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Mirdamadi JL, Ting LH, Borich MR. Distinct Cortical Correlates of Perception and Motor Function in Balance Control. J Neurosci 2024; 44:e1520232024. [PMID: 38413231 PMCID: PMC11007305 DOI: 10.1523/jneurosci.1520-23.2024] [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: 08/08/2023] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024] Open
Abstract
Fluctuations in brain activity alter how we perceive our body and generate movements but have not been investigated in functional whole-body behaviors. During reactive balance, we recently showed that evoked brain activity is associated with the balance ability in young individuals. Furthermore, in PD, impaired whole-body motion perception in reactive balance is associated with impaired balance. Here, we investigated the brain activity during the whole-body motion perception in reactive balance in young adults (9 female, 10 male). We hypothesized that both ongoing and evoked cortical activity influences the efficiency of information processing for successful perception and movement during whole-body behaviors. We characterized two cortical signals using electroencephalography localized to the SMA: (1) the "N1," a perturbation-evoked potential that decreases in amplitude with expectancy and is larger in individuals with lower balance function, and (2) preperturbation β power, a transient rhythm that favors maintenance of the current sensorimotor state and is inversely associated with tactile perception. In a two-alternative forced choice task, participants judged whether pairs of backward support surface perturbations during standing were in the "same" or "different" direction. As expected, lower whole-body perception was associated with lower balance ability. Within a perturbation pair, N1 attenuation was larger on correctly perceived trials and associated with better balance, but not perception. In contrast, preperturbation β power was higher on incorrectly perceived trials and associated with poorer perception, but not balance. Together, ongoing and evoked cortical activity have unique roles in information processing that give rise to distinct associations with perceptual and balance ability.
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Affiliation(s)
- Jasmine L Mirdamadi
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia 30322
| | - Lena H Ting
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia 30322
- The Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia 30322
| | - Michael R Borich
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia 30322
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Walters RK, Gudipudi R, Gordis T, Davidson K, Nguyen SA, O'Rourke AK. A Systematic Review of Pharyngeal High-Resolution Manometry Normative Data. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1059-1068. [PMID: 38127890 DOI: 10.1044/2023_ajslp-23-00221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE The utilization of high-resolution pharyngeal manometry (HRPM) in the evaluation of pharyngeal dysphagia has been increasing; however, standardization of its use has lagged behind. Without standardization using normative values, it is difficult for clinicians to adopt this emerging technology into meaningful use. Our goal is to map and compare the published normative values for common HRPM metrics in order to help establish consensus reference values. METHOD A systematic review was conducted on prospective and retrospective studies that included HRPM metrics, defined by an international working group consensus, in healthy adult populations. Data on the following variables were extracted when available: contractile integrals of the pharynx (PhCI), velopharynx, mesopharynx, and hypopharynx, as well as the upper esophageal sphincter (UES) integrated relaxation pressure (IRP), relaxation time (RT), maximum admittance, and hypopharyngeal intrabolus pressure. RESULTS Thirty studies were included. Significant variation existed in the technique and equipment used to perform procedures between the different studies. Lower PhCIs and UES IRPs were seen in younger compared to older individuals. Higher UES RTs were found in individuals in the upright position compared to the supine position and in those using larger boluses sizes or smaller catheters. CONCLUSIONS Due to the wide variety of protocols, catheter configurations, manufacturers, and software used in the existing literature, it is difficult to formulate consensus on HPRM normative values using pooled data. Prospective studies adhering to standardized HRPM protocols for specific catheter configurations and manufacturers with larger cohorts of normal individuals are necessary to establish proper reference values for HRPM metrics. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24843753.
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Affiliation(s)
- Rameen K Walters
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Rachana Gudipudi
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Tamar Gordis
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Kate Davidson
- Department of Speech-Language Pathology, Medical University of South Carolina, Charleston
| | - Shaun A Nguyen
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
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Sadeghi M, Bristow T, Fakorede S, Liao K, Palmer JA, Lyons KE, Pahwa R, Huang CK, Akinwuntan A, Devos H. The Effect of Sensory Reweighting on Postural Control and Cortical Activity in Parkinson's Disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.26.24301687. [PMID: 38352617 PMCID: PMC10862999 DOI: 10.1101/2024.01.26.24301687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
Aims Balance requires the cortical control of visual, somatosensory, and vestibular inputs. The aim of this cross-sectional study was to compare the contributions of each of these systems on postural control and cortical activity using a sensory reweighting approach between participants with Parkinson's disease (PD) and controls. Methods Ten participants with PD (age: 72 ± 9; 3 women; Hoehn & Yahr: 2 [1.5 - 2.50]) and 11 controls (age: 70 ± 3; 4 women) completed a sensory organization test in virtual reality (VR-SOT) while cortical activity was being recorded using electroencephalography (EEG). Conditions 1 to 3 were completed on a stable platform; conditions 4 to 6 on a foam. Conditions 1 and 4 were done with eyes open; conditions 2 and 5 in a darkened VR environment; and conditions 3 and 6 in a moving VR environment. Linear mixed models were used to evaluate changes in center of pressure (COP) displacement and EEG alpha and theta/beta ratio power between the two groups across the postural control conditions. Condition 1 was used as reference in all analyses. Results Participants with PD showed greater COP displacement than controls in the anteroposterior (AP) direction when relying on vestibular input (condition 5; p<0.0001). The mediolateral (ML) COP sway was greater in PD than in controls when relying on the somatosensory (condition 2; p = 0.03), visual (condition 4; p = 0.002), and vestibular (condition 5; p < 0.0001) systems. Participants with PD exhibited greater alpha power compared to controls when relying on visual input (condition 2; p = 0.003) and greater theta/beta ratio power when relying on somatosensory input (condition 4; p = 0.001). Conclusions PD affects reweighting of postural control, exemplified by greater COP displacement and increased cortical activity. Further research is needed to establish the temporal dynamics between cortical activity and COP displacement.
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Legutke BR, Gobbi LTB, Orcioli-Silva D, Santos PCRD, Moraca GAG, Vitório R, Beretta VS. Transcranial direct current stimulation suggests not improving postural control during adapted tandem position in people with Parkinson's disease: A pilot study. Behav Brain Res 2023; 452:114581. [PMID: 37453515 DOI: 10.1016/j.bbr.2023.114581] [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: 01/19/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Balance impairments in people with Parkinson's disease (PD) demonstrated mainly in challenging postural tasks, such as increased body oscillation may be attributed to the deficits in the brain structures functionality involved in postural control (e.g., motor cortex, midbrain, and brainstem). Although promising results, the effect of transcranial direct current stimulation (tDCS) on postural control in people with PD is unclear, especially in objective measures such as the center of pressure (CoP) parameters. Thus, we analyzed the effects of a single session of tDCS on the CoP parameters during the adapted tandem position in people with PD. METHODS Nineteen people with PD participated in this crossover, randomized, and double-blind study. Anodal tDCS was applied over the primary motor cortex in two conditions of stimulation (2 mA/active and sham) on two different days for 20 min immediately before the postural control evaluation. Participants remained standing in an adapted tandem position for the postural control assessment for 30 s (three trials). CoP parameters were acquired by a force plate. RESULTS No significant differences were demonstrated between stimulation conditions (p-value range = 0.15-0.89). CONCLUSIONS Our results suggested that a single session of tDCS with 2 mA does not improve the postural control of people with PD during adapted tandem.
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Affiliation(s)
- Beatriz Regina Legutke
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Campinas (UNICAMP), School of Applied Sciences (FCA), Laboratory of Applied Sport Physiology (LAFAE), Limeira, Brazil
| | - Paulo Cezar Rocha Dos Santos
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Israel; The Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel
| | - Gabriel Antonio Gazziero Moraca
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil
| | - Rodrigo Vitório
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Graduate Program in Movement Sciences, São Paulo State University - UNESP, Brazil; São Paulo State University (Unesp), School of Technology and Sciences, Presidente Prudente, São Paulo, Brazil.
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Mirdamadi JL, Ting LH, Borich MR. Distinct cortical correlates of perception and motor function in balance control. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.22.554282. [PMID: 37662247 PMCID: PMC10473579 DOI: 10.1101/2023.08.22.554282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Fluctuations in brain state alter how we perceive our body and generate movements but have not been investigated in functional whole-body behaviors. During reactive balance control, we recently showed that evoked brain activity is associated with balance ability in healthy young individuals. Further, in individuals with Parkinson's disease, impairments in whole-body motion perception in reactive balance are associated with clinical balance impairment. Here we investigated brain activity during whole-body motion perception in reactive balance in healthy young adults. We hypothesized that flexibility in brain states underlies successful perception and movement during whole-body movement. We characterized two cortical sensorimotor signals using electroencephalography localized to the supplementary motor area: 1) the "N1 response", a perturbation-evoked potential that decreases in amplitude with expectancy and is larger in individuals with lower balance function; and 2) pre-perturbation beta oscillatory activity, a rhythm that favors maintenance of the current sensorimotor state and is inversely associated with perception in seated somatosensory perceptual tasks. In a two-alternative forced choice task, participants judged whether pairs of backward support-surface perturbations during standing were in the "same" or "different" direction. As expected, lower whole-body perception was associated with lower balance ability. Within a perturbation pair, N1 attenuation was larger on correctly perceived trials and associated with better balance, but not perception. In contrast, pre-perturbation beta power was higher on incorrectly perceived trials and associated with poorer perception, but not balance. Taken together, flexibility in different cortical processes influences perceptual accuracy but have distinct associations with balance and perceptual ability.
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Affiliation(s)
- Jasmine L. Mirdamadi
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Lena H. Ting
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA 30322, USA
- The Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30322, USA
| | - Michael R. Borich
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA 30322, USA
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Beretta VS, Santos PCR, Orcioli-Silva D, Jaimes DAR, Pereira MP, Barbieri FA, Gobbi LTB. Cumulative additional information does not improve the neuromuscular control during postural responses to perturbations in postural instability/gait disorders subtype of Parkinson's disease. Exp Gerontol 2022; 166:111892. [PMID: 35811017 DOI: 10.1016/j.exger.2022.111892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/15/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Postural response impairments in postural instability and gait disorders (PIGD) subtype patients may be attributed to Parkinson's disease (PD)-deterioration in central-set (programing/modulating of central outputs during motor responses). Although additional information improves some PD motor impairments, an unanswered question is whether additional information can benefit postural response in PIGD subtype. OBJECTIVE To analyze the effect of cumulative additional information on postural responses after perturbation in PIGD and neurologically healthy older adults (CG). METHODS Perturbations were applied in 16 PIGD and 19 CG by the support-base translation. Participants performed 3 blocks of 5 trials without additional information (B1-B3, Day 1) and 5 trials of each cumulative additional information (C1-C4, Day 2): information about perturbation (C1), visual (C2), verbal (C3), and somatosensory information (C4). Electromyography and center of pressure (CoP) parameters were analyzed by ANOVAs with Group (PIGD × CG) and Block (B1 × B2 × B3) and with Group (PIGD × CG) and Condition (B3 × C1 × C2 × C3 × C4). RESULTS PIGD decreased the range of CoP in B3 while CG decreased both range of CoP and the integral of antagonist's muscle activity (iEMG) in B2. Also, PIGD decreased the recovery time in C4 while CG increased the iEMG of agonist's muscle in C2 and antagonist's muscle in all conditions except C2. CONCLUSION Additional information provided before postural control assessment influences the postural response in PIGD and CG differently. PIGD demonstrated inflexibility of central-set in modulating the neuromuscular control regardless of additional information. CG presents a flexible system evidenced by the increase of agonist muscle iEMG when provided visual information.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Paulo Cezar Rocha Santos
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Israel
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Campinas (UNICAMP), School of Applied Sciences (FCA), Laboratory of Applied Sport Physiology (LAFAE), Limeira, Brazil
| | - Diego Alejandro Rojas Jaimes
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of San Buenaventura Medellin, Graduate Program in Physical Education and Sports, Medellín, Colombia
| | - Marcelo Pinto Pereira
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Fabio Augusto Barbieri
- São Paulo State University (UNESP), School of Sciences, Graduate Program in Movement Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
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Engel D, Student J, Schwenk JCB, Morris AP, Waldthaler J, Timmermann L, Bremmer F. Visual perturbation of balance suggests impaired motor control but intact visuomotor processing in Parkinson's disease. J Neurophysiol 2021; 126:1076-1089. [PMID: 34469704 DOI: 10.1152/jn.00183.2021] [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] [Indexed: 12/11/2022] Open
Abstract
Postural instability marks one of the most disabling features of Parkinson's disease (PD), but it only reveals itself after affected brain areas have already been significantly damaged. Thus there is a need to detect deviations in balance and postural control before visible symptoms occur. In this study, we visually perturbed balance in the anterior-posterior direction using sinusoidal oscillations of a moving room in virtual reality at different frequencies. We tested three groups: individuals with PD under dopaminergic medication, an age-matched control group, and a group of young healthy adults. We tracked their center of pressure and their full-body motion, from which we also extracted the center of mass. We investigated sway amplitudes and applied newly introduced phase-locking analyses to investigate responses across participants' bodies. Patients exhibited significantly higher sway amplitudes as compared with the control subjects. However, their sway was phase locked to the visual motion like that of age-matched and young healthy adults. Furthermore, all groups successfully compensated for the visual perturbation by phase locking their sway to the stimulus. As frequency of the perturbation increased, distribution of phase locking (PL) across the body revealed a shift of the highest PL values from the upper body toward the hip region for young healthy adults, which could not be observed in patients and elderly healthy adults. Our findings suggest an impaired motor control, but intact visuomotor processing in early stages of PD, while less flexibility to adapt postural strategy to different perturbations revealed to be an effect of age rather than disease.NEW & NOTEWORTHY A better understanding of visuomotor control in Parkinson's disease (PD) potentially serves as a tool for earlier diagnosis, which is crucial for improving patient's quality of life. In our study, we assess body sway responses to visual perturbations of the balance control system in patients with early-to-mid stage PD, using motion tracking along with recently established phase-locking techniques. Our findings suggest patients at this stage have an impaired muscular stability but intact visuomotor control.
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Affiliation(s)
- David Engel
- Department of Neurophysics, Philipps-Universität Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior (CMBB), Philipps-Universität Marburg and Justus-Liebig-Universität Giessen, Germany
| | - Justus Student
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Jakob C B Schwenk
- Department of Neurophysics, Philipps-Universität Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior (CMBB), Philipps-Universität Marburg and Justus-Liebig-Universität Giessen, Germany
| | - Adam P Morris
- Neuroscience Program, Biomedicine Discovery Institute, Department of Physiology, Monash University, Clayton, Victoria, Australia.,Data Science and Artificial Intellegience Platform, Monash eResearch Centre, Monash University, Clayton, Victoria, Australia
| | - Josefine Waldthaler
- Center for Mind, Brain and Behavior (CMBB), Philipps-Universität Marburg and Justus-Liebig-Universität Giessen, Germany.,Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Lars Timmermann
- Center for Mind, Brain and Behavior (CMBB), Philipps-Universität Marburg and Justus-Liebig-Universität Giessen, Germany.,Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Frank Bremmer
- Department of Neurophysics, Philipps-Universität Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior (CMBB), Philipps-Universität Marburg and Justus-Liebig-Universität Giessen, Germany
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Chong R, Wakade C, Seamon M, Giri B, Morgan J, Purohit S. Niacin Enhancement for Parkinson's Disease: An Effectiveness Trial. Front Aging Neurosci 2021; 13:667032. [PMID: 34220485 PMCID: PMC8245760 DOI: 10.3389/fnagi.2021.667032] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
We previously reported that individuals with Parkinson’s disease (PD) present with lower vitamin B3 levels compared to controls. It may be related to carbidopa interaction, defective tryptophan metabolism, and stresses of night sleep disorder. Vitamin B3 is the energy source for all cells by producing NAD+ and NADP+ in redox reactions of oxidative phosphorylation. Thus, some symptoms of PD such as fatigue, sleep dysfunction, and mood changes may be related to the deficiency of vitamin B3. Here, we conducted an effectiveness trial to determine the effect of 12 months of low-dose niacin (a vitamin B3 derivative) enhancement in PD individuals. An average of 9 ± 6-point improvement in the Unified Parkinson’s Disease Rating Scale (UPDRS) III (motor) score was observed after 12 months of daily niacin compared to the expected decline in score (effect size = 0.78, 95% CI = 7–11). Additionally, secondary outcome measures improved. Notably, handwriting size increased, fatigue perception decreased, mood improved, frontal beta rhythm during quiet stance increased, and stance postural sway amplitude and range of acceleration decreased. Set shifting, however, as measured by the Trail Making-B test, worsened from 66 to 96 s. Other measures did not change after 12 months, but it is not clear whether this represents a positive benefit of the vitamin. For example, while the quality of night sleep remained the same, there was a trend towards a decrease in the frequency of awakening episodes. These results suggest that niacin enhancement has the potential to maintain or improve quality of life in PD and slow disease progression.
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Affiliation(s)
- Raymond Chong
- Department of Interdisciplinary Health Sciences, Augusta University, Augusta, GA, United States.,Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, United States
| | - Chandramohan Wakade
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, United States.,Department of Neuroscience and Regenerative Medicine, Augusta University, Augusta, GA, United States.,Department of Neurology, Augusta University, Augusta, GA, United States.,Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, GA, United States
| | - Marissa Seamon
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, United States.,Department of Neuroscience and Regenerative Medicine, Augusta University, Augusta, GA, United States.,Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, GA, United States
| | - Banabihari Giri
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, United States.,Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, GA, United States
| | - John Morgan
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, United States.,Department of Neurology, Augusta University, Augusta, GA, United States
| | - Sharad Purohit
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, United States.,Department of Undergraduate Health Professions, Augusta University, Augusta, GA, United States
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Beretta VS, Carpenter MG, Barbieri FA, Santos PCR, Orcioli-Silva D, Pereira MP, Gobbi LTB. Does the impaired postural control in Parkinson's disease affect the habituation to non-sequential external perturbation trials? Clin Biomech (Bristol, Avon) 2021; 85:105363. [PMID: 33932865 DOI: 10.1016/j.clinbiomech.2021.105363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND How people with Parkinson's disease habituate their postural response to unpredictable translation perturbation is not totally understood. We compared the capacity to change the postural responses after unexpected external perturbation and investigated the habituation plateaus of postural responses to non-sequential perturbation trials in people with Parkinson's disease and healthy older adults. METHODS In people with Parkinson's disease (n = 37) and older adults (n = 20), sudden posterior support-surface translational were applied in 7 out of 17 randomized trials to ensure perturbation unpredictability. Electromyography and center of pressure parameters of postural response were analyzed by ANOVAs (Group vs. Trials). Two simple planned contrasts were performed to determine at which trial the responses first significantly habituate, and by which trials the habituation plateaus. FINDINGS Older adults demonstrated a first response change in trial 5 and habituation plateaus after trial 4, while for people with Parkinson's disease, the first change occurred in trial 2 and habituation plateau after trial 5 observed by center of pressure range. People with Parkinson's disease demonstrated a greater center of pressure range in trial 1 compared to older adults. Independent of trial, people with Parkinson's disease vs. older adults demonstrated a greater ankle muscle co-activation and recovery time. INTERPRETATION Despite the greater center of pressure range in the first trial, people with Parkinson's disease can habituate to unpredictable perturbations. This is reflected by little, to no difference in the time-course of adaptation for all but 2 parameters that showed only marginal differences between people with Parkinson's disease and older adults.
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Affiliation(s)
- Victor Spiandor Beretta
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Mark Gregory Carpenter
- School of Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Fabio Augusto Barbieri
- São Paulo State University (Unesp), School of Sciences, Graduate Program in Movement Sciences, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Paulo Cezar Rocha Santos
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Diego Orcioli-Silva
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Marcelo Pinto Pereira
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- São Paulo State University (Unesp), Institute of Biosciences, Graduate Program in Movement Sciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
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Abraham A, Duncan RP, Earhart GM. The Role of Mental Imagery in Parkinson's Disease Rehabilitation. Brain Sci 2021; 11:brainsci11020185. [PMID: 33540883 PMCID: PMC7913152 DOI: 10.3390/brainsci11020185] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Parkinson’s disease (PD) is a disabling neurodegenerative disease whose manifestations span motor, sensorimotor, and sensory domains. While current therapies for PD include pharmacological, invasive, and physical interventions, there is a constant need for developing additional approaches for optimizing rehabilitation gains. Mental imagery is an emerging field in neurorehabilitation and has the potential to serve as an adjunct therapy to enhance patient function. Yet, the literature on this topic is sparse. The current paper reviews the motor, sensorimotor, and sensory domains impacted by PD using gait, balance, and pain as examples, respectively. Then, mental imagery and its potential for PD motor and non-motor rehabilitation is discussed, with an emphasis on its suitability for addressing gait, balance, and pain deficits in people with PD. Lastly, future research directions are suggested.
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Affiliation(s)
- Amit Abraham
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel 4077625, Israel
- Navigation and Accessibility Research Center of Ariel University (NARCA), Ariel University, Ariel 4077625, Israel
- Correspondence:
| | - Ryan P. Duncan
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO 63108, USA; (R.P.D.); (G.M.E.)
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Gammon M. Earhart
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO 63108, USA; (R.P.D.); (G.M.E.)
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
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Jones CA, Ciucci MR, Abdelhalim SM, McCulloch TM. Swallowing Pressure Variability as a Function of Pharyngeal Region, Bolus Volume, Age, and Sex. Laryngoscope 2020; 131:E52-E58. [PMID: 32304341 DOI: 10.1002/lary.28667] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/14/2020] [Accepted: 03/20/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Within-individual movement variability occurs in most motor domains. However, it is unknown how pharyngeal swallowing pressure varies in healthy individuals. We hypothesized that: 1) variability would differ among pharyngeal regions; 2) variability would decrease with increased bolus volume; 3) variability would increase with age; and 4) there would be no sex differences. STUDY DESIGN Case series. METHODS We used pharyngeal high-resolution manometry to measure swallowing pressure in the following regions: velopharynx, tongue base, hypopharynx, and upper esophageal sphincter. Data were collected from 97 healthy adults (41 male) aged 21 to 89 years during thin liquid swallows: 2 mL, 10 mL, and participant-selected comfortable volume. Pressure variability was measured using coefficient of variation. Repeated measures analysis of variance was used to assess impacts of region, bolus volume, age, and sex on pressure variability. RESULTS There was a significant region × volume interaction (P < .001) and significant main effect of age (P = .005). Pressures in the hypopharynx region were more variable than all other regions (P ≤ .028), and pressures in the tongue base region were less variable than all other regions (P ≤ .002) except at 2 mL volumes (P = .065). Swallowing pressure variability was significantly different in the velopharynx and upper esophageal sphincter regions, with comfortable volume and 2 mL swallows having greater variability than 10 mL swallows (P ≤ .026). Pressure variability significantly increased with increasing age (P = .002). There were no effects of sex on pressure variability (P ≥ .15). CONCLUSION Pharyngeal swallowing pressure variability differs according pharyngeal region, volume, and age but not sex. Abnormal swallowing pressure variability may reflect deviations in motor control in persons with swallowing impairment, and results from this study can be used as normative data for future investigations evaluating swallowing pressure generation. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E52-E58, 2021.
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Affiliation(s)
- Corinne A Jones
- Department of Neurology, The University of Texas at Austin, Austin, Texas, U.S.A.,Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.,Department of Communication Sciences & Disorders, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Michelle R Ciucci
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.,Department of Communication Sciences & Disorders, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Suzan M Abdelhalim
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Timothy M McCulloch
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
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12
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Mei S, Eisinger RS, Hu W, Tsuboi T, Foote KD, Hass CJ, Okun MS, Chan P, Ramirez-Zamora A. Three-Year Gait and Axial Outcomes of Bilateral STN and GPi Parkinson's Disease Deep Brain Stimulation. Front Hum Neurosci 2020; 14:1. [PMID: 32116598 PMCID: PMC7026192 DOI: 10.3389/fnhum.2020.00001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/03/2020] [Indexed: 01/18/2023] Open
Abstract
Objective: To examine the short- and long-term clinical outcomes of the bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) on gait and axial symptoms in Parkinson's disease (PD) patients. Available data have been inconsistent and mostly short-term regarding the effect of both brain targets on gait and axial symptoms. We aimed to identify potential target specific differences at 3-year follow-up from a large single-center experience. Methods: We retrospectively reviewed short-term (6-month follow-up) and long-term (36-month follow-up) changes in the Unified Parkinson's Disease Rating Scale (UPDRS) Part II and III total scores of 72 PD patients (53 with bilateral STN-DBS and 19 with bilateral GPi-DBS). An interdisciplinary team made target-specific decisions for each DBS patient. We analyzed changes in gait and axial subscores derived from UPDRS II and III. Results: In both the STN- and GPi-DBS cohorts, we observed no significant differences in gait and axial UPDRS derived subscores in the off-med/on stimulation state at long-term follow-up when compared to baseline. On-med axial scores remained similar in the short-term but worsened in both groups (STN, 2.23 ± 3.43, p < 0.001; GPi, 2.53 ± 2.37, p < 0.01) in the long-term possibly due to disease progression. At long-term follow-up, the UPDRS III off-med/on stimulation scores worsened but were persistently improved from baseline in both groups (-9.07 ± 13.9, p < 0.001). Conclusions: The study showed that long-term both STN- and GPi-DBS had a similar effect on gait and axial symptoms in UPDRS derived subscores at 36-month follow-up despite potential baseline differences in criteria for selection of each target. More sophisticated measures of gait and balance beyond the categorical UPDRS score will be needed for future studies.
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Affiliation(s)
- Shanshan Mei
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Robert S Eisinger
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Wei Hu
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Takashi Tsuboi
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Kelly D Foote
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Christopher J Hass
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States.,College of Health and Human Performance, University of Florida, Gainesville, FL, United States
| | - Michael S Okun
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Piu Chan
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Adolfo Ramirez-Zamora
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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13
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Hasegawa N, Ishikawa K, Sato Y, Nakayama Y, Asaka T. Short-term effects of postural control by standing on a tilting board in patients with Parkinson’s disease. Physiother Theory Pract 2019; 37:1306-1312. [DOI: 10.1080/09593985.2019.1695302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Naoya Hasegawa
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
- Department of Rehabilitation, Sapporo Yamanoue Hospital, Sapporo, Hokkaido, Japan
| | - Keita Ishikawa
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yuki Sato
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yasuhide Nakayama
- Department of Rehabilitation, The Jikei University Hospital, Tokyo, Japan
| | - Tadayoshi Asaka
- Department of Rehabilitatiton Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
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14
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Hasegawa N, Shah VV, Carlson-Kuhta P, Nutt JG, Horak FB, Mancini M. How to Select Balance Measures Sensitive to Parkinson's Disease from Body-Worn Inertial Sensors-Separating the Trees from the Forest. SENSORS 2019; 19:s19153320. [PMID: 31357742 PMCID: PMC6696209 DOI: 10.3390/s19153320] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/16/2022]
Abstract
This study aimed to determine the most sensitive objective measures of balance dysfunction that differ between people with Parkinson’s Disease (PD) and healthy controls. One-hundred and forty-four people with PD and 79 age-matched healthy controls wore eight inertial sensors while performing tasks to measure five domains of balance: standing posture (Sway), anticipatory postural adjustments (APAs), automatic postural responses (APRs), dynamic posture (Gait) and limits of stability (LOS). To reduce the initial 93 measures, we selected uncorrelated measures that were most sensitive to PD. After applying a threshold on the Standardized Mean Difference between PD and healthy controls, 44 measures remained; and after reducing highly correlated measures, 24 measures remained. The four most sensitive measures were from APAs and Gait domains. The random forest with 10-fold cross-validation on the remaining measures (n = 24) showed an accuracy to separate PD from healthy controls of 82.4%—identical to result for all measures. Measures from the most sensitive domains, APAs and Gait, were significantly correlated with the severity of disease and with patient-related outcomes. This method greatly reduced the objective measures of balance to the most sensitive for PD, while still capturing four of the five domains of balance.
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Affiliation(s)
- Naoya Hasegawa
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Vrutangkumar V Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Patricia Carlson-Kuhta
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - John G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA.
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15
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Pickle NT, Shearin SM, Fey NP. Dynamic neural network approach to targeted balance assessment of individuals with and without neurological disease during non-steady-state locomotion. J Neuroeng Rehabil 2019; 16:88. [PMID: 31300001 PMCID: PMC6625014 DOI: 10.1186/s12984-019-0550-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 06/12/2019] [Indexed: 12/01/2022] Open
Abstract
Background Clinical balance assessments often rely on functional tasks as a proxy for balance (e.g., Timed Up and Go). In contrast, analyses of balance in research settings incorporate quantitative biomechanical measurements (e.g., whole-body angular momentum, H) using motion capture techniques. Fully instrumenting patients in the clinic is not feasible, and thus it is desirable to estimate biomechanical quantities related to balance from measurements taken from a subset of the body segments. Machine learning algorithms are well-suited for this type of low- to high-dimensional mapping. Thus, our goal was to develop and test an artificial neural network that to predict segment contributions to whole-body angular momentum from linear acceleration and angular velocity signals (i.e., those typically available to wearable inertial measurement units, IMUs) taken from a sparse set of body segments. Methods Optical motion capture data were collected from five able-bodied individuals and five individuals with Parkinson's disease (PD) walking on a non-steady-state locomotor circuit comprising stairs, ramps and changes of direction. Motion data were used to calculate angular momentum (i.e., “gold standard” output data) and body-segment linear acceleration and angular velocity data from local reference frames at the wrists, ankles and neck (i.e., network input). A dynamic nonlinear autoregressive neural network was trained using the able-bodied data (pooled across subjects). The neural network was tested on data from individuals with PD with noise added to simulate real-world IMU data. Results Correlation coefficients of the predicted segment contributions to whole-body angular momentum with the gold standard data were 0.989 for able-bodied individuals and 0.987 for individuals with PD. Mean RMS errors were between 2 and 7% peak signal magnitude for all body segments during completion of the locomotor circuits. Conclusion Our results suggest that estimating segment contributions to angular momentum from mechanical signals (linear acceleration, angular velocity) from a sparse set of body segments is a feasible method for assessing coordination of balance—even using a network trained on able-bodied data to assess individuals with neurological disease. These targeted estimates of segmental momenta could potentially be delivered to clinicians using a sparse sensor set (and likely in real-time) in order to enhance balance rehabilitation of people with PD.
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Affiliation(s)
- Nathaniel T Pickle
- Department of Bioengineering, The University of Texas at Dallas, 800 W Campbell Rd, Richardson, TX, 75080, USA.
| | - Staci M Shearin
- Department of Physical Therapy, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Nicholas P Fey
- Department of Bioengineering, The University of Texas at Dallas, 800 W Campbell Rd, Richardson, TX, 75080, USA.,Department of Physical Medicine and Rehabilitation, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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16
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Feller KJ, Peterka RJ, Horak FB. Sensory Re-weighting for Postural Control in Parkinson's Disease. Front Hum Neurosci 2019; 13:126. [PMID: 31057379 PMCID: PMC6478764 DOI: 10.3389/fnhum.2019.00126] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/27/2019] [Indexed: 12/15/2022] Open
Abstract
Postural instability in Parkinson's disease (PD) is characterized by impaired postural responses to transient perturbations, increased postural sway in stance and difficulty transitioning between tasks. In addition, some studies suggest that loss of dopamine in the basal ganglia due to PD results in difficulty in using proprioceptive information for motor control. Here, we quantify the ability of subjects with PD and age-matched control subjects to use and re-weight sensory information for postural control during steady-state conditions of continuous rotations of the stance surface or visual surround. We measure the postural sway of subjects in response to a pseudorandom, surface-tilt stimulus with eyes closed, and in response to a pseudorandom, visual-tilt stimulus. We use a feedback control model of the postural control system to interpret our results, focusing on sensory weighting as a function of stimulus amplitude. We find that subjects with PD can re-weight their dependence upon sensory information in response to changes in surface- or visual-stimulus amplitude. Specifically, subjects with PD behaved like age-matched control subjects by decreasing proprioceptive contribution to stance control with increasing surface-tilt amplitude and decreasing visual contribution with increasing visual-tilt amplitude. However, subjects with PD do not decrease their reliance on proprioception as much as age-matched controls for small increases in surface-stimulus amplitudes. Levodopa medication did not affect sensory re-weighting behaviors for postural control. The impairment in PD subject's ability to respond differently to small changes in surface rotation amplitudes is consistent with an increased threshold for perceiving proprioceptive signals, which may result from decreased signal-to-noise in the dopaminergic pathways associated with sensory processing and/or sensory integration.
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Affiliation(s)
- Kelly J. Feller
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, United States,Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Robert J. Peterka
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States,Veterans Adminstration Portland Health Care System, Portland, OR, United States
| | - Fay B. Horak
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, United States,Department of Neurology, Oregon Health & Science University, Portland, OR, United States,Veterans Adminstration Portland Health Care System, Portland, OR, United States,*Correspondence: Fay B. Horak
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17
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Cheng FY, Yang YR, Wu YR, Lu CF, Cheng SJ, Wang RY. Beta event-related desynchronization can be enhanced by different training programs and is correlated with improved postural control in individuals with Parkinson's disease. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1957-1964. [PMID: 30183638 DOI: 10.1109/tnsre.2018.2868140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study was to investigate the effects of a specific exercise (SE) training program focusing on balance and muscle strengthening and a turning-based treadmill (TT) training program on cortical desynchronization and postural control in Parkinson's disease (PD). METHODS Eighteen patients with PD were recruited and randomly assigned to the SE group, TT training group or control exercise (CE) group and participated in 12 30-min training sessions focusing on balance and strengthening, turning-based treadmill training, or general exercise training, respectively, followed by 10 minutes of over-ground walking in each session for 4 to 6 weeks. The outcomes included alpha event-related desynchronization (ERD), beta ERD, postural control ability indicated by postural instability and gait disorder (PIGD), the step/quick turn test (SQT), and the sensory organization test (SOT). All measurements were assessed at baseline and after training. RESULTS The results (n=6 for each group) showed that both the SE and TT groups had improved beta ERD, but not alpha ERD, in the Cz area, PIGD score, and turn sway/time in the SQT compared with the CE group. Furthermore, postural control ability was positively correlated with beta ERD in the Cz area. However, there was no significant correlation between SOT total score and alpha ERD in the Cz area. CONCLUSIONS This study showed that beta ERD in the central area and postural control can be improved with balance training, along with lower extremity muscle strengthening exercise and turning-based treadmill training, in patients with PD. Furthermore, improvement in beta ERD in the central area correlated with improvements in postural control ability. This trial was registered at http://www.anzctr.org.au/ (ACTRN12616000198426).
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18
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Bonnì S, Ponzo V, Tramontano M, Martino Cinnera A, Caltagirone C, Koch G, Peppe A. Neurophysiological and clinical effects of blindfolded balance training (BBT) in Parkinson's disease patients: a preliminary study. Eur J Phys Rehabil Med 2018; 55:176-182. [PMID: 29745627 DOI: 10.23736/s1973-9087.18.05126-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recent evidence supports the hypothesis that rehabilitative strategies based on sensorimotor stimulation in the neurorehabilitation of Parkinson's disease (PD) may be useful to improve gait in PD patients. AIM We supposed that sensorimotor stimulation produces modulation of anticipatory postural adjustments (APAs) arising from the supplementary motor area (SMA). We aimed to investigate the clinical and neurophysiological effects of a blindfolded balance training (BBT). DESIGN Randomized controlled trial. SETTING Italian hospital. POPULATION Sixteen PD patients. METHODS The patients were randomized in two groups, one group treated with two-weeks BBT and one group treated with two-weeks of physical therapy (PT). We assessed gait parameters (swing, stance, double stance phase of cycle gait) and neurophysiological measurement (functional connectivity between SMA and motor area M1) before and after treatments. RESULTS We found a decrease of stance and double stance phase and increase of swing phase respect to gait cycle, in BBT group compared to PT group, paralleled by a selective modulation in functional connectivity between M1 and SMA for BBT group. CONCLUSIONS Our findings support that BBT represents a complementary rehabilitative strategy, based on visual deprivation and proprioceptive perturbation in recovery of gait in PD patients, in short time window, likely involving vestibular system and its connections with motor areas. CLINICAL REHABILITATION IMPACT The use of vestibular system stimulation, involving SMA-M1 circuits, may be useful to improve gait control in PD patients.
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Affiliation(s)
- Sonia Bonnì
- Non-invasive Brain Stimulation Unit, Santa Lucia Foundation and Institute for Research and Care, Rome, Italy -
| | - Viviana Ponzo
- Non-invasive Brain Stimulation Unit, Santa Lucia Foundation and Institute for Research and Care, Rome, Italy
| | - Marco Tramontano
- Santa Lucia Foundation, Scientific Institute for Research and Care, Rome, Italy
| | - Alex Martino Cinnera
- Non-invasive Brain Stimulation Unit, Santa Lucia Foundation and Institute for Research and Care, Rome, Italy
| | - Carlo Caltagirone
- Santa Lucia Foundation, Scientific Institute for Research and Care, Rome, Italy
| | - Giacomo Koch
- Non-invasive Brain Stimulation Unit, Santa Lucia Foundation and Institute for Research and Care, Rome, Italy.,Santa Lucia Foundation, Scientific Institute for Research and Care, Rome, Italy.,Stroke Unit, Tor Vergata University, Rome, Italy
| | - Antonella Peppe
- Santa Lucia Foundation, Scientific Institute for Research and Care, Rome, Italy
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19
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McKay JL, Lang KC, Ting LH, Hackney ME. Impaired set shifting is associated with previous falls in individuals with and without Parkinson's disease. Gait Posture 2018; 62:220-226. [PMID: 29571090 PMCID: PMC5960619 DOI: 10.1016/j.gaitpost.2018.02.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/11/2018] [Accepted: 02/22/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with Parkinson's disease (PD) are at increased risk for falls, which lead to substantial morbidity and mortality. Understanding the motor and non-motor impairments associated with falls in PD is critical to informing prevention strategies. In addition to motor symptoms, individuals with PD exhibit non-motor deficits, including impaired set shifting, an aspect of executive function related to cognitive flexibility that can be measured quickly with the Trailmaking Test. RESEARCH QUESTION To determine whether impaired set shifting is associated with fall history in people with and without PD. METHODS We examined associations between set shifting, PD status, and fall history (≥1 falls in the previous 6 months) in data from PD patients (n = 65) with and without freezing of gait (FOG) and community-dwelling neurologically-normal older adults (NON-PD) (n = 73) who had participated in our rehabilitation studies. RESULTS Impaired set shifting was associated with previous falls after controlling for age, sex, overall cognitive function, PD status, FOG, and PD disease duration (OR = 1.29 [1.03-1.60]; P = 0.02). Consistent with literature, PD and FOG were also independently associated with increased fall prevalence (PD OR = 4.15 [95% CI 1.65-10.44], P < 0.01; FOG OR = 3.63 [1.22-10.80], P = 0.02). Although the strongest associations between set shifting and falling were observed among PD without FOG (OR = 2.11) compared to HOA (OR = 1.14) and PD with FOG (OR = 1.46), no statistically-significant differences were observed across groups. SIGNIFICANCE Impaired set shifting is associated with previous falls in older adults with and without PD. Set shifting may be useful to include in fall risk assessments, particularly when global cognitive measures are within reference limits.
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Affiliation(s)
- J. Lucas McKay
- Coulter Department of Biomedical Engineering, Emory University and the Georgia Institute of Technology, Atlanta, GA, USA,Corresponding author: J. Lucas McKay, PhD MSCR, Room W-202, Health Sciences Research Building, 1760 Haygood Dr NE, Atlanta, GA 30322, , (404) 550-5157 (voice), (404) 727-9873 (fax)
| | - Kimberly C. Lang
- Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA
| | - Lena H. Ting
- Coulter Department of Biomedical Engineering, Emory University and the Georgia Institute of Technology, Atlanta, GA, USA
| | - Madeleine E. Hackney
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, USA,Atlanta VA Medical Center, Atlanta, GA, USA
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20
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An Overview of the Physiology and Pathophysiology of Postural Control. BIOSYSTEMS & BIOROBOTICS 2018. [DOI: 10.1007/978-3-319-72736-3_1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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21
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Dharmadasa T, Matamala JM, Huynh W, Zoing MC, Kiernan MC. Motor neurone disease. HANDBOOK OF CLINICAL NEUROLOGY 2018; 159:345-357. [PMID: 30482326 DOI: 10.1016/b978-0-444-63916-5.00022-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Motor neurone disease (MND) patients exhibit poor gait, balance, and postural control, all of which significantly increases their risk of falling. Falls are frequent in the MND population, and are associated with an increased burden of disease. The complex interplay of both motor and extramotor manifestations in this disease contributes to the heterogeneous and multifactorial causes of such dysfunction. This review highlights the pathophysiologic influence of motor degeneration in gait disturbance, but also the additional influence on postural instability from other inputs such as cognitive impairment, autonomic dysregulation, cerebellar dysfunction, sensory impairment, and extrapyramidal involvement. In various combinations, these impairments are responsible for reduced gait speed and alteration in gait cycle, as well as structurally more variable and disorganized gait patterns. Based on these features, this chapter will also provide disease-specific interventions to assess, manage, and prevent falls in the MND cohort.
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Affiliation(s)
| | | | - William Huynh
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Margaret C Zoing
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
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22
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Martelli D, Luo L, Kang J, Kang UJ, Fahn S, Agrawal SK. Adaptation of Stability during Perturbed Walking in Parkinson's Disease. Sci Rep 2017; 7:17875. [PMID: 29259237 PMCID: PMC5736588 DOI: 10.1038/s41598-017-18075-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/05/2017] [Indexed: 11/11/2022] Open
Abstract
Gait and balance disorders are major problems that contribute to falls among subjects with Parkinson's disease (PD). Strengthening the compensatory responses through the use of balance perturbations may improve balance in PD. To date, it is unclear how PD affects the ability to react and adapt to perturbations delivered while walking. This study aims to investigate how PD affects the ability to walk, respond to balance perturbations, and produce acute short-term effects to improve compensatory reactions and gait stability. A cable-driven robot was used to train nine patients with PD and nine age-matched controls with multidirectional waist-pull perturbations while walking on a treadmill. Margin of stability and base of support were evaluated while walking without cables and reacting to the perturbations. PD was associated with a reduced stability in the forward direction and the inability to produce proactive anticipatory adjustments. Both groups were able to improve the response to the disturbances and produce short-term aftereffects of increased gait stability once the cables were removed. A single session of perturbation-based balance training produced acute effects that ameliorated gait instability in PD. This result is encouraging for designing new therapeutic interventions that remediate falls risk.
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Affiliation(s)
- Dario Martelli
- Department of Mechanical Engineering, Columbia University, New York, NY, USA.
| | - Lan Luo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jiyeon Kang
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Un Jung Kang
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Stanley Fahn
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Sunil K Agrawal
- Department of Mechanical Engineering, Columbia University, New York, NY, USA.
- Department of Rehabilitation and Regenerative Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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23
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Mollaei N, Bicho E, Sousa N, Gago MF. Different protocols for analyzing behavior and adaptability in obstacle crossing in Parkinson's disease. Clin Interv Aging 2017; 12:1843-1857. [PMID: 29158667 PMCID: PMC5683812 DOI: 10.2147/cia.s147428] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Imbalance and tripping over obstacles as a result of altered gait in older adults, especially in patients with Parkinson’s disease (PD), are one of the most common causes of falls. During obstacle crossing, patients with PD modify their behavior in order to decrease the mechanical demands and enhance dynamic stability. Various descriptions of dynamic traits of gait that have been collected over longer periods, probably better synthesize the underlying structure and pattern of fluctuations in gait and can be more sensitive markers of aging or early neurological dysfunction and increased risk of falls. This confirmation challenges the clinimetric of different protocols and paradigms used for gait analysis up till now, in particular when analyzing obstacle crossing. The authors here present a critical review of current knowledge concerning the interplay between the cognition and gait in aging and PD, emphasizing the differences in gait behavior and adaptability while walking over different and challenging obstacle paradigms, and the implications of obstacle negotiation as a predictor of falls. Some evidence concerning the effectiveness of future rehabilitation protocols on reviving obstacle crossing behavior by trial and error relearning, taking advantage of dual-task paradigms, physical exercise, and virtual reality have been put forward in this article.
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Affiliation(s)
- Nafiseh Mollaei
- Centro Algoritmi, Campus Azurem, University of Minho, Guimarães
| | - Estela Bicho
- Centro Algoritmi, Campus Azurem, University of Minho, Guimarães
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga.,ICVS-3B's-PT Government Associate Laboratory, Braga
| | - Miguel Fernandes Gago
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga.,ICVS-3B's-PT Government Associate Laboratory, Braga.,Neurology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
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Lee KH, Baksh A, Bryant A, McGowan M, McMillan R, Chong RK. Two Mechanisms of Sensorimotor Set Adaptation to Inclined Stance. Front Hum Neurosci 2017; 11:480. [PMID: 29109683 PMCID: PMC5660095 DOI: 10.3389/fnhum.2017.00480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/19/2017] [Indexed: 12/05/2022] Open
Abstract
Orientation of posture relative to the environment depends on the contributions from the somatosensory, vestibular, and visual systems mixed in varying proportions to produce a sensorimotor set. Here, we probed the sensorimotor set composition using a postural adaptation task in which healthy adults stood on an inclined surface for 3 min. Upon returning to a horizontal surface, participants displayed a range of postural orientations – from an aftereffect that consisted of a large forward postural lean to an upright stance with little or no aftereffect. It has been hypothesized that the post-incline postural change depends on each individual’s sensorimotor set: whether the set was dominated by the somatosensory or vestibular system: Somatosensory dominance would cause the lean aftereffect whereas vestibular dominance should steer stance posture toward upright orientation. We investigated the individuals who displayed somatosensory dominance by manipulating their attention to spatial orientation. We introduced a distraction condition in which subjects concurrently performed a difficult arithmetic subtraction task. This manipulation altered the time course of their post-incline aftereffect. When not distracted, participants returned to upright stance within the 3-min period. However, they continued leaning forward when distracted. These results suggest that the mechanism of sensorimotor set adaptation to inclined stance comprises at least two components. The first component reflects the dominant contribution from the somatosensory system. Since the postural lean was observed among these subjects even when they were not distracted, it suggests that the aftereffect is difficult to overcome. The second component includes a covert attentional component which manifests as the dissipation of the aftereffect and the return of posture to upright orientation.
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Affiliation(s)
- Kyoung-Hyun Lee
- Center for Sport Science in Gwangju, Gwangju Sports Council, Gwangju, South Korea
| | - Asheeba Baksh
- Department of Physical Therapy, Augusta University, Augusta, GA, United States
| | - Alyssa Bryant
- Department of Physical Therapy, Augusta University, Augusta, GA, United States
| | - Mollie McGowan
- Department of Physical Therapy, Augusta University, Augusta, GA, United States
| | - Ryan McMillan
- Department of Physical Therapy, Augusta University, Augusta, GA, United States
| | - Raymond K Chong
- Department of Physical Therapy, Augusta University, Augusta, GA, United States
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Lee KH, Chong RK. Hysteresis in Center of Mass Velocity Control during the Stance Phase of Treadmill Walking. Front Hum Neurosci 2017; 11:187. [PMID: 28496403 PMCID: PMC5406455 DOI: 10.3389/fnhum.2017.00187] [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: 01/02/2017] [Accepted: 03/30/2017] [Indexed: 11/20/2022] Open
Abstract
Achieving a soft landing during walking can be quantified by analyzing changes in the vertical velocity of the body center of mass (CoM) just prior to the landing of the swing limb. Previous research suggests that walking speed and step length may predictably influence the extent of this CoM control. Here we ask how stable this control is. We altered treadmill walking speed by systematically increasing or decreasing it at fixed intervals. We then reversed direction. We hypothesized that the control of the CoM vertical velocity during the late stance of the walking gait may serve as an order parameter which has an attribute of hysteresis. The presence of hysteresis implies that the CoM control is not based on simply knowing the current input conditions to predict the output response. Instead, there is also the influence of previous speed conditions on the ongoing responses. We found that the magnitudes of CoM control were different depending on whether the treadmill speed (as the control parameter) was ramped up or down. Changes in step length also influenced CoM control. A stronger effect was observed when the treadmill speed was speeded up compared to down. However, the effect of speed direction remained significant after controlling for step length. The hysteresis effect of CoM control as a function of speed history demonstrated in the current study suggests that the regulation of CoM vertical velocity during late stance is influenced by previous external conditions and constraints which combine to influence the desired behavioral outcome.
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Affiliation(s)
- Kyoung-Hyun Lee
- Center for Sport Science in Gwangju, Gwangju Sports CouncilGwangju, South Korea
| | - Raymond K Chong
- Department of Physical Therapy, Augusta UniversityAugusta, GA, USA
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Coelho DB, Teixeira LA. Cognition and balance control: does processing of explicit contextual cues of impending perturbations modulate automatic postural responses? Exp Brain Res 2017; 235:2375-2390. [PMID: 28493066 DOI: 10.1007/s00221-017-4980-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/06/2017] [Indexed: 01/12/2023]
Abstract
Processing of predictive contextual cues of an impending perturbation is thought to induce adaptive postural responses. Cueing in previous research has been provided through repeated perturbations with a constant foreperiod. This experimental strategy confounds explicit predictive cueing with adaptation and non-specific properties of temporal cueing. Two experiments were performed to assess those factors separately. To perturb upright balance, the base of support was suddenly displaced backwards in three amplitudes: 5, 10 and 15 cm. In Experiment 1, we tested the effect of cueing the amplitude of the impending postural perturbation by means of visual signals, and the effect of adaptation to repeated exposures by comparing block versus random sequences of perturbation. In Experiment 2, we evaluated separately the effects of cueing the characteristics of an impending balance perturbation and cueing the timing of perturbation onset. Results from Experiment 1 showed that the block sequence of perturbations led to increased stability of automatic postural responses, and modulation of magnitude and onset latency of muscular responses. Results from Experiment 2 showed that only the condition cueing timing of platform translation onset led to increased balance stability and modulation of onset latency of muscular responses. Conversely, cueing platform displacement amplitude failed to induce any effects on automatic postural responses in both experiments. Our findings support the interpretation of improved postural responses via optimized sensorimotor processes, at the same time that cast doubt on the notion that cognitive processing of explicit contextual cues advancing the magnitude of an impending perturbation can preset adaptive postural responses.
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Affiliation(s)
- Daniel Boari Coelho
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, Av. Prof. Mello Moraes, 65, São Paulo, SP, 05508-030, Brazil.
| | - Luis Augusto Teixeira
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, Av. Prof. Mello Moraes, 65, São Paulo, SP, 05508-030, Brazil
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Ahmed MM, Mosalem DM, Alfeeli AK, Baqer AB, Soliman DY. Relationship between Gait Parameters and Postural Stability in Early and Late Parkinson's Disease and Visual Feedback-Based Balance Training Effects. Open Access Maced J Med Sci 2017; 5:207-214. [PMID: 28507630 PMCID: PMC5420776 DOI: 10.3889/oamjms.2017.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/21/2017] [Accepted: 03/05/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Gait disorders or postural instability has been done before. However, lack of reviews has addressed the relation between gait and postural stability in Parkinson's disease (PD). AIM The aim was to evaluate the relation between gait parameters and postural stability in early and late stages of PD. MATERIALS AND METHODS The forty-one idiopathic PD patients were divided into two groups into a group (A) considered as early PD and group (B) considered as late ambulant PD. They were evaluated for postural stability by computerised dynamic posturography (CDP) device and gait analysis using an 8 m-camera Vicon 612 data capturing system set. RESULTS There was a statistically significant improvement of composite equilibrium score, the composite latency of motor response, walking speed and cadence after treatment as compared to before training (p < 0.05) in early PD. However, in the late PD, there was a non-significant change of previous parameters after treatment as compared to before training (p > 0.05). There was a significant correlation between UPDRS motor part score, walking speed and composite equilibrium score after training in early PD (p > 0.05). CONCLUSIONS Both gait analysis and CDP are important quantitative assessment tools of gait and posture instability.
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Affiliation(s)
- Mohieldin M Ahmed
- Amiri Hospital, Physical Medicine and Rehabilitation Department, Ministry of Health, Kuwait
| | - Douaa M Mosalem
- Amiri Hospital, Physical Medicine and Rehabilitation Department, Ministry of Health, Kuwait
| | - Aziz K Alfeeli
- Amiri Hospital, Physical Medicine and Rehabilitation Department, Ministry of Health, Kuwait
| | - Ayyoub B Baqer
- Al-Farwania Hospital, Physical Medicine and Rehabilitation Department, Ministry of Health, Kuwait
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An fMRI-compatible force measurement system for the evaluation of the neural correlates of step initiation. Sci Rep 2017; 7:43088. [PMID: 28230070 PMCID: PMC5322382 DOI: 10.1038/srep43088] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/18/2017] [Indexed: 11/24/2022] Open
Abstract
Knowledge of brain correlates of postural control is limited by the technical difficulties in performing controlled experiments with currently available neuroimaging methods. Here we present a system that allows the measurement of anticipatory postural adjustment of human legs to be synchronized with the acquisition of functional magnetic resonance imaging data. The device is composed of Magnetic Resonance Imaging (MRI) compatible force sensors able to measure the level of force applied by both feet. We tested the device in a group of healthy young subjects and a group of elderly subjects with Parkinson’s disease using an event-related functional MRI (fMRI) experiment design. In both groups the postural behavior inside the magnetic resonance was correlated to the behavior during gait initiation outside the scanner. The system did not produce noticeable imaging artifacts in the data. Healthy young people showed brain activation patterns coherent with movement planning. Parkinson’s disease patients demonstrated an altered pattern of activation within the motor circuitry. We concluded that this force measurement system is able to index both normal and abnormal preparation for gait initiation within an fMRI experiment.
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Conradsson D, Paquette C, Lökk J, Franzén E. Pre- and unplanned walking turns in Parkinson's disease - Effects of dopaminergic medication. Neuroscience 2016; 341:18-26. [PMID: 27867059 DOI: 10.1016/j.neuroscience.2016.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/07/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
Although dopaminergic medication improves functional mobility in individuals with Parkinson's disease (PD), its effects on walking turns are uncertain. Our goals was to determine whether dopaminergic medication improves preplanned and unplanned walking turns in individuals with PD, compared to healthy controls. Nineteen older adults with mild-to-moderate PD and 17 healthy controls performed one of the following three tasks, presented randomly: walking straight, or walking and turning 180° to the right or left. The walking direction was visually cued before starting to walk (preplanned) or after (unplanned, i.e., 0.6m before reaching the turning point). Subjects with PD were assessed off dopaminergic medication (OFF) and on dopaminergic medication (ON) medication. Turning strategy (step and spin turns), turning performance (turning distance and body rotation) and walking pattern were analyzed for three turning steps. Irrespective of medication state and turning condition, step and spin turns followed a nearly 50:50 distribution. After intake of dopaminergic medication, subjects with PD increased their turning distance but not the amount of body rotation or their walking pattern. Compared to controls, turning impairments in subjects with PD remained while ON medication and problems regulating step width were the most prominent features of their walking pattern. Specifically, subjects with PD turned with narrower cross-over steps, i.e. when the external foot crossed over the line of progression of the internal leg. We conclude that turning impairments remained even after dopaminergic medication and problems modulating step width appears to be a critical feature for turning in PD.
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Affiliation(s)
- David Conradsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Alle 23, 141 83 Huddinge, Sweden; Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.
| | - Caroline Paquette
- Department of Kinesiology and Physical Education, McGill University, and Interdisciplinary Research Center in Rehabilitation (CRIR), 475 Pine Avenue West, Montreal, Quebec H2W 1S4, Canada.
| | - Johan Lökk
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Novum Pl 5, Blickagången 6/Hälsovägen 7 14157 Huddinge, Sweden; Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Sweden.
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Alle 23, 141 83 Huddinge, Sweden; Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.
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Jessop RT, Horowicz C, Dibble LE. Motor Learning and Parkinson Disease: Refinement of Movement Velocity and Endpoint Excursion in a Limits of Stability Balance Task. Neurorehabil Neural Repair 2016; 20:459-67. [PMID: 17082501 DOI: 10.1177/1545968306287107] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To investigate the effects of practice on performance and retention of a balance task in persons with Parkinson disease (PD). Methods. Ten persons with PD and 10 age and gender-matched healthy control subjects were tested on an anticipatory, static base of support, limits of stability (LOS) balance task on a force plate. The motor learning paradigm utilized for all subjects included an acquisition phase and retention tests at 24 h and 1 week after acquisition. A force plate was used for testing and to collect outcome measures including movement velocity (MVL), endpoint excursion (EPE), and directional control. Data were analyzed for differences between groups and change over time. Results.Persons with PD demonstrated performance deficits relative to controls for MVL at all testing periods ( P < 0.05), and initially for EPE ( P < 0.05), but were able to maintain significant improvements through retention testing relative to baseline ( P < 0.05). Conclusions. Persons with PD demonstrated unimpaired capacity for motor learning in a LOS balance task for MVL and EPE, although performance deficits remained for MVL. The results concur with previous motor learning research of upper extremity tasks by suggesting that individuals with mild to moderate PD exhibit a preserved ability to benefit from practice as a means of improving balance task performance.
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Gago MF, Yelshyna D, Bicho E, Silva HD, Rocha L, Lurdes Rodrigues M, Sousa N. Compensatory Postural Adjustments in an Oculus Virtual Reality Environment and the Risk of Falling in Alzheimer's Disease. Dement Geriatr Cogn Dis Extra 2016; 6:252-67. [PMID: 27489559 PMCID: PMC4959436 DOI: 10.1159/000447124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background/Aims Alzheimer's disease (AD) patients have an impaired ability to quickly reweight central sensory dependence in response to unexpected body perturbations. Herein, we aim to study provoked compensatory postural adjustments (CPAs) in a conflicting sensory paradigm with unpredictable visual displacements using virtual reality goggles. Methods We used kinematic time-frequency analyses of two frequency bands: a low-frequency band (LB; 0.3-1.5 Hz; mechanical strategy) and a high-frequency band (HB; 1.5-3.5 Hz; cognitive strategy). We enrolled 19 healthy subjects (controls) and 21 AD patients, divided according to their previous history of falls. Results The AD faller group presented higher-power LB CPAs, reflecting their worse inherent postural stability. The AD patients had a time lag in their HB CPA reaction. Conclusion The slower reaction by CPA in AD may be a reflection of different cognitive resources including body schema self-perception, visual motion, depth perception, or a different state of fear and/or anxiety.
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Affiliation(s)
- Miguel F Gago
- Neurology Department, Hospital da Senhora da Oliveira, EPE, Guimarães, Braga/Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS-3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Darya Yelshyna
- Centro ALGORITMI, Department of Industrial Electronics, School of Engineering, University of Minho, Braga, Portugal
| | - Estela Bicho
- Centro ALGORITMI, Department of Industrial Electronics, School of Engineering, University of Minho, Braga, Portugal
| | - Hélder David Silva
- Centro ALGORITMI, Department of Industrial Electronics, School of Engineering, University of Minho, Braga, Portugal
| | - Luís Rocha
- Centro ALGORITMI, Department of Industrial Electronics, School of Engineering, University of Minho, Braga, Portugal
| | - Maria Lurdes Rodrigues
- Neurology Department, Hospital da Senhora da Oliveira, EPE, Guimarães, Braga/Guimarães, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS-3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Fling BW, Dale ML, Curtze C, Smulders K, Nutt JG, Horak FB. Associations between mobility, cognition and callosal integrity in people with parkinsonism. NEUROIMAGE-CLINICAL 2016; 11:415-422. [PMID: 27104136 PMCID: PMC4827724 DOI: 10.1016/j.nicl.2016.03.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 02/26/2016] [Accepted: 03/07/2016] [Indexed: 01/15/2023]
Abstract
Falls in people with parkinsonism are likely related to both motor and cognitive impairments. In addition to idiopathic Parkinson's disease (PD), some older adults have lower body parkinsonism (a frontal gait disorder), characterized by impaired lower extremity balance and gait as well as cognition, but without tremor or rigidity. Neuroimaging during virtual gait suggests that interhemispheric, prefrontal cortex communication may be involved in locomotion, but contributions of neuroanatomy connecting these regions to objective measures of gait in people with parkinsonism remains unknown. Our objectives were to compare the integrity of fiber tracts connecting prefrontal and sensorimotor cortical regions via the corpus callosum in people with two types of parkinsonism and an age-matched control group and to relate integrity of these callosal fibers with clinical and objective measures of mobility and cognition. We recruited 10 patients with frontal gait disorders, 10 patients with idiopathic PD and 10 age-matched healthy control participants. Participants underwent cognitive and mobility testing as well as diffusion weighted magnetic resonance imaging to quantify white matter microstructural integrity of interhemispheric fiber tracts. People with frontal gait disorders displayed poorer cognitive performance and a slower, wider-based gait compared to subjects with PD and age-matched control subjects. Despite a widespread network of reduced white matter integrity in people with frontal gait disorders, gait and cognitive deficits were solely related to interhemispheric circuitry employing the genu of the corpus callosum. Current results highlight the importance of prefrontal interhemispheric communication for lower extremity control in neurological patients with cognitive dysfunction. Those with a frontal gait disorder have a slower, wider-based gait compared to idiopathic PD. Gait performance was related to integrity of genu fiber tracts in those with FGD. Prefrontal cortices may become more involved in locomotion with cognitive dysfunction.
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Affiliation(s)
- Brett W Fling
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA.
| | - Marian L Dale
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA
| | - Carolin Curtze
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA
| | - Katrijn Smulders
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA
| | - John G Nutt
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA
| | - Fay B Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA; VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239-9264, USA
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Abstract
People with Parkinson's disease exhibit debilitating gait impairments, including gait slowness, increased step variability, and poor postural control. A widespread supraspinal locomotor network including the cortex, cerebellum, basal ganglia, and brain stem contributes to the control of human locomotion, and altered activity of these structures underlies gait dysfunction due to Parkinson's disease.
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Affiliation(s)
- D S Peterson
- Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon; and Oregon Health & Science University, Department of Neurology, Portland, Oregon
| | - F B Horak
- Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon; and Oregon Health & Science University, Department of Neurology, Portland, Oregon
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Compensatory postural adjustments in Parkinson’s disease assessed via a virtual reality environment. Behav Brain Res 2016; 296:384-392. [DOI: 10.1016/j.bbr.2015.08.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/07/2015] [Accepted: 08/17/2015] [Indexed: 11/23/2022]
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Mierau A, Hülsdünker T, Strüder HK. Changes in cortical activity associated with adaptive behavior during repeated balance perturbation of unpredictable timing. Front Behav Neurosci 2015; 9:272. [PMID: 26528154 PMCID: PMC4604244 DOI: 10.3389/fnbeh.2015.00272] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 09/25/2015] [Indexed: 11/13/2022] Open
Abstract
The compensation for a sudden balance perturbation, unpracticed and unpredictable in timing and magnitude is accompanied by pronounced postural instability that is suggested to be causal to falls. However, subsequent presentations of an identical perturbation are characterized by a marked decrease of the amplitude of postural reactions; a phenomenon called adaptation or habituation. This study aimed to identify cortical characteristics associated with adaptive behavior during repetitive balance perturbations based on single-trial analyses of the P1 and N1 perturbation-evoked potentials. Thirty-seven young men were exposed to ten transient balance perturbations while balancing on the dominant leg. Thirty two-channel electroencephalography (EEG), surface electromyography (EMG) of the ankle plantar flexor muscles and postural sway (i.e., Euclidean distance of the supporting platform) were recorded simultaneously. The P1 and N1 potentials were localized and the amplitude/latency was analyzed trial by trial. The best match sources for P1 and N1 potentials were located in the parietal (Brodmann area (BA) 5) and midline fronto-central cortex (BA 6), respectively. The amplitude and latency of the P1 potential remained unchanged over trials. In contrast, a significant adaptation of the N1 amplitude was observed. Similar adaptation effects were found with regard to postural sway and ankle plantarflexors EMG activity of the non-dominant (free) leg; i.e., an indicator for reduced muscular co-contraction and/or less temporary bipedal stance to regain stability. Significant but weak correlations were found between N1 amplitude and postural sway as well as EMG activity. These results highlight the important role of the midline fronto-central cortex for adaptive behavior associated with balance control.
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Affiliation(s)
- Andreas Mierau
- Institute of Movement and Neurosciences, German Sport University Cologne Cologne, Germany
| | - Thorben Hülsdünker
- Institute of Movement and Neurosciences, German Sport University Cologne Cologne, Germany
| | - Heiko K Strüder
- Institute of Movement and Neurosciences, German Sport University Cologne Cologne, Germany
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Balance Dysfunction in Parkinson's Disease: The Role of Posturography in Developing a Rehabilitation Program. PARKINSONS DISEASE 2015; 2015:520128. [PMID: 26504611 PMCID: PMC4609480 DOI: 10.1155/2015/520128] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/20/2015] [Accepted: 04/23/2015] [Indexed: 11/22/2022]
Abstract
Balance dysfunction (BD) in Parkinson's disease (PD) is a disabling symptom, difficult to treat and predisposing to falls. The dopaminergic drugs or deep brain stimulation does not always provide significant improvements of BD and rehabilitative approaches have also failed to restore this condition. In this study, we investigated the suitability of quantitative posturographic indicators to early identify patients that could develop disabling BD. Parkinsonian patients not complaining of a subjective BD and controls were tested using a posturographic platform (PP) with open eyes (OE) and performing a simple cognitive task [counting (OEC)]. We found that patients show higher values of total standard deviation (SD) of body sway and along the medio-lateral (ML) axis during OE condition. Furthermore, total and ML SD of body sway during OE condition and total SD of body sway with OEC were higher than controls also in a subgroup of patients with normal Berg Balance Scale. We conclude that BD in Parkinsonian patients can be discovered before its appearance using a PP and that these data may allow developing specific rehabilitative treatment to prevent or delay their onset.
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McVey MA, Barnds AN, Lyons KE, Pahwa R, Mahnken JD, Luchies CW. The characterization of a base-width neutral step as the first step for balance recovery in moderate Parkinson's disease. Int J Neurosci 2015; 126:713-22. [PMID: 26371386 DOI: 10.3109/00207454.2015.1094472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study is to characterize the base-width neutral step (BNS) as the first step in a compensatory step response in persons with moderate Parkinson's disease (PD), and its effect on balance recovery. MATERIALS AND METHODS Ten PD and 10 healthy controls (HCs) responded to a posterior waist pull. A BNS was defined if the first step was less than 50 mm. The length, height, duration and velocity of the BNS and its effect on balance recovery time and center of mass location at recovery were compared to the first step within other stepping strategies (single step (SS), multiple step (MS)). A linear mixed model was used to compare across strategies. RESULTS Six of ten persons with PD compared to zero HC used a BNS. The BNS was shorter in length and duration compared to MS responses in HC, and shorter in duration compared to MS responses in PD. The BNS was slower in velocity compared to every other strategy. BNS use resulted in a longer recovery time compared to all strategies in HC and SS responses in PD, and trended toward a longer recovery time compared to MS responses in PD. CONCLUSIONS The BNS as the first step in a MS response may be an unreported strategy for compensatory stepping in PD. This study suggests that the cost of utilizing the BNS may be a longer time for recovery, but further work is necessary to understand the progression of the BNS as PD severity increases.
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Affiliation(s)
- Molly A McVey
- a 1 Department of Mechanical Engineering , University of Kansas , Lawrence, Kansas , KS , USA
| | - Annaria N Barnds
- b 2 Bioengineering, University of Kansas , Lawrence, Kansas , KS , USA
| | - Kelly E Lyons
- c 3 Department of Neurology , University of Kansas Medical Center , Kansas City , KS , USA
| | - Rajesh Pahwa
- c 3 Department of Neurology , University of Kansas Medical Center , Kansas City , KS , USA
| | - Jonathan D Mahnken
- d 4 Department of Biostatistics , University of Kansas Medical Center , Kansas City , KS , USA
| | - Carl W Luchies
- a 1 Department of Mechanical Engineering , University of Kansas , Lawrence, Kansas , KS , USA.,b 2 Bioengineering, University of Kansas , Lawrence, Kansas , KS , USA
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Park JH, Kang YJ, Horak FB. What Is Wrong with Balance in Parkinson's Disease? J Mov Disord 2015; 8:109-14. [PMID: 26413237 PMCID: PMC4572660 DOI: 10.14802/jmd.15018] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/19/2015] [Accepted: 06/22/2015] [Indexed: 11/24/2022] Open
Abstract
Postural instability and resulting falls are major factors determining quality of life, morbidity, and mortality in individuals with Parkinson’s disease (PD). A better understanding of balance impairments would improve management of balance dysfunction and prevent falls in patients with PD. The effects of bradykinesia, rigidity, impaired proprioception, freezing of gait and attention on postural stability in patients with idiopathic PD have been well characterized in laboratory studies. The purpose of this review is to systematically summarize the types of balance impairments contributing to postural instability in people with PD.
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Affiliation(s)
- Jeong-Ho Park
- Department of Neurology, College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Yeo-Jeong Kang
- Department of Neurology, College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Fay Bahling Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA ; Portland VA Medical Center, Portland, OR, USA
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Chong RK, Lee KH, Morgan J, Wakade C. Duration of step initiation predicts freezing in Parkinson's disease. Acta Neurol Scand 2015; 132:105-10. [PMID: 25659591 DOI: 10.1111/ane.12361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In some individuals with idiopathic Parkinson's disease (PD), freezing of gait episodes develops as the disease progresses. The neural mechanism underlying freezing in PD is poorly understood. Here, we report a 2-year follow-up on the novel discovery of prolonged step initiation duration as a potential marker of impending freezing. METHODS Non-freezing PD participants in stages 2.5-4 of the Hoehn and Yahr disease severity scale were recruited from an earlier study which determined the effect of semi-virtual cues on walking. Responders were those who completed the first step faster in the presence of the virtual cues while non-responders either did not change or took longer to complete the first step. Both groups of participants were interviewed 2 years later to determine who had developed freezing of gait. RESULTS Participants in the responder group had a 13-fold risk of developing freezing of gait within 2 years following the cueing study (OR=13.3, 95% CI=1.1-167). A cutoff score of -2.6% (i.e., a decrease in the duration of the first step with visual cues by 2.6% relative to no cues) gave a sensitivity and specificity of 100% and 89%, respectively. CONCLUSIONS To the best of our knowledge, this is the first novel discovery of a physical predictor of freezing in PD. The time to complete the first step is a simple test to administer in the clinic or at home and may therefore be easily incorporated into a fall prevention training program for PD before the inception of freezing.
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Affiliation(s)
- R. K. Chong
- Department of Physical Therapy; Georgia Regents University; Augusta GA USA
| | - K.-H. Lee
- Department of Physical Therapy; Georgia Regents University; Augusta GA USA
| | - J. Morgan
- Department of Neurology; Georgia Regents University; Augusta GA USA
| | - C. Wakade
- Department of Physical Therapy; Georgia Regents University; Augusta GA USA
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Delafontaine A, Honeine JL, Do MC, Gagey O, Chong RK. Comparative gait initiation kinematics between simulated unilateral and bilateral ankle hypomobility: Does bilateral constraint improve speed performance? Neurosci Lett 2015. [PMID: 26197055 DOI: 10.1016/j.neulet.2015.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Improvement of motor performance in unilateral upper limb motor disability has been shown when utilizing inter-limb coupling strategies during physical rehabilitation. This suggests that 'default' bilateral central motor commands are facilitated. Here, we tested whether this bilateral motor control principle may be generalized to the lower limbs during gait initiation, which involves alternate bilateral actions. Disability was simulated by strapping to produce ankle hypomobility. Healthy adult subjects initiated gait at a self-paced speed with no ankle constraint (control), or with the stance, swing or bilateral ankles strapped. The duration of the anticipatory postural adjustments lengthened and the center of mass instantaneous progression velocity at foot-off decreased when the ankle was strapped. During the step execution phase, progression velocity at foot-contact was higher when both ankles were strapped compared to unilateral strapping of the stance ankle. These findings suggest that bilateral central motor commands are favored during walking tasks. Indeed, unilateral constraint of the stance ankle should compel the central nervous system to adapt specific commands to the constraint and normal sides whereas the 'default' bilateral motor commands would be utilized when both ankles are strapped leading to better kinematics performance. Bilateral in-phase upper limb coordination and bilateral alternating lower limb locomotor movements may share similar control mechanisms.
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Affiliation(s)
- A Delafontaine
- CIAMS Laboratory, UFR-STAPS, University Paris-Sud, Orsay, France.
| | - J-L Honeine
- CIAMS Laboratory, UFR-STAPS, University Paris-Sud, Orsay, France
| | - M-C Do
- CIAMS Laboratory, UFR-STAPS, University Paris-Sud, Orsay, France
| | - O Gagey
- CIAMS Laboratory, UFR-STAPS, University Paris-Sud, Orsay, France; Service de chirurgie orthopédique, C.H.U Kremlin Bicêtre, Kremlin Bicêtre, France
| | - R K Chong
- Department of Physical Therapy, Georgia Regents University, Augusta, GA, USA
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Ting LH, Chiel HJ, Trumbower RD, Allen JL, McKay JL, Hackney ME, Kesar TM. Neuromechanical principles underlying movement modularity and their implications for rehabilitation. Neuron 2015; 86:38-54. [PMID: 25856485 DOI: 10.1016/j.neuron.2015.02.042] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Neuromechanical principles define the properties and problems that shape neural solutions for movement. Although the theoretical and experimental evidence is debated, we present arguments for consistent structures in motor patterns, i.e., motor modules, that are neuromechanical solutions for movement particular to an individual and shaped by evolutionary, developmental, and learning processes. As a consequence, motor modules may be useful in assessing sensorimotor deficits specific to an individual and define targets for the rational development of novel rehabilitation therapies that enhance neural plasticity and sculpt motor recovery. We propose that motor module organization is disrupted and may be improved by therapy in spinal cord injury, stroke, and Parkinson's disease. Recent studies provide insights into the yet-unknown underlying neural mechanisms of motor modules, motor impairment, and motor learning and may lead to better understanding of the causal nature of modularity and its underlying neural substrates.
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Affiliation(s)
- Lena H Ting
- W.H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA; Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA 30322, USA.
| | - Hillel J Chiel
- Department of Biology, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Neurosciences, Case Western Reserve University, Cleveland, OH 44106, USA; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Randy D Trumbower
- W.H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA; Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA 30322, USA
| | - Jessica L Allen
- W.H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - J Lucas McKay
- W.H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Madeleine E Hackney
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA 30033, USA; Department of Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, GA 30322, USA
| | - Trisha M Kesar
- W.H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA 30332, USA; Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, Atlanta, GA 30322, USA
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Effects of amplitude cueing on postural responses and preparatory cortical activity of people with Parkinson disease. J Neurol Phys Ther 2015; 38:207-15. [PMID: 25198870 DOI: 10.1097/npt.0000000000000058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Persons with Parkinson disease (PD) are unable to modify their postural responses, and show an associated increase in cortical preparatory activity for anticipated postural perturbations. In this study we asked whether participants with PD could modify their postural responses and cortical preparatory activity when cued to focus on increasing movement amplitude before a series of predictable postural perturbations. METHODS Twelve participants with PD performed postural responses to 30 identical backward surface translations. We cued participants to focus on increasing movement amplitude, and examined the effects of cueing by measuring postural responses (center-of-pressure initial rate of change, automatic postural response stability, peak trunk flexion, peak ankle extension) and preparatory cortical activity (electroencephalographic measures of contingent negative variation, alpha and beta event-related desynchronization). RESULTS Participants with PD modified their postural responses during the amplitude trials by increasing trunk flexion, slowing center-of-pressure initial rate of change, and decreasing automatic postural response stability. However, no significant differences in contingent negative variation amplitude or alpha or beta event-related desynchronization were observed with versus without amplitude cueing. DISCUSSION AND CONCLUSIONS Persons with PD were able to modify their feet-in-place postural responses with amplitude cueing. These changes were not associated with changes in cortical preparation during amplitude cue trials, suggesting that other regions or measures of brain function were responsible for changes in postural responses. Future studies are needed to determine the effects of long-term amplitude-cueing practice on cortical preparation and postural stability.Video Abstract available. See Video (Supplemental Digital Content 1, http://links.lww.com/JNPT/A78) for more insights from the authors.
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Kaminer J, Thakur P, Evinger C. Effects of subthalamic deep brain stimulation on blink abnormalities of 6-OHDA lesioned rats. J Neurophysiol 2015; 113:3038-46. [PMID: 25673748 DOI: 10.1152/jn.01072.2014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/10/2015] [Indexed: 11/22/2022] Open
Abstract
Parkinson's disease (PD) patients and the 6-hydroxydopamine (6-OHDA) lesioned rat model share blink abnormalities. In view of the evolutionarily conserved organization of blinking, characterization of blink reflex circuits in rodents may elucidate the neural mechanisms of PD reflex abnormalities. We examine the extent of this shared pattern of blink abnormalities by measuring blink reflex excitability, blink reflex plasticity, and spontaneous blinking in 6-OHDA lesioned rats. We also investigate whether 130-Hz subthalamic nucleus deep brain stimulation (STN DBS) affects blink abnormalities, as it does in PD patients. Like PD patients, 6-OHDA-lesioned rats exhibit reflex blink hyperexcitability, impaired blink plasticity, and a reduced spontaneous blink rate. At 130 Hz, but not 16 Hz, STN DBS eliminates reflex blink hyperexcitability and restores both short- and long-term blink plasticity. Replicating its lack of effect in PD patients, 130-Hz STN DBS does not reinstate a normal temporal pattern or rate to spontaneous blinking in 6-OHDA lesioned rats. These data show that the 6-OHDA lesioned rat is an ideal model system for investigating the neural bases of reflex abnormalities in PD and highlight the complexity of PD's effects on motor control, by showing that dopamine depletion does not affect all blink systems via the same neural mechanisms.
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Affiliation(s)
- Jaime Kaminer
- Program of Integrative Neuroscience, Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Pratibha Thakur
- Program in Neuroscience, Stony Brook University, Stony Brook, New York
| | - Craig Evinger
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York; and SUNY Eye Institute, Syracuse, New York
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Panyakaew P, Anan C, Bhidayasiri R. Visual deprivation elicits subclinical postural inflexibilities in early Parkinson's disease. J Neurol Sci 2015; 349:214-9. [PMID: 25656100 DOI: 10.1016/j.jns.2015.01.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 01/16/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Postural instability is often experienced in the late stages of PD and is a marker of disease progression. Little information is available on the role of visual inputs as an adaptive strategy to compensate for postural instability in PD. The purpose of this study was to determine visual dependency for postural control in early PD. METHODS Thirty early PD subjects without postural complaints and 30 matched controls were evaluated for subtle postural instability using static posturography under eyes opened and eyes closed conditions. RESULTS No significant differences between groups were observed under eyes opened condition. In eyes closed condition, there was significantly greater mean sway in the mediolateral direction (p=0.01), mean sway velocity (p=0.03), lateral sway velocity (p=0.04), and sway area (p=0.04) in PD than in the control subjects. 95% confidence ellipse of mean sway was largest in PD patients with eyes closed. A strong and significant correlation was observed between disease duration and mean mediolateral sway, sway area, mean sway and lateral sway velocity, and a moderate correlation was shown between Hoehn & Yahr stage and mean mediolateral sway, and sway area. CONCLUSION Our findings suggest that visual dependency exists in early PD and visual deprivation task can help identify subclinical postural instability.
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Affiliation(s)
- Pattamon Panyakaew
- Chulalongkorn Center of Excellence on Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Chanawat Anan
- Chulalongkorn Center of Excellence on Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence on Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles 90095, USA.
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Smulders K, Esselink RA, Bloem BR, Cools R. Freezing of gait in Parkinson's disease is related to impaired motor switching during stepping. Mov Disord 2015; 30:1090-7. [DOI: 10.1002/mds.26133] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 11/07/2014] [Accepted: 11/26/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Katrijn Smulders
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology; 6500 HB Nijmegen The Netherlands
- HAN University of Applied Sciences; Institute for Studies in Sports and Exercise; 6503 GL Nijmegen The Netherlands
| | - Rianne A. Esselink
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology; 6500 HB Nijmegen The Netherlands
| | - Bastiaan R. Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology; 6500 HB Nijmegen The Netherlands
| | - Roshan Cools
- Radboud University Medical Center; Donders Institute for Brain, Cognition and Behaviour; Department of Psychiatry; 6500 HB Nijmegen The Netherlands
- Radboud University; Donders Institute for Brain, Cognition and Behaviour; Centre for Cognitive Neuroimaging; 6500 HB Nijmegen The Netherlands
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46
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Balance dysfunction in Parkinson's disease. BIOMED RESEARCH INTERNATIONAL 2015; 2015:434683. [PMID: 25654100 PMCID: PMC4310258 DOI: 10.1155/2015/434683] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 09/15/2014] [Accepted: 09/22/2014] [Indexed: 11/18/2022]
Abstract
Stability and mobility in functional motor activities depend on a precise regulation of phasic and tonic muscular activity that is carried out automatically, without conscious awareness. The sensorimotor control of posture involves a complex integration of multisensory inputs that results in a final motor adjustment process. All or some of the components of this system may be dysfunctional in Parkinsonian patients, rendering postural instability one of the most disabling features of Parkinson's disease (PD). Balance control is critical for moving safely in and adapting to the environment. PD induces a multilevel impairment of this function, therefore worsening the patients' physical and psychosocial disability. In this review, we describe the complex ways in which PD impairs posture and balance, collecting and reviewing the available experimental evidence.
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de Lima-Pardini AC, Coelho DB, Silva MB, Azzi NM, Martinelli AR, Horak FB, Teixeira LA. Aging increases flexibility of postural reactive responses based on constraints imposed by a manual task. Front Aging Neurosci 2014; 6:327. [PMID: 25520656 PMCID: PMC4253961 DOI: 10.3389/fnagi.2014.00327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 11/08/2014] [Indexed: 11/14/2022] Open
Abstract
This study compared the effect of stability constraints imposed by a manual task on the adaptation of postural responses between 16 healthy elderly (mean age = 71.56 years, SD = 7.38) and 16 healthy young (mean age = 22.94 years, SD = 4.82) individuals. Postural stability was perturbed through unexpected release of a load attached to the participant’s trunk while performing two versions of a voluntary task: holding a tray with a cylinder placed with its flat side down (low constraint) or with its rolling round side down (high constraint). Low and high constraint tasks were performed in alternate blocks of trials. Results showed that young participants adapted muscular activation and kinematics of postural responses in association with previous experience with the first block of manual task constraint, whereas the elderly modulated postural responses based on the current manual constraint. This study provides evidence for flexibility of postural strategies in the elderly to deal with constraints imposed by a manual task.
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Affiliation(s)
- Andrea Cristina de Lima-Pardini
- Laboratory of Medical Investigation (LIM44), Institute of Radiology, Faculty of Medicine, University of São Paulo São Paulo, SP, Brazil
| | - Daniel Boari Coelho
- Human Motor Systems Laboratory, Department of Human Movement Biodynamics, School of Physical Education and Sport, University of São Paulo São Paulo, SP, Brazil
| | - Marina Brito Silva
- Human Motor Systems Laboratory, Department of Human Movement Biodynamics, School of Physical Education and Sport, University of São Paulo São Paulo, SP, Brazil
| | - Nametala Maia Azzi
- Human Motor Systems Laboratory, Department of Human Movement Biodynamics, School of Physical Education and Sport, University of São Paulo São Paulo, SP, Brazil
| | - Alessandra Rezende Martinelli
- Human Motor Systems Laboratory, Department of Human Movement Biodynamics, School of Physical Education and Sport, University of São Paulo São Paulo, SP, Brazil
| | - Fay Bahling Horak
- Portland VA Medical Center and the Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health and Science University Portland, OR, USA
| | - Luis Augusto Teixeira
- Human Motor Systems Laboratory, Department of Human Movement Biodynamics, School of Physical Education and Sport, University of São Paulo São Paulo, SP, Brazil
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Bekkers EMJ, Dockx K, Heremans E, Vercruysse S, Verschueren SMP, Mirelman A, Nieuwboer A. The contribution of proprioceptive information to postural control in elderly and patients with Parkinson's disease with a history of falls. Front Hum Neurosci 2014; 8:939. [PMID: 25505395 PMCID: PMC4241823 DOI: 10.3389/fnhum.2014.00939] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 11/04/2014] [Indexed: 11/30/2022] Open
Abstract
Proprioceptive deficits negatively affect postural control but their precise contribution to postural instability in Parkinson’s disease (PD) is unclear. We investigated if proprioceptive manipulations differentially affect balance, measured by force plates, during quiet standing in 13 PD patients and 13 age-matched controls with a history of falls. Perceived limits of stability (LoS) were derived from the differences between maximal center of pressure (CoP) displacement in anterior–posterior (AP) and medio-lateral (ML) direction during a maximal leaning task. Task conditions comprised standing with eyes open (EO) and eyes closed (EC): (1) on a stable surface; (2) an unstable surface; and (3) with Achilles tendon vibration. CoP displacements were calculated as a percentage of their respective LoS. Perceived LoS did not differ between groups. PD patients showed greater ML CoP displacement than elderly fallers (EF) across all conditions (p = 0.043) and tended to have higher postural sway in relation to the LoS (p = 0.050). Both groups performed worse on an unstable surface and during tendon vibration compared to standing on a stable surface with EO and even more so with EC. Both PD and EF had more AP sway in all conditions with EC compared to EO (p < 0.001) and showed increased CoP displacements when relying on proprioception only compared to standing with normal sensory input. This implies a similar role of the proprioceptive system in postural control in fallers with and without PD. PD fallers showed higher ML sway after sensory manipulations, as a result of which these values approached their perceived LoS more closely than in EF. We conclude that despite a similar fall history, PD patients showed more ML instability than EF, irrespective of sensory manipulation, but had a similar reliance on ankle proprioception. Hence, we recommend that rehabilitation and fall prevention for PD should focus on motor rather than on sensory aspects.
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Affiliation(s)
- Esther M J Bekkers
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven , Leuven , Belgium
| | - Kim Dockx
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven , Leuven , Belgium
| | - Elke Heremans
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven , Leuven , Belgium
| | - Sarah Vercruysse
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven , Leuven , Belgium
| | - Sabine M P Verschueren
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven , Leuven , Belgium
| | - Anat Mirelman
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center , Tel-Aviv , Israel
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven , Leuven , Belgium
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Wakade C, Chong R. A novel treatment target for Parkinson's disease. J Neurol Sci 2014; 347:34-8. [PMID: 25455298 DOI: 10.1016/j.jns.2014.10.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 09/19/2014] [Accepted: 10/14/2014] [Indexed: 01/19/2023]
Abstract
We hypothesize that GPR109A message and expression are up-regulated in individuals with Parkinson's disease (PD). GPR109A is a high-affinity niacin receptor. Niacin is a precursor for NAD-NADH which is needed for dopamine production. Thus, niacin supplementation may serve three purposes: reduce inflammation through GPR109A-related mechanisms, increase dopamine synthesis in the striatum through NADPH supply and increase NAD/NADH ratio to boost mitochondrial functions. GPR109A and its agonists are known to exert anti-inflammatory actions in the skin, gut and retina. However these roles are neither anticipated nor established in the CNS. For the first time here we propose the roles of GPR109A and its agonists including niacin in CNS pathology. Moreover we predict that the neuroprotective roles of either niacin or butyrates in CNS occur via GPR109A.
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Affiliation(s)
- Chandramohan Wakade
- Department of Physical Therapy, Georgia Regents University, Augusta, GA, USA.
| | - Raymond Chong
- Department of Physical Therapy, Georgia Regents University, Augusta, GA, USA.
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50
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Cohen RG, Klein KA, Nomura M, Fleming M, Mancini M, Giladi N, Nutt JG, Horak FB. Inhibition, executive function, and freezing of gait. JOURNAL OF PARKINSONS DISEASE 2014; 4:111-22. [PMID: 24496099 DOI: 10.3233/jpd-130221] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies suggest that freezing of gait (FoG) in people with Parkinson's disease (PD) is associated with declines in executive function (EF). However, EF is multi-faceted, including three dissociable components: inhibiting prepotent responses, switching between task sets, and updating working memory. OBJECTIVE This study investigated which aspect of EF is most strongly associated with FoG in PD. METHOD Three groups were studied: adults with PD (with and without FoG) and age-matched, healthy adults. All participants completed a battery of cognitive tasks previously shown to discriminate among the three EF components. Participants also completed a turning-in-place task that was scored for FoG by neurologists blind to subjects' self-reported FoG. RESULTS Compared to both other groups, participants with FoG showed significant performance deficits in tasks associated with inhibitory control, even after accounting for differences in disease severity, but no significant deficits in task-switching or updating working memory. Surprisingly, the strongest effect was an intermittent tendency of participants with FoG to hesitate, and thus miss the response window, on go trials in the Go-Nogo task. The FoG group also made slower responses in the conflict condition of the Stroop task. Physician-rated FoG scores were correlated both with failures to respond on go trials and with failures to inhibit responses on nogo trials in the Go-Nogo task. CONCLUSION These results suggest that FoG is associated with a specific inability to appropriately engage and release inhibition, rather than with a general executive deficit.
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Affiliation(s)
- Rajal G Cohen
- Department of Psychology and Communication Studies, University of Idaho, Moscow, ID, USA
| | - Krystal A Klein
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Mariko Nomura
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Michael Fleming
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Nir Giladi
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - John G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
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