang L, Peng JL, Ou-Yang JB, Gan L, Zeng S, Wang HY, Zuo GC, Qiu L. Effects of Rhythmic Auditory Stimulation on Gait and Motor Function in Parkinson's Disease: A Systematic Review and Meta-Analysis of Clinical Randomized Controlled Studies. Front Neurol 2022; 13:818559. [PMID: 35493833 PMCID: PMC9053573 DOI: 10.3389/fneur.2022.818559] [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: 11/19/2021] [Accepted: 03/14/2022] [Indexed: 11/15/2022] Open
Abstract
Objective This study aimed to summarize the effectiveness of rhythmic auditory stimulation (RAS) for the treatment of gait and motor function in Parkinson's disease (PD) through a systematic review and meta-analysis. Methods All studies were retrieved from eight databases. The effects of RAS on PD were determined using the following indicators: gait parameters including step length, stride width, step cadence, velocity, stride length; motor function including 6 min walk test (6MWT) and timed up-and-go test (TUGT); the Unified Parkinson's Disease Rating Scale (UPDRS); and the Berg Balance Scale (BBS). The risk map of bias of the quality of the studies and the meta-analysis results of the indicators was prepared with RevMan 5.2 software. Results Twenty-one studies were included in the systematic review, and 14 studies were included in the meta-analysis. In the meta-analysis, the results of gait parameters, namely, velocity, step length, and stride length, were statistically significant (P < 0.05), whereas the results of cadence and stride width were not statistically significant (P ≧ 0.05). The results of 6MWT and TUGT for motor function as well as UPDRS-II, UPDRS-III, and BBS were statistically significant (P < 0.05). Conclusions RAS could improve gait parameters, walking function, balance function, and daily living activities of individuals with PD. The application of RAS in conventional rehabilitation approaches can enhance motor performance in PD. Future studies should use a large sample size and a rigorous design to obtain strong conclusions about the advantages of RAS for the treatment of gait and motor function in PD.
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Affiliation(s)
- Lei Wang
- Department of Rehabilitation Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
- *Correspondence: Lei Wang
| | - Jin-lin Peng
- Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jian-bin Ou-Yang
- Department of Pain, Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, China
| | - Li Gan
- Sichuan Rehabilitation Hospital Affiliated of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shuai Zeng
- Department of Pain, Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, China
| | - Hong-Yan Wang
- Sichuan Rehabilitation Hospital Affiliated of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Guan-Chao Zuo
- Sichuan Rehabilitation Hospital Affiliated of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ling Qiu
- Department of Pain, Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, China
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Vitório R, El-Gohary M, Pearson S, Carlson-Kuhta P, Harker G, Horak FB, Lapidus J, Studer M, Mancini M. Effectiveness of the Mobility Rehab System for Mobility Training in Older Adults: A Pragmatic Clinical Trial. Front Neurol 2021; 12:680637. [PMID: 34552549 PMCID: PMC8451718 DOI: 10.3389/fneur.2021.680637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/27/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction: Mobility impairments are among the main causes of falls in older adults and patients with neurological diseases, leading to functional dependence and substantial health care costs. Feedback-based interventions applied in controlled, laboratory environments have shown promising results for mobility rehabilitation, enhancing the benefits of standard therapy. However, the effectiveness of sensor-based feedback to improve gait in actual outpatient physical therapy settings is unknown. The proposed trial examines the effectiveness of a physical therapist-assisted, visual feedback system using wearable inertial sensors, Mobility Rehab, for mobility training in older adults with gait disturbances in an outpatient clinic. Methods: The study is a single site, pragmatic clinical trial in older adults with gait disturbances. Two hundred patients undergoing their outpatient rehabilitation program are assigned, by an independent assistant, for screening by one of four therapists, and assigned to either a standard physical therapy or therapist-assisted feedback therapy. Both groups train twice a week for 6 weeks. Four physical therapists were randomized and stratified by years of experience to deliver standard therapy or therapist-assisted feedback rehabilitation. Each session is 45 min long. Gait is trained for 30 min. The additional 15 min include exercises for endurance, strength, and static and dynamic balance in functional tasks. Mobility Rehab uses unobtrusive, inertial sensors on the feet and belt with real-time algorithms to provide real-time feedback on gait metrics (i.e., gait speed, double support time, foot clearance, angle at foot strike, and arm swing), which are displayed on a hand-held monitor. Blinded assessments are carried out before and after the intervention. The primary outcome measure is subjects' perception of balance as measured by the Activities-specific Balance Confidence scale. Gait speed, as measured with wearable inertial sensors during walking, is the secondary outcome measure. Discussion: We hypothesize that therapist-assisted feedback rehabilitation will be more effective than standard rehabilitation for gait. Feedback of motor performance plays a crucial role in rehabilitation and objective characterization of gait impairments by Mobility Rehab has the potential to improve the accuracy of patient-specific gait feedback. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03869879.
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Affiliation(s)
- Rodrigo Vitório
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Mahmoud El-Gohary
- APDM Wearable Technologies – an ERT Company, Portland, OR, United States
| | - Sean Pearson
- APDM Wearable Technologies – an ERT Company, Portland, OR, United States
| | - Patricia Carlson-Kuhta
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Graham Harker
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Fay B. Horak
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States,APDM Wearable Technologies – an ERT Company, Portland, OR, United States
| | - Jodi Lapidus
- Biostatistics and Design Program Core, Oregon Health and Science University, Portland, OR, United States
| | - Mike Studer
- Northwest Rehabilitation Associates, Salem, OR, United States
| | - Martina Mancini
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States,*Correspondence: Martina Mancini
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Music as Add-On Therapy in the Rehabilitation Program of Parkinson's Disease Patients-A Romanian Pilot Study. Brain Sci 2021; 11:brainsci11050569. [PMID: 33946687 PMCID: PMC8145473 DOI: 10.3390/brainsci11050569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/24/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
Music has been proven to have therapeutic potential in neurological disorders, especially Parkinson’s disease (PD), since rhythmic auditory cueing can partially replace the progressive loss of rhythmicity and automaticity. Several reports have highlighted improvements in motor outcomes in PD patients undergoing music therapy, but only a few studies have evaluated non-motor outcomes, such as quality of life (QoL), which deteriorates with disease progression. The current pilot study aims to examine the effects of a multimodal rehabilitation program centered on physical therapy combined with listening to music on self-reported QoL in people with PD, compared to the same rehabilitation program alone. The study was conducted on patients with idiopathic PD who attended a specific rehabilitation program with a duration of 2.5 h daily for 14 days. The patients were divided into the study group (16 patients), who listened to background music during the rehabilitation program sessions, and the control group who did not listen to music during sessions. The patients were assessed using the self-report Parkinson’s Disease Questionnaire (PDQ-39) at the beginning of the program and 1 month after its initiation. The patients in the study group registered greater improvements in five of the eight areas of life assessed by PDQ-39 compared to the control group. In conclusion, listening to music combined with a multimodal rehabilitation program centered on physical therapy may be beneficial for the patients’ quality of life.
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Zhu Y, Lu W, Wang Y, Yang J, Gan W. Extraction and selection of gait recognition features using skeleton point detection and improved fuzzy decision. Med Eng Phys 2020; 84:161-168. [PMID: 32977914 DOI: 10.1016/j.medengphy.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 01/29/2023]
Abstract
It is of great importance to effectively measure gait features and recognize the signature gait patterns for gait rehabilitation. In this work, we used a skeleton point detection to extract gait features and proposed an improved fuzzy decision to select the most significant features for classifying gait patterns. Thirteen gait recognition features were extracted from the obtained skeleton points data. Taking the extracted features as an input, our improved fuzzy similarity priority decision method has obtained important sequences of all features based on the relatively important scores. Then, the ranked features were delivered in different classifiers by a sequential forward selection strategy to select the optimal feature subset. There were significant differences between groups in each of the thirteen gait recognition features (p < 0.005), indicating that all extracted features are potential influence factors for classifying gait patterns. We also found that the highest classification accuracy of 100% for gait feature subsets included the stride frequency, maximum flexion angle of knee, and toe-out angle, on the all classifiers. The results suggest that the proposed approaches are very useful in searching for the optimal feature subset in present dataset.
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Affiliation(s)
- Yean Zhu
- Bioengineering College, Chongqing University, Chongqing, China; School of Transportation and Logistics, East China Jiaotong University, Nanchang, China
| | - Wei Lu
- Department of Rehabilitation Medicine, Jiangxi Provincial People's Hospital, Nanchang, China.
| | - Yong Wang
- School of Mechanical Engineering, HeFei University of Technology, HeFei, China
| | - Jingjing Yang
- School of Public Health and Management, Chongqing Medical University, Chongqing, China.
| | - Weihua Gan
- School of Transportation and Logistics, East China Jiaotong University, Nanchang, China
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Gooßes M, Saliger J, Folkerts AK, Nielsen J, Zierer J, Schmoll P, Niepold A, Colbach L, Leemhuis J, Engels L, van Krüchten M, Ophey A, Allert N, Karbe H, Kalbe E. Feasibility of Music-Assisted Treadmill Training in Parkinson's Disease Patients With and Without Deep Brain Stimulation: Insights From an Ongoing Pilot Randomized Controlled Trial. Front Neurol 2020; 11:790. [PMID: 33013612 PMCID: PMC7498575 DOI: 10.3389/fneur.2020.00790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/25/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Music-assisted treadmill training (MATT) is a new therapeutic approach for Parkinson's disease (PD) patients, combining treadmill training with rhythmic auditory cueing and visual feedback. PD studies have shown larger positive effects on motor outcomes than usual treadmill training. However, effects on cognition, in contrast, are less clear. Existing studies provided intensive training protocols and included only stable medicated patients. Thus, a pilot randomized controlled trial was designed to analyze the feasibility of a shorter training protocol as well as preliminary effects on cognition, motor function, and patient-centered outcomes in a rehabilitation setting where PD patients with and without deep brain stimulation (DBS) undergo adaptation of medication and DBS settings. Here, we present the results from the feasibility analysis of the still ongoing trial. Methods: Non-demented PD patients with and without DBS were recruited during their inpatient rehabilitation and randomized to an experimental group (EG; 20 min MATT) or an active control group (CG; 20 min bike ergometer training). The trainings took place for 8 consecutive days and were added to the usual rehabilitation. Feasibility was assessed with the following parameters: patients' study protocol acceptance, study protocol transferability into clinical routine, training-induced adverse events, and patients' training perception. Results: Thirty-two patients (EG: n = 15; CG: n = 17; 72% DBS) were included. The study protocol was well-accepted (inclusion rate: 84%). It was transferable into clinical routines; dropout rates of 40% (EG) and 18% (CG) were observed. However, an in-depth analysis of the dropout cohort did not reveal intervention-related dropout reasons. The MATT and the standard ergometer training showed no adverse events and were positively perceived by PD patients with and without DBS. Conclusion: MATT was shown to be a feasible, safe, and enjoyable treatment option in PD patients with and without DBS. Furthermore, the dropout cohort analysis revealed some exciting first insights into possible dropout reasons that go beyond the form of intervention. Therefore, research would benefit from a common practice of dropout analyses, as this would enhance our understanding of patients' therapy adherence and expectations.
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Affiliation(s)
- Mareike Gooßes
- Medical Psychology
- Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Neurological Rehabilitation Center Godeshoehe, Bonn, Germany
| | - Jochen Saliger
- Neurological Rehabilitation Center Godeshoehe, Bonn, Germany
| | - Ann-Kristin Folkerts
- Medical Psychology
- Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jörn Nielsen
- Neurological Rehabilitation Center Godeshoehe, Bonn, Germany
| | - Jürgen Zierer
- Neurological Rehabilitation Center Godeshoehe, Bonn, Germany
| | - Paula Schmoll
- Medical Psychology
- Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Neurological Rehabilitation Center Godeshoehe, Bonn, Germany
| | - Annika Niepold
- Medical Psychology
- Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Liz Colbach
- Medical Psychology
- Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Neurological Rehabilitation Center Godeshoehe, Bonn, Germany
| | - Janna Leemhuis
- Medical Psychology
- Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lea Engels
- Medical Psychology
- Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maria van Krüchten
- Medical Psychology
- Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Neurological Rehabilitation Center Godeshoehe, Bonn, Germany
| | - Anja Ophey
- Medical Psychology
- Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Niels Allert
- Neurological Rehabilitation Center Godeshoehe, Bonn, Germany
| | - Hans Karbe
- Neurological Rehabilitation Center Godeshoehe, Bonn, Germany
| | - Elke Kalbe
- Medical Psychology
- Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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10
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Carvalho LP, Mate KKV, Cinar E, Abou-Sharkh A, Lafontaine AL, Mayo NE. A new approach toward gait training in patients with Parkinson's Disease. Gait Posture 2020; 81:14-20. [PMID: 32650238 DOI: 10.1016/j.gaitpost.2020.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Typically, people with Parkinson's Disease (PD) progress to develop a gait pattern that is characterized by quick, short and shuffling steps. Gait cycle is altered and lacks definition and fluidity. Gait training combined with a variety of feedback modalities for PD are usually based on non-immediate and externally-based cues but none of these provide real-time feedback on gait quality and acquired gains tend to abate shortly after rehabilitation. Based on principals of motor learning, our team has developed the Heel2Toe sensor to provide real-time auditory feedback during gait training. RESEARCH QUESTION Is a short-term training using the Heel2Toe sensor feasible and efficient to improve gait in people with PD? Our objectives are to identify the extent of the immediate response to the feedback within the same session and the carry-over response to training and; 2) to identify patients' perceived effects, pleasures and challenges of using the Heel2Toe. METHODS Single-arm, proof-of-concept study. Six people received five sessions of gait training over a 2-3-week period using the Heel2Toe augmented with mobility exercises as an adjunct to gait training. The main outcomes were technically assessed gait parameters collected over a 2-minute walk test, without and with feedback. Heel2Toe signals were analyzed to extract angular velocity(AV), percentage of good steps, average cadence, and AV coefficient of variation(CV). RESULTS An immediate response to the Heel2Toe use and a carry-over response to the short-term training with the sensor were observed: an increase in AV with a reduction in CV (better heel strike and gait regularity); an increase in %good steps; and a near-optimal and homogeneous cadence (∼100 steps/min), which is equivalent to a moderate-intensity walking. SIGNIFICANCE Gait training using the Heel2Toe sensor is feasible and potentially effective for improving gait quality in people with PD. A definitive trial is a logical next step.
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Affiliation(s)
- Livia P Carvalho
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
| | - Kedar K V Mate
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
| | - Eda Cinar
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
| | - Ahmed Abou-Sharkh
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
| | | | - Nancy E Mayo
- Department of Medicine, School of Physical and Occupational Therapy, McGill University, Center for Outcomes Research and Evaluation, Research Institute-McGill University Health Center, Montreal, H4A 3S5, Canada.
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Mortenson WB, Pysklywec A, Chau L, Prescott M, Townson A. Therapists’ experience of training and implementing an exoskeleton in a rehabilitation centre. Disabil Rehabil 2020; 44:1060-1066. [DOI: 10.1080/09638288.2020.1789765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- W. Ben Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | | | - Leena Chau
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Michael Prescott
- Faculty of Graduate and Postdoctoral Studies, University of British Columbia, Vancouver, Canada
| | - Andrea Townson
- Department of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, Canada
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Baizabal-Carvallo JF, Alonso-Juarez M, Jankovic J. Functional gait disorders, clinical phenomenology, and classification. Neurol Sci 2019; 41:911-915. [PMID: 31832998 DOI: 10.1007/s10072-019-04185-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/29/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Functional gait disorders (FGDs) are relatively common in patients presenting for evaluation of a functional movement disorder (FMD). The diagnosis and classification of FGDs is complex because patients may have a primary FGD or a FMD interfering with gait. METHODS We performed a detailed evaluation of clinical information and video recordings of gait in patients diagnosed with FMDs. RESULTS We studied a total of 153 patients with FMDs, 68% females, with a mean age at onset of 36.4 years. A primary FGD was observed in 39.2% of patients; among these patients, 13 (8.5%) had an isolated FGD (a gait disorder without other FMDs). FMDs presented in 34% of patients with otherwise normal gait. Tremor was the most common FMD appearing during gait, but dystonia was the most common FMD interfering with gait. Patients with FGD had a higher frequency of slow-hesitant gait, astasia-abasia, bouncing, wide-based gait and scissoring compared with patients with FMDs occurring during gait. Bouncing gait with knee buckling was more frequently observed in patients with isolated FGD (P = 0.017). Patients with FGDs had a trend for higher frequency of wheelchair dependency (P = 0.073) than those with FMDs interfering with gait. CONCLUSIONS Abnormal gait may be observed as a primary FGD or in patients with other FMDs appearing during gait; both conditions are common and may cause disability.
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Affiliation(s)
- José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
- Department of Internal Medicine, University of Guanajuato, C.P. 37320, León, Guanajuato, Mexico.
| | | | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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13
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Mate KK, Abou-Sharkh A, Morais JA, Mayo NE. Real-Time Auditory Feedback-Induced Adaptation to Walking Among Seniors Using the Heel2Toe Sensor: Proof-of-Concept Study. JMIR Rehabil Assist Technol 2019; 6:e13889. [PMID: 31825320 PMCID: PMC6931056 DOI: 10.2196/13889] [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: 03/02/2019] [Revised: 06/19/2019] [Accepted: 09/24/2019] [Indexed: 11/13/2022] Open
Abstract
Background Evidence shows that gait training in older adults is effective in improving the gait pattern, but the effects abate with cessation of training. During gait training, therapists use a number of verbal and visual cues to place the heel first when stepping. This simple strategy changes posture from stooped to upright, lengthens the stride, stimulates pelvic and trunk rotation, and facilitates arm swing. These principles guided the development of the Heel2Toe sensor that provides real-time auditory feedback for each good step, in which the heel strikes first. Objective This feasibility study aimed (1) to contribute evidence toward the feasibility and efficacy potential for home use of the Heel2Toe sensor that provides real-time feedback and (2) to estimate changes in gait parameters after five training sessions using the sensor. Methods A pre-post study included 5 training sessions over 2 weeks in the community on a purposive sample of six seniors. Proportion of good steps, angular velocity (AV) at each step, and cadence over a 2- minute period were assessed as was usability and experience. Results All gait parameters, proportion of good steps, AV, and duration of walking bouts improved. The coefficient of variation of AV decreased, indicating consistency of stepping. Conclusions Efficacy potential and feasibility of the Heel2Toe sensor were demonstrated.
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Affiliation(s)
- Kedar Kv Mate
- McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - Ahmed Abou-Sharkh
- McGill University Health Centre Research Institute, Montreal, QC, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - José A Morais
- McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - Nancy E Mayo
- McGill University Health Centre Research Institute, Montreal, QC, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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Music and Metronomes Differentially Impact Motor Timing in People with and without Parkinson's Disease: Effects of Slow, Medium, and Fast Tempi on Entrainment and Synchronization Performances in Finger Tapping, Toe Tapping, and Stepping on the Spot Tasks. PARKINSONS DISEASE 2019; 2019:6530838. [PMID: 31531220 PMCID: PMC6721399 DOI: 10.1155/2019/6530838] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/21/2019] [Accepted: 06/26/2019] [Indexed: 11/18/2022]
Abstract
Introduction Rhythmic auditory stimulation (RAS) has successfully helped regulate gait for people with Parkinson's disease. However, the way in which different auditory cues and types of movements affect entrainment, synchronization, and pacing stability has not been directly compared in different aged people with and without Parkinson's. Therefore, this study compared music and metronomes (cue types) in finger tapping, toe tapping, and stepping on the spot tasks to explore the potential of RAS training for general use. Methods Participants (aged 18–78 years) included people with Parkinson's (n = 30, Hoehn and Yahr mean = 1.78), older (n = 26), and younger adult controls (n = 36), as age may effect motor timing. Timed motor production was assessed using an extended synchronization-continuation task in cue type and movement conditions for slow, medium, and fast tempi (81, 116, and 140 mean beats per minute, respectively). Results Analyses revealed main effects of cue and movement type but no between-group interactions, suggesting no differences in motor timing between people with Parkinson's and controls. Music supported entrainment better than metronomes in medium and fast tempi, and stepping on the spot enabled better entrainment and less asynchrony, as well as more stable pacing compared to tapping in medium and fast tempi. Age was not confirmed as a factor, and no differences were observed in slow tempo. Conclusion This is the first study to directly compare how different external auditory cues and movement types affect motor timing. The music and the stepping enabled participants to maintain entrainment once the external pacing cue ceased, suggesting endogenous mechanisms continued to regulate the movements. The superior performance of stepping on the spot suggests embodied entrainment can occur during continuous movement, and this may be related to emergent timing in tempi above 600 ms. These findings can be applied therapeutically to manage and improve adaptive behaviours for people with Parkinson's.
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Calabrò RS, Naro A, Filoni S, Pullia M, Billeri L, Tomasello P, Portaro S, Di Lorenzo G, Tomaino C, Bramanti P. Walking to your right music: a randomized controlled trial on the novel use of treadmill plus music in Parkinson's disease. J Neuroeng Rehabil 2019; 16:68. [PMID: 31174570 PMCID: PMC6555981 DOI: 10.1186/s12984-019-0533-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/08/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Rhythmic Auditory Stimulation (RAS) can compensate for the loss of automatic and rhythmic movements in patients with idiopathic Parkinson's disease (PD). However, the neurophysiological mechanisms underlying the effects of RAS are still poorly understood. We aimed at identifying which mechanisms sustain gait improvement in a cohort of patients with PD who practiced RAS gait training. METHODS We enrolled 50 patients with PD who were randomly assigned to two different modalities of treadmill gait training using GaitTrainer3 with and without RAS (non_RAS) during an 8-week training program. We measured clinical, kinematic, and electrophysiological effects of both the gait trainings. RESULTS We found a greater improvement in Functional Gait Assessment (p < 0.001), Tinetti Falls Efficacy Scale (p < 0.001), Unified Parkinson Disease Rating Scale (p = 0.001), and overall gait quality index (p < 0.001) following RAS than non_RAS training. In addition, the RAS gait training induced a stronger EEG power increase within the sensorimotor rhythms related to specific periods of the gait cycle, and a greater improvement of fronto-centroparietal/temporal electrode connectivity than the non_RAS gait training. CONCLUSIONS The findings of our study suggest that the usefulness of cueing strategies during gait training consists of a reshape of sensorimotor rhythms and fronto-centroparietal/temporal connectivity. Restoring the internal timing mechanisms that generate and control motor rhythmicity, thus improving gait performance, likely depends on a contribution of the cerebellum. Finally, identifying these mechanisms is crucial to create patient-tailored, RAS-based rehabilitative approaches in PD. TRIAL REGISTRATION NCT03434496 . Registered 15 February 2018, retrospectively registered.
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Affiliation(s)
- Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, Contrada Casazza, S.S. 113, 98124, Messina, Italy.
| | - Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, Contrada Casazza, S.S. 113, 98124, Messina, Italy
| | - Serena Filoni
- Fondazione Centri di Riabilitazione Padre Pio Onlus, San Giovanni Rotondo, FG, Italy
| | - Massimo Pullia
- IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, Contrada Casazza, S.S. 113, 98124, Messina, Italy
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, Contrada Casazza, S.S. 113, 98124, Messina, Italy
| | - Provvidenza Tomasello
- IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, Contrada Casazza, S.S. 113, 98124, Messina, Italy
| | - Simona Portaro
- IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, Contrada Casazza, S.S. 113, 98124, Messina, Italy
| | - Giuseppe Di Lorenzo
- IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, Contrada Casazza, S.S. 113, 98124, Messina, Italy
| | - Concetta Tomaino
- Institute for Music and Neurologic Function, Mount Vernon, NY, USA
| | - Placido Bramanti
- IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, Contrada Casazza, S.S. 113, 98124, Messina, Italy
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Rodrigues-de-Paula F, Lana RDC, Lopes LKR, Cardoso F, Lindquist ARR, Piemonte MEP, Correa CL, Israel VL, Mendes F, Lima LO. Determinants of the use of physiotherapy services among individuals with Parkinson's disease living in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 76:592-598. [PMID: 30365622 DOI: 10.1590/0004-282x20180087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 06/05/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To identify the factors affecting the use of physiotherapy services among individuals with Parkinson's disease (PD) living in Brazil. METHODS Overall, 479 individuals with idiopathic PD, of both sexes, at any stage of the Hoehn & Yahr (HY) scale, and from seven capital cities in Brazil were recruited from 2014 to 2016. Multivariate logistic regression was the main statistical tool. For the construction of the logistic model, the association of the dependent variable "physiotherapy" with the independent sociodemographic/economic and clinical variables: age, education, family income, time of PD since onset, HY, the activities of daily living and motor subscales of the Unified Parkinson's Disease Rating Scale, cognitive aspects, depressive symptoms, fear of falling, freezing gait, history of falls, physical activity level, gait speed, walking performance and balance, were verified. RESULTS The 479 individuals had an average age of 65.2 ± 11.0 years, 88% were in the HY I-III stages and 43.4% were under physiotherapy treatment. The analysis identified two determinant variables related to the use of the physiotherapy service: level of education (OR = 1.24) and walking performance (OR = 0.82). Decreased walking performance and a higher educational level increased the use of a physiotherapy service in individuals with PD living in Brazil. CONCLUSIONS The present study shows that individuals with PD, residents from different regions of Brazil, have limited access to physiotherapy services. In addition, the Brazilian Public Health Care System, as well as local programs, need to target PD individuals with a low educational level to improve their access to physiotherapy services. Goals should aim towards the development of physical exercise programs to improve the patients' functional performance for a longer period.
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Affiliation(s)
| | - Raquel de Carvalho Lana
- Universidade Federal de Minas Gerais, Departamento de Fisioterapia, Belo Horizonte MG, Brasil
| | | | - Francisco Cardoso
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brasil
| | | | | | - Clynton Lourenço Correa
- Universidade Federal do Rio de Janeiro, Departamento de Fisioterapia, Rio de Janeiro RJ, Brasil
| | - Vera Lúcia Israel
- Universidade Federal do Paraná, Universidade de Fisioterapia, Curitiba PR, Brasil
| | - Felipe Mendes
- Universidade de Brasília, Departamento de Fisioterapia, Brasília DF, Brasil
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Tandem gait abnormality in Parkinson disease: Prevalence and implication as a predictor of fall risk. Parkinsonism Relat Disord 2019; 63:83-87. [PMID: 30824282 DOI: 10.1016/j.parkreldis.2019.02.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION We report the prevalence of abnormal tandem gait (TG) in patients with idiopathic Parkinson disease (PD) and its association with symptoms of subjective unsteadiness, falls, freezing of gait, and cognitive impairment. METHODS We assessed subjective balance impairment, fall history, antero-posterior postural instability, and TG in PD patients (Hoehn and Yahr (HY) stage 0-4). We recorded the age, sex, current medications, HY stage, Schwab and England (S&E) scale score, and MOCA score for each patient. Logistic regression was used to evaluate age-adjusted associations between TG and other demographic and clinical factors. RESULTS A total of 102 patients with PD were assessed. Of those, 63.5% of HY 2 patients and 100% of HY 2.5 and 3 patients had a TG abnormality. The presence of TG abnormality was associated with subjective imbalance, falls, freezing of gait, S&E < 80, and MOCA score <24 after adjustment for age. CONCLUSIONS TG abnormality is common in PD, precedes the development of antero-posterior postural instability, is associated with cognitive impairment, and may predict fall risk. A longitudinal study will help determine if TG is a predictor of impending progression from HY 2 to HY 3.
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Ghosh S. Improvement of gait and balance by non-invasive brain stimulation: its use in rehabilitation. Expert Rev Neurother 2019; 19:133-144. [DOI: 10.1080/14737175.2019.1564042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Soumya Ghosh
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, Australia
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19
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Effectiveness of robot-assisted gait training on motor impairments in people with Parkinson’s disease: a systematic review and meta-analysis. Int J Rehabil Res 2018; 41:287-296. [DOI: 10.1097/mrr.0000000000000312] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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20
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Petraglia F, Scarcella L, Pedrazzi G, Brancato L, Puers R, Costantino C. Inertial sensors versus standard systems in gait analysis: a systematic review and meta-analysis. Eur J Phys Rehabil Med 2018; 55:265-280. [PMID: 30311493 DOI: 10.23736/s1973-9087.18.05306-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The increasing popularity of inertial sensors in clinical practice is not supported by precise information on their reliability or guidelines for their use in rehabilitation. The authors investigated the state of the literature concerning the use of inertial sensors for gait analysis in both healthy and pathological adults comparing traditional systems. Furthermore, trying to define directions for clinicians. EVIDENCE ACQUISITION In accordance with the PRISMA statement, authors searched in PubMed, Web of Science and Scopus all paper published from January 1st, 2005 until December 31st, 2017. They included both healthy and pathological adults' subjects as population, wearable or inertial sensors used for gait analysis and compared with classical gait analysis performed in a Motion Lab as intervention and comparison, gait parameters as outcomes. Considering the methodological quality, authors focused on: sample; description of the study; type of gait analysis used for comparison; type of sensor; sensor placement on the body; gait task requested. EVIDENCE SYNTHESIS From a total of 888 articles, 16 manuscripts were selected and 7 of them were considered for meta-analysis for different gait parameters. Demographic data, tested devices, reference systems, test procedures and outcomes were analyzed. CONCLUSIONS Our results show a good agreement between inertial sensors and classical gait analysis for some gait parameters, supporting their use as a solution for capturing kinematic information over an extended space and time and even outside a laboratory in real-life conditions. Authors can support the use of portable inertial sensors for a practical gait analysis in clinical setting with good reliability. It will then be the experience of the clinician to direct the decision-making process.
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Affiliation(s)
| | - Luca Scarcella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giuseppe Pedrazzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, Parma, Italy -
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Primary progressive freezing gait with impressive response to laser light visual cueing: a video case report. J Neurol 2018; 265:2146-2148. [DOI: 10.1007/s00415-018-8966-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
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Stand-Alone Wearable System for Ubiquitous Real-Time Monitoring of Muscle Activation Potentials. SENSORS 2018; 18:s18061748. [PMID: 29844275 PMCID: PMC6021925 DOI: 10.3390/s18061748] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 01/29/2023]
Abstract
Wearable technology is attracting most attention in healthcare for the acquisition of physiological signals. We propose a stand-alone wearable surface ElectroMyoGraphy (sEMG) system for monitoring the muscle activity in real time. With respect to other wearable sEMG devices, the proposed system includes circuits for detecting the muscle activation potentials and it embeds the complete real-time data processing, without using any external device. The system is optimized with respect to power consumption, with a measured battery life that allows for monitoring the activity during the day. Thanks to its compactness and energy autonomy, it can be used outdoor and it provides a pathway to valuable diagnostic data sets for patients during their own day-life. Our system has performances that are comparable to state-of-art wired equipment in the detection of muscle contractions with the advantage of being wearable, compact, and ubiquitous.
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Cucca A, Biagioni MC, Sharma K, Golomb J, Gilbert RM, Di Rocco A, Fleisher JE. Comorbid Normal Pressure Hydrocephalus with Parkinsonism: A Clinical Challenge and Call for Awareness. Case Rep Neurol Med 2018; 2018:2513474. [PMID: 29610690 PMCID: PMC5828340 DOI: 10.1155/2018/2513474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/06/2017] [Accepted: 12/24/2017] [Indexed: 12/13/2022] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is the most common cause of hydrocephalus in adults. The diagnosis may be challenging, requiring collaborative efforts between different specialists. According to the International Society for Hydrocephalus and Cerebrospinal Fluid Disorders, iNPH should be considered in the differential of any unexplained gait failure with insidious onset. Recognizing iNPH can be even more difficult in the presence of comorbid neurologic disorders. Among these, idiopathic Parkinson's disease (PD) is one of the major neurologic causes of gait dysfunction in the elderly. Both conditions have their peak prevalence between the 6th and the 7th decade. Importantly, postural instability and gait dysfunction are core clinical features in both iNPH and PD. Therefore, diagnosing iNPH where diagnostic criteria of PD have been met represents an additional clinical challenge. Here, we report a patient with parkinsonism initially consistent with PD who subsequently displayed rapidly progressive postural instability and gait dysfunction leading to the diagnosis of concomitant iNPH. In the following sections, we will review the clinical features of iNPH, as well as the overlapping and discriminating features when degenerative parkinsonism is in the differential diagnosis. Understanding and recognizing the potential for concomitant disease are critical when treating both conditions.
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Affiliation(s)
- A. Cucca
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - M. C. Biagioni
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - K. Sharma
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - J. Golomb
- Department of Neurosurgery, Adult Hydrocephalus Program, NYU School of Medicine, New York, NY, USA
| | - R. M. Gilbert
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - A. Di Rocco
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, NYU Langone Medical Center, New York, NY, USA
| | - J. E. Fleisher
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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Margolesky J, Singer C. How tandem gait stumbled into the neurological exam: a review. Neurol Sci 2017; 39:23-29. [PMID: 28894988 DOI: 10.1007/s10072-017-3108-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/01/2017] [Indexed: 12/22/2022]
Abstract
Tandem gait testing is an integral part of the neurological exam. It is informative in a wide variety of disorders ranging from cerebellar disease to vestibular and peripheral neuropathies, parkinsonism, and other neurodegenerative conditions. We discuss the history and development of tandem gait testing as well as its technique, utility, and limitations in the assessment of neurological conditions. Tandem gait has emerged as a tool in the assessment of cerebellar disease, Huntington disease, idiopathic Parkinson's disease, atypical parkinsonism, peripheral neuropathies, and vestibulopathies. Its origin can be deduced from experimental observation and clinical experience as far back as the early nineteenth century. Despite the long history and ubiquitous performance of tandem gait testing, there is no standardized, guideline-based protocol to model for more homogenous research and clinical practices. Such a protocol should be developed using historical texts and manuscripts as well as the consensus of the medical research community. With standard protocols, further studies could define the sensitivity of abnormal tandem gait testing in cerebellar disorders, more diffuse neurodegeneration, and peripheral pathologies. Tandem gait can be a useful marker of dysfunction in neurologic conditions whose pathologies extend beyond the vermis or vestibulocerebellar module to include interconnected networks throughout the nervous system.
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Affiliation(s)
- Jason Margolesky
- University of Miami School of Medicine, Professional Arts Center, 1150 NW 14th Street, Suite 609, Miami, FL, 33136, USA.
| | - Carlos Singer
- University of Miami School of Medicine, Professional Arts Center, 1150 NW 14th Street, Suite 609, Miami, FL, 33136, USA
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Furnari A, Calabrò RS, De Cola MC, Bartolo M, Castelli A, Mapelli A, Buttacchio G, Farini E, Bramanti P, Casale R. Robotic-assisted gait training in Parkinson's disease: a three-month follow-up randomized clinical trial. Int J Neurosci 2017; 127:996-1004. [DOI: 10.1080/00207454.2017.1288623] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Anna Furnari
- Neurorehabilitation Unit, HABILITA Care & Research Rehabilitation Hospitals, Zingonia di Ciserano (Bergamo), Zingonia, Italy
| | | | | | - Michelangelo Bartolo
- Neurorehabilitation Unit, HABILITA Care & Research Rehabilitation Hospitals, Zingonia di Ciserano (Bergamo), Zingonia, Italy
| | - Alberto Castelli
- Neurorehabilitation Unit, HABILITA Care & Research Rehabilitation Hospitals, Zingonia di Ciserano (Bergamo), Zingonia, Italy
| | - Alessia Mapelli
- Neurorehabilitation Unit, HABILITA Care & Research Rehabilitation Hospitals, Zingonia di Ciserano (Bergamo), Zingonia, Italy
| | - Giampiero Buttacchio
- Neurorehabilitation Unit, HABILITA Care & Research Rehabilitation Hospitals, Zingonia di Ciserano (Bergamo), Zingonia, Italy
| | - Elena Farini
- Neurorehabilitation Unit, HABILITA Care & Research Rehabilitation Hospitals, Zingonia di Ciserano (Bergamo), Zingonia, Italy
| | - Placido Bramanti
- Neurorehabilitation Unit, HABILITA Care & Research Rehabilitation Hospitals, Zingonia di Ciserano (Bergamo), Zingonia, Italy
| | - Roberto Casale
- Neurorehabilitation Unit, HABILITA Care & Research Rehabilitation Hospitals, Zingonia di Ciserano (Bergamo), Zingonia, Italy
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26
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Cucca A, Biagioni MC, Fleisher JE, Agarwal S, Son A, Kumar P, Brys M, Di Rocco A. Freezing of gait in Parkinson's disease: from pathophysiology to emerging therapies. Neurodegener Dis Manag 2016; 6:431-46. [PMID: 27599588 DOI: 10.2217/nmt-2016-0018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Freezing of gait (FOG) is 'an episodic inability to generate effective stepping in the absence of any known cause other than parkinsonism or high level gait disorders'. FOG is one of the most disabling symptoms in Parkinson's disease, especially in its more advanced stages. Early recognition is important as FOG is related to higher fall risk and poorer prognosis. Although specific treatments are still elusive, there have been recent advances in the development of new therapeutic approaches. The aim of this review is to present the latest knowledge regarding the phenomenology, pathogenesis, diagnostic assessment and conventional treatment of FOG in Parkinson's disease. A review of the evidence supporting noninvasive brain stimulation will follow to highlight the potential of these strategies.
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Affiliation(s)
- Alberto Cucca
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA.,Department of Medicine, Surgery & Health Sciences, University of Trieste, Clinica Neurologica, Trieste, Italy
| | - Milton C Biagioni
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Jori E Fleisher
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Shashank Agarwal
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Andre Son
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Pawan Kumar
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Miroslaw Brys
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Alessandro Di Rocco
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
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Christofoletti G, McNeely ME, Campbell MC, Duncan RP, Earhart GM. Investigation of factors impacting mobility and gait in Parkinson disease. Hum Mov Sci 2016; 49:308-14. [PMID: 27551818 DOI: 10.1016/j.humov.2016.08.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 12/20/2022]
Abstract
Mobility and gait limitations are major issues for people with Parkinson disease (PD). Identification of factors that contribute to these impairments may inform treatment and intervention strategies. In this study we investigated factors that predict mobility and gait impairment in PD. Participants with mild to moderate PD and without dementia (n=114) were tested in one session 'off' medication. Mobility measures included the 6-Minute Walk test and Timed-Up-and-Go. Gait velocity was collected in four conditions: forward preferred speed, forward dual task, forward fast as possible and backward walking. The predictors analyzed were age, gender, disease severity, balance, balance confidence, fall history, self-reported physical activity, and executive function. Multiple regression models were used to assess the relationships between predictors and outcomes. The predictors, in different combinations for each outcome measure, explained 55.7% to 66.9% of variability for mobility and 39.5% to 52.8% for gait velocity. Balance was the most relevant factor (explaining up to 54.1% of variance in mobility and up to 45.6% in gait velocity). Balance confidence contributed to a lesser extent (2.0% to 8.2% of variance) in all models. Age explained a small percentage of variance in mobility and gait velocity (up to 2.9%). Executive function explained 3.0% of variance during forward walking only. The strong predictive relationships between balance deficits and mobility and gait impairment suggest targeting balance deficits may be particularly important for improving mobility and gait in people with PD, regardless of an individual's age, disease severity, fall history, or other demographic features.
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Affiliation(s)
- Gustavo Christofoletti
- Federal University of Mato Grosso do Sul, Program in Health and Development, Campo Grande, MS 79060-900, Brazil; Washington University School of Medicine in Saint Louis, Program in Physical Therapy, St. Louis, MO 63108, USA
| | - Marie E McNeely
- Washington University School of Medicine in Saint Louis, Program in Physical Therapy, St. Louis, MO 63108, USA; Washington University School of Medicine in Saint Louis, Department of Neurology, St. Louis, MO 63110, USA
| | - Meghan C Campbell
- Washington University School of Medicine in Saint Louis, Department of Neurology, St. Louis, MO 63110, USA; Washington University School of Medicine in Saint Louis, Department of Radiology, St. Louis, MO 63110, USA
| | - Ryan P Duncan
- Washington University School of Medicine in Saint Louis, Program in Physical Therapy, St. Louis, MO 63108, USA; Washington University School of Medicine in Saint Louis, Department of Neurology, St. Louis, MO 63110, USA
| | - Gammon M Earhart
- Washington University School of Medicine in Saint Louis, Program in Physical Therapy, St. Louis, MO 63108, USA; Washington University School of Medicine in Saint Louis, Department of Neurology, St. Louis, MO 63110, USA; Washington University School of Medicine in Saint Louis, Department of Neuroscience, St. Louis, MO 63110, USA.
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28
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Lenardt MH, de Sousa JAV, Grden CRB, Betiolli SE, Carneiro NHK, Ribeiro DKDMN. Gait speed and cognitive score in elderly users of the primary care service. Rev Bras Enferm 2015; 68:1163-8. [PMID: 26676441 DOI: 10.1590/0034-7167.2015680623i] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/22/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE to investigate the association between gait speed and the cognitive score of elderly patients enrolled in a Basic Health Unit. METHOD a quantitative cross-sectional study with 203 elderly, a sample calculated based on the estimated population proportion. Data were collected using a sociodemographic and clinical questionnaire, gait speed test (GS) and the Mini Mental State Examination (MMSE). RESULTS the illiterate patients had a mean MMSE=19.33(±3.7) and GS = 0.76m/s (±0.3); those with low/medium education had a MMSE = 25.43(±2.8) and GS = 0.92m/s (±0.2); and the elderly with higher education had a MMSE = 27.33(±2.9) and GS=1.12m/s (±0.3).There was a weak correlation (R2=00354) between gait speed and cognitive score, with statistical significance (Prob>F = 0.0072) and a positive linear trend. CONCLUSION the better cognitive score the higher the gait speed; the illiterate elderly were those with lower gait speed, thereby indicating a poorer physical performance.
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Affiliation(s)
- Maria Helena Lenardt
- Grupo Multiprofissional de Pesquisa Sobre Idosos, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | | | | | - Susanne Elero Betiolli
- Grupo Multiprofissional de Pesquisa Sobre Idosos, Universidade Federal do Paraná, Curitiba, PR, Brasil
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Ashoori A, Eagleman DM, Jankovic J. Effects of Auditory Rhythm and Music on Gait Disturbances in Parkinson's Disease. Front Neurol 2015; 6:234. [PMID: 26617566 PMCID: PMC4641247 DOI: 10.3389/fneur.2015.00234] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/22/2015] [Indexed: 12/05/2022] Open
Abstract
Gait abnormalities, such as shuffling steps, start hesitation, and freezing, are common and often incapacitating symptoms of Parkinson’s disease (PD) and other parkinsonian disorders. Pharmacological and surgical approaches have only limited efficacy in treating these gait disorders. Rhythmic auditory stimulation (RAS), such as playing marching music and dance therapy, has been shown to be a safe, inexpensive, and an effective method in improving gait in PD patients. However, RAS that adapts to patients’ movements may be more effective than rigid, fixed-tempo RAS used in most studies. In addition to auditory cueing, immersive virtual reality technologies that utilize interactive computer-generated systems through wearable devices are increasingly used for improving brain–body interaction and sensory–motor integration. Using multisensory cues, these therapies may be particularly suitable for the treatment of parkinsonian freezing and other gait disorders. In this review, we examine the affected neurological circuits underlying gait and temporal processing in PD patients and summarize the current studies demonstrating the effects of RAS on improving these gait deficits.
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Affiliation(s)
- Aidin Ashoori
- Columbia University College of Physicians & Surgeons , New York, NY , USA
| | - David M Eagleman
- Department of Neuroscience, Baylor College of Medicine , Houston, TX , USA
| | - Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine , Houston, TX , USA
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