1
|
Shan Q, Yu X, Lin X, Tian Y. Reduced inhibitory synaptic transmission onto striatopallidal neurons may underlie aging-related motor skill deficits. Neurobiol Dis 2024; 199:106582. [PMID: 38942325 DOI: 10.1016/j.nbd.2024.106582] [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: 01/12/2024] [Revised: 06/03/2024] [Accepted: 06/25/2024] [Indexed: 06/30/2024] Open
Abstract
Human beings are living longer than ever before and aging is accompanied by an increased incidence of motor deficits, including those associated with the neurodegenerative conditions, Parkinson's disease (PD) and Huntington's disease (HD). However, the biological correlates underlying this epidemiological finding, especially the functional basis at the synapse level, have been elusive. This study reveals that motor skill performance examined via rotarod, beam walking and pole tests is impaired in aged mice. This study, via electrophysiology recordings, further identifies an aging-related reduction in the efficacy of inhibitory synaptic transmission onto dorsolateral striatum (DLS) indirect-pathway medium spiny neurons (iMSNs), i.e., a disinhibition effect on DLS iMSNs. In addition, pharmacologically enhancing the activity of DLS iMSNs by infusing an adenosine A2A receptor (A2AR) agonist, which presumably mimics the disinhibition effect, impairs motor skill performance in young mice, simulating the behavior in aged naïve mice. Conversely, pharmacologically suppressing the activity of DLS iMSNs by infusing an A2AR antagonist, in order to offset the disinhibition effect, restores motor skill performance in aged mice, mimicking the behavior in young naïve mice. In conclusion, this study identifies a functional inhibitory synaptic plasticity in DLS iMSNs that likely contributes to the aging-related motor skill deficits, which would potentially serve as a striatal synaptic basis underlying age being a prominent risk factor for neurodegenerative motor deficits.
Collapse
Affiliation(s)
- Qiang Shan
- Laboratory for Synaptic Plasticity, Shantou University Medical College, Shantou, Guangdong 515041, China.
| | - Xiaoxuan Yu
- Laboratory for Synaptic Plasticity, Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Xiaoli Lin
- Laboratory for Synaptic Plasticity, Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Yao Tian
- Chern Institute of Mathematics, Nankai University, Tianjin 300071, China
| |
Collapse
|
2
|
Albrecht F, Johansson H, Poulakis K, Westman E, Hagströmer M, Franzén E. Exploring Responsiveness to Highly Challenging Balance and Gait Training in Parkinson's Disease. Mov Disord Clin Pract 2024. [PMID: 39166410 DOI: 10.1002/mdc3.14194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 07/08/2024] [Accepted: 07/25/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Exercise potentially improves gait, balance, and habitual physical activity in Parkinson's disease (PD). However, given the heterogeneous nature of the disease, it is likely that people respond differently to exercise interventions. Factors determining responsiveness to exercise interventions remain unclear. OBJECTIVES To address this uncertainty, we explored the responsiveness to our highly challenging balance and gait intervention (HiBalance) in people with PD. METHODS Thirty-nine participants with mild-moderate PD who underwent the HiBalance intervention from our randomized controlled trial were included. We defined response in three domains: (1) balance based on Mini-BESTest, (2) gait based on gait velocity, and (3) physical activity based on accelerometry-derived steps per day. In each domain, we explored three responsiveness levels: high, low, or non-responders according to the change from pre- to post-intervention. Separate Random Forests for each responder domain classified these responsiveness levels and identified variable importance. RESULTS Only the Random Forest for the balance domain classified all responsiveness levels above the chance level indicated by a Cohen's kappa of "slight" agreement. Variable importance differed among the responsiveness levels. Slow gait velocity indicated high responders in the balance domain but showed low probabilities for low and non-responders. For low and non-responders, fall history or no falls, respectively, were more important. CONCLUSIONS Among three responder domains and responsiveness levels, we could moderately classify responders in the balance domain, but not for the gait or physical activity domain. This can guide inclusion criteria for balance-targeted, personalized intervention studies in people with PD.
Collapse
Affiliation(s)
- Franziska Albrecht
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Johansson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Stockholm, Sweden
| | - Konstantinos Poulakis
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Hagströmer
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Erika Franzén
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Stockholm Sjukhem Foundation, Stockholm, Sweden
| |
Collapse
|
3
|
Yun SJ, Lee HS, Kim DH, Im S, Yoo YJ, Kim NY, Lee J, Kim D, Park HY, Yoon MJ, Kim YS, Chang WH, Seo HG. Efficacy of personalized repetitive transcranial magnetic stimulation based on functional reserve to enhance ambulatory function in patients with Parkinson's disease: study protocol for a randomized controlled trial. Trials 2024; 25:543. [PMID: 39152467 PMCID: PMC11328369 DOI: 10.1186/s13063-024-08385-2] [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: 04/28/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is one of the non-invasive brain stimulations that modulate cortical excitability through magnetic pulses. However, the effects of rTMS on Parkinson's disease (PD) have yielded mixed results, influenced by factors including various rTMS stimulation parameters as well as the clinical characteristics of patients with PD. There is no clear evidence regarding which patients should be applied with which parameters of rTMS. The study aims to investigate the efficacy and safety of personalized rTMS in patients with PD, focusing on individual functional reserves to improve ambulatory function. METHODS This is a prospective, exploratory, multi-center, single-blind, parallel-group, randomized controlled trial. Sixty patients with PD will be recruited for this study. This study comprises two sub-studies, each structured as a two-arm trial. Participants are classified into sub-studies based on their functional reserves for ambulatory function, into either the motor or cognitive priority group. The Timed-Up and Go (TUG) test is employed under both single and cognitive dual-task conditions (serial 3 subtraction). The motor dual-task effect, using stride length, and the cognitive dual-task effect, using the correct response rate of subtraction, are calculated. In the motor priority group, high-frequency rTMS targets the primary motor cortex of the lower limb, whereas the cognitive priority group receives rTMS over the left dorsolateral prefrontal cortex. The active comparator for each sub-study is bilateral rTMS of the primary motor cortex of the upper limb. Over 4 weeks, the participants will undergo 10 rTMS sessions, with evaluations conducted pre-intervention, mid-intervention, immediately post-intervention, and at 2-month follow-up. The primary outcome is a change in TUG time between the pre- and immediate post-intervention evaluations. The secondary outcome variables are the TUG under cognitive dual-task conditions, Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III, New Freezing of Gait Questionnaire, Digit Span, trail-making test, transcranial magnetic stimulation-induced motor-evoked potentials, diffusion tensor imaging, and resting state functional magnetic resonance imaging. DISCUSSION The study will reveal the effect of personalized rTMS based on functional reserve compared to the conventional rTMS approach in PD. Furthermore, the findings of this study may provide empirical evidence for an rTMS protocol tailored to individual functional reserves to enhance ambulatory function in patients with PD. TRIAL REGISTRATION ClinicalTrials.gov NCT06350617. Registered on 5 April 2024.
Collapse
Affiliation(s)
- Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Seok Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dae Hyun Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeun Jie Yoo
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Na Young Kim
- Department of Rehabilitation Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Jungsoo Lee
- Department of Medical IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, Republic of Korea
| | - Donghyeon Kim
- Research Institute, NEUROPHET Inc, Seoul, Republic of Korea
| | - Hae-Yeon Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi-Jeong Yoon
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Seok Kim
- Department of Rehabilitation Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Health Science and Technology, Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
4
|
Skrzatek A, Nuic D, Cherif S, Beranger B, Gallea C, Bardinet E, Welter ML. Brain modulation after exergaming training in advanced forms of Parkinson's disease: a randomized controlled study. J Neuroeng Rehabil 2024; 21:133. [PMID: 39103924 DOI: 10.1186/s12984-024-01430-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/22/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Physical activity combined with virtual reality and exergaming has emerged as a new technique to improve engagement and provide clinical benefit for gait and balance disorders in people with Parkinson's disease (PD). OBJECTIVE To investigate the effects of a training protocol using a home-based exergaming system on brain volume and resting-state functional connectivity (rs-FC) in persons with PD. METHODS A single blind randomized controlled trial was conducted in people with PD with gait and/or balance disorders. The experimental (active) group performed 18 training sessions at home by playing a custom-designed exergame with full body movements, standing in front of a RGB-D Kinect® motion sensor, while the control group played using the computer keyboard. Both groups received the same training program. Clinical scales, gait recordings, and brain MRI were performed before and after training. We assessed the effects of both training on both the grey matter volumes (GVM) and rs-FC, within and between groups. RESULTS Twenty-three patients were enrolled and randomly assigned to either the active (n = 11) or control (n = 12) training groups. Comparing pre- to post-training, the active group showed significant improvements in gait and balance disorders, with decreased rs-FC between the sensorimotor, attentional and basal ganglia networks, but with an increase between the cerebellar and basal ganglia networks. In contrast, the control group showed no significant changes, and rs-FC significantly decreased in the mesolimbic and visuospatial cerebellar and basal ganglia networks. Post-training, the rs-FC was greater in the active relative to the control group between the basal ganglia, motor cortical and cerebellar areas, and bilaterally between the insula and the inferior temporal lobe. Conversely, rs FC was lower in the active relative to the control group between the pedunculopontine nucleus and cerebellar areas, between the temporal inferior lobes and the right thalamus, between the left putamen and dorsolateral prefrontal cortex, and within the default mode network. CONCLUSIONS Full-body movement training using a customized exergame induced brain rs-FC changes within the sensorimotor, attentional and cerebellar networks in people with PD. Further research is needed to comprehensively understand the neurophysiological effects of such training approaches. Trial registration ClinicalTrials.gov NCT03560089.
Collapse
Affiliation(s)
- Anna Skrzatek
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
| | - Dijana Nuic
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
| | - Saoussen Cherif
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
- Genious Healthcare France, Paris, France
| | - Benoit Beranger
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
- CENIR core facility, Paris Brain Institute, Paris, France
| | - Cecile Gallea
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
- CENIR core facility, Paris Brain Institute, Paris, France
| | - Eric Bardinet
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France
- CENIR core facility, Paris Brain Institute, Paris, France
| | - Marie-Laure Welter
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, 47 bd de l'Hôpital, 75013, Paris, France.
- PANAM core facility, Paris Brain Institute, Paris, France.
- Neurophysiology Department, CHU Rouen, Rouen University, Rouen, France.
| |
Collapse
|
5
|
Peto D, Schmidmeier F, Katzdobler S, Fietzek UM, Levin J, Wuehr M, Zwergal A. No evidence for effects of low-intensity vestibular noise stimulation on mild-to-moderate gait impairments in patients with Parkinson's disease. J Neurol 2024; 271:5489-5497. [PMID: 38884790 PMCID: PMC11319499 DOI: 10.1007/s00415-024-12504-z] [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: 04/23/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Gait impairment is a key feature in later stages of Parkinson's disease (PD), which often responds poorly to pharmacological therapies. Neuromodulatory treatment by low-intensity noisy galvanic vestibular stimulation (nGVS) has indicated positive effects on postural instability in PD, which may possibly be conveyed to improvement of dynamic gait dysfunction. OBJECTIVE To investigate the effects of individually tuned nGVS on normal and cognitively challenged walking in PD patients with mild-to-moderate gait dysfunction. METHODS Effects of nGVS of varying intensities (0-0.7 mA) on body sway were examined in 32 patients with PD (ON medication state, Hoehn and Yahr: 2.3 ± 0.5), who were standing with eyes closed on a posturographic force plate. Treatment response and optimal nGVS stimulation intensity were determined on an individual patient level. In a second step, the effects of optimal nGVS vs. sham treatment on walking with preferred speed and with a cognitive dual task were investigated by assessment of spatiotemporal gait parameters on a pressure-sensitive gait carpet. RESULTS Evaluation of individual balance responses yielded that 59% of patients displayed a beneficial balance response to nGVS treatment with an average optimal improvement of 23%. However, optimal nGVS had no effects on gait parameters neither for the normal nor the cognitively challenged walking condition compared to sham stimulation irrespective of the nGVS responder status. CONCLUSIONS Low-intensity nGVS seems to have differential treatment effects on static postural imbalance and continuous gait dysfunction in PD, which could be explained by a selective modulation of midbrain-thalamic circuits of balance control.
Collapse
Affiliation(s)
- Daniela Peto
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Florian Schmidmeier
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sabrina Katzdobler
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Urban M Fietzek
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- Schön Klinik München Schwabing, Munich, Germany
| | - Johannes Levin
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377, Munich, Germany.
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377, Munich, Germany
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
6
|
Kim J, Rider JV, Zinselmeier A, Chiu YF, Peterson D, Longhurst JK. Dual-task gait has prognostic value for cognitive decline in Parkinson's disease. J Clin Neurosci 2024; 126:101-107. [PMID: 38865942 DOI: 10.1016/j.jocn.2024.06.006] [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: 01/15/2024] [Revised: 05/31/2024] [Accepted: 06/07/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Cognitive decline frequently occurs in individuals with Parkinson's disease (PD), but the clinical methods to predict the onset of cognitive changes are limited. Given preliminary evidence of the link between gait and cognition, the purpose of this study was to determine if dual task (DT) gait was related to declines in cognition over two years in PD. METHODS A retrospective two-year longitudinal study of 48 individuals with PD using data from the Parkinson's Progression Markers Initiative of the Michael J. Fox Foundation. The following data were extracted at baseline: spatiotemporal gait (during single and DT), demographics (age, sex), PD disease duration (time since diagnosis), motor function (Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS)), and cognition (Montreal Cognitive Assessment (MoCA)), with MoCA scores also extracted after two years. RESULTS A binomial logistic regression was conducted, with all covariates (above) in block 1 and DT effect (DTE) of gait characteristics in block 2 entered in a stepwise fashion. The final model was statistically significant (χ2(6) = 23.20, p < 0.001) and correctly classified 78.7 % of participants by cognitive status after two years. Only DTE of arm swing asymmetry (ASA) (p = 0.030) was included in block 2 such that a 1 % decline in DTE resulted in 1.6 % increased odds of cognitive decline. CONCLUSIONS Individuals with greater change in arm swing asymmetry from single to DT gait may be more likely to experience a decline in cognition within two years. These results suggested that reduced automaticity or poor utilization of attentional resources may be indicative of subtle changes in cognition and indicate that DT paradigms may hold promise as a marker of future cognitive decline.
Collapse
Affiliation(s)
- Jemma Kim
- Department of Physical Therapy, University of Delaware, 540 South College Avenue Suite 210 Newark, 19713, DE, USA; Department of Physical Therapy and Athletic Training, Saint Louis University, 3437 Caroline Street, St. Louis 63103, MO, USA.
| | - John V Rider
- School of Occupational Therapy, Touro University Nevada, 874 American Pacific Drive, Henderson 89014, Nevada, USA.
| | - Anne Zinselmeier
- Department of Physical Therapy and Athletic Training, Saint Louis University, 3437 Caroline Street, St. Louis 63103, MO, USA.
| | - Yi-Fang Chiu
- Department of Speech, Language, and Hearing Sciences, Saint Louis University, 3750 Lindell Blvd., St. Louis 63103, MO, USA.
| | - Daniel Peterson
- College of Health Solutions, Arizona State University, 550 N 3rd Street Suite 501, Phoenix, Tempe 85004, AZ, USA.
| | - Jason K Longhurst
- Department of Physical Therapy and Athletic Training, Saint Louis University, 3437 Caroline Street, Suite 1011, St. Louis 63103, MO, USA.
| |
Collapse
|
7
|
Shida T, Hatanaka S, Ohta T, Osuka Y, Kojima N, Motokawa K, Iwasaki M, Miyamae F, Okamura T, Hirano H, Awata S, Sasai H. Proposal and validation of an equation to identify sarcopenia using bioelectrical impedance analysis-derived parameters. Nutrition 2024; 124:112453. [PMID: 38669830 DOI: 10.1016/j.nut.2024.112453] [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: 01/21/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE This study aimed to develop a simpler approach for diagnosing sarcopenia by using only bioelectrical impedance vector analysis parameters. METHODS The study design was a cross-sectional study. The research was conducted based on the Itabashi Longitudinal Study on Aging, a community-based cohort study, with data collected from the 2022 and 2023 surveys in Itabashi Ward, Tokyo, Japan. The development cohort consisted of 1146 participants from the 2022 survey, and the validation cohort included 656 participants from the 2023 survey. Both cohorts were comprised of community-dwelling older adults with similar inclusion criteria. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. The logistic model utilized height divided by impedance at 50 kHz and phase angle to establish a new regression equation to identify sarcopenia. Regression equations were generated for the development cohort and validated for the validation cohort. Discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC) for men and women. RESULTS The prevalence of sarcopenia was 20.7% and 14.8% in the development and validation cohort, respectively. The AUC (95% confidence interval) of the logistic model in discriminating sarcopenia was 0.92 (0.88, 0.95) for men and 0.82 (0.78, 0.86) for women in the development cohort and 0.85 (0.78, 0.91) for men and 0.90 (0.86, 0.95) for women in the validation cohort. CONCLUSION The study demonstrated that a simple formula using bioelectrical parameters at 50 kHz proved useful in identifying sarcopenia in the older adult population.
Collapse
Affiliation(s)
- Takashi Shida
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
| | - Sho Hatanaka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Takahisa Ohta
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yosuke Osuka
- Department of Frailty Research, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Narumi Kojima
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Keiko Motokawa
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Masanori Iwasaki
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; Department of Preventive Dentistry, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Hokkaido, Japan
| | - Fumiko Miyamae
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Tsuyoshi Okamura
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hirohiko Hirano
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| |
Collapse
|
8
|
Zhang X, Wang M, Lee SY, Yue Y, Chen Z, Zhang Y, Wang L, Guan Q, Fan W, Shen T. Cholinergic nucleus degeneration and its association with gait impairment in Parkinson's disease. J Neuroeng Rehabil 2024; 21:120. [PMID: 39026279 PMCID: PMC11256459 DOI: 10.1186/s12984-024-01417-7] [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: 11/23/2023] [Accepted: 07/04/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND The contribution of cholinergic degeneration to gait disturbance in Parkinson's disease (PD) is increasingly recognized, yet its relationship with dopaminergic-resistant gait parameters has been poorly investigated. We investigated the association between comprehensive gait parameters and cholinergic nucleus degeneration in PD. METHODS This cross-sectional study enrolled 84 PD patients and 69 controls. All subjects underwent brain structural magnetic resonance imaging to assess the gray matter density (GMD) and volume (GMV) of the cholinergic nuclei (Ch123/Ch4). Gait parameters under single-task (ST) and dual-task (DT) walking tests were acquired using sensor wearables in PD group. We compared cholinergic nucleus morphology and gait performance between groups and examined their association. RESULTS PD patients exhibited significantly decreased GMD and GMV of the left Ch4 compared to controls after reaching HY stage > 2. Significant correlations were observed between multiple gait parameters and bilateral Ch123/Ch4. After multiple testing correction, the Ch123/Ch4 degeneration was significantly associated with shorter stride length, lower gait velocity, longer stance phase, smaller ankle toe-off and heel-strike angles under both ST and DT condition. For PD patients with HY stage 1-2, there were no significant degeneration of Ch123/4, and only right side Ch123/Ch4 were corrected with the gait parameters. However, as the disease progressed to HY stage > 2, bilateral Ch123/Ch4 nuclei showed correlations with gait performance, with more extensive significant correlations were observed in the right side. CONCLUSIONS Our study demonstrated the progressive association between cholinergic nuclei degeneration and gait impairment across different stages of PD, and highlighting the potential lateralization of the cholinergic nuclei's impact on gait impairment. These findings offer insights for the design and implementation of future clinical trials investigating cholinergic treatments as a promising approach to address gait impairments in PD.
Collapse
Affiliation(s)
- Xiaodan Zhang
- Department of Neurology, Ningbo NO.2 Hospital, NO.6 Building, 41 Xibei Street, Haishu District, Ningbo, Zhejiang Province, China
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Mateng Wang
- Department of General Surgery, Yinzhou NO.2 Hospital, Ningbo, Zhejiang Province, China
| | - Shi Yeow Lee
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yumei Yue
- Department of Neurology of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Zhaoying Chen
- Department of Neurology, Ningbo NO.2 Hospital, NO.6 Building, 41 Xibei Street, Haishu District, Ningbo, Zhejiang Province, China
| | - Yilin Zhang
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lulu Wang
- Department of Neurology, Ningbo NO.2 Hospital, NO.6 Building, 41 Xibei Street, Haishu District, Ningbo, Zhejiang Province, China
| | - Qiongfeng Guan
- Department of Neurology, Ningbo NO.2 Hospital, NO.6 Building, 41 Xibei Street, Haishu District, Ningbo, Zhejiang Province, China
| | - Weinv Fan
- Department of Neurology, Ningbo NO.2 Hospital, NO.6 Building, 41 Xibei Street, Haishu District, Ningbo, Zhejiang Province, China.
| | - Ting Shen
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
9
|
Sarasso E, Gardoni A, Marelli S, Balestrino R, Zenere L, Castelnuovo A, Malcangi M, Basaia S, Grassi A, Tettamanti A, Canu E, Ferini-Strambi L, Filippi M, Agosta F. Gait Analysis and Magnetic Resonance Imaging Characteristics in Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder. Mov Disord 2024. [PMID: 38962883 DOI: 10.1002/mds.29911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/20/2024] [Accepted: 06/17/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Isolated rapid eye movement sleep behavioral disorder (iRBD) can precede neurodegenerative diseases. There is an urgent need for biomarkers to aid early intervention and neuroprotection. OBJECTIVE The aim is to assess quantitative motor, cognitive, and brain magnetic resonance imaging (MRI) characteristics in iRBD patients. METHODS Thirty-eight polysomnography-confirmed iRBD patients and 28 age- and sex-matched healthy controls underwent clinical, cognitive, and motor functional evaluations, along with brain MRI. Motor tasks included nine-hole peg test, five-times-sit-to-stand test, timed-up-and-go test, and 4-meter walking test with and without cognitive dual task. Quantitative spatiotemporal gait parameters were obtained using an optoelectronic system. Brain MRI analysis included functional connectivity (FC) of the main resting-state networks, gray matter (GM) volume using voxel-based morphometry, cortical thickness, and deep GM and brainstem volumes using FMRIB's Integrated Registration and Segmentation Tool and FreeSurfer. RESULTS iRBD patients relative to healthy subjects exhibited a poorer performance during the nine-hole peg test and five-times-sit-to-stand test, and greater asymmetry of arm-swing amplitude and stride length variability during dual-task gait. Dual task significantly worsened the walking performance of iRBD patients more than healthy controls. iRBD patients exhibited nonmotor symptoms, and memory, abstract reasoning, and visuospatial deficits. iRBD patients exhibited decreased FC of pallidum and putamen within the basal ganglia network and occipital and temporal areas within the visuo-associative network, and a reduced volume of the supramarginal gyrus. Brain functional alterations correlated with gait changes. CONCLUSIONS Subtle motor and nonmotor alterations were identified in iRBD patients, alongside brain structural and functional MRI changes. These findings may represent early signs of neurodegeneration and contribute to the development of predictive models for progression to parkinsonism. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Andrea Gardoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Marelli
- Vita-Salute San Raffaele University, Milan, Italy
- Sleep Disorders Center, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Balestrino
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lucia Zenere
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Castelnuovo
- Vita-Salute San Raffaele University, Milan, Italy
- Sleep Disorders Center, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Malcangi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Grassi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Tettamanti
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Ferini-Strambi
- Vita-Salute San Raffaele University, Milan, Italy
- Sleep Disorders Center, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
10
|
Carli G, Kanel P, Roytman S, Pongmala C, Albin RL, Raffel DM, Scott PJH, Bohnen NI. Noradrenergic cardiac denervation is associated with gait velocity in Parkinson disease: a dual ligand PET study. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06822-7. [PMID: 38958681 DOI: 10.1007/s00259-024-06822-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Preliminary data suggest that gait abnormalities in Parkinson disease (PD) may be associated with sympathetic cardiac denervation. No kinematic gait studies were performed to confirm this observation. We aimed to correlate spatiotemporal kinematic gait parameters with cardiac sympathetic denervation as determined by cardiac [11C]HED PET in PD. METHODS Retrospective database analysis of 27 PD patients with cardiac sympathetic denervation. All patients underwent spatiotemporal kinematic gait assessment (medication 'off' state), cardiac [11C]HED and dopaminergic brain [11C]DTBZ PET scans. We employed a hierarchical regression approach to examine associations between the extent of cardiac denervation, dopaminergic nigrostriatal neurodegeneration, and three gait parameters - velocity, step length and cadence. RESULTS More extensive cardiac denervation was associated with slower velocity (estimate: -1.034, 95% CI [-1.65, -0.42], p = 0.002), shorter step length (estimate: -0.818, 95% CI [-1.43, -0.21], p = 0.011) and lower cadence (estimate: -0.752, 95% CI [-1.28, -0.23], p = 0.007) explaining alone 30% (Adjusted-R²: 0.297), 20% (Adjusted-R²: 0.202) and 23% (Adjusted-R²: 0.227) of the variability, respecivetly. These associations remained independent of striatal dopaminergic impairment and confounding factors such as age, Hoehn and Yahr (HY) stages, peripheral neuropathy, cognition, and autonomic symptoms. In contrast, striatal dopaminergic denervation was significantly associated with step length (estimate: 0.883, 95% CI [0.29, 1.48], p = 0.005), explaining about 24% of the variability but was dependent of HY stage. CONCLUSIONS More severe cardiac noradrenergic denervation was associated with lower gait velocity, independent of striatal dopaminergic denervation and HY stage, impacting both step length and cadence. These results suggest independent contributions of the peripheral autonomic system degeneration on gait dynsfunction in PD.
Collapse
Affiliation(s)
- G Carli
- Department of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA.
- Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, 48109, USA.
- Functional Neuroimaging, Cognitive, and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
| | - P Kanel
- Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, USA
- Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, 48109, USA
- Functional Neuroimaging, Cognitive, and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - S Roytman
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, USA
- Functional Neuroimaging, Cognitive, and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - C Pongmala
- Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, USA
- Functional Neuroimaging, Cognitive, and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - R L Albin
- Department of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
- Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, 48109, USA
- Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI, 48105, USA
| | - D M Raffel
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - P J H Scott
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - N I Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
- Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Radiology, University of Michigan, Ann Arbor, MI, 48109, USA
- Parkinson's Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI, 48105, USA
- Functional Neuroimaging, Cognitive, and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
11
|
Zhao J, Wang J, Zhao K, Zhang Y, Hu W. Protopanaxadiols Eliminate Behavioral Impairments and Mitochondrial Dysfunction in Parkinson's Disease Mice Model. Neurochem Res 2024; 49:1751-1761. [PMID: 38551796 PMCID: PMC11144128 DOI: 10.1007/s11064-024-04132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 06/02/2024]
Abstract
Currently, there are no effective therapies to cure Parkinson's disease (PD), which is the second most common neurodegenerative disease primarily characterized by motor dysfunction and degeneration of dopaminergic neurons in the substantia nigra pars compacta (SNc). Protopanaxadiols (PPDs), including 20 (R)- protopanaxadiol (R-PPD) and 20 (S)- protopanaxadiol (S-PPD), are main metabolites of ginsenosides. The role of ginsenosides in neurodegenerative diseases has been thoroughly studied, however, it is unknown whether PPDs can attenuate behavioral deficits and dopaminergic neuron injury in PD model mice to date. Here, we administered PPDs to MPTP-induced PD model mice and monitored the effects on behavior and dopaminergic neurons to investigate the effects of R-PPD and S-PPD against PD. Our results showed that R-PPD and S-PPD (at a dose of 20 mg/kg, i.g.) treatment alleviated MPTP (30 mg/kg, i.p.) induced behavioral deficits. Besides, R-PPD and S-PPD protected MPP+-induced neuron injury and mitochondrial dysfunction, and reduced the abnormal expression of Cyt C, Bax, caspase-3 and Bcl-2. These findings demonstrate that R-PPD and S-PPD were potentially useful to ameliorate PD.
Collapse
Affiliation(s)
- Jindong Zhao
- School of Pharmaceutical Science & Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Kunming, 650500, People's Republic of China
- College of Modern Biomedical Industry, Kunming Medical University, Kunming, 650500, People's Republic of China
| | - Ji Wang
- School of Pharmaceutical Science & Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Kunming, 650500, People's Republic of China
- School of Chinese Materia Medica &Yunnan Key Laboratory of Southern Medicine Utilization, Yunnan University of Chinese Medicine, Kunming, 650500, People's Republic of China
| | - Kunying Zhao
- School of Pharmaceutical Science & Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Kunming, 650500, People's Republic of China
- College of Modern Biomedical Industry, Kunming Medical University, Kunming, 650500, People's Republic of China
| | - Yuxiao Zhang
- School of Pharmaceutical Science & Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Kunming, 650500, People's Republic of China
- College of Modern Biomedical Industry, Kunming Medical University, Kunming, 650500, People's Republic of China
| | - Weiyan Hu
- School of Pharmaceutical Science & Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Kunming, 650500, People's Republic of China.
- College of Modern Biomedical Industry, Kunming Medical University, Kunming, 650500, People's Republic of China.
| |
Collapse
|
12
|
Jiang W, Zhou H, Wu J, Chen H, Li L, Wu Y, Meng T, Zuo G, Fan W, Shi C. Short Step Length Estimation for Parkinson's Disease Patients by Using Fusion Data From Camera-IMU in Smart Glasses. IEEE Trans Biomed Eng 2024; 71:2265-2275. [PMID: 38376981 DOI: 10.1109/tbme.2024.3367923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Shortened step length is a prominent motor abnormality in Parkinson's disease (PD) patients. Current methods for estimating short step length have the limitation of relying on laboratory scenarios, wearing multiple sensors, and inaccurate estimation results from a single sensor. In this paper, we proposed a novel method for estimating short step length for PD patients by fusing data from camera and inertial measurement units in smart glasses. A simultaneous localization and mapping technique and acceleration thresholding-based step detection technique were combined to realize the step length estimation. Two sets of experiments were conducted to demonstrate the performance of our method. In the first set of experiments with 12 healthy subjects, the proposed method demonstrated an average error of 8.44% across all experiments including six fixed step lengths below 30 cm. The second set of straightly walking experiments were implemented with 12 PD patients, the proposed method exhibited an average error of 4.27% compared to a standard gait evaluation technique in total walking distance. Notably, among the results of step lengths below 40 cm, our method agreed with the standard technique (R 2=0.8659). This study offers a promising approach for estimating short step length for PD patients during smart glasses-based gait training.
Collapse
|
13
|
Bouchard-Tremblay J, Théberge M, Ayoub T, Martel-Brosseau G, Levasseur-Ouellet MP, Tremblay M, Houde-Thibeault A, Wotto EA, Carezolli FR, Hébert LJ, da Silva RA. Age- and Parkinson-related differences in trunk and lower-limb muscle activation during four balance tasks: A case-control pilot study. Clin Biomech (Bristol, Avon) 2024; 117:106298. [PMID: 38936292 DOI: 10.1016/j.clinbiomech.2024.106298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Poor postural control has been reported in people with Parkinson's disease, which could be explained by the changes in muscular activation patterns related to antigravitational muscles. This study aims to measure the muscle activation of antigravitational muscles during balance tasks in individuals, with and without Parkinson's. METHODS Sixteen (16) participants (9 with Parkinson's), aged ≥65 yrs., performed 2 × 30-s trials of 4 balance tasks (bipodal and semi-tandem opened eyes and closed eyes) on a force platform (center of pressure measurement); while surface electromyography measurements were obtained bilaterally on the multifidus at L5, biceps femoris and medialis gastrocnemius. Electromyography amplitude analysis was processed by the Root Mean Square (250 ms window epochs) and normalized by the peak of activation during the balance task, to determine each muscle's activity level. FINDINGS The Parkinson's group reported lower muscle activation than control across tasks (in mean for multifidus = 8%, biceps femoris = 16%, gastrocnemius = 7%), although not statistically significant. Parkinson's reported significantly poorer postural control than control, mainly for the center of pressure sway ellipse area (p = 0.016) from challenge balance tasks such as semi-tandem. INTERPRETATION Poor postural control was confirmed in the Parkinson's group, but not significantly associated by the changes from muscle activation of trunk and lower limbs, during balance performance.
Collapse
Affiliation(s)
- Jérôme Bouchard-Tremblay
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1; Centre Intersectoriel en Santé Durable, Laboratoire de Recherche BioNR, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Michael Théberge
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Tamami Ayoub
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Gabrielle Martel-Brosseau
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Marie-Pier Levasseur-Ouellet
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Maxim Tremblay
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Alexandra Houde-Thibeault
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Enafa Anais Wotto
- Centre Intersectoriel en Santé Durable, Laboratoire de Recherche BioNR, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1
| | - Fernando Rezende Carezolli
- Doctoral and Master Programs in Human Movement and Rehabilitation, University Center of Anapolis, Anapolis, GO, Brazil
| | - Luc J Hébert
- School of Rehabilitation Sciences, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, Quebec City, Quebec, Canada, G1V 0A6
| | - Rubens A da Silva
- Programme de Maîtrise en Physiothérapie, Département des Sciences de la Santé l'Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1; Centre Intersectoriel en Santé Durable, Laboratoire de Recherche BioNR, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada, G7H 2B1; Doctoral and Master Programs in Human Movement and Rehabilitation, University Center of Anapolis, Anapolis, GO, Brazil; Centre Intégré de Santé et Services Sociaux du Saguenay-Lac-Saint-Jean (CIUSSS SLSJ), Specialized Geriatrics Services at La Baie Hospital, Saguenay, Quebec, Canada, G7H 7K9.
| |
Collapse
|
14
|
Barbosa R, Mendonça M, Bastos P, Pita Lobo P, Valadas A, Correia Guedes L, Ferreira JJ, Rosa MM, Matias R, Coelho M. 3D Kinematics Quantifies Gait Response to Levodopa earlier and to a more Comprehensive Extent than the MDS-Unified Parkinson's Disease Rating Scale in Patients with Motor Complications. Mov Disord Clin Pract 2024; 11:795-807. [PMID: 38610081 PMCID: PMC11233852 DOI: 10.1002/mdc3.14016] [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: 09/17/2023] [Revised: 01/20/2024] [Accepted: 02/13/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Quantitative 3D movement analysis using inertial measurement units (IMUs) allows for a more detailed characterization of motor patterns than clinical assessment alone. It is essential to discriminate between gait features that are responsive or unresponsive to current therapies to better understand the underlying pathophysiological basis and identify potential therapeutic strategies. OBJECTIVES This study aims to characterize the responsiveness and temporal evolution of different gait subcomponents in Parkinson's disease (PD) patients in their OFF and various ON states following levodopa administration, utilizing both wearable sensors and the gold-standard MDS-UPDRS motor part III. METHODS Seventeen PD patients were assessed while wearing a full-body set of 15 IMUs in their OFF state and at 20-minute intervals following the administration of a supra-threshold levodopa dose. Gait was reconstructed using a biomechanical model of the human body to quantify how each feature was modulated. Comparisons with non-PD control subjects were conducted in parallel. RESULTS Significant motor changes were observed in both the upper and lower limbs according to the MDS-UPDRS III, 40 minutes after levodopa intake. IMU-assisted 3D kinematics detected significant motor alterations as early as 20 minutes after levodopa administration, particularly in upper limbs metrics. Although all "pace-domain" gait features showed significant improvement in the Best-ON state, most rhythmicity, asymmetry, and variability features did not. CONCLUSION IMUs are capable of detecting motor alterations earlier and in a more comprehensive manner than the MDS-UPDRS III. The upper limbs respond more rapidly to levodopa, possibly reflecting distinct thresholds to levodopa across striatal regions.
Collapse
Affiliation(s)
- Raquel Barbosa
- Neurology DeparmentCentre Hospitalier Universitaire ToulouseToulouseFrance
- Nova Medical School, Faculdade de Ciências MedicasUniversidade Nova de LisboaLisbonPortugal
| | - Marcelo Mendonça
- Nova Medical School, Faculdade de Ciências MedicasUniversidade Nova de LisboaLisbonPortugal
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the UnknownLisbonPortugal
| | - Paulo Bastos
- Neurology DeparmentCentre Hospitalier Universitaire ToulouseToulouseFrance
- Nova Medical School, Faculdade de Ciências MedicasUniversidade Nova de LisboaLisbonPortugal
| | - Patrícia Pita Lobo
- Department of Neurosciences and Mental HealthNeurology Hospital Santa Maria, CHLUNLisbonPortugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of MedicineUniversity of LisbonLisbonPortugal
| | - Anabela Valadas
- Department of Neurosciences and Mental HealthNeurology Hospital Santa Maria, CHLUNLisbonPortugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of MedicineUniversity of LisbonLisbonPortugal
| | - Leonor Correia Guedes
- Department of Neurosciences and Mental HealthNeurology Hospital Santa Maria, CHLUNLisbonPortugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of MedicineUniversity of LisbonLisbonPortugal
| | - Joaquim J. Ferreira
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of MedicineUniversity of LisbonLisbonPortugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
- CNS‐ Campus Neurológico SeniorTorres VedrasPortugal
| | - Mário Miguel Rosa
- Department of Neurosciences and Mental HealthNeurology Hospital Santa Maria, CHLUNLisbonPortugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of MedicineUniversity of LisbonLisbonPortugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
| | - Ricardo Matias
- Physics Department & Institute of Biophysics and Biomedical Engineering (IBEB), Faculty of SciencesUniversity of LisbonLisbonPortugal
- KinetikosCoimbraPortugal
| | - Miguel Coelho
- Department of Neurosciences and Mental HealthNeurology Hospital Santa Maria, CHLUNLisbonPortugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculty of MedicineUniversity of LisbonLisbonPortugal
| |
Collapse
|
15
|
She Y, He Y, Wu J, Liu N. Association between the sarcopenia-related traits and Parkinson's disease: A bidirectional two-sample Mendelian randomization study. Arch Gerontol Geriatr 2024; 122:105374. [PMID: 38452652 DOI: 10.1016/j.archger.2024.105374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/28/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To explore the causal association between sarcopenia-related traits and Parkinson's disease by Mendelian randomization (MR) approach. METHODS A genome-wide association study (GWAS) of sarcopenia-related traits was done at the UK Biobank (UKB). The traits were appendicular lean mass, low hand grip strength (including the European Working Group on Sarcopenia in Older People (EWGSOP) and the Foundation for the National Institutes of Health (FNIH) criteria and usual walking pace. The International Parkinson's Disease Genomics Consortium (IPDGC) gave us GWAS data for Parkinson's disease (PD). We used three different types of MR analyses: including Inverse-variance weighted (IVW), Mendelian randomized Egger regression (MR-Egger), and weighted median methods (both weighted and simple modes). RESULTS The MR analysis showed that low hand grip strength was negatively associated with the risk of developing Parkinson's disease, including EWGSOP criterion (odds ratio (OR) = 0.734; 95% confidence interval (CI) = 0.575-0.937, P = 0.013) and FNIH criterion (OR = 0.619; 95% CI = 0.419-0.914, P = 0.016), and usual walking pace was also a risk factor for Parkinson's disease (OR = 3.307, 95% CI = 1.277-8.565, P = 0.014). CONCLUSIONS In European population, low hand grip strength is negatively associated with the risk of developing Parkinson's disease, and usual walking pace is also a risk factor for Parkinson's disease. Further exploration of the potential genetic mechanisms underlying hand grip strength and Parkinson's disease and the potential relationship between walking pace, balance, and falls in Parkinson's patients may help to reduce the burden of sarcopenia and Parkinson's disease.
Collapse
Affiliation(s)
- Yingqi She
- Kiang Wu Nursing College of Macau, Avenida do Hospital das Ilhas no.447, Coloane, RAEM, 999078, Macau, China
| | - Yaming He
- Kiang Wu Nursing College of Macau, Avenida do Hospital das Ilhas no.447, Coloane, RAEM, 999078, Macau, China
| | - Jianwei Wu
- Kiang Wu Nursing College of Macau, Avenida do Hospital das Ilhas no.447, Coloane, RAEM, 999078, Macau, China.
| | - Ning Liu
- Kiang Wu Nursing College of Macau, Avenida do Hospital das Ilhas no.447, Coloane, RAEM, 999078, Macau, China.
| |
Collapse
|
16
|
Zhang W, Ling Y, Chen Z, Ren K, Chen S, Huang P, Tan Y. Wearable sensor-based quantitative gait analysis in Parkinson's disease patients with different motor subtypes. NPJ Digit Med 2024; 7:169. [PMID: 38926552 PMCID: PMC11208588 DOI: 10.1038/s41746-024-01163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Gait impairments are among the most common and disabling symptoms of Parkinson's disease and worsen as the disease progresses. Early detection and diagnosis of subtype-specific gait deficits, as well as progression monitoring, can help to implement effective and preventive personalized treatment for PD patients. Yet, the gait features have not been fully studied in PD and its motor subtypes. To characterize comprehensive and objective gait alterations and to identify the potential gait biomarkers for early diagnosis, subtype differentiation, and disease severity monitoring. We analyzed gait parameters related to upper/lower limbs, trunk and lumbar, and postural transitions from 24 tremor-dominant (TD) and 20 postural instability gait difficulty (PIGD) dominant PD patients who were in early stage and 39 matched healthy controls (HC) during the Timed Up and Go test using wearable sensors. Results show: (1) Both TD and PIGD groups showed restricted backswing range in bilateral lower extremities and more affected side (MAS) arm, reduced trunk and lumbar rotation range in the coronal plane, and low turning efficiency. The receiver operating characteristic (ROC) analysis revealed these objective gait features had high discriminative value in distinguishing both PD subtypes from the HC with the area under the curve (AUC) values of 0.7~0.9 (p < 0.01). (2) Subtle but measurable gait differences existed between TD and PIGD patients before the onset of clinically apparent gait impairment. (3) Specific gait parameters were significantly associated with disease severity in TD and PIGD subtypes. Objective gait biomarkers based on wearable sensors may facilitate timely and personalized gait treatments in PD subtypes through early diagnosis, subtype differentiation, and disease severity monitoring.
Collapse
Affiliation(s)
- Weishan Zhang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Ling
- GYENNO SCIENCE Co., Ltd. Department of Research, Shenzhen, Guangdong, China
- HUST-GYENNO CNS Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Zhonglue Chen
- GYENNO SCIENCE Co., Ltd. Department of Research, Shenzhen, Guangdong, China
- HUST-GYENNO CNS Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Kang Ren
- GYENNO SCIENCE Co., Ltd. Department of Research, Shenzhen, Guangdong, China
- HUST-GYENNO CNS Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Shengdi Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pei Huang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yuyan Tan
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
17
|
Hu CH, Lai YR, Huang CC, Lien CY, Chen YS, Yu CC, Lee SY, Lin WC, Cheng BC, Chiu WC, Chiang YF, Kung CF, Lu CH. Exploring the role of anticipatory postural adjustment duration within APA2 subphase as a potential mediator between clinical disease severity and fall risk in Parkinson's disease. Front Aging Neurosci 2024; 16:1354387. [PMID: 38988326 PMCID: PMC11234839 DOI: 10.3389/fnagi.2024.1354387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 06/05/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction People with Parkinson's Disease (PD) often show reduced anticipatory postural adjustments (APAs) before voluntary steps, impacting their stability. The specific subphase within the APA stage contributing significantly to fall risk remains unclear. Methods We analyzed center of pressure (CoP) trajectory parameters, including duration, length, and velocity, throughout gait initiation. This examination encompassed both the postural phase, referred to as anticipatory postural adjustment (APA) (APA1, APA2a, APA2b), and the subsequent locomotor phases (LOC). Participants were instructed to initiate a step and then stop (initiating a single step). Furthermore, we conducted assessments of clinical disease severity using the Unified Parkinson's Disease Rating Scale (UPDRS) and evaluated fall risk using Tinetti gait and balance scores during off-medication periods. Results Freezing of gait (FOG) was observed in 18 out of 110 participants during the measurement of CoP trajectories. The Ramer-Douglas-Peucker algorithm successfully identified CoP displacement trajectories in 105 participants (95.5%), while the remaining 5 cases could not be identified due to FOG. Tinetti balance and gait score showed significant associations with levodopa equivalent daily dose, UPDRS total score, disease duration, duration (s) in APA2a (s) and LOC (s), length in APA1 (cm) and APA2b (cm), mediolateral velocity in APA1 (X) (cm/s), APA2a (X) (cm/s), APA2b (X) (cm/s) and LOC (X) (cm/s), and anterior-posterior velocity in APA2a (Z) (cm/s) and APA2b (Z) (cm/s). Multiple linear regression revealed that only duration (s) in APA2a and UPDRS total score was independently associated with Tinetti gait and balance score. Further mediation analysis showed that the duration (s) in APA2a served as a mediator between UPDRS total score and Tinetti balance and gait score (Sobel test, p = 0.047). Conclusion APA2 subphase duration mediates the link between disease severity and fall risk in PD, suggesting that longer APA2a duration may indicate reduced control during gait initiation, thereby increasing fall risk.
Collapse
Affiliation(s)
- Cheng-Hao Hu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yun-Ru Lai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Hyperbaric Oxygen Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Cheng Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Yi Lien
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Sheng Chen
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiun-Chieh Yu
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sieh-Yang Lee
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ben-Chung Cheng
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Chan Chiu
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Fang Chiang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Feng Kung
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Intelligent Commerce, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| |
Collapse
|
18
|
Mohammed A, Li S, Liu X. Exploring the Potentials of Wearable Technologies in Managing Vestibular Hypofunction. Bioengineering (Basel) 2024; 11:641. [PMID: 39061723 PMCID: PMC11274252 DOI: 10.3390/bioengineering11070641] [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: 05/04/2024] [Revised: 05/26/2024] [Accepted: 05/31/2024] [Indexed: 07/28/2024] Open
Abstract
The vestibular system is dedicated to gaze stabilization, postural balance, and spatial orientation; this makes vestibular function crucial for our ability to interact effectively with our environment. Vestibular hypofunction (VH) progresses over time, and it presents differently in its early and advanced stages. In the initial stages of VH, the effects of VH are mitigated using vestibular rehabilitation therapy (VRT), which can be facilitated with the aid of technology. At more advanced stages of VH, novel techniques that use wearable technologies for sensory augmentation and sensory substitution have been applied to manage VH. Despite this, the potential of assistive technologies for VH management remains underexplored over the past decades. Hence, in this review article, we present the state-of-the-art technologies for facilitating early-stage VRT and for managing advanced-stage VH. Also, challenges and strategies on how these technologies can be improved to enable long-term ambulatory and home use are presented.
Collapse
Affiliation(s)
- Ameer Mohammed
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
| | - Shutong Li
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
| | - Xiao Liu
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
| |
Collapse
|
19
|
Single M, Bruhin LC, Naef AC, Krack P, Nef T, Gerber SM. Unobtrusive measurement of gait parameters using seismographs: An observational study. Sci Rep 2024; 14:14487. [PMID: 38914628 PMCID: PMC11196696 DOI: 10.1038/s41598-024-64508-4] [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: 09/26/2023] [Accepted: 06/10/2024] [Indexed: 06/26/2024] Open
Abstract
Analyzing irregularities in walking patterns helps detect human locomotion abnormalities that can signal health changes. Traditional observation-based assessments have limitations due to subjective biases and capture only a single time point. Ambient and wearable sensor technologies allow continuous and objective locomotion monitoring but face challenges due to the need for specialized expertise and user compliance. This work proposes a seismograph-based algorithm for quantifying human gait, incorporating a step extraction algorithm derived from mathematical morphologies, with the goal of achieving the accuracy of clinical reference systems. To evaluate our method, we compared the gait parameters of 50 healthy participants, as recorded by seismographs, and those obtained from reference systems (a pressure-sensitive walkway and a camera system). Participants performed four walking tests, including traversing a walkway and completing the timed up-and-go (TUG) test. In our findings, we observed linear relationships with strong positive correlations (R2 > 0.9) and tight 95% confidence intervals for all gait parameters (step time, cycle time, ambulation time, and cadence). We demonstrated that clinical gait parameters and TUG mobility test timings can be accurately derived from seismographic signals, with our method exhibiting no significant differences from established clinical reference systems.
Collapse
Affiliation(s)
- Michael Single
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
| | - Lena C Bruhin
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Aileen C Naef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Paul Krack
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan M Gerber
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| |
Collapse
|
20
|
Mylius V, Zenev E, Brook CS, Brugger F, Maetzler W, Gonzenbach R, Paraschiv-Ionescu A. Imbalance and Falls in Patients with Parkinson's Disease: Causes and Recent Developments in Training and Sensor-Based Assessment. Brain Sci 2024; 14:625. [PMID: 39061366 PMCID: PMC11274436 DOI: 10.3390/brainsci14070625] [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: 04/22/2024] [Revised: 05/16/2024] [Accepted: 05/28/2024] [Indexed: 07/28/2024] Open
Abstract
Imbalance and falls in patients with Parkinson's disease (PD) do not only reduce their quality of life but also their life expectancy. Aging-related symptoms as well as disease-specific motor and non-motor symptoms contribute to these conditions and should be treated when appropriate. In addition to an active lifestyle, advanced exercise training is useful and effective, especially for less medically responsive symptoms such as freezing of gait and postural instability at advanced stages. As treadmill training in non-immersive virtual reality, including dual tasks, significantly reduced the number of falls in PD patients, the mechanism(s) explaining this effect should be further investigated. Such research could help to select the most suitable patients and develop the most effective training protocols based on this novel technology. Real-life digital surrogate markers of mobility, such as those describing aspects of endurance, performance, and the complexity of specific movements, can further improve the quality of mobility assessment using wearables.
Collapse
Affiliation(s)
- Veit Mylius
- Department of Neurology, Center for Neurorehabilitation, 7317 Valens, Switzerland; (E.Z.); (C.S.B.); (R.G.)
- Department of Neurology, Philipps University, 35043 Marburg, Germany
| | - Elisabeth Zenev
- Department of Neurology, Center for Neurorehabilitation, 7317 Valens, Switzerland; (E.Z.); (C.S.B.); (R.G.)
| | - Caroline S. Brook
- Department of Neurology, Center for Neurorehabilitation, 7317 Valens, Switzerland; (E.Z.); (C.S.B.); (R.G.)
- Department of Neurology, University of Bern, Inselspital Bern, 3010 Bern, Switzerland
| | - Florian Brugger
- Department of Neurology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland;
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel University, 24105 Kiel, Germany;
| | - Roman Gonzenbach
- Department of Neurology, Center for Neurorehabilitation, 7317 Valens, Switzerland; (E.Z.); (C.S.B.); (R.G.)
| | - Anisoara Paraschiv-Ionescu
- Signal Processing Laboratory 5, Ecole Polytechnique Federale de Lausanne (EPFL), 1015 Lausanne, Switzerland;
| |
Collapse
|
21
|
Bonato P, Feipel V, Corniani G, Arin-Bal G, Leardini A. Position paper on how technology for human motion analysis and relevant clinical applications have evolved over the past decades: Striking a balance between accuracy and convenience. Gait Posture 2024; 113:191-203. [PMID: 38917666 DOI: 10.1016/j.gaitpost.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/30/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Over the past decades, tremendous technological advances have emerged in human motion analysis (HMA). RESEARCH QUESTION How has technology for analysing human motion evolved over the past decades, and what clinical applications has it enabled? METHODS The literature on HMA has been extensively reviewed, focusing on three main approaches: Fully-Instrumented Gait Analysis (FGA), Wearable Sensor Analysis (WSA), and Deep-Learning Video Analysis (DVA), considering both technical and clinical aspects. RESULTS FGA techniques relying on data collected using stereophotogrammetric systems, force plates, and electromyographic sensors have been dramatically improved providing highly accurate estimates of the biomechanics of motion. WSA techniques have been developed with the advances in data collection at home and in community settings. DVA techniques have emerged through artificial intelligence, which has marked the last decade. Some authors have considered WSA and DVA techniques as alternatives to "traditional" HMA techniques. They have suggested that WSA and DVA techniques are destined to replace FGA. SIGNIFICANCE We argue that FGA, WSA, and DVA complement each other and hence should be accounted as "synergistic" in the context of modern HMA and its clinical applications. We point out that DVA techniques are especially attractive as screening techniques, WSA methods enable data collection in the home and community for extensive periods of time, and FGA does maintain superior accuracy and should be the preferred technique when a complete and highly accurate biomechanical data is required. Accordingly, we envision that future clinical applications of HMA would favour screening patients using DVA in the outpatient setting. If deemed clinically appropriate, then WSA would be used to collect data in the home and community to derive relevant information. If accurate kinetic data is needed, then patients should be referred to specialized centres where an FGA system is available, together with medical imaging and thorough clinical assessments.
Collapse
Affiliation(s)
- Paolo Bonato
- Dept of PM&R, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, USA
| | - Véronique Feipel
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Laboratory of Anatomy, Biomechanics and Organogenesis, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Giulia Corniani
- Dept of PM&R, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, USA
| | - Gamze Arin-Bal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey; Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
22
|
Hutin E, Poirier T, Meimoun M, Mardale V, Ghédira M. Model-based cueing-as-needed for walking in Parkinson's disease: A randomized cross-over study. Rev Neurol (Paris) 2024:S0035-3787(24)00532-0. [PMID: 38834484 DOI: 10.1016/j.neurol.2024.05.003] [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: 10/20/2023] [Revised: 03/29/2024] [Accepted: 05/03/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Correcting of the lack of regularity in steps is a key component of gait rehabilitation in Parkinson's disease. We proposed to introduce adaptive spatial auditory cueing (ASAC) based on verbal instruction "lengthen the step" automatically delivered when the stride length decreased below a predetermined threshold. OBJECTIVES The present study compared the effect of usual rhythmic auditory cueing versus ASAC used during a walking training in Parkinson's disease. METHODS Fifteen patients with Parkinson's disease performed both interventions in randomized order, one week apart: a 20-minute walking training with rhythmic auditory cueing, in form of a metronome adjusted on 110% of the patient's own cadence, or ASAC delivered when the stride length is less than 110% of the patient's own stride length. Assessment criteria were walking distance covered during the intervention, speed, step length, cadence, coefficients of variation of step length and step duration, and indexes of spatial and temporal asymmetry during a walking test before and just after the intervention. RESULTS The walking distance is higher with ASAC compared with rhythmic auditory cueing (rhythmic auditory cueing, 905 (203) m, mean (standard deviation); ASAC, 1043 (212) m; P=0.002). Between-intervention comparison showed some similar effects on walking after the intervention including free speed and step length increases (P<0.05). CONCLUSION The distance covered during 20-minute walking with ASAC increases by 15% compared to the use of classical rhythmic auditory cueing, while the immediate therapeutic effects show similar spatial-temporal benefits on short-distance walking. Auditory biofeedback cueing promoting the increase in step length might improve gait relearning in Parkinson's disease.
Collapse
Affiliation(s)
- E Hutin
- Laboratoire Analyse et Restauration du Mouvement (ARM), Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri-Mondor, AP-HP, 1, rue Gustave-Eiffel, 94010 Créteil cedex, France.
| | - T Poirier
- Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France
| | - M Meimoun
- Laboratoire Analyse et Restauration du Mouvement (ARM), Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri-Mondor, AP-HP, 1, rue Gustave-Eiffel, 94010 Créteil cedex, France
| | - V Mardale
- Laboratoire Analyse et Restauration du Mouvement (ARM), Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri-Mondor, AP-HP, 1, rue Gustave-Eiffel, 94010 Créteil cedex, France; Service de Médecine Physique et de Réadaptation, Hôpital Dupuytren, AP-HP, 1, avenue Eugène-Delacroix, 91210 Draveil, France
| | - M Ghédira
- Laboratoire Analyse et Restauration du Mouvement (ARM), Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri-Mondor, AP-HP, 1, rue Gustave-Eiffel, 94010 Créteil cedex, France
| |
Collapse
|
23
|
Li H, Ma W, Li C, He Q, Zhou Y, Xie A. Combined diagnosis for Parkinson's disease via gait and eye movement disorders. Parkinsonism Relat Disord 2024; 123:106979. [PMID: 38669851 DOI: 10.1016/j.parkreldis.2024.106979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/14/2024] [Accepted: 04/21/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND AND OBJECTIVES With the discovery of the potential role of gait and eye movement disorders in Parkinson's disease (PD) recognition, we intend to investigate the combined diagnostic value of gait and eye movement disorders for PD. METHODS We enrolled some Chinese PD patients and healthy controls and separated them into the training and validation sets based on enrollment time. Performance in five oculomotor paradigms and in one gait paradigm was examined using an infrared eye tracking device and a wearable gait analysis device. We developed and validated a combined model for PD diagnosis via multivariate stepwise logistic regression analysis. Furthermore, subgroup comparisons and multi-model comparison were performed to assess its applicability and advantages. RESULTS A total of 145 PD patients and 80 healthy controls in China were recruited. The pro-saccade velocity, the trunk-sway max, and the turn mean angular velocity were finally screened out for the model development. Incorporating age factor, the ternary model demonstrated more satisfactory performance on ROC (AUC of 0.953 in the training set and AUC of 0.972 in the validation set), calibration curve, and decision curve. A nomogram was drawn to visualize the model. The combined model outperforms individual models with a broad application and the unique diagnostic value for early detection of PD patients, especially TD-PD patients. CONCLUSION We demonstrated the presence of gait and eye movement disorders, as well as the feasibility, applicability, and superiority of employing them together to diagnose PD.
Collapse
Affiliation(s)
- Han Li
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Wenqi Ma
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Chengqian Li
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Qiqing He
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Yuting Zhou
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Anmu Xie
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China; Institute of Cerebrovascular Diseases, The Affiliated Hospital of Qingdao University, Qingdao, China.
| |
Collapse
|
24
|
Wuehr M, Möhwald K, Zwergal A. [Gait disorders - What the general practitioner should know]. MMW Fortschr Med 2024; 166:56-62. [PMID: 38806926 DOI: 10.1007/s15006-024-3853-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Affiliation(s)
- Max Wuehr
- Ludwig--Maximilians-Universität München, Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Marchioninistraße 15, 81377, München, Deutschland.
| | - Ken Möhwald
- Campus Großhadern, LMU, DSGZ, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Deutschland
| | - Andreas Zwergal
- Neurolog. Klinik u. Deutsches Schwindel- u. Gleichgewichtszentrum, Universitätsklinikum München, Marchioninistraße 15, 81377, München, Deutschland
| |
Collapse
|
25
|
Almeida LRS, Vasconcelos L, Valenca GT, Carvalho K, Pinto EB, Oliveira-Filho J, Canning CG. Psychometric properties of the Brazilian-Portuguese version of the Falls Behavioral Scale in people with Parkinson's disease. Disabil Rehabil 2024; 46:2684-2690. [PMID: 37403370 DOI: 10.1080/09638288.2023.2230132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/23/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To verify the psychometric properties of the Brazilian-Portuguese version of the Falls Behavioral (FaB-Brazil) Scale in Parkinson's disease (PD). MATERIAL AND METHODS Participants (n = 96) were assessed by disease-specific, self-report and functional mobility measures. Internal consistency of the FaB-Brazil scale was evaluated using Cronbach's alpha and inter-rater and test-retest reliability using intraclass correlation coefficients (ICC). The standard error of measurement (SEM), minimal detectable change (MDC), ceiling and floor effects, and convergent and discriminative validity were evaluated. RESULTS Internal consistency was moderate (α = 0.77). Excellent inter-rater (ICC = 0.90; p < 0.001) and test-retest (ICC = 0.91; p < 0.001) reliability were found. The SEM was 0.20 and MDC was 0.38. Ceiling and floor effects were not found. Convergent validity was established by the positive correlations between the FaB-Brazil scale and age, modified Hoehn and Yahr, PD duration, Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Motor Aspects of Experiences of Daily Living, Timed Up & Go and 8-item Parkinson's Disease Questionnaire, and negative correlations between the FaB-Brazil scale and community mobility, Schwab & England, and Activities-specific Balance Confidence scale. Females showed greater protective behaviors than males; recurrent fallers showed greater protective behaviors than non-recurrent fallers (p < 0.05). CONCLUSIONS The FaB-Brazil scale is reliable and valid for assessing people with PD.
Collapse
Affiliation(s)
- Lorena Rosa S Almeida
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Bahia, Brazil
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Bahia, Brazil
| | - Lara Vasconcelos
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - Guilherme T Valenca
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Bahia, Brazil
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Kárin Carvalho
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Bahia, Brazil
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - Elen Beatriz Pinto
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Bahia, Brazil
- Department of Life Sciences (DCV), Bahia State University, Salvador, Bahia, Brazil
| | - Jamary Oliveira-Filho
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
26
|
Sakai K, Kawasaki T, Kiminarita H, Kim K, Ogawa J. Validity, reliability, and measurement error of the Japanese version of the Freezing of Gait Questionnaire for patients with Parkinson's disease. Physiother Theory Pract 2024:1-7. [PMID: 38813872 DOI: 10.1080/09593985.2024.2361325] [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: 10/03/2023] [Accepted: 05/24/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The Freezing of Gait Questionnaire has been translated into several languages. However, it has not been translated into Japanese and its measurement error remains unclear.Objectives: This study aimed to translate the Freezing of Gait Questionnaire into Japanese, investigate its validity and reliability, and calculate its measurement errors. METHODS Thirty-five patients with Parkinson's disease participated in the study. The Freezing of Gait Questionnaire was translated into Japanese using a forward - backward translation method. Convergent validity was assessed using the Freezing of Gait Questionnaire and Unified Parkinson's Disease Rating Scale Part II(item 14-freezing). The content validity index was calculated using the Freezing of Gait Questionnaire score using correlation coefficients. Internal consistency was measured using Cronbach's alpha. The test - retest reliability was evaluated using the intraclass correlation coefficient(1,1). The Bland - Altman analysis was performed to detect the limits of agreement. RESULTS The mean Freezing of Gait Questionnaire score was 9.1 (5.0) points. Convergent validity was 0.655 and content validity index was 0.958. Cronbach's alpha was 0.958, intraclass correlation coefficient(1,1) was 0.951, and the limits of agreement ranged from - 4.9 to3.2 points. CONCLUSIONS The Japanese version of the Freezing of Gait Questionnaire is a valid and useful tool to evaluate patients with Parkinson's disease.
Collapse
Affiliation(s)
- Katsuya Sakai
- Department of Physical Therapy, Faculty of Healthcare Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Tsubasa Kawasaki
- Department of Physical Therapy, School of Health Sciences, Tokyo International University, Kawagoe, Japan
| | - Hiroya Kiminarita
- Department of Rehabilitation, Kirameki Visiting Nursing Rehabilitation, Kawagoe, Japan
| | - Kichol Kim
- Department of Rehabilitation, Kawaguchi Neurosurgery Rehabilitation Clinic, Osaka, Japan
| | - Jyunya Ogawa
- Department of Rehabilitation, PDit Studio, Tokyo, Japan
| |
Collapse
|
27
|
Zadka A, Rabin N, Gazit E, Mirelman A, Nieuwboer A, Rochester L, Del Din S, Pelosin E, Avanzino L, Bloem BR, Della Croce U, Cereatti A, Hausdorff JM. A wearable sensor and machine learning estimate step length in older adults and patients with neurological disorders. NPJ Digit Med 2024; 7:142. [PMID: 38796519 PMCID: PMC11127966 DOI: 10.1038/s41746-024-01136-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/10/2024] [Indexed: 05/28/2024] Open
Abstract
Step length is an important diagnostic and prognostic measure of health and disease. Wearable devices can estimate step length continuously (e.g., in clinic or real-world settings), however, the accuracy of current estimation methods is not yet optimal. We developed machine-learning models to estimate step length based on data derived from a single lower-back inertial measurement unit worn by 472 young and older adults with different neurological conditions, including Parkinson's disease and healthy controls. Studying more than 80,000 steps, the best model showed high accuracy for a single step (root mean square error, RMSE = 6.08 cm, ICC(2,1) = 0.89) and higher accuracy when averaged over ten consecutive steps (RMSE = 4.79 cm, ICC(2,1) = 0.93), successfully reaching the predefined goal of an RMSE below 5 cm (often considered the minimal-clinically-important-difference). Combining machine-learning with a single, wearable sensor generates accurate step length measures, even in patients with neurologic disease. Additional research may be needed to further reduce the errors in certain conditions.
Collapse
Affiliation(s)
- Assaf Zadka
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Neta Rabin
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
- Department of Industrial Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Eran Gazit
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Anat Mirelman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of Medical & Health Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Alice Nieuwboer
- Department of Rehabilitation Science, KU Leuven, Neuromotor Rehabilitation Research Group, Leuven, Belgium
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Tyne, NE1 7RU, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Tyne, NE1 7RU, UK
- National Institute for Health and Care Research (NIHR) Newcastle Biomedical Research Centre (BRC), Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino Teaching Hospital, Genoa, Italy
| | - Laura Avanzino
- IRCCS Policlinico San Martino Teaching Hospital, Genoa, Italy
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy
| | - Bastiaan R Bloem
- Radboud university medical center, Donders Institute for Brain, Cognition, and Behavior; Department of Neurology, Nijmegen, The Netherlands
| | - Ugo Della Croce
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Andrea Cereatti
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel.
- Faculty of Medical & Health Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
- Department of Physical Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Orthopedic Surgery, Rush Alzheimer's Disease Center and Rush University Medical Center, Chicago, Illinois, USA.
| |
Collapse
|
28
|
Sarasso E, Parente MP, Agosta F, Filippi M, Corbetta D. Dual-Task vs. Single-Task Gait Training to Improve Spatiotemporal Gait Parameters in People with Parkinson's Disease: A Systematic Review and Meta-Analysis. Brain Sci 2024; 14:517. [PMID: 38790495 PMCID: PMC11119953 DOI: 10.3390/brainsci14050517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND People with Parkinson's disease (pwPD) present alterations of spatiotemporal gait parameters that impact walking ability. While preliminary studies suggested that dual-task gait training improves spatiotemporal gait parameters, it remains unclear whether dual-task gait training specifically improves dual-task gait performance compared to single-task gait training. The aim of this review is to assess the effect of dual-task training relative to single-task gait training on specific gait parameters during dual-task tests in pwPD. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), searching three electronic databases. Two reviewers independently selected RCTs, extracted data, and applied the Cochrane risk-of-bias tool for randomized trials (Version 2) and the GRADE framework for assessing the certainty of evidence. The primary outcomes were dual-task gait speed, stride length, and cadence. Secondary outcomes included dual-task costs on gait speed, balance confidence, and quality of life. RESULTS We included 14 RCTs (548 patients). Meta-analyses showed effects favoring dual-task training over single-task training in improving dual-task gait speed (standardized mean difference [SMD] = 0.48, 95% confidence interval [CI] = 0.20-0.77; 11 studies; low certainty evidence), stride length (mean difference [MD] = 0.09 m, 95% CI = 0.04-0.14; 4 studies; very low certainty evidence), and cadence (MD = 5.45 steps/min, 95% CI = 3.59-7.31; 5 studies; very low certainty evidence). We also found a significant effect of dual-task training over single-task training on dual-task cost and quality of life, but not on balance confidence. CONCLUSIONS Our findings support the use of dual-task training relative to single-task training to improve dual-task spatiotemporal gait parameters in pwPD. Further studies are encouraged to better define the features of dual-task training and the clinical characteristics of pwPD to identify better responders.
Collapse
Affiliation(s)
- Elisabetta Sarasso
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.S.); (M.P.P.); (F.A.); (M.F.)
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, 16132 Genoa, Italy
| | - Marco Pietro Parente
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.S.); (M.P.P.); (F.A.); (M.F.)
| | - Federica Agosta
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.S.); (M.P.P.); (F.A.); (M.F.)
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Massimo Filippi
- Vita-Salute San Raffaele University, 20132 Milan, Italy; (E.S.); (M.P.P.); (F.A.); (M.F.)
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Davide Corbetta
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| |
Collapse
|
29
|
Zanoletti M, Bufano P, Bossi F, Di Rienzo F, Marinai C, Rho G, Vallati C, Carbonaro N, Greco A, Laurino M, Tognetti A. Combining Different Wearable Devices to Assess Gait Speed in Real-World Settings. SENSORS (BASEL, SWITZERLAND) 2024; 24:3205. [PMID: 38794059 PMCID: PMC11124953 DOI: 10.3390/s24103205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/30/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
Assessing mobility in daily life can provide significant insights into several clinical conditions, such as Chronic Obstructive Pulmonary Disease (COPD). In this paper, we present a comprehensive analysis of wearable devices' performance in gait speed estimation and explore optimal device combinations for everyday use. Using data collected from smartphones, smartwatches, and smart shoes, we evaluated the individual capabilities of each device and explored their synergistic effects when combined, thereby accommodating the preferences and possibilities of individuals for wearing different types of devices. Our study involved 20 healthy subjects performing a modified Six-Minute Walking Test (6MWT) under various conditions. The results revealed only little performance differences among devices, with the combination of smartwatches and smart shoes exhibiting superior estimation accuracy. Particularly, smartwatches captured additional health-related information and demonstrated enhanced accuracy when paired with other devices. Surprisingly, wearing all devices concurrently did not yield optimal results, suggesting a potential redundancy in feature extraction. Feature importance analysis highlighted key variables contributing to gait speed estimation, providing valuable insights for model refinement.
Collapse
Affiliation(s)
- Michele Zanoletti
- National Research Council, Institute of Clinical Physiology, 56124 Pisa, Italy; (P.B.); (M.L.)
- Department Information Engineering, University of Pisa, 56122 Pisa, Italy; (F.B.); (F.D.R.); (C.M.); (G.R.); (C.V.); (N.C.); (A.G.); (A.T.)
| | - Pasquale Bufano
- National Research Council, Institute of Clinical Physiology, 56124 Pisa, Italy; (P.B.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Francesco Bossi
- Department Information Engineering, University of Pisa, 56122 Pisa, Italy; (F.B.); (F.D.R.); (C.M.); (G.R.); (C.V.); (N.C.); (A.G.); (A.T.)
| | - Francesco Di Rienzo
- Department Information Engineering, University of Pisa, 56122 Pisa, Italy; (F.B.); (F.D.R.); (C.M.); (G.R.); (C.V.); (N.C.); (A.G.); (A.T.)
| | - Carlotta Marinai
- Department Information Engineering, University of Pisa, 56122 Pisa, Italy; (F.B.); (F.D.R.); (C.M.); (G.R.); (C.V.); (N.C.); (A.G.); (A.T.)
| | - Gianluca Rho
- Department Information Engineering, University of Pisa, 56122 Pisa, Italy; (F.B.); (F.D.R.); (C.M.); (G.R.); (C.V.); (N.C.); (A.G.); (A.T.)
| | - Carlo Vallati
- Department Information Engineering, University of Pisa, 56122 Pisa, Italy; (F.B.); (F.D.R.); (C.M.); (G.R.); (C.V.); (N.C.); (A.G.); (A.T.)
| | - Nicola Carbonaro
- Department Information Engineering, University of Pisa, 56122 Pisa, Italy; (F.B.); (F.D.R.); (C.M.); (G.R.); (C.V.); (N.C.); (A.G.); (A.T.)
| | - Alberto Greco
- Department Information Engineering, University of Pisa, 56122 Pisa, Italy; (F.B.); (F.D.R.); (C.M.); (G.R.); (C.V.); (N.C.); (A.G.); (A.T.)
| | - Marco Laurino
- National Research Council, Institute of Clinical Physiology, 56124 Pisa, Italy; (P.B.); (M.L.)
| | - Alessandro Tognetti
- Department Information Engineering, University of Pisa, 56122 Pisa, Italy; (F.B.); (F.D.R.); (C.M.); (G.R.); (C.V.); (N.C.); (A.G.); (A.T.)
| |
Collapse
|
30
|
Jovanovic L, Damaševičius R, Matic R, Kabiljo M, Simic V, Kunjadic G, Antonijevic M, Zivkovic M, Bacanin N. Detecting Parkinson's disease from shoe-mounted accelerometer sensors using convolutional neural networks optimized with modified metaheuristics. PeerJ Comput Sci 2024; 10:e2031. [PMID: 38855236 PMCID: PMC11157549 DOI: 10.7717/peerj-cs.2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/09/2024] [Indexed: 06/11/2024]
Abstract
Neurodegenerative conditions significantly impact patient quality of life. Many conditions do not have a cure, but with appropriate and timely treatment the advance of the disease could be diminished. However, many patients only seek a diagnosis once the condition progresses to a point at which the quality of life is significantly impacted. Effective non-invasive and readily accessible methods for early diagnosis can considerably enhance the quality of life of patients affected by neurodegenerative conditions. This work explores the potential of convolutional neural networks (CNNs) for patient gain freezing associated with Parkinson's disease. Sensor data collected from wearable gyroscopes located at the sole of the patient's shoe record walking patterns. These patterns are further analyzed using convolutional networks to accurately detect abnormal walking patterns. The suggested method is assessed on a public real-world dataset collected from parents affected by Parkinson's as well as individuals from a control group. To improve the accuracy of the classification, an altered variant of the recent crayfish optimization algorithm is introduced and compared to contemporary optimization metaheuristics. Our findings reveal that the modified algorithm (MSCHO) significantly outperforms other methods in accuracy, demonstrated by low error rates and high Cohen's Kappa, precision, sensitivity, and F1-measures across three datasets. These results suggest the potential of CNNs, combined with advanced optimization techniques, for early, non-invasive diagnosis of neurodegenerative conditions, offering a path to improve patient quality of life.
Collapse
Affiliation(s)
- Luka Jovanovic
- Faculty of Technical Sciences, Singidunum University, Belgrade, Serbia
| | | | - Rade Matic
- Department for Information Systems and Technologies, Belgrade Academy for Business and Arts Applied Studies, Belgrade, Serbia
| | - Milos Kabiljo
- Department for Information Systems and Technologies, Belgrade Academy for Business and Arts Applied Studies, Belgrade, Serbia
| | - Vladimir Simic
- Faculty of Transport and Traffic Engineering, University of Belgrade, Belgrade, Serbia
- College of Engineering, Department of Industrial Engineering and Management, Yuan Ze University, Taoyuan City, Taiwan
| | - Goran Kunjadic
- Higher Colleges of Technology, Abu Dhabi, United Arab Emirates
| | - Milos Antonijevic
- Faculty of Informatics and Computing, Singidunum University, Belgrade, Serbia
| | - Miodrag Zivkovic
- Faculty of Informatics and Computing, Singidunum University, Belgrade, Serbia
| | - Nebojsa Bacanin
- Faculty of Informatics and Computing, Singidunum University, Belgrade, Serbia
- MEU Research Unit, Middle East University, Amman, Jordan
| |
Collapse
|
31
|
Yeh CH, Xu Y, Shi W, Fitzgerald JJ, Green AL, Fischer P, Tan H, Oswal A. Auditory cues modulate the short timescale dynamics of STN activity during stepping in Parkinson's disease. Brain Stimul 2024; 17:501-509. [PMID: 38636820 PMCID: PMC7616027 DOI: 10.1016/j.brs.2024.04.006] [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: 01/16/2024] [Revised: 03/26/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Gait impairment has a major impact on quality of life in patients with Parkinson's disease (PD). It is believed that basal ganglia oscillatory activity at β frequencies (15-30 Hz) may contribute to gait impairment, but the precise dynamics of this oscillatory activity during gait remain unclear. Additionally, auditory cues are known to lead to improvements in gait kinematics in PD. If the neurophysiological mechanisms of this cueing effect were better understood they could be leveraged to treat gait impairments using adaptive Deep Brain Stimulation (aDBS) technologies. OBJECTIVE We aimed to characterize the dynamics of subthalamic nucleus (STN) oscillatory activity during stepping movements in PD and to establish the neurophysiological mechanisms by which auditory cues modulate gait. METHODS We studied STN local field potentials (LFPs) in eight PD patients while they performed stepping movements. Hidden Markov Models (HMMs) were used to discover transient states of spectral activity that occurred during stepping with and without auditory cues. RESULTS The occurrence of low and high β bursts was suppressed during and after auditory cues. This manifested as a decrease in their fractional occupancy and state lifetimes. Interestingly, α transients showed the opposite effect, with fractional occupancy and state lifetimes increasing during and after auditory cues. CONCLUSIONS We show that STN oscillatory activity in the α and β frequency bands are differentially modulated by gait-promoting oscillatory cues. These findings suggest that the enhancement of α rhythms may be an approach for ameliorating gait impairments in PD.
Collapse
Affiliation(s)
- Chien-Hung Yeh
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China; Key Laboratory of Brain Health Intelligent Evaluation and Intervention, Ministry of Education (Beijing Institute of Technology), Beijing, China.
| | - Yifan Xu
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China
| | - Wenbin Shi
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China; Key Laboratory of Brain Health Intelligent Evaluation and Intervention, Ministry of Education (Beijing Institute of Technology), Beijing, China.
| | - James J Fitzgerald
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom; Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alexander L Green
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom; Oxford Functional Neurosurgery, John Radcliffe Hospital, Oxford, United Kingdom
| | - Petra Fischer
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Huiling Tan
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, United Kingdom
| | - Ashwini Oswal
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
| |
Collapse
|
32
|
Zoetewei D, Herman T, Ginis P, Palmerini L, Brozgol M, Thumm PC, Ferrari A, Ceulemans E, Decaluwé E, Hausdorff JM, Nieuwboer A. On-Demand Cueing for Freezing of Gait in Parkinson's Disease: A Randomized Controlled Trial. Mov Disord 2024; 39:876-886. [PMID: 38486430 DOI: 10.1002/mds.29762] [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: 11/22/2023] [Revised: 01/24/2024] [Accepted: 02/09/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Cueing can alleviate freezing of gait (FOG) in people with Parkinson's disease (PD), but using the same cues continuously in daily life may compromise effectiveness. Therefore, we developed the DeFOG-system to deliver personalized auditory cues on detection of a FOG episode. OBJECTIVES We aimed to evaluate the effects of DeFOG during a FOG-provoking protocol: (1) after 4 weeks of DeFOG-use in daily life against an active control group; (2) after immediate DeFOG-use (within-group) in different medication states. METHOD In this randomized controlled trial, 63 people with PD and daily FOG were allocated to the DeFOG or active control group. Both groups received feedback on their daily living step counts using the device, but the DeFOG group also received on-demand cueing. Video-rated FOG severity was compared pre- and post-intervention through a FOG-provoking protocol administered at home off and on-medication, but without using DeFOG. Within-group effects were tested by comparing FOG during the protocol with and without DeFOG. RESULTS DeFOG-use during the 4 weeks was similar between groups, but we found no between-group differences in FOG-severity. However, the within-group analysis showed that FOG was alleviated by DeFOG (effect size d = 0.57), regardless of medication state. Combining DeFOG and medication yielded an effect size of d = 0.67. CONCLUSIONS DeFOG reduced FOG considerably in a population of severe freezers both off and on medication. Nonetheless, 4 weeks of DeFOG-use in daily life did not ameliorate FOG during the protocol unless DeFOG was worn. These findings suggest that on-demand cueing is only effective when used, similar to other walking aids. © 2024 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Demi Zoetewei
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Talia Herman
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Pieter Ginis
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Luca Palmerini
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
- Health Sciences and Technologies-Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
| | - Marina Brozgol
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Pablo Cornejo Thumm
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alberto Ferrari
- Department of Engineering "Enzo Ferrari", University of Modena and Reggio Emilia, Modena, Italy
- Science and Technology Park for Medicine, TPM, Democenter Foundation Mirandola, Modena, Italy
| | - Eva Ceulemans
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Eva Decaluwé
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Israel
- Department of Physical Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University, Chicago, Illinois, USA
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), Leuven, Belgium
| |
Collapse
|
33
|
Wu X, Ma L, Wei P, Shan Y, Chan P, Wang K, Zhao G. Wearable sensor devices can automatically identify the ON-OFF status of patients with Parkinson's disease through an interpretable machine learning model. Front Neurol 2024; 15:1387477. [PMID: 38751881 PMCID: PMC11094303 DOI: 10.3389/fneur.2024.1387477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Accurately and objectively quantifying the clinical features of Parkinson's disease (PD) is crucial for assisting in diagnosis and guiding the formulation of treatment plans. Therefore, based on the data on multi-site motor features, this study aimed to develop an interpretable machine learning (ML) model for classifying the "OFF" and "ON" status of patients with PD, as well as to explore the motor features that are most associated with changes in clinical symptoms. Methods We employed a support vector machine with a recursive feature elimination (SVM-RFE) algorithm to select promising motion features. Subsequently, 12 ML models were constructed based on these features, and we identified the model with the best classification performance. Then, we used the SHapley Additive exPlanations (SHAP) and the Local Interpretable Model agnostic Explanations (LIME) methods to explain the model and rank the importance of those motor features. Results A total of 96 patients were finally included in this study. The naive Bayes (NB) model had the highest classification performance (AUC = 0.956; sensitivity = 0.8947, 95% CI 0.6686-0.9870; accuracy = 0.8421, 95% CI 0.6875-0.9398). Based on the NB model, we analyzed the importance of eight motor features toward the classification results using the SHAP algorithm. The Gait: range of motion (RoM) Shank left (L) (degrees) [Mean] might be the most important motor feature for all classification horizons. Conclusion The symptoms of PD could be objectively quantified. By utilizing suitable motor features to construct ML models, it became possible to intelligently identify whether patients with PD were in the "ON" or "OFF" status. The variations in these motor features were significantly correlated with improvement rates in patients' quality of life. In the future, they might act as objective digital biomarkers to elucidate the changes in symptoms observed in patients with PD and might be used to assist in the diagnosis and treatment of patients with PD.
Collapse
Affiliation(s)
- Xiaolong Wu
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Lin Ma
- Department of Neurorehabilitation, Rehabilitation Medicine of Capital Medical University, China Rehabilitation Research Centre, Beijing, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Piu Chan
- Department of Neurology and Neurobiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Kailiang Wang
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Beijing, China
- Beijing Municipal Geriatric Medical Research Center, Beijing, China
| |
Collapse
|
34
|
Radlicka-Borysewska A, Jabłońska J, Lenarczyk M, Szumiec Ł, Harda Z, Bagińska M, Barut J, Pera J, Kreiner G, Wójcik DK, Rodriguez Parkitna J. Non-motor symptoms associated with progressive loss of dopaminergic neurons in a mouse model of Parkinson's disease. Front Neurosci 2024; 18:1375265. [PMID: 38745938 PMCID: PMC11091341 DOI: 10.3389/fnins.2024.1375265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Parkinson's disease (PD) is characterized by three main motor symptoms: bradykinesia, rigidity and tremor. PD is also associated with diverse non-motor symptoms that may develop in parallel or precede motor dysfunctions, ranging from autonomic system dysfunctions and impaired sensory perception to cognitive deficits and depression. Here, we examine the role of the progressive loss of dopaminergic transmission in behaviors related to the non-motor symptoms of PD in a mouse model of the disease (the TIF-IADATCreERT2 strain). We found that in the period from 5 to 12 weeks after the induction of a gradual loss of dopaminergic neurons, mild motor symptoms became detectable, including changes in the distance between paws while standing as well as the swing speed and step sequence. Male mutant mice showed no apparent changes in olfactory acuity, no anhedonia-like behaviors, and normal learning in an instrumental task; however, a pronounced increase in the number of operant responses performed was noted. Similarly, female mice with progressive dopaminergic neuron degeneration showed normal learning in the probabilistic reversal learning task and no loss of sweet-taste preference, but again, a robustly higher number of choices were performed in the task. In both males and females, the higher number of instrumental responses did not affect the accuracy or the fraction of rewarded responses. Taken together, these data reveal discrete, dopamine-dependent non-motor symptoms that emerge in the early stages of dopaminergic neuron degeneration.
Collapse
Affiliation(s)
- Anna Radlicka-Borysewska
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Judyta Jabłońska
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Michał Lenarczyk
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Łukasz Szumiec
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Zofia Harda
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Monika Bagińska
- Department of Brain Biochemistry, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Justyna Barut
- Department of Brain Biochemistry, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Joanna Pera
- Department of Neurology, Jagiellonian University Medical College, Kraków, Poland
| | - Grzegorz Kreiner
- Department of Brain Biochemistry, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| | - Daniel K. Wójcik
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
- Laboratory of Neuroinformatics, Nencki Institute of Experimental Biology of the Polish Academy of Sciences, Warsaw, Poland
| | - Jan Rodriguez Parkitna
- Department of Molecular Neuropharmacology, Maj Institute of Pharmacology of the Polish Academy of Sciences, Kraków, Poland
| |
Collapse
|
35
|
Zhang X, Jin Y, Wang M, Ji C, Chen Z, Fan W, Rainer TH, Guan Q, Li Q. The impact of anxiety on gait impairments in Parkinson's disease: insights from sensor-based gait analysis. J Neuroeng Rehabil 2024; 21:68. [PMID: 38689288 PMCID: PMC11059709 DOI: 10.1186/s12984-024-01364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Sensor-based gait analysis provides a robust quantitative tool for assessing gait impairments and their associated factors in Parkinson's disease (PD). Anxiety is observed to interfere with gait clinically, but this has been poorly investigated. Our purpose is to utilize gait analysis to uncover the effect of anxiety on gait in patients with PD. METHODS We enrolled 38 and 106 PD patients with and without anxiety, respectively. Gait parameters were quantitively examined and compared between two groups both in single-task (ST) and dual-task (DT) walking tests. Multiple linear regression was applied to evaluate whether anxiety independently contributed to gait impairments. RESULTS During ST, PD patients with anxiety presented significantly shorter stride length, lower gait velocity, longer stride time and stance time, longer stance phase, smaller toe-off (TO) and heel-strike (HS) angles than those without anxiety. While under DT status, the differences were diminished. Multiple linear regression analysis demonstrated that anxiety was an independent factor to a serials of gait parameters, particularly ST-TO (B = -2.599, (-4.82, -0.38)), ST-HS (B = -2.532, (-4.71, -0.35)), ST-TO-CV (B = 4.627, (1.71, 7.64)), ST-HS-CV(B = 4.597, (1.66, 7.53)), ST stance phase (B = 1.4, (0.22, 2.58)), and DT stance phase (B = 1.749, (0.56, 2.94)). CONCLUSION Our study discovered that anxiety has a significant impact on gait impairments in PD patients, especially exacerbating shuffling steps and prolonging stance phase. These findings highlight the importance of addressing anxiety in PD precision therapy to achieve better treatment outcomes.
Collapse
Affiliation(s)
- Xiaodan Zhang
- Department of Neurology, Ningbo NO.2 Hospital, Ningbo, Zhejiang Province, China
- Department of Emergency Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Yulan Jin
- Department of Clinical Laboratory, Ningbo NO.2 Hospital, Ningbo, Zhejiang Province, China
| | - Mateng Wang
- Department of General Surgery, Yinzhou NO.2 Hospital, Ningbo, Zhejiang Province, China
| | - Chengcheng Ji
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang Province, China
| | - Zhaoying Chen
- Department of Neurology, Ningbo NO.2 Hospital, Ningbo, Zhejiang Province, China
| | - Weinv Fan
- Department of Neurology, Ningbo NO.2 Hospital, Ningbo, Zhejiang Province, China
| | | | - Qiongfeng Guan
- Department of Neurology, Ningbo NO.2 Hospital, Ningbo, Zhejiang Province, China.
| | - Qianyun Li
- Department of Neurology, Ningbo NO.2 Hospital, Ningbo, Zhejiang Province, China.
- Department of Emergency Medicine, University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
36
|
Barta K, Boddy AH, Flores M, Perry L, Sawyer K, Campbell A. Psychometric properties of 3-meter backward walk test (3MBWT) in people with Parkinson disease. Physiother Theory Pract 2024:1-8. [PMID: 38678542 DOI: 10.1080/09593985.2024.2348034] [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: 11/28/2023] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to investigate the 3-meter backward walk test (3MBWT) in individuals with Parkinson Disease (PD) to determine the following: (1) concurrent validity with other gait velocity measures and (2) interrater and intrarater reliability of in-person and video assessment. METHODS A convenience sample of 25 people with PD participated. Forward gait velocity was measured using a computerized walkway (Zeno Walkway System), the 10-meter walk test (10MWT), and 4-meter walk test (4MWT). Backward gait velocity was measured using the 3MBWT. Concurrent validity was assessed using Pearson's correlations. Reliability was assessed using intra-class correlation coefficients (ICC(2,1)). RESULTS All relationships between the 3MBWT and gait outcome measures were significant. The 3MBWT demonstrated strong correlations with the 4MWT dual task (r = .795, p=<.001) and moderate correlations with 4MWT comfortable walking speed (r = .658, p < .001), 4MWT fast walking speed (r = .601,p=.002), 10MWT comfortable walking speed (r = .512, p = .009), and 10MWT dual task (r = .535, p = .006). A low yet significant correlation was noted with the 10MWT fast walking speed (r = .398, p = .049). Association between the 3MBWT and the Zeno Walkway System revealed moderate correlations. All reliability tests were significant at p < .001. Interrater reliability ICC(2,1) values were very high for 3MBWT (ICC(2,1) = 0.93, [0.83-0.91]). Intrarater reliability was also very high (ICC(2,1) = 0.96 [0.90-0.98]). CONCLUSION The 3MBWT demonstrates validity and reliability as a tool for assessing gait speed in the posterior direction in people with PD.
Collapse
Affiliation(s)
| | | | | | | | | | - Ashley Campbell
- University of St. Augustine for Health Sciences, Austin, TX, USA
| |
Collapse
|
37
|
Langer A, Hansen C, Roth D, Santer A, Flotz A, Gruber J, Wizany L, Hasenauer S, Pokan R, Dabnichki P, Treven M, Zimmel S, Schmoeger M, Willinger U, Gassner L, Brücke C, Maetzler W, Zach H. Vertical locomotion improves horizontal locomotion: effects of climbing on gait and other mobility aspects in Parkinson's disease. A secondary analysis from a randomized controlled trial. J Neuroeng Rehabil 2024; 21:63. [PMID: 38678241 PMCID: PMC11055236 DOI: 10.1186/s12984-024-01363-4] [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: 11/04/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND In the Climb Up! Head Up! trial, we showed that sport climbing reduces bradykinesia, tremor, and rigidity in mildly to moderately affected participants with Parkinson's disease. This secondary analysis aimed to evaluate the effects of sport climbing on gait and functional mobility in this cohort. METHODS Climb Up! Head Up! was a 1:1 randomized controlled trial. Forty-eight PD participants (Hoehn and Yahr stage 2-3) either participated in a 12-week, 90-min-per-week sport climbing course (intervention group) or were engaged in regular unsupervised physical activity (control group). Relevant outcome measures for this analysis were extracted from six inertial measurement units placed on the extremities, chest, and lower back, that were worn during supervised gait and functional mobility assessments before and after the intervention. Assessments included normal and fast walking, dual-tasking walking, Timed Up and Go test, Instrumented Stand and Walk test, and Five Times Sit to Stand test. RESULTS Compared to baseline, climbing improved gait speed during normal walking by 0.09 m/s (p = 0.005) and during fast walking by 0.1 m/s. Climbing also reduced the time spent in the stance phase during fast walking by 0.03 s. Climbing improved the walking speed in the 7-m- Timed Up and Go test by 0.1 m/s (p < 0.001) and the turning speed by 0.39 s (p = 0.052), the speed in the Instrumented Stand and Walk test by 0.1 m/s (p < 0.001), and the speed in the Five Times Sit to Stand test by 2.5 s (p = 0.014). There was no effect of sport climbing on gait speed or gait variables during dual-task walking. CONCLUSIONS Sport climbing improves gait speed during normal and fast walking, as well as functional mobility in people with Parkinson's disease. Trial registration This study was registered within the U.S. National Library of Medicine (No: NCT04569981, date of registration September 30th, 2020).
Collapse
Affiliation(s)
- Agnes Langer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, 24105, Kiel, Germany
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, 1090, Vienna, Austria
| | - Agnes Santer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Anna Flotz
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Jakob Gruber
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Laurenz Wizany
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Sebastian Hasenauer
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Rochus Pokan
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, 1090, Vienna, Austria
| | - Peter Dabnichki
- School of Engineering, RMIT University, 3000, Melbourne, VIC, Australia
| | - Marco Treven
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Sarah Zimmel
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Michaela Schmoeger
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Ulrike Willinger
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Lucia Gassner
- Department of Sport Physiology, Institute of Sports Sciences, University of Vienna, 1090, Vienna, Austria
- School of Engineering, RMIT University, 3000, Melbourne, VIC, Australia
| | - Christof Brücke
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, 24105, Kiel, Germany
| | - Heidemarie Zach
- Department of Neurology, Medical University of Vienna, Waehringerstrasse 18-21, 1090, Vienna, Austria.
| |
Collapse
|
38
|
Moraca GAG, Orcioli-Silva D, Legutke BR, Gutierrez PP, Sirico TM, Zampier VC, Beretta VS, Gobbi LTB, Barbieri FA. Aerobic exercise on the treadmill combined with transcranial direct current stimulation on the gait of people with Parkinson's disease: A protocol for a randomized clinical trial. PLoS One 2024; 19:e0300243. [PMID: 38662740 PMCID: PMC11045059 DOI: 10.1371/journal.pone.0300243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/28/2024] Open
Abstract
Gait impairments negatively affect the quality of life of people with Parkinson's disease (PwPD). Aerobic exercise (AE) is an alternative to alleviate these impairments and its combination with transcranial direct current stimulation (tDCS) has demonstrated synergistic effects. However, the effect of multitarget tDCS application (i.e., motor, and prefrontal cortices simultaneously) combined with physical exercise on gait impairments is still little known. Thus, the proposed randomized clinical trial will verify the acute effects of AE combined with tDCS applied on motor and prefrontal cortices separately and simultaneously on gait (spatial-temporal and cortical activity parameters) in PwPD. Twenty-four PwPD in Hoehn & Yahr stages I-III will be recruited for this crossover study. PwPD will practice AE on treadmill simultaneously with the application of anodal tDCS during four intervention sessions on different days (∼ one week of interval). Active tDCS will be applied to the primary motor cortex, prefrontal cortex, and both areas simultaneously (multitarget), with an intensity of 2 mA for 20 min. For sham, the stimulation will remain at 2 mA for 10 s. The AE will last a total of 30 min, consisting of warm-up, main part (20 min with application of tDCS), and recovery. Exercise intensity will be controlled by heart rate. Spatial-temporal and cortical activity parameters will be acquired before and after each session during overground walking, walking with obstacle avoidance, and walking with a cognitive dual task at self-preferred velocity. An accelerometer will be positioned on the fifth lumbar vertebra to obtain the spatial-temporal parameters (i.e., step length, duration, velocity, and swing phase duration). Prefrontal cortex activity will be recorded from a portable functional near-infrared spectroscopy system and oxygenated and deoxygenated hemoglobin concentrations will be analyzed. Two-way ANOVAs with repeated measures for stimulation and moment will be performed. The findings of the study may contribute to improving gait in PwPD. Trial registration: Brazilian Clinical Trials Registry (RBR-738zkp7).
Collapse
Affiliation(s)
- Gabriel Antonio Gazziero Moraca
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
- Human Movement Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University, Bauru, São Paulo, Brazil
| | - Diego Orcioli-Silva
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Beatriz Regina Legutke
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Pedro Paulo Gutierrez
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Thiago Martins Sirico
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Vinicius Cavassano Zampier
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
- Human Movement Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University, Bauru, São Paulo, Brazil
| | - Victor Spiandor Beretta
- School of Technology and Sciences, Department of Physical Education, São Paulo State University, Presidente Prudente, São Paulo, Brazil
| | - Lilian Teresa Bucken Gobbi
- Posture and Gait Studies Laboratory, Department of Physical Education, Institute of Biosciences, São Paulo State University, Rio Claro, São Paulo, Brazil
| | - Fabio Augusto Barbieri
- Human Movement Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University, Bauru, São Paulo, Brazil
| |
Collapse
|
39
|
Lu J, Zhang X, Shu Z, Han J, Yu N. A dynamic brain network decomposition method discovers effective brain hemodynamic sub-networks for Parkinson's disease. J Neural Eng 2024; 21:026047. [PMID: 38621377 DOI: 10.1088/1741-2552/ad3eb6] [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: 01/17/2024] [Accepted: 04/15/2024] [Indexed: 04/17/2024]
Abstract
Objective.Dopaminergic treatment is effective for Parkinson's disease (PD). Nevertheless, the conventional treatment assessment mainly focuses on human-administered behavior examination while the underlying functional improvements have not been well explored. This paper aims to investigate brain functional variations of PD patients after dopaminergic therapy.Approach.This paper proposed a dynamic brain network decomposition method and discovered brain hemodynamic sub-networks that well characterized the efficacy of dopaminergic treatment in PD. Firstly, a clinical walking procedure with functional near-infrared spectroscopy was developed, and brain activations during the procedure from fifty PD patients under the OFF and ON states (without and with dopaminergic medication) were captured. Then, dynamic brain networks were constructed with sliding-window analysis of phase lag index and integrated time-varying functional networks across all patients. Afterwards, an aggregated network decomposition algorithm was formulated based on aggregated effectiveness optimization of functional networks in spanning network topology and cross-validation network variations, and utilized to unveil effective brain hemodynamic sub-networks for PD patients. Further, dynamic sub-network features were constructed to characterize the brain flexibility and dynamics according to the temporal switching and activation variations of discovered sub-networks, and their correlations with differential treatment-induced gait alterations were analyzed.Results.The results demonstrated that PD patients exhibited significantly enhanced flexibility after dopaminergic therapy within a sub-network related to the improvement of motor functions. Other sub-networks were significantly correlated with trunk-related axial symptoms and exhibited no significant treatment-induced dynamic interactions.Significance.The proposed method promises a quantified and objective approach for dopaminergic treatment evaluation. Moreover, the findings suggest that the gait of PD patients comprises distinct motor domains, and the corresponding neural controls are selectively responsive to dopaminergic treatment.
Collapse
Affiliation(s)
- Jiewei Lu
- College of Artificial Intelligence, Nankai University, Tianjin, People's Republic of China
| | - Xinyuan Zhang
- College of Artificial Intelligence, Nankai University, Tianjin, People's Republic of China
| | - Zhilin Shu
- College of Artificial Intelligence, Nankai University, Tianjin, People's Republic of China
| | - Jianda Han
- College of Artificial Intelligence, Nankai University, Tianjin, People's Republic of China
- Engineering Research Center of Trusted Behavior Intelligence, Ministry of Education, Nankai University, Tianjin, People's Republic of China
- Institute of Intelligence Technology and Robotic Systems, Shenzhen Research Institute of Nankai University, Shenzhen, People's Republic of China
| | - Ningbo Yu
- College of Artificial Intelligence, Nankai University, Tianjin, People's Republic of China
- Engineering Research Center of Trusted Behavior Intelligence, Ministry of Education, Nankai University, Tianjin, People's Republic of China
- Institute of Intelligence Technology and Robotic Systems, Shenzhen Research Institute of Nankai University, Shenzhen, People's Republic of China
| |
Collapse
|
40
|
Hoogendoorn EM, Geerse DJ, van Dam AT, Stins JF, Roerdink M. Gait-modifying effects of augmented-reality cueing in people with Parkinson's disease. Front Neurol 2024; 15:1379243. [PMID: 38654737 PMCID: PMC11037397 DOI: 10.3389/fneur.2024.1379243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/04/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction External cueing can improve gait in people with Parkinson's disease (PD), but there is a need for wearable, personalized and flexible cueing techniques that can exploit the power of action-relevant visual cues. Augmented Reality (AR) involving headsets or glasses represents a promising technology in those regards. This study examines the gait-modifying effects of real-world and AR cueing in people with PD. Methods 21 people with PD performed walking tasks augmented with either real-world or AR cues, imposing changes in gait speed, step length, crossing step length, and step height. Two different AR headsets, differing in AR field of view (AR-FOV) size, were used to evaluate potential AR-FOV-size effects on the gait-modifying effects of AR cues as well as on the head orientation required for interacting with them. Results Participants modified their gait speed, step length, and crossing step length significantly to changes in both real-world and AR cues, with step lengths also being statistically equivalent to those imposed. Due to technical issues, step-height modulation could not be analyzed. AR-FOV size had no significant effect on gait modifications, although small differences in head orientation were observed when interacting with nearby objects between AR headsets. Conclusion People with PD can modify their gait to AR cues as effectively as to real-world cues with state-of-the-art AR headsets, for which AR-FOV size is no longer a limiting factor. Future studies are warranted to explore the merit of a library of cue modalities and individually-tailored AR cueing for facilitating gait in real-world environments.
Collapse
Affiliation(s)
- Eva M. Hoogendoorn
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | | | | | | | | |
Collapse
|
41
|
Baudendistel ST, Franz JR, Schmitt AC, Wade FE, Pappas MC, Au KLK, Hass CJ. Visual feedback improves propulsive force generation during treadmill walking in people with Parkinson disease. J Biomech 2024; 167:112073. [PMID: 38599018 PMCID: PMC11046741 DOI: 10.1016/j.jbiomech.2024.112073] [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: 08/29/2023] [Revised: 01/29/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
Persons with Parkinson's disease experience gait alterations, such as reduced step length. Gait dysfunction is a significant research priority as the current treatments targeting gait impairment are limited. This study aimed to investigate the effects of visual biofeedback on propulsive force during treadmill walking in persons with Parkinson's. Sixteen ambulatory persons with Parkinson's participated in the study. They received real-time biofeedback of anterior ground reaction force during treadmill walking at a constant speed. Peak propulsive force values were measured and normalized to body weight. Spatiotemporal parameters were also assessed, including stride length and double support percent. Persons with Parkinson's significantly increased peak propulsive force during biofeedback compared to baseline (p <.0001, Cohen's dz = 1.69). Variability in peak anterior ground reaction force decreased across repeated trials (p <.0001, dz = 1.51). While spatiotemporal parameters did not show significant changes individually, stride length and double support percent improved marginally during biofeedback trials. Persons with Parkinson's can increase propulsive force with visual biofeedback, suggesting the presence of a propulsive reserve. Though stride length did not significantly change, clinically meaningful improvements were observed. Targeting push-off force through visual biofeedback may offer a potential rehabilitation technique to enhance gait performance in Persons with Parkinson's. Future studies could explore the long-term efficacy of this intervention and investigate additional strategies to improve gait in Parkinson's disease.
Collapse
Affiliation(s)
- Sidney T Baudendistel
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA; Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA.
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Abigail C Schmitt
- Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, AR, USA
| | - Francesca E Wade
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Marc C Pappas
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA
| | | | - Chris J Hass
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, USA; Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| |
Collapse
|
42
|
Cregg JM, Sidhu SK, Leiras R, Kiehn O. Basal ganglia-spinal cord pathway that commands locomotor gait asymmetries in mice. Nat Neurosci 2024; 27:716-727. [PMID: 38347200 PMCID: PMC11001584 DOI: 10.1038/s41593-024-01569-8] [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: 02/28/2023] [Accepted: 01/05/2024] [Indexed: 04/10/2024]
Abstract
The basal ganglia are essential for executing motor actions. How the basal ganglia engage spinal motor networks has remained elusive. Medullary Chx10 gigantocellular (Gi) neurons are required for turning gait programs, suggesting that turning gaits organized by the basal ganglia are executed via this descending pathway. Performing deep brainstem recordings of Chx10 Gi Ca2+ activity in adult mice, we show that striatal projection neurons initiate turning gaits via a dominant crossed pathway to Chx10 Gi neurons on the contralateral side. Using intersectional viral tracing and cell-type-specific modulation, we uncover the principal basal ganglia-spinal cord pathway for locomotor asymmetries in mice: basal ganglia → pontine reticular nucleus, oral part (PnO) → Chx10 Gi → spinal cord. Modulating the restricted PnO → Chx10 Gi pathway restores turning competence upon striatal damage, suggesting that dysfunction of this pathway may contribute to debilitating turning deficits observed in Parkinson's disease. Our results reveal the stratified circuit architecture underlying a critical motor program.
Collapse
Affiliation(s)
- Jared M Cregg
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Simrandeep K Sidhu
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Roberto Leiras
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Kiehn
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
43
|
Yang L, Singla D, Wu AK, Cross KA, Masmanidis SC. Dopamine lesions alter the striatal encoding of single-limb gait. eLife 2024; 12:RP92821. [PMID: 38526916 PMCID: PMC10963031 DOI: 10.7554/elife.92821] [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] [Indexed: 03/27/2024] Open
Abstract
The striatum serves an important role in motor control, and neurons in this area encode the body's initiation, cessation, and speed of locomotion. However, it remains unclear whether the same neurons also encode the step-by-step rhythmic motor patterns of individual limbs that characterize gait. By combining high-speed video tracking, electrophysiology, and optogenetic tagging, we found that a sizable population of both D1 and D2 receptor expressing medium spiny projection neurons (MSNs) were phase-locked to the gait cycle of individual limbs in mice. Healthy animals showed balanced limb phase-locking between D1 and D2 MSNs, while dopamine depletion led to stronger phase-locking in D2 MSNs. These findings indicate that striatal neurons represent gait on a single-limb and step basis, and suggest that elevated limb phase-locking of D2 MSNs may underlie some of the gait impairments associated with dopamine loss.
Collapse
Affiliation(s)
- Long Yang
- Department of Neurobiology, University of California Los AngelesLos AngelesUnited States
| | - Deepak Singla
- Department of Bioengineering, University of California Los AngelesLos AngelesUnited States
| | - Alexander K Wu
- Department of Neurobiology, University of California Los AngelesLos AngelesUnited States
| | - Katy A Cross
- Department of Neurology, University of California Los AngelesLos AngelesUnited States
| | - Sotiris C Masmanidis
- Department of Neurobiology, University of California Los AngelesLos AngelesUnited States
- California Nanosystems Institute, University of California Los AngelesLos AngelesUnited States
| |
Collapse
|
44
|
Skalny AV, Aschner M, Gritsenko VA, Martins AC, Tizabi Y, Korobeinikova TV, Paoliello MM, Tinkov AA. Modulation of gut microbiota with probiotics as a strategy to counteract endogenous and exogenous neurotoxicity. ADVANCES IN NEUROTOXICOLOGY 2024; 11:133-176. [PMID: 38741946 PMCID: PMC11090489 DOI: 10.1016/bs.ant.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
The existing data demonstrate that probiotic supplementation affords protective effects against neurotoxicity of exogenous (e.g., metals, ethanol, propionic acid, aflatoxin B1, organic pollutants) and endogenous (e.g., LPS, glucose, Aβ, phospho-tau, α-synuclein) agents. Although the protective mechanisms of probiotic treatments differ between various neurotoxic agents, several key mechanisms at both the intestinal and brain levels seem inherent to all of them. Specifically, probiotic-induced improvement in gut microbiota diversity and taxonomic characteristics results in modulation of gut-derived metabolite production with increased secretion of SFCA. Moreover, modulation of gut microbiota results in inhibition of intestinal absorption of neurotoxic agents and their deposition in brain. Probiotics also maintain gut wall integrity and inhibit intestinal inflammation, thus reducing systemic levels of LPS. Centrally, probiotics ameliorate neurotoxin-induced neuroinflammation by decreasing LPS-induced TLR4/MyD88/NF-κB signaling and prevention of microglia activation. Neuroprotective mechanisms of probiotics also include inhibition of apoptosis and oxidative stress, at least partially by up-regulation of SIRT1 signaling. Moreover, probiotics reduce inhibitory effect of neurotoxic agents on BDNF expression, on neurogenesis, and on synaptic function. They can also reverse altered neurotransmitter metabolism and exert an antiamyloidogenic effect. The latter may be due to up-regulation of ADAM10 activity and down-regulation of presenilin 1 expression. Therefore, in view of the multiple mechanisms invoked for the neuroprotective effect of probiotics, as well as their high tolerance and safety, the use of probiotics should be considered as a therapeutic strategy for ameliorating adverse brain effects of various endogenous and exogenous agents.
Collapse
Affiliation(s)
- Anatoly V. Skalny
- Center of Bioelementology and Human Ecology, IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Medical Elementology, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Viktor A. Gritsenko
- Institute of Cellular and Intracellular Symbiosis, Ural Branch of the Russian Academy of Sciences, Orenburg, Russia
| | - Airton C. Martins
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, Washington, DC, United States
| | - Tatiana V. Korobeinikova
- Center of Bioelementology and Human Ecology, IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Medical Elementology, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Monica M.B. Paoliello
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Alexey A. Tinkov
- Institute of Cellular and Intracellular Symbiosis, Ural Branch of the Russian Academy of Sciences, Orenburg, Russia
- Laboratory of Ecobiomonitoring and Quality Control, Yaroslavl State University, Yaroslavl, Russia
| |
Collapse
|
45
|
Calvano A, Kleinholdermann U, Heun AS, Bopp MHA, Nimsky C, Timmermann L, Pedrosa DJ. Structural connectivity of low-frequency subthalamic stimulation for improving stride length in Parkinson's disease. Neuroimage Clin 2024; 42:103591. [PMID: 38507954 PMCID: PMC10965492 DOI: 10.1016/j.nicl.2024.103591] [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: 01/19/2024] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND A reduction in stride length is considered a key characteristic of gait kinematics in Parkinson's disease (PD) and has been identified as a predictor of falls. Although low-frequency stimulation (LFS) has been suggested as a method to improve gait characteristics, the underlying structural network is not well understood. OBJECTIVE This study aims to investigate the structural correlates of changes in stride length during LFS (85 Hz). METHODS Objective gait performance was retrospectively evaluated in 19 PD patients who underwent deep brain stimulation (DBS) at 85 Hz and 130 Hz. Individual DBS contacts and volumes of activated tissue (VAT) were computed using preoperative magnetic resonance imaging (MRI) and postoperative computed tomography (CT) scans. Structural connectivity profiles to predetermined cortical and mesencephalic areas were estimated using a normative connectome. RESULTS LFS led to a significant improvement in stride length compared to 130 Hz stimulation. The intersection between VAT and the associative subregion of the subthalamic nucleus (STN) was associated with an improvement in stride length and had structural connections to the supplementary motor area, prefrontal cortex, and pedunculopontine nucleus. Conversely, we found that a lack of improvement was linked to stimulation volumes connected to cortico-diencephalic fibers bypassing the STN dorsolaterally. The robustness of the connectivity model was verified through leave-one-patient-out, 5-, and 10-fold cross cross-validation paradigms. CONCLUSION These findings offer new insights into the structural connectivity that underlies gait changes following LFS. Targeting the non-motor subregion of the STN with LFS on an individual level may present a potential therapeutic approach for PD patients with gait disorders.
Collapse
Affiliation(s)
- Alexander Calvano
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Urs Kleinholdermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany
| | | | - Miriam H A Bopp
- Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany; Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Christopher Nimsky
- Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany; Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany
| | - David J Pedrosa
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany.
| |
Collapse
|
46
|
Hong Y, Bao D, Manor B, Zhou J. Characterizing the supraspinal sensorimotor control of walking using MRI-compatible system: a systematic review. J Neuroeng Rehabil 2024; 21:34. [PMID: 38443983 PMCID: PMC10913571 DOI: 10.1186/s12984-024-01323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/09/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The regulation of gait is critical to many activities of everyday life. When walking, somatosensory information obtained from mechanoreceptors throughout body is delivered to numerous supraspinal networks and used to execute the appropriate motion to meet ever-changing environmental and task demands. Aging and age-related conditions oftentimes alter the supraspinal sensorimotor control of walking, including the responsiveness of the cortical brain regions to the sensorimotor inputs obtained from the peripheral nervous system, resulting in diminished mobility in the older adult population. It is thus important to explicitly characterize such supraspinal sensorimotor elements of walking, providing knowledge informing novel rehabilitative targets. The past efforts majorly relied upon mental imagery or virtual reality to study the supraspinal control of walking. Recent efforts have been made to develop magnetic resonance imaging (MRI)-compatible devices simulating specific somatosensory and/or motor aspects of walking. However, there exists large variance in the design and functionality of these devices, and as such inconsistent functional MRI (fMRI) observations. METHODS We have therefore completed a systematic review to summarize current achievements in the development of these MRI-compatible devices and synthesize available imaging results emanating from studies that have utilized these devices. RESULTS The device design, study protocol and neuroimaging observations of 26 studies using 13 types of devices were extracted. Three of these devices can provide somatosensory stimuli, eight motor stimuli, and two both types of stimuli. Our review demonstrated that using these devices, fMRI data of brain activation can be successfully obtained when participants remain motionless and experience sensorimotor stimulation during fMRI acquisition. The activation in multiple cortical (e.g., primary sensorimotor cortex) and subcortical (e.g., cerebellum) regions has been each linked to these types of walking-related sensorimotor stimuli. CONCLUSION The observations of these publications suggest the promise of implementing these devices to characterize the supraspinal sensorimotor control of walking. Still, the evidence level of these neuroimaging observations was still low due to small sample size and varied study protocols, which thus needs to be confirmed via studies with more rigorous design.
Collapse
Affiliation(s)
- Yinglu Hong
- School of Sport Medicine and Physical Therapy, Beijing Sport University, Beijing, China
| | - Dapeng Bao
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China.
| | - Brad Manor
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, USA
| | - Junhong Zhou
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
47
|
Reimann H, Bruijn SM. The condition for dynamic stability in humans walking with feedback control. PLoS Comput Biol 2024; 20:e1011861. [PMID: 38498569 PMCID: PMC10997112 DOI: 10.1371/journal.pcbi.1011861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 04/05/2024] [Accepted: 01/24/2024] [Indexed: 03/20/2024] Open
Abstract
The walking human body is mechanically unstable. Loss of stability and falling is more likely in certain groups of people, such as older adults or people with neuromotor impairments, as well as in certain situations, such as when experiencing conflicting or distracting sensory inputs. Stability during walking is often characterized biomechanically, by measures based on body dynamics and the base of support. Neural control of upright stability, on the other hand, does not factor into commonly used stability measures. Here we analyze stability of human walking accounting for both biomechanics and neural control, using a modeling approach. We define a walking system as a combination of biomechanics, using the well known inverted pendulum model, and neural control, using a proportional-derivative controller for foot placement based on the state of the center of mass at midstance. We analyze this system formally and show that for any choice of system parameters there is always one periodic orbit. We then determine when this periodic orbit is stable, i.e. how the neural control gain values have to be chosen for stable walking. Following the formal analysis, we use this model to make predictions about neural control gains and compare these predictions with the literature and existing experimental data. The model predicts that control gains should increase with decreasing cadence. This finding appears in agreement with literature showing stronger effects of visual or vestibular manipulations at different walking speeds.
Collapse
Affiliation(s)
- Hendrik Reimann
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States of America
| | - Sjoerd M. Bruijn
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Institute of Brain and Behavior, Amsterdam, The Netherlands
| |
Collapse
|
48
|
Kwon KY, You J, Kim RO, Lee EJ, Lee J, Kim I, Kim J, Koh SB. Association Between Baseline Gait Parameters and Future Fall Risk in Patients With De Novo Parkinson's Disease: Forward Versus Backward Gait. J Clin Neurol 2024; 20:201-207. [PMID: 38171499 PMCID: PMC10921052 DOI: 10.3988/jcn.2022.0299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 04/03/2023] [Accepted: 06/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND PURPOSE Falls are not uncommon even in patients with early stages of Parkinson's disease (PD). The aims of this study were to determine the relationships between gait parameters and falls and identify crucial gait parameters for predicting future falls in patients with de novo PD. METHODS We prospectively recruited patients with de novo PD, and evaluated their baseline demographics, global cognitive function on the Montreal Cognitive Assessment test, and parkinsonian motor symptoms including their subtypes. Both forward gait (FG) and backward gait (BG) were measured using the GAITRite system. The history of falls in consecutive patients with de novo PD was examined along with 1 year of follow-up data. RESULTS Among the 76 patients with de novo PD finally included in the study, 16 (21.1%) were classified as fallers. Fallers had slower gait and shorter stride for FG and BG parameters than did non-fallers, while stride-time variability was greater in fallers but only for BG. Multivariable logistic regression analysis revealed that slow gait was an independent risk factor in BG. CONCLUSIONS Among the patients with de novo PD, gait speed and stride length were more impaired for both FG and BG in fallers than in non-fallers. It was particularly notable that slow BG was significantly associated with future fall risk, indicating that BG speed is a potential biomarker for predicting future falls in patients with early-stage PD.
Collapse
Affiliation(s)
- Kyum-Yil Kwon
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jihwan You
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Rae On Kim
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Eun Ji Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jungyeun Lee
- Department of Neurology and Parkinson's Disease Centre, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ilsoo Kim
- Department of Neurology and Parkinson's Disease Centre, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jinhee Kim
- Department of Neurology, Na-Eun Hospital, Incheon, Korea
| | - Seong-Beom Koh
- Department of Neurology and Parkinson's Disease Centre, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
| |
Collapse
|
49
|
Tsai SY, Tai CH, Lee YY. Exploring Potential Predictors of Treadmill Training Effects in People With Parkinson Disease. Arch Phys Med Rehabil 2024; 105:525-530. [PMID: 37757940 DOI: 10.1016/j.apmr.2023.09.008] [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: 02/16/2023] [Revised: 06/30/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To explore the potential predictors of people with Parkinson disease (PD) who would benefit the most from treadmill training. DESIGN A cohort study. SETTING Medical university rehabilitation settings. PARTICIPANTS Seventy participants diagnosed of idiopathic PD. INTERVENTIONS Twelve sessions of treadmill training. MAIN OUTCOME MEASURES Hierarchical logistic regression models were used to explore significant predictors of the treadmill training effect with respect to 3 health domains: Unified Parkinson's Disease Rating Scales part III (UPDRS III); gait speed; Parkinson's Disease Questionnaire-39 (PDQ-39). A receiver operating characteristic (ROC) curve analysis was conducted to identify proper cut-off points for clinical use. RESULTS Male sex (adjusted odds ratio [OR]: 3.73, P=.036) significantly predicted the improvement of UPDRS III. Individuals with a slower baseline gait speed (cut-off: 0.92 m/s, adjusted OR: 14.06, P<.001) and higher baseline balance confidence measured by the Activity-specific Balance Confidence scale (cut-off: 84.5 points, adjusted OR: 4.66, P=.022) have greater potential to achieve clinically relevant improvements in gait speed. A poorer baseline PDQ-39 score (cut-off: 23.1, adjusted OR: 7.47, P<.001) predicted a greater quality of life improvement after treadmill training. CONCLUSIONS These findings provide a guideline for clinicians to easily identify suitable candidates for treadmill training. Generalization to more advanced patients with PD warrants further investigation.
Collapse
Affiliation(s)
- Si-Yu Tsai
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Hwei Tai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
50
|
Amin RM, Phillips JJ, Humbert AT, Cholerton BA, Short VD, Smith MJ, Zabetian CP, Mata IF, Kelly VE. Associations between baseline cognitive status and motor outcomes after treadmill training in people with Parkinson's disease: a pilot study. Disabil Rehabil 2024; 46:1082-1091. [PMID: 37010072 PMCID: PMC10545807 DOI: 10.1080/09638288.2023.2189318] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/27/2023] [Accepted: 03/05/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To determine the effect of baseline cognition on gait outcomes after a treadmill training program for people with Parkinson's disease (PD). METHODS This pilot clinical trial involved people with PD who were classified as having no cognitive impairment (PD-NCI) or mild cognitive impairment (PD-MCI). Baseline executive function and memory were assessed. The intervention was a 10-week gait training program (twice-weekly treadmill sessions), with structured speed and distance progression and verbal cues for gait quality. Response to intervention was assessed by gait speed measured after week 2 (short-term) and week 10 (long-term). RESULTS Participants (n = 19; 12 PD-NCI, 7 PD-MCI) had a mean (standard deviation) age of 66.5 (6.3) years, disease duration of 8.8 (6.3) years, and MDS-UPDRS III score of 21.3 (10.7). Gait speed increased at short-term and long-term assessments. The response did not differ between PD-NCI and PD-MCI groups; however, better baseline memory performance and milder PD motor severity were independently associated with greater improvements in gait speed in unadjusted and adjusted models. CONCLUSIONS These findings suggest that memory impairments and more severe motor involvement can influence the response to gait rehabilitation in PD and highlight the need for treatments optimized for people with greater cognitive and motor impairment.IMPLICATIONS FOR REHABILITATIONCognitive deficits in Parkinson's disease (PD) could impact motor learning and gait rehabilitation, yet little is known about the effects of cognitive impairments on the response to rehabilitation in people with PD.This study demonstrates that the response to gait rehabilitation did not differ between people with PD who had no cognitive impairment and those with mild cognitive impairment.Across all participants, better baseline memory was associated with greater improvements in gait speed.Rehabilitation professionals should be mindful of PD severity, as those with more substantial memory and motor impairments may require additional dosing or support to maximize gait training benefits.
Collapse
Affiliation(s)
- Raima M. Amin
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | | | - Andrew T. Humbert
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Brenna A. Cholerton
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Valerie D. Short
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Melissa J. Smith
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Cyrus P. Zabetian
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Ignacio F. Mata
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Valerie E. Kelly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|