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Bartolo M, Castelli A, Calabrese M, Buttacchio G, Zucchella C, Tamburin S, Fontana A, Copetti M, Fasano A, Intiso D. A wearable system for visual cueing gait rehabilitation in Parkinson's disease: a randomized non-inferiority trial. Eur J Phys Rehabil Med 2024; 60:245-256. [PMID: 38483335 PMCID: PMC11114153 DOI: 10.23736/s1973-9087.24.08381-3] [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: 12/17/2023] [Revised: 01/30/2024] [Accepted: 02/19/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Gait disturbances represent one of the most disabling features of Parkinson's disease (PD). AIM The aim of this study was to evaluate the non-inferiority of a new wearable visual cueing system (Q-Walk) for gait rehabilitation in PD subjects, compared to traditional visual cues (stripes on the floor). DESIGN Open-label, monocentric, randomized controlled non-inferiority trial. SETTING Outpatients. POPULATION Patients affected by idiopathic PD without cognitive impairment, Hoehn and Yahr stage II-IV, Unified Parkinson's Disease Rating Scale motor section III ≥2, stable drug usage since at least 3 weeks. METHODS At the enrollment (T0), all subjects underwent a clinical/functional evaluation and the instrumental gait and postural analysis; then they were randomly assigned to the Study Group (SG) or Control Group (CG). Rehabilitation program consisted in 10 consecutive individual sessions (5 sessions/week for 2 consecutive weeks). Each session included 60 minutes of conventional physiotherapy plus 30 minutes of gait training by Q-Walk (SG) or by traditional visual cues (CG). Follow-up visits were scheduled at the end of the treatment (T1) and after 3 months (T2). RESULTS Fifty-two subjects were enrolled in the study, 26 in each group. The within-groups analysis showed a significant improvement in clinical scales and instrumental data at T1 and at T2, compared to baseline, in both groups. According to the between-group analysis, Q-Walk cueing system was not-inferior to the traditional cues for gait rehabilitation. The satisfaction questionnaire revealed that most subjects described the Q-Walk cueing system as simple, motivating and easily usable, possibly suitable for home use. CONCLUSIONS Data showed that motor rehabilitation of PD subjects performed by means of the new wearable Q-Walk cueing system was feasible and as effective as traditional cues in improving gait parameters and balance. CLINICAL REHABILITATION IMPACT Wearable devices can act as an additional rehabilitation strategy for long-term and continuous care, allowing patients to train intensively and extensively in household settings, favoring a tailor-made and personalized approach as well as remote monitoring.
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Affiliation(s)
- Michelangelo Bartolo
- Neurorehabilitation Unit, Rehabilitation Department, HABILITA Zingonia, Zingonia, Bergamo, Italy -
| | - Alberto Castelli
- Neurorehabilitation Unit, Rehabilitation Department, HABILITA Zingonia, Zingonia, Bergamo, Italy
| | - Marzia Calabrese
- Neurorehabilitation Unit, Rehabilitation Department, HABILITA Zingonia, Zingonia, Bergamo, Italy
| | - Giampiero Buttacchio
- Neurorehabilitation Unit, Rehabilitation Department, HABILITA Zingonia, Zingonia, Bergamo, Italy
| | | | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Department of Parkinson's Disease and Movement Disorders Rehabilitation, Moriggia-Pelascini Hospital, Gravedona ed Uniti, Como, Italy
| | - Domenico Intiso
- Unit of Neurorehabilitation and Rehabilitation Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
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Wang J, Li Y, Wang Y, Wang C, Qie S, Jin Z, Du W. Comparison of different rhythmic auditory stimuli on prefrontal cortex cortical activation during upper limb movement in patients with Parkinson's disease: a functional near-infrared spectroscopy study. Front Neurol 2024; 15:1336268. [PMID: 38476192 PMCID: PMC10927970 DOI: 10.3389/fneur.2024.1336268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/30/2024] [Indexed: 03/14/2024] Open
Abstract
Background A large number of literatures show that rhythmic auditory stimulation (RAS) can effectively improve Parkinson's disease (PD) patients' gait speed, frequency and speed. Its application and curative effect on upper limb motor function is relatively few. Objective By studying the immediate effect of RAS with different rhythms on the prefrontal cortex (PFC) blood oxygen response during upper limb movement in PD patients, this study discusses the potential neurophysiological mechanism of RAS on upper limb movement in PD patients, which is expected to provide guidance for patients with upper limb dysfunction such as Parkinson's disease. Methods In this study, 31 PD patients with upper limb static tremors were recruited to complete the nail board task on the healthy upper limb under the baseline rhythm, slow rhythm and fast rhythm provided by the therapist. At the same time, fNIRS was used to observe the blood oxygen response of PFC. Results There was no significant main effect onsidein all brain regions (p > 0.05), and there was no interaction between rhythm and side (p > 0.05); Except lPFC, the main effect of rhythm in other brain regions was significant (p < 0.05), and ΔHbO increased with the change of rhythm. Paired analysis showed that there were significant differences in ΔHbO between slow rhythm and baseline rhythm, between fast rhythm and baseline rhythm, and between slow rhythm and fast rhythm (p < 0.05); The ΔHbO of rPFC, lDLPFC and rDLPFC were significantly different between slow rhythm and fast rhythm (p < 0.05); there were significant differences in the ΔHbO of BA8 between slow rhythm and baseline rhythm, and between slow rhythm and fast rhythm (p < 0.05). Conclusion RAS may be a useful upper limb rehabilitation strategy for PD patients with upper limb dysfunction. At the same time, RAS with different rhythms also have different responses to PFC blood oxygen during upper limb movement in PD patients, so that we can design interventions for this kind of cortical mechanism. Identifying the neurophysiological mechanism of RAS on upper limb movement in PD patients may help clinicians customize rehabilitation methods for patients according to clues, so as to highly personalize upper limb training and optimize its effect.
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Affiliation(s)
- Jie Wang
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yingqi Li
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yingpeng Wang
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Congxiao Wang
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Shuyan Qie
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Jin
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Wenjun Du
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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Ghai S. Does Music Therapy Improve Gait after Traumatic Brain Injury and Spinal Cord Injury? A Mini Systematic Review and Meta-Analysis. Brain Sci 2023; 13:brainsci13030522. [PMID: 36979332 PMCID: PMC10046548 DOI: 10.3390/brainsci13030522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
There is a growing body of research examining the potential benefits of music therapy-based auditory stimulation (MT) for individuals with movement disorders in improving gait performance. However, there is limited knowledge about the effects of MT on gait outcomes in individuals with traumatic brain injury (TBI) or spinal cord injury (SCI). A previous review of MT's impact on gait in TBI had limitations, and there are no studies on its effects on gait in SCI. In this study, we conducted a meta-analysis to more thoroughly evaluate the impact of MT on gait outcomes in individuals with TBI and SCI. We systematically searched through eight databases and found six studies on MT in TBI and four on SCI. Our meta-analysis showed that MT has positive medium effect improvements on spatiotemporal aspects of gait in individuals with TBI (Hedge's g: 0.52) and SCI (0.53). These findings suggest that MT could be a practical intervention for enhancing different aspects of gait in these populations, although the limited number and "fair" quality of the studies included in the meta-analysis may affect the generalizability of the outcomes. Further research is needed to fully understand the mechanisms by which MT may influence gait and determine the optimal parameters for its use.
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Affiliation(s)
- Shashank Ghai
- Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, 01069 Dresden, Germany
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, 01069 Dresden, Germany
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Wu J, Zhou C, Guo T, Guan X, Gao T, Bai X, Wu H, Chen J, Wen J, Liu X, Gu L, Song Z, Xuan M, Gu Q, Huang P, Pu J, Zhang B, Xu X, Zhang M. Cholinergic relevant functional reactivity is associated with dopamine responsiveness of tremor in Parkinson's disease. Brain Imaging Behav 2022; 16:1234-1245. [PMID: 34973120 PMCID: PMC9107430 DOI: 10.1007/s11682-021-00610-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/30/2022]
Abstract
Tremor in Parkinson's disease (PD) has distinct responsiveness to dopamine, which is supposed not be exclusively related to dopamine deficiency but has a close relationship with cholinergic system. This phenomenon indicates that cholinergic system may be an important regulatory for distinct dopamine responsiveness of parkinsonian tremor. Through investigating the alterations of cholinergic and dopaminergic network during levodopa administration, we aimed at exploring the mechanisms of differed dopamine responsiveness of parkinsonian tremor. Fifty-two PD patients with tremor were enrolled. MRI scanning, UPDRS III and its sub-symptom scores were collected in OFF and ON status (dopaminergic challenge test). Then, patients were divided into two groups (dopamine-resistant tremor and dopamine-responsive tremor) according to the tremor change rate median score. Dopaminergic and cholinergic network were obtained. LASSO regression was conducted to identify functional connectivity with distinct reactivity during levodopa administration between groups. Afterwards, detailed group comparisons, interaction and correlation analyses were performed. The reactivity of cholinergic connectivity showed the highest possibility to distinguish two groups, especially connectivity of right basal forebrain 123 to right parietal operculum cortex (R.BF123-R.PO). After levodopa administration, connectivity of R.BF123-R.PO was decreased for dopamine-responsive tremor while which remained unchanged for dopamine-resistant tremor. The reactivity of R.BF123-R.PO was negatively correlated with tremor change rate. Reduced cholinergic connectivity to parietal operculum may be an underlying mechanism for the responsive tremor in PD and the distinct cholinergic reactivity of parietal operculum to levodopa may be a core pathophysiology for the differed DA responsiveness of tremor in PD.
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Affiliation(s)
- Jingjing Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Ting Gao
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xueqin Bai
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Haoting Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Jingwen Chen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Jiaqi Wen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Xiaocao Liu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Luyan Gu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Zhe Song
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Min Xuan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Quanquan Gu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Jiali Pu
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xiaojun Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China.
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LASSO Homotopy-Based Sparse Representation Classification for fNIRS-BCI. SENSORS 2022; 22:s22072575. [PMID: 35408190 PMCID: PMC9003428 DOI: 10.3390/s22072575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/07/2022] [Accepted: 03/23/2022] [Indexed: 12/26/2022]
Abstract
Brain-computer interface (BCI) systems based on functional near-infrared spectroscopy (fNIRS) have been used as a way of facilitating communication between the brain and peripheral devices. The BCI provides an option to improve the walking pattern of people with poor walking dysfunction, by applying a rehabilitation process. A state-of-the-art step-wise BCI system includes data acquisition, pre-processing, channel selection, feature extraction, and classification. In fNIRS-based BCI (fNIRS-BCI), channel selection plays a vital role in enhancing the classification accuracy of the BCI problem. In this study, the concentration of blood oxygenation (HbO) in a resting state and in a walking state was used to decode the walking activity and the resting state of the subject, using channel selection by Least Absolute Shrinkage and Selection Operator (LASSO) homotopy-based sparse representation classification. The fNIRS signals of nine subjects were collected from the left hemisphere of the primary motor cortex. The subjects performed the task of walking on a treadmill for 10 s, followed by a 20 s rest. Appropriate filters were applied to the collected signals to remove motion artifacts and physiological noises. LASSO homotopy-based sparse representation was used to select the most significant channels, and then classification was performed to identify walking and resting states. For comparison, the statistical spatial features of mean, peak, variance, and skewness, and their combination, were used for classification. The classification results after channel selection were then compared with the classification based on the extracted features. The classifiers used for both methods were linear discrimination analysis (LDA), support vector machine (SVM), and logistic regression (LR). The study found that LASSO homotopy-based sparse representation classification successfully discriminated between the walking and resting states, with a better average classification accuracy (p < 0.016) of 91.32%. This research provides a step forward in improving the classification accuracy of fNIRS-BCI systems. The proposed methodology may also be used for rehabilitation purposes, such as controlling wheelchairs and prostheses, as well as an active rehabilitation training technique for patients with motor dysfunction.
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Nishida D, Mizuno K, Yamada E, Tsuji T, Hanakawa T, Liu M. Correlation between the brain activity with gait imagery and gait performance in adults with Parkinson's disease: A data set. Data Brief 2021; 36:106993. [PMID: 33889696 PMCID: PMC8050720 DOI: 10.1016/j.dib.2021.106993] [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: 02/09/2021] [Revised: 03/04/2021] [Accepted: 03/19/2021] [Indexed: 11/30/2022] Open
Abstract
This article describes data related to the research study entitled “The neural correlate of gait improvement by rhythmic sound stimulation in adults with Parkinson's disease – A functional magnetic resonance imaging study” [1]. We evaluated gait performance using the 10-meter walk test (10MWT) in adults with Parkinson's disease (PD) and age-matched healthy controls (HC). Gait speed (GS) and step length (SL) were calculated from the results of the 10MWT. We also evaluated neural activities in regions that were significantly activated by gait imagery in adults with PD using functional magnetic resonance imaging (fMRI). The correlation among GS, SL, and activation of blood oxygenation level-dependent (BOLD) signals by gait imagery in adults with PD. Both GS and SL were smaller in adults with PD than in HCs. The left parietal operculum (PO), left supplementary motor area (SMA), and right cerebellum were activated by gait imagery in adults with PD. No significant correlation was found in any pair of gait performance and neural activation of such regions. This data set could be reused for studies to investigate the relationship between gait performance and neural activities in adults with PD.
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Affiliation(s)
- Daisuke Nishida
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Rehabilitation, Saiseikai Kanagawa-ken Hospital, Kanagawa, Japan.,Department of Rehabilitation Medicine, School of Medicine Keio University, Tokyo, Japan
| | - Katsuhiro Mizuno
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Rehabilitation, Saiseikai Kanagawa-ken Hospital, Kanagawa, Japan.,Department of Rehabilitation Medicine, School of Medicine Keio University, Tokyo, Japan
| | - Emi Yamada
- Department of Clinical Physiology, School of Medicine Kyushu University, Fukuoka, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, School of Medicine Keio University, Tokyo, Japan
| | - Takashi Hanakawa
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, School of Medicine Keio University, Tokyo, Japan
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