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Skrzatek A, Nuic D, Cherif S, Beranger B, Gallea C, Bardinet E, Welter ML. Brain modulation after exergaming training in advanced forms of Parkinson's disease: a randomized controlled study. J Neuroeng Rehabil 2024; 21:133. [PMID: 39103924 DOI: 10.1186/s12984-024-01430-w] [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: 03/25/2024] [Accepted: 07/22/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Physical activity combined with virtual reality and exergaming has emerged as a new technique to improve engagement and provide clinical benefit for gait and balance disorders in people with Parkinson's disease (PD). OBJECTIVE To investigate the effects of a training protocol using a home-based exergaming system on brain volume and resting-state functional connectivity (rs-FC) in persons with PD. METHODS A single blind randomized controlled trial was conducted in people with PD with gait and/or balance disorders. The experimental (active) group performed 18 training sessions at home by playing a custom-designed exergame with full body movements, standing in front of a RGB-D Kinect® motion sensor, while the control group played using the computer keyboard. Both groups received the same training program. Clinical scales, gait recordings, and brain MRI were performed before and after training. We assessed the effects of both training on both the grey matter volumes (GVM) and rs-FC, within and between groups. RESULTS Twenty-three patients were enrolled and randomly assigned to either the active (n = 11) or control (n = 12) training groups. Comparing pre- to post-training, the active group showed significant improvements in gait and balance disorders, with decreased rs-FC between the sensorimotor, attentional and basal ganglia networks, but with an increase between the cerebellar and basal ganglia networks. In contrast, the control group showed no significant changes, and rs-FC significantly decreased in the mesolimbic and visuospatial cerebellar and basal ganglia networks. Post-training, the rs-FC was greater in the active relative to the control group between the basal ganglia, motor cortical and cerebellar areas, and bilaterally between the insula and the inferior temporal lobe. Conversely, rs FC was lower in the active relative to the control group between the pedunculopontine nucleus and cerebellar areas, between the temporal inferior lobes and the right thalamus, between the left putamen and dorsolateral prefrontal cortex, and within the default mode network. CONCLUSIONS Full-body movement training using a customized exergame induced brain rs-FC changes within the sensorimotor, attentional and cerebellar networks in people with PD. Further research is needed to comprehensively understand the neurophysiological effects of such training approaches. Trial registration ClinicalTrials.gov NCT03560089.
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Affiliation(s)
- Anna Skrzatek
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
| | - Dijana Nuic
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
| | - Saoussen Cherif
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
- Genious Healthcare France, Paris, France
| | - Benoit Beranger
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
- CENIR core facility, Paris Brain Institute, Paris, France
| | - Cecile Gallea
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
- CENIR core facility, Paris Brain Institute, Paris, France
| | - Eric Bardinet
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
- CENIR core facility, Paris Brain Institute, Paris, France
| | - Marie-Laure Welter
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France.
- PANAM core facility, Paris Brain Institute, Paris, France.
- Neurophysiology Department, CHU Rouen, Rouen University, Rouen, France.
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Hvingelby VS, Carra RB, Terkelsen MH, Hamani C, Capato T, Košutzká Z, Krauss JK, Moro E, Pavese N, Cury RG. A Pragmatic Review on Spinal Cord Stimulation Therapy for Parkinson's Disease Gait Related Disorders: Gaps and Controversies. Mov Disord Clin Pract 2024; 11:927-947. [PMID: 38899557 PMCID: PMC11329578 DOI: 10.1002/mdc3.14143] [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: 08/01/2023] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Parkinson's Disease (PD) is a progressive neurological disorder that results in potentially debilitating mobility deficits. Recently, spinal cord stimulation (SCS) has been proposed as a novel therapy for PD gait disorders. The highest levels of evidence remain limited for SCS. OBJECTIVES In this systematic review and narrative synthesis, the literature was searched using combinations of key phrases indicating spinal cord stimulation and PD. METHODS We included pre-clinical studies and all published clinical trials, case reports, conference abstracts as well as protocols for ongoing clinical trials. Additionally, we included trials of SCS applied to atypical parkinsonism. RESULTS A total of 45 human studies and trials met the inclusion criteria. Based on the narrative synthesis, a number of knowledge gaps and future avenues of potential research were identified. This review demonstrated that evidence for SCS is currently not sufficient to recommend it as an evidence-based therapy for PD related gait disorders. There remain challenges and significant barriers to widespread implementation, including issues regarding patient selection, effective outcome selection, stimulation location and mode, and in programming parameter optimization. Results of early randomized controlled trials are currently pending. SCS is prone to placebo, lessebo and nocebo as well as blinding effects which may impact interpretation of outcomes, particularly when studies are underpowered. CONCLUSION Therapies such as SCS may build on current evidence and be shown to improve specific gait features in PD. Early negative trials should be interpreted with caution, as more evidence will be required to develop effective methodologies in order to drive clinical outcomes.
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Affiliation(s)
- Victor S. Hvingelby
- Department of Clinical Medicine – Nuclear Medicine and PET CenterAarhus UniversityAarhusDenmark
| | - Rafael B. Carra
- Department of Neurology, School of MedicineUniversity of São PauloSão PauloBrazil
| | - Miriam H. Terkelsen
- Department of Clinical Medicine – Nuclear Medicine and PET CenterAarhus UniversityAarhusDenmark
| | - Clement Hamani
- Division of Neurosurgery, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Tamine Capato
- Department of Neurology, School of MedicineUniversity of São PauloSão PauloBrazil
| | - Zuzana Košutzká
- Second Department of NeurologyComenius University BratislavaBratislavaSlovakia
| | - Joachim K. Krauss
- Department of Neurosurgery, Hannover Medical SchoolHannoverGermany
- Center for Systems NeuroscienceHannoverGermany
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, CHU of Grenoble, Grenoble Institute of NeurosciencesGrenobleFrance
| | - Nicola Pavese
- Clinical Ageing Research Unit Newcastle UniversityNewcastle upon TyneUK
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Song W, Zhang Z, Lv B, Li J, Chen H, Zhang S, Zu J, Dong L, Xu C, Zhou M, Zhang T, Xu R, Zhu J, Shen T, Zhou S, Cui C, Huang S, Wang X, Nie Y, Aftab K, Xiao Q, Zhang X, Cui G, Zhang W. High-frequency rTMS over bilateral primary motor cortex improves freezing of gait and emotion regulation in patients with Parkinson's disease: a randomized controlled trial. Front Aging Neurosci 2024; 16:1354455. [PMID: 38327498 PMCID: PMC10847258 DOI: 10.3389/fnagi.2024.1354455] [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: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Background Freezing of gait (FOG) is a common and disabling phenomenon in patients with Parkinson's disease (PD), but effective treatment approach remains inconclusive. Dysfunctional emotional factors play a key role in FOG. Since primary motor cortex (M1) connects with prefrontal areas via the frontal longitudinal system, where are responsible for emotional regulation, we hypothesized M1 may be a potential neuromodulation target for FOG therapy. The purpose of this study is to explore whether high-frequency rTMS over bilateral M1 could relieve FOG and emotional dysregulation in patients with PD. Methods This study is a single-center, randomized double-blind clinical trial. Forty-eight patients with PD and FOG from the Affiliated Hospital of Xuzhou Medical University were randomly assigned to receive 10 sessions of either active (N = 24) or sham (N = 24) 10 Hz rTMS over the bilateral M1. Patients were evaluated at baseline (T0), after the last session of treatment (T1) and 30 days after the last session (T2). The primary outcomes were Freezing of Gait Questionnaire (FOGQ) scores, with Timed Up and Go Test (TUG) time, Standing-Start 180° Turn (SS-180) time, SS-180 steps, United Parkinson Disease Rating Scales (UPDRS) III, Hamilton Depression scale (HAMD)-24 and Hamilton Anxiety scale (HAMA)-14 as secondary outcomes. Results Two patients in each group dropped out at T2 and no serious adverse events were reported by any subject. Two-way repeated ANOVAs revealed significant group × time interactions in FOGQ, TUG, SS-180 turn time, SS-180 turning steps, UPDRS III, HAMD-24 and HAMA-14. Post-hoc analyses showed that compared to T0, the active group exhibited remarkable improvements in FOGQ, TUG, SS-180 turn time, SS-180 turning steps, UPDRS III, HAMD-24 and HAMA-14 at T1 and T2. No significant improvement was found in the sham group. The Spearman correlation analysis revealed a significantly positive association between the changes in HAMD-24 and HAMA-14 scores and FOGQ scores at T1. Conclusion High-frequency rTMS over bilateral M1 can improve FOG and reduce depression and anxiety in patients with PD.
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Affiliation(s)
- Wenjing Song
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Zixuan Zhang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Bingchen Lv
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jinyu Li
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hao Chen
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shenyang Zhang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jie Zu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Liguo Dong
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chuanying Xu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Manli Zhou
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Tao Zhang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ran Xu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jienan Zhu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Tong Shen
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Su Zhou
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chenchen Cui
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shuming Huang
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xi Wang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yujing Nie
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Kainat Aftab
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Qihua Xiao
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xueling Zhang
- Department of Neurology, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Guiyun Cui
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, Suining County People’s Hospital, Xuzhou, Jiangsu, China
| | - Wei Zhang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, The First Clinical College, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Neurology, Suining County People’s Hospital, Xuzhou, Jiangsu, China
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de Oliveira CEN, Coelho DB, de Souza CR, Batista AX, Marquesini R, Moreira-Neto A, Silva-Batista C, Bitiati AT, Teixeira LA, de Lima-Pardini AC. Cognitive and emotional factors influence specific domains of postural control in individuals with moderate-to-severe Parkinson's disease. Gait Posture 2023; 101:66-72. [PMID: 36758424 DOI: 10.1016/j.gaitpost.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/13/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Cognition and emotional state are domains that highly interfere with postural control in individuals with Parkinson's disease (PD). This study aims to find associations between executive function, anxiety, depression, and reactive and anticipatory postural control domains in individuals with moderate-to-severe Parkinson's disease. METHODS In this study, 34 individuals with PD while on medication were thoroughly assessed for postural control in perturbed, quiet standing and stepping. We performed multiple linear stepwise regressions using postural variables as dependent and cognitive/emotional as independent variables. RESULTS The results showed that cognitive flexibility explained 23 % of anticipatory postural adjustments (APA) duration, inhibitory control explained 42 % of instability on a malleable surface, anxiety explained 21 % of APA amplitude, and 38 % of reactive postural response amplitude. CONCLUSION Our results highlight the impact of emotional and cognitive states on particular domains of postural control in individuals with PD while on medication. These results may have significant implications for future treatments, mainly considering the predictors for postural control domains, which were consistent with the assumption that impairments in affective and executive domains underlie posture. As we have shown that cognitive and emotional states influence postural control domains in individuals with PD, this should be taken into account in rehabilitation protocols.
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Affiliation(s)
| | - Daniel Boari Coelho
- Center for Mathematics, Computation, and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil; Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, São Paulo, Brazil.
| | - Caroline Ribeiro de Souza
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Alana Xavier Batista
- Department of Radiology, Faculty of Medicine, University of São Paulo, Sao Paulo, SP, Brazil
| | - Raquel Marquesini
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Acácio Moreira-Neto
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo, Brazil
| | - Carla Silva-Batista
- Exercise Neuroscience Research Group, University of São Paulo, São Paulo, Brazil
| | | | - Luis Augusto Teixeira
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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Wang L, Gan C, Sun H, Ji M, Zhang H, Cao X, Wang M, Yuan Y, Zhang K. Impaired structural and reserved functional topological organizations of brain networks in Parkinson's disease with freezing of gait. Quant Imaging Med Surg 2023; 13:66-79. [PMID: 36620158 PMCID: PMC9816763 DOI: 10.21037/qims-22-351] [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: 04/10/2022] [Accepted: 09/16/2022] [Indexed: 01/11/2023]
Abstract
Background Freezing of gait (FOG) is a common disabling motor disturbance in Parkinson's disease (PD). Our study aimed to probe the topological organizations of structural and functional brain networks and their coupling in FOG. Methods In this cross-sectional retrospective study, a total of 30 PD patients with FOG (PD-FOG), 40 patients without FOG, and 25 healthy controls (HCs) underwent clinical assessments and magnetic resonance imaging (MRI) scanning. Large-scale structural and functional brain networks were constructed. Subsequently, global and nodal graph theoretical properties and functional-structural coupling were investigated. Finally, correlations between the altered brain topological properties and freezing severity were analyzed in PD-FOG. Results For structural networks, at the global level, PD-FOG exhibited increased normalized characteristic path length (P=0.040, Bonferroni-corrected) and decreased global efficiency (P=0.005, Bonferroni-corrected) compared with controls, and showed reduced global (P=0.001, Bonferroni-corrected) and local (P=0.032, Bonferroni-corrected) efficiency relative to patients without FOG. At the nodal level, nodal efficiency of structural networks was reduced in PD-FOG compared with PD patients without FOG, located in the left supplementary motor area (SMA), gyrus rectus, and middle cingulate cortex (MCC) (all P<0.05, Bonferroni-corrected). Notably, altered global and nodal properties of structural networks were significantly correlated with Freezing of Gait Questionnaire scores [all P<0.05, false discovery rate (FDR)-corrected]. However, only an increase in local efficiency (P=0.003, Bonferroni-corrected) of functional networks was identified in PD-FOG compared with those without FOG. No significant structural-functional coupling was detected among the 3 groups. Conclusions This study demonstrates the extensively impaired structural and relatively reserved functional network topological organizations in PD-FOG. Our results also provide evidence that the pathogenesis of PD-FOG is primarily attributable to network vulnerability established by crucial structural damage, especially in the left SMA, gyrus rectus, and MCC.
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Affiliation(s)
- Lina Wang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Caiting Gan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huimin Sun
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Ji
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Heng Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xingyue Cao
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yongsheng Yuan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kezhong Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Doine R, Sakamaki T. Human Standing Posture Motion Evaluation by the Visual Simulation of Multi-Directional Sea-Waves. SENSORS (BASEL, SWITZERLAND) 2022; 22:5884. [PMID: 35957442 PMCID: PMC9371429 DOI: 10.3390/s22155884] [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: 05/15/2022] [Revised: 07/19/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
Crew fatigue from standing posture motion, caused by ship motion, can lead to marine accidents. Therefore, the mechanism of fatigue in crew members ought to be elucidated. The standing posture of humans is maintained by postural state detection through the visual, vestibular, and somatosensory systems. Humans can adjust their posture through corrective postural reactions (CPR) generated after anticipatory postural adjustments (APAs) by using information from these sensory systems. APAs refer to skills acquired by learning from past motions and perturbations and are prepared by the central nervous system based on visual information before the actual perturbation occurs. We hypothesized that APAs would decrease fatigue in crew members by stabilizing their standing posture motions. We aimed to clarify the human standing posture control influenced by APAs based on visual information. To this end, we presented wave images with different wave directions to the participants using a visual simulator and analyzed their standing posture motion. We found that the participants stabilized their standing posture based on the projected wave directions. This showed that the participants predicted ship motion from the wave images and controlled their center of pressure (COP) through APAs. Individual differences in standing postural motion may indicate the subjective variation of APAs based on individual experiences. This study was limited to males aged 20-23 years. To generalize this study, randomized controlled trials should be performed with participants of multiple age groups, including men and women.
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Affiliation(s)
- Renon Doine
- Department of Clinical Engineering, Faculty of Human Care at Makuhari, Tohto University, Chiba 261-0021, Japan
| | - Takanori Sakamaki
- Department of Informatics and Mechanical Engineering, National Institute of Technology, Toba College, Toba 517-8501, Japan
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Farinelli V, Bolzoni F, Marchese SM, Esposti R, Cavallari P. A Novel Viewpoint on the Anticipatory Postural Adjustments During Gait Initiation. Front Hum Neurosci 2021; 15:709780. [PMID: 34707487 PMCID: PMC8543010 DOI: 10.3389/fnhum.2021.709780] [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: 05/14/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022] Open
Abstract
Anticipatory postural adjustments (APAs) are the coordinated muscular activities that precede the voluntary movements to counteract the associated postural perturbations. Many studies about gait initiation call APAs those activities that precede the heel-off of the leading foot, thus taking heel-off as the onset of voluntary movement. In particular, leg muscles drive the center of pressure (CoP) both laterally, to shift the body weight over the trailing foot and backward, to create a disequilibrium torque pushing forward the center of mass (CoM). However, since subjects want to propel their body rather than lift their foot, the onset of gait should be the CoM displacement, which starts with the backward CoP shift. If so, the leg muscles driving such a shift are the prime movers. Moreover, since the disequilibrium torque is mechanically equivalent to a forward force acting at the pelvis level, APAs should be required to link the body segments to the pelvis: distributing such concentrated force throughout the body would make all segments move homogeneously. In the aim of testing this hypothesis, we analyzed gait initiation in 15 right-footed healthy subjects, searching for activities in trunk muscles that precede the onset of the backward CoP shift. Subjects stood on a force plate for about 10 s and then started walking at their natural speed. A minimum of 10 trials were collected. A force plate measured the CoP position while wireless probes recorded the electromyographic activities. Recordings ascertained that at gait onset APAs develop in trunk muscles. On the right side, Rectus Abdominis and Obliquus Abdominis were activated in 11 and 13 subjects, respectively, starting on average 33 and 54 ms before the CoP shift; Erector Spinae (ES) at L2 and T3 levels was instead inhibited (9 and 7 subjects, 104 and 120 ms). On the contralateral side, the same muscles showed excitatory APAs (abdominals in 11 and 12 subjects, 27 and 82 ms; ES in 10 and 7 subjects, 75 and 32 ms). The results of this study provide a novel framework for distinguishing postural from voluntary actions, which may be relevant for the diagnosis and rehabilitation of gait disorders.
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Affiliation(s)
- Veronica Farinelli
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Francesco Bolzoni
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Silvia Maria Marchese
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Roberto Esposti
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Paolo Cavallari
- Human Physiology Section of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Wang H, Li HY, Guo X, Zhou Y. Posture Instability Is Associated with Dopamine Drop of Nigrostriatal System and Hypometabolism of Cerebral Cortex in Parkinson Disease. Curr Neurovasc Res 2021; 18:244-253. [PMID: 34082681 DOI: 10.2174/1567202618666210603124814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Posture instability (PI) is known to be a severe complication in Parkinson's disease (PD), and its mechanism remains poorly understood. Our study aims to explore the changes of brain network in PI of PD, and further investigate the role of peripheral inflammation on activities of different brain regions in PD with PI. METHODS 167 individuals were recruited, including 36 PD cases with PI and 131 ones without PI. We carefully assessed the status of motor and cognitive function, measured serum inflammatory factors, and detected the dopaminergic pathways and the metabolism of different brain regions by positron emission tomography (PET). Data analysis was conducted by variance, univariate analysis, chi-square analysis, logistic regression, and partial correlation. RESULT No difference was found for age or onset age between the two groups (P>0.05). Female patients were susceptible to posture impairment and had a 2.14-fold risk for PI compared with male patients in PD (P<0.05). Patients with PI had more severe impairment of motor and cognitive function for a longer duration than those without PI (P<0.05). The mean uptake ratios of presynaptic vesicular monoamine transporter (VMAT2), which were detected in the caudate nucleus and putamen, were lower in PI group than those without PI (P<0.05). There were lower activities of the midbrain, caudate nucleus, and anterior medial temporal cortex in PI group than those in the non-PI group (P<0.05). Although serum concentrations of immunoglobulins (IgG, IgM, and IgA) and complements (C3, C4) were higher in PI group than those in the non-PI group, only serum IgM concentration had a significant difference between the two groups (P<0.05). We further explored significant inverse correlations of IgG, IgM, IgA, and C4 with activities of some cerebral cortex in PI of PD (P<0.05). CONCLUSION Female patients were susceptible to posture instability and had a 2.14-fold risk for PI of PD. Patients with PI had more severe impairments of motor and cognitive function for a longer duration than those without PI. PI was associated with dopamine drop of the nigrostriatal system and lower activities of the limbic cortex in PD. Peripheral inflammation may be involved in degeneration of the cerebral cortex in PD combined with PI.
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Affiliation(s)
- Hongyan Wang
- The Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 10053, China
| | - Hong-Yu Li
- School of Pharmacy, Lanzhou University, Lanzhou 730000, China
| | - Xiuhai Guo
- The Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 10053, China
| | - Yongtao Zhou
- The Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 10053, China
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