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Ban R, Ahn J, Simpkins C, Lazarus J, Yang F. Dynamic gait stability in people with mild to moderate Parkinson's disease. Clin Biomech (Bristol, Avon) 2024; 118:106316. [PMID: 39059102 DOI: 10.1016/j.clinbiomech.2024.106316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/15/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Falls are a serious health threat for people with Parkinson's disease. Dynamic gait stability has been associated with fall risk. Developing effective fall prevention interventions requires a sound understanding of how Parkinson's disease affects dynamic gait stability. This study compared dynamic gait stability within the Feasible Stability Region framework between people with and without Parkinson's disease during level walking at a self-selected speed. METHODS Twenty adults with Parkinson's disease and twenty age- and gender-matched healthy individuals were recruited. Dynamic gait stability at two gait instants: touchdown and liftoff, was assessed as the primary outcome measurement. Spatiotemporal gait parameters, including stance phase duration, step length, gait speed, and cadence were determined as explanatory variables. FINDINGS People with Parkinson's disease walked more slowly (p < 0.001) with a shorter step (p = 0.05), and prolonged stance phase (p = 0.04) than their healthy peers with moderate to large effect sizes. Dynamic gait stability did not show any group-associated differences (p > 0.36). INTERPRETATION Despite the different gait parameters between groups, people with Parkinson's disease exhibited similar dynamic gait stability to their healthy counterparts. To compensate for the potential dynamic gait stability deficit resulting from slow gait speed, individuals with Parkinson's disease adopted a short step length to shift the center of mass motion state closer to the Feasible Stability Region. Our findings could provide insight into the impact of Parkinson's disease on the control of dynamic gait stability.
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Affiliation(s)
- Rebecca Ban
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
| | - Jiyun Ahn
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
| | - Caroline Simpkins
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA
| | - Joash Lazarus
- Atlanta Neuroscience Institute, Atlanta, GA 30327, USA
| | - Feng Yang
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, USA.
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Espinoza-Araneda J, Caparrós-Manosalva C, Caballero PM, da Cunha MJ, Marchese RR, Pagnussat AS. Arm swing asymmetry in people with Parkinson's disease and its relationship with gait: A systematic review and meta-analysis. Braz J Phys Ther 2023; 27:100559. [PMID: 37980716 PMCID: PMC10695845 DOI: 10.1016/j.bjpt.2023.100559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Individuals with Parkinson's disease present arm swing alterations that can adversely affect their locomotion. OBJECTIVE To identify differences in arm swing asymmetry (ASA) between individuals with Parkinson's disease (PD) and healthy individuals and to investigate the relationship between ASA, temporal-spatial gait parameters, and disease progression. METHODS A literature search was conducted in PubMed, Scopus, ProQuest, Web of Science, and EBSCOhost up to February 2023. Cross-sectional studies evaluating parameters of arm swing (AS) and ASA were included. Methodological quality was assessed using the Critical Appraisal Checklist, and the quality of the evidence was measured with a modified Grading of Recommendations Assessment, Development, and Evaluation. RESULTS Fourteen studies were included in the systematic review (1130 participants). Irrespective of the medication phase (ON or OFF) and the type of walk test employed, the meta-analysis showed moderate-quality evidence that individuals with PD have increased ASA amplitude (SMD = 0.84; 95% CI: 0.69, 0.99; I²= 0%).Very low-quality evidence suggests higher ASA velocity (SMD=0.64; 95% CI: 0.24, 1.05; I²=59%) and lower AS amplitude on both the most affected (ES = -1.99, 95% CI: -3.04, -0.94, I2: 91%) and the least affected sides (ES = -0.75, 95% CI: -1.05, -0.44; I²=66%). Meta-regression indicated that ASA is inversely related to disease duration (Z: -2.4892, P< 0.05) and motor symptoms progression (Z: -2.1336, P< 0.05). CONCLUSIONS Regardless of the medication phase and the type of walk test employed, individuals with PD exhibited greater ASA and decreased AS amplitude than healthy individuals. ASA decreases as the disease progresses and symptoms worsen.
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Affiliation(s)
- Jessica Espinoza-Araneda
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Department of Human Movement Sciences, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Cristian Caparrós-Manosalva
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Department of Human Movement Sciences, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Paula M Caballero
- Department of Human Movement Sciences, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Maira J da Cunha
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, UFCSPA, Porto Alegre, RS, Brazil
| | - Ritchele R Marchese
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, UFCSPA, Porto Alegre, RS, Brazil
| | - Aline S Pagnussat
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, UFCSPA, Porto Alegre, RS, Brazil.
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Mezzarobba S, Cosentino C, Putzolu M, Panuccio F, Fabbrini G, Valente D, Costi S, Galeoto G, Pelosin E. Assessment of the psychometric properties of the Italian version of the New Freezing of Gait Questionnaire (NFOG-Q-IT) in people with Parkinson disease: a validity and reliability study. Neurol Sci 2023; 44:3133-3140. [PMID: 37072581 PMCID: PMC10112304 DOI: 10.1007/s10072-023-06800-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 04/03/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Freezing of gait (FOG) in Parkinson's disease (PD) is a challenging clinical symptom to assess, due to its episodic nature. A valid and reliable tool is the New FOG Questionnaire (NFOG-Q) used worldwide to measure FOG symptoms in PD. OBJECTIVE The aim of this study was to translate, to culturally adapt, and to test the psychometric characteristics of the Italian version of the NFOG-Q (NFOG-Q-It). METHODS The translation and cultural adaptation was based on ISPOR TCA guidelines to finalize the 9-item NFOG-Q-It. Internal consistency was assessed in 181 Italian PD native speakers who experienced FOG using Cronbach's alpha. Cross-cultural analysis was tested using the Spearman's correlation between the NFOG-Q-It and the Modified Hoehn-Yahr Scale (M-H&Y). To assess construct validity, correlations among NFOG-Q-It, Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Falls Efficacy Scale-International (FES-I), the 6-min Walking Test (6MWT), the Mini Balance Evaluation System Test (Mini-BESTest) and the Short Physical Performance Battery (SPPB) were investigated. RESULTS The Italian N-FOGQ had high internal consistency (Cronbach's α = 0.859). Validity analysis showed significant correlations between NFOG-Q-IT total score and M-H&Y scores (r = 0.281 p < 0.001), MDS-UPDRS (r = 0.359 p < 0.001), FES-I (r = 0.230 p = 0.002), Mini BESTest (r = -0.256 p = 0.001) and 6MWT (r = -0.166 p = 0.026). No significant correlations were found with SPPB, MOCA and MMSE. CONCLUSION The NFOG-It is a valuable and reliable tool for assessing FOG symptoms, duration and frequency in PD subjects. Results provide the validity of NFOG-Q-It by reproducing and enlarging previous psychometric data.
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Affiliation(s)
- Susanna Mezzarobba
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Carola Cosentino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | | | - Francescaroberta Panuccio
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, CAP 00185, City Rome, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, CAP 00185, City Rome, Italy
- IRCSS Neuromed, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, CAP 00185, City Rome, Italy
- IRCSS Neuromed, Via Atinense, 18, 86077, Pozzilli, IS, Italy
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit, Azienda Unità Sanitaria Locale - IRCCS Di Reggio Emilia, Via Risorgimento 80, 42123, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, Università Di Modena E Reggio Emilia, 41100, Modena, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, Viale Dell'Università 30, CAP 00185, City Rome, Italy.
- IRCSS Neuromed, Via Atinense, 18, 86077, Pozzilli, IS, Italy.
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
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Slemenšek J, Fister I, Geršak J, Bratina B, van Midden VM, Pirtošek Z, Šafarič R. Human Gait Activity Recognition Machine Learning Methods. SENSORS (BASEL, SWITZERLAND) 2023; 23:745. [PMID: 36679546 PMCID: PMC9865094 DOI: 10.3390/s23020745] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
Human gait activity recognition is an emerging field of motion analysis that can be applied in various application domains. One of the most attractive applications includes monitoring of gait disorder patients, tracking their disease progression and the modification/evaluation of drugs. This paper proposes a robust, wearable gait motion data acquisition system that allows either the classification of recorded gait data into desirable activities or the identification of common risk factors, thus enhancing the subject's quality of life. Gait motion information was acquired using accelerometers and gyroscopes mounted on the lower limbs, where the sensors were exposed to inertial forces during gait. Additionally, leg muscle activity was measured using strain gauge sensors. As a matter of fact, we wanted to identify different gait activities within each gait recording by utilizing Machine Learning algorithms. In line with this, various Machine Learning methods were tested and compared to establish the best-performing algorithm for the classification of the recorded gait information. The combination of attention-based convolutional and recurrent neural networks algorithms outperformed the other tested algorithms and was individually tested further on the datasets of five subjects and delivered the following averaged results of classification: 98.9% accuracy, 96.8% precision, 97.8% sensitivity, 99.1% specificity and 97.3% F1-score. Moreover, the algorithm's robustness was also verified with the successful detection of freezing gait episodes in a Parkinson's disease patient. The results of this study indicate a feasible gait event classification method capable of complete algorithm personalization.
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Affiliation(s)
- Jan Slemenšek
- Faculty of Mechanical Engineering, University of Maribor, 2000 Maribor, Slovenia
| | - Iztok Fister
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia
| | - Jelka Geršak
- Faculty of Mechanical Engineering, University of Maribor, 2000 Maribor, Slovenia
| | - Božidar Bratina
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia
| | | | - Zvezdan Pirtošek
- Department of Neurology, University Clinical Centre, 1000 Ljubljana, Slovenia
| | - Riko Šafarič
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia
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Nikaido Y, Urakami H, Okada Y, Kajimoto Y, Ishida N, Kawami Y, Akisue T, Saura R. Dynamic gait stability in patients with idiopathic normal pressure hydrocephalus with high and low fall-risk. Clin Biomech (Bristol, Avon) 2022; 99:105757. [PMID: 36113194 DOI: 10.1016/j.clinbiomech.2022.105757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/17/2022] [Accepted: 08/30/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to investigate whether dynamic gait stability differs between idiopathic normal-pressure hydrocephalus with high- and low-fall-risk. METHODS Participants comprised 40 idiopathic normal-pressure hydrocephalus patients and 23 healthy-controls. Idiopathic normal-pressure hydrocephalus patients were divided into those with high-fall-risk (n = 20) and low-fall-risk (n = 20) groups using the cut-off score of ≤14/30 for fall-risk on the Functional Gait Assessment. Dynamic stability during gait was assessed by three-dimensional motion analysis. Dynamic stability was defined as the ability to maintain an extrapolated center of mass within the base of support at heel contact, with the distance between the two defined as the margin of stability. Conscious motor control was assessed by the Movement-Specific Reinvestment Scale. FINDINGS Anteroposterior and mediolateral margin of stabilities were significantly larger in both idiopathic normal-pressure hydrocephalus groups than in healthy-controls. The mediolateral margin of stability was significantly higher in the high-fall-risk group than in the low-fall-risk group; whereas, the anteroposterior margin of stability did not differ between idiopathic normal-pressure hydrocephalus groups. The Movement-Specific Reinvestment Scale was significantly higher in the high-fall-risk group than in the low-fall-risk group. INTERPRETATION Idiopathic normal-pressure hydrocephalus patients with have high forward and lateral dynamic stability during gait regardless of their fall-risk. In particular, idiopathic normal-pressure hydrocephalus patients with high-fall-risk may consciously maintain lateral dynamic stability to a greater extent than those with low-fall-risk. These findings highlight a conscious motor control component in the pathological gait of idiopathic normal-pressure hydrocephalus, and provide clues for rehabilitation and fall prevention strategies in idiopathic normal-pressure hydrocephalus patients.
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Affiliation(s)
- Yasutaka Nikaido
- Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.
| | - Hideyuki Urakami
- Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Yohei Okada
- Graduate School of Health Sciences, Kio University, Nara, Japan; Neurorehabilitation Research Center of Kio University, Nara, Japan
| | - Yoshinaga Kajimoto
- Department of Neurosurgery, Division of Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Naoya Ishida
- Clinical Department of Rehabilitation, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Yuki Kawami
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan; Department of Physical Therapy, Faculty of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, Hyogo, Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Ryuichi Saura
- Department of Physical and Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
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Son M, Cheon SM, Youm C, Kim JW. Turning reveals the characteristics of gait freezing better than walking forward and backward in Parkinson's disease. Gait Posture 2022; 94:131-137. [PMID: 35306381 DOI: 10.1016/j.gaitpost.2022.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/27/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUNDS People with Parkinson's disease (PD) experiences walking disturbances and freezing of gait (FoG) is one of the most distressing symptoms. RESEARCH QUESTION This study aimed to comprehensively analyze the walking characteristics of patients with PD, including forward and backward walking and turning, in order to define the characteristics of FoG. METHODS A total of 68 patients with PD and 14 control subjects were enrolled in this study. Forward and backward walking and 360-degree turning were recorded at preferred speed in "off" state using three-dimensional motion analysis system. RESULTS PD patients showed a narrower step length, slower walking speed, and higher asymmetry index (AI) of step length during forward and backward walking. During turning, the PD patients had more turning steps, longer turning time, and shorter step length than the control subjects. No difference was observed in the characteristics of forward walking according to the FoG status, but the freezer group showed a narrower step length and decreased range of motion in the ankle joints during backward walking. Freezer group showed longer step time and higher AI of step length at turning. The severity of FoG was correlated with step length and walking speed during forward and backward walking, total step count, total step time, and walking speed during turning. SIGNIFICANCE The characteristics and impacts of FoG in PD were most prominent during turning, followed by backward and forward walking. Further comprehensive analyses of walking including turning might contribute to the understanding of the pathophysiology of walking disturbances in PD.
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Affiliation(s)
- Minji Son
- Department of Health Care and Science, College of Health Sciences, Dong-A University, Busan, Republic of Korea
| | - Sang-Myung Cheon
- Department of Neurology, School of Medicine, Dong-A University, Busan, Republic of Korea.
| | - Changhong Youm
- Department of Health Care and Science, College of Health Sciences, Dong-A University, Busan, Republic of Korea
| | - Jae Woo Kim
- Department of Neurology, School of Medicine, Dong-A University, Busan, Republic of Korea
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Nikaido Y, Okada Y, Urakami H, Ishida N, Akisue T, Kawami Y, Kuroda K, Kajimoto Y, Saura R. Dynamic stability during gait in idiopathic normal pressure hydrocephalus and Parkinson's disease. Acta Neurol Scand 2022; 145:215-222. [PMID: 34633069 DOI: 10.1111/ane.13537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/14/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To clarify a characteristic of dynamic stability during gait in idiopathic normal pressure hydrocephalus (iNPH) and Parkinson's disease (PD), and to explore the association between dynamic stability and disease severity in each disease. MATERIALS AND METHODS The 5-m gait of 36 iNPH (precerebrospinal fluid drainage), 20 PD (medicated state), and 25 healthy controls (HC) were evaluated using three-dimensional motion analysis. Ambulatory dynamic stability was defined as the ability to maintain the extrapolated center of mass within the base of support at heel contact, with the distance between the two referred to as the margin of stability (MOS). RESULTS Anteroposterior direction (AP) MOS was significantly larger in the iNPH and PD groups than in the HC group; no significant difference was found between the iNPH and PD groups. Mediolateral direction (ML) MOS was significantly larger in the iNPH and PD groups than in the HC group and significantly larger in the iNPH group than in the PD group. In the iNPH group, the disease severity was positively correlated with only ML MOS. In the PD group, the disease severity was positively correlated with the AP MOS and ML MOS. CONCLUSIONS Dynamic stability in iNPH increases in AP and ML, and it may be associated with not only iNPH-associated gait disturbance but also with a voluntarily cautious gait strategy. Dynamic stability in PD only increased in AP, and this may be associated with PD symptoms. These findings will help physicians understand the difference in pathological gait including dynamic stability between patients with iNPH and PD.
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Affiliation(s)
- Yasutaka Nikaido
- Clinical Department of Rehabilitation Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Yohei Okada
- Graduate School of Health Sciences Kio University Nara Japan
- Neurorehabilitation Research Center of Kio University Nara Japan
| | - Hideyuki Urakami
- Clinical Department of Rehabilitation Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Naoya Ishida
- Clinical Department of Rehabilitation Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Sciences, Graduate School of Health Sciences Kobe University Kobe Japan
| | - Yuki Kawami
- Department of Rehabilitation Sciences, Graduate School of Health Sciences Kobe University Kobe Japan
- Department of Physical Therapy, Faculty of Rehabilitation Hyogo Prefectural Rehabilitation Hospital at Nishi‐Harima Hyogo Japan
| | - Kenji Kuroda
- Clinical Department of Rehabilitation Osaka Medical and Pharmaceutical University Hospital Osaka Japan
| | - Yoshinaga Kajimoto
- Department of Neurosurgery, Division of Surgery Osaka Medical and Pharmaceutical University Osaka Japan
| | - Ryuichi Saura
- Department of Physical and Rehabilitation Medicine, Division of Comprehensive Medicine Osaka Medical and Pharmaceutical University Osaka Japan
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Besharat A, Imsdahl SI, Yamagami M, Nhan N, Bellatin O, Burden SA, Cummer K, Pradhan SD, Kelly VE. Virtual reality doorway and hallway environments alter gait kinematics in people with Parkinson disease and freezing. Gait Posture 2022; 92:442-448. [PMID: 34996008 DOI: 10.1016/j.gaitpost.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/24/2021] [Accepted: 12/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many people with Parkinson disease (PD) experience freezing of gait (FoG), a transient gait disturbance associated with increased fall risk and reduced quality of life. Head-mounted virtual reality (VR) systems allow overground walking and can create immersive simulations of physical environments that induce FoG. RESEARCH QUESTION For people with PD who experience FoG (PD+FoG), are kinematic gait changes observed in VR simulations of FoG-provoking environments? METHODS In a cross-sectional experiment, people with PD+FoG walked at their self-selected speed in a physical laboratory and virtual laboratory, doorway, and hallway environments. Motion analysis assessed whole-body kinematics, including lower extremity joint excursions, swing phase toe clearance, trunk flexion, arm swing, sagittal plane inclination angle, and spatiotemporal characteristics. One-way repeated measures analysis of variance was conducted to examine the effects of environment on gait variables, with planned contrasts between laboratory environments and the virtual doorway and hallway. RESULTS Twelve participants with PD+FoG (mean age [standard deviation]=72.8 [6.5] years, disease duration=8.8 [8.9] years, 3 females) completed the protocol. The environment had significant and widespread effects on kinematic and spatiotemporal variables. Compared to the physical laboratory, reduced joint excursions were observed in the ankle, knee, and hip when walking in the virtual doorway and in the knee and hip when walking in the virtual hallway. In both the virtual doorway and hallway compared to the physical laboratory, peak swing phase toe clearance, arm swing, and inclination angle were reduced, and walking was slower, with shorter, wider steps. SIGNIFICANCE Virtual doorway and hallway environments induced kinematic changes commonly associated with FoG episodes, and these kinematic changes are consistent with forward falls that are common during FoG episodes. Combined with the flexibility of emerging VR technology, this research supports the potential of VR applications designed to improve the understanding, assessment, and treatment of FoG.
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Affiliation(s)
- Amir Besharat
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Neurology, University of Washington, Seattle, WA, USA; Department of Neurology, University of Southern California, Los Angeles, CA, USA
| | - Sheri I Imsdahl
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Momona Yamagami
- Department of Electrical & Computer Engineering, University of Washington, Seattle, WA, USA
| | - Nawat Nhan
- Department of Mechanical Engineering, Gonzaga University, Spokane, WA, USA
| | - Olivia Bellatin
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI, USA
| | - Samuel A Burden
- Department of Electrical & Computer Engineering, University of Washington, Seattle, WA, USA
| | - Kathleen Cummer
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sujata D Pradhan
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Valerie E Kelly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
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