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Zhao Y, Hodossy BK, Jing S, Todoh M, Farina D. Delayed reinforcement learning converges to intermittent control for human quiet stance. Med Eng Phys 2024; 130:104197. [PMID: 39160025 DOI: 10.1016/j.medengphy.2024.104197] [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: 10/01/2023] [Revised: 06/13/2024] [Accepted: 06/25/2024] [Indexed: 08/21/2024]
Abstract
The neural control of human quiet stance remains controversial, with classic views suggesting a limited role of the brain and recent findings conversely indicating direct cortical control of muscles during upright posture. Conceptual neural feedback control models have been proposed and tested against experimental evidence. The most renowned model is the continuous impedance control model. However, when time delays are included in this model to simulate neural transmission, the continuous controller becomes unstable. Another model, the intermittent control model, assumes that the central nervous system (CNS) activates muscles intermittently, and not continuously, to counteract gravitational torque. In this study, a delayed reinforcement learning algorithm was developed to seek optimal control policy to balance a one-segment inverted pendulum model representing the human body. According to this approach, there was no a-priori strategy imposed on the controller but rather the optimal strategy emerged from the reward-based learning. The simulation results indicated that the optimal neural controller exhibits intermittent, and not continuous, characteristics, in agreement with the possibility that the CNS intermittently provides neural feedback torque to maintain an upright posture.
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Affiliation(s)
- Yongkun Zhao
- Department of Bioengineering, Faculty of Engineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Balint K Hodossy
- Department of Bioengineering, Faculty of Engineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Shibo Jing
- Department of Mechanical Engineering, Faculty of Engineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Masahiro Todoh
- Division of Mechanical and Aerospace Engineering, Faculty of Engineering, Hokkaido University, Sapporo 060-8628, Japan
| | - Dario Farina
- Department of Bioengineering, Faculty of Engineering, Imperial College London, London, SW7 2AZ, United Kingdom.
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Takazawa T, Suzuki Y, Nakamura A, Matsuo R, Morasso P, Nomura T. How the brain can be trained to achieve an intermittent control strategy for stabilizing quiet stance by means of reinforcement learning. BIOLOGICAL CYBERNETICS 2024; 118:229-248. [PMID: 38995347 PMCID: PMC11289178 DOI: 10.1007/s00422-024-00993-0] [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: 04/08/2024] [Accepted: 06/21/2024] [Indexed: 07/13/2024]
Abstract
The stabilization of human quiet stance is achieved by a combination of the intrinsic elastic properties of ankle muscles and an active closed-loop activation of the ankle muscles, driven by the delayed feedback of the ongoing sway angle and the corresponding angular velocity in a way of a delayed proportional (P) and derivative (D) feedback controller. It has been shown that the active component of the stabilization process is likely to operate in an intermittent manner rather than as a continuous controller: the switching policy is defined in the phase-plane, which is divided in dangerous and safe regions, separated by appropriate switching boundaries. When the state enters a dangerous region, the delayed PD control is activated, and it is switched off when it enters a safe region, leaving the system to evolve freely. In comparison with continuous feedback control, the intermittent mechanism is more robust and capable to better reproduce postural sway patterns in healthy people. However, the superior performance of the intermittent control paradigm as well as its biological plausibility, suggested by experimental evidence of the intermittent activation of the ankle muscles, leaves open the quest of a feasible learning process, by which the brain can identify the appropriate state-dependent switching policy and tune accordingly the P and D parameters. In this work, it is shown how such a goal can be achieved with a reinforcement motor learning paradigm, building upon the evidence that, in general, the basal ganglia are known to play a central role in reinforcement learning for action selection and, in particular, were found to be specifically involved in postural stabilization.
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Affiliation(s)
- Tomoki Takazawa
- Graduate School of Engineering Science, Osaka University, 1-3 Machikaneyama, Toyonaka, Osaka, 5608531, Japan
| | - Yasuyuki Suzuki
- Graduate School of Engineering Science, Osaka University, 1-3 Machikaneyama, Toyonaka, Osaka, 5608531, Japan
| | - Akihiro Nakamura
- Graduate School of Engineering Science, Osaka University, 1-3 Machikaneyama, Toyonaka, Osaka, 5608531, Japan
| | - Risa Matsuo
- Graduate School of Engineering Science, Osaka University, 1-3 Machikaneyama, Toyonaka, Osaka, 5608531, Japan
| | - Pietro Morasso
- Istituto Italiano di Tecnologia, Via Enrico Melen 83, Bldg B, 16152, Genoa, Italy
| | - Taishin Nomura
- Graduate School of Engineering Science, Osaka University, 1-3 Machikaneyama, Toyonaka, Osaka, 5608531, Japan.
- Graduate School of Informatics, Kyoto University, Yoshida Honmachi, Sakyo-ku, Kyoto, 6068501, Japan.
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Gao M, Chen K, Yang Y. An improved intermittent control model of postural sway during quiet standing implemented by a data driven approach. J Biomech 2024; 163:111921. [PMID: 38215545 DOI: 10.1016/j.jbiomech.2023.111921] [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: 07/05/2023] [Revised: 10/16/2023] [Accepted: 12/31/2023] [Indexed: 01/14/2024]
Abstract
This paper proposes a new intermittent control model during human quiet standing, which is consisted of postulated "regular intervention" and "imminent intervention". The regular intervention is within the main control loop, and its trigger condition is equivalent to the switching frequency of center of pressure (COP) data calculated by wavelet transform. The imminent intervention will only be triggered after the postural sway angle exceeds a certain threshold. In order to prove the effectiveness of the new model, the simulation results of the new model and the model proposed by Asai et al. (2009) are compared with the experimental data. The setting parameters of both models are retrieved by Bayesian regression from the experimental data. The results show that the new model not only could exhibit two power law scaling regimes of power spectral density (PSD) of COP, but also show that indices of the probability density function distance, root mean square (RMS), Total Sway Path, displacement Range, 50% power frequency of center of mass (COP) between the simulation results and the experimental data are closer compared to the existing model. Moreover, the limit cycle oscillations (LCOs) obtained from the simulation results of the new model have a higher degree of matching with those retrieved from the experimental data.
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Affiliation(s)
- Maosheng Gao
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, Zhejiang 310018, China
| | - Kai Chen
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, Zhejiang 310018, China
| | - Ying Yang
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, Zhejiang 310018, China.
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Chen HL, Yu XH, Yin YH, Shan EF, Xing Y, Min M, Ding YP, Fei Y, Li XW. Multimorbidity patterns and the association with health status of the oldest-old in long-term care facilities in China: a two-step analysis. BMC Geriatr 2023; 23:851. [PMID: 38093203 PMCID: PMC10720091 DOI: 10.1186/s12877-023-04507-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The increasing prevalence of multimorbidity has created a serious global public health problem in aging populations. Certain multimorbidity patterns across different age ranges and their association with health status remain unclear. The main aim of this study is to identify multimorbidity patterns discrepancies and associated health status between younger-old and oldest-old. METHODS The Ethics Committee of Nanjing Medical University approved the study protocol (No.2019-473). Convenience sampling method was used to recruit older adults aged ≥ 60 years with multimorbidity from July to December 2021 from 38 Landsea long-term care facilities in China. The multimorbidity patterns were analyzed using network analysis and two-step cluster analysis. One-Way ANOVA was utilized to explore their association with health status including body function, activity of daily living, and social participation. A Sankey diagram visualized the flow of health status within different multimorbidity patterns. This study is reported following the STROBE guidelines. RESULTS A total of 214 younger-old (60-84 years) and 173 oldest-old (≥ 85 years) were included. Leading coexisting diseases were cardiovascular disease (CD), metabolic and endocrine disease (MED), neurological disease (ND), and orthopedic disease (OD). Cluster 1 (53, 24.8%) of CD-ND (50, 94.3%; 31, 58.8%), cluster 2 (39, 18.2%) of MED-ND-CD (39, 100%; 39, 100%; 37, 94.9%), cluster 3 (37, 17.3%) of OD-CD-MED-ND (37, 100%; 33, 89.2%; 27, 73.0%; 16, 43.2%), and cluster 4 (34, 15.9%) of CD-MED (34, 100%; 34, 100%) were identified in the younger-old. In the oldest-old, the primary multimorbidity patterns were: cluster 1 (33, 19.1%) of CD-respiratory disease-digestive disease-urogenital disease (CD-RD-DSD-UD) (32, 97.0%; 9, 27.3%; 8, 24.2%; 7, 21.2%), cluster 2 (42, 24.3%) of ND-CD-MED (42, 100%; 35, 83.3%; 14, 33.3%), cluster 3 (28, 16.2%) of OD-CD-MED (28, 100%; 25, 89.3%; 18, 64.3%), and cluster 4 (35, 20.2%) of CD-MED (35, 100%; 35, 100%). Younger-old with CD-ND or MED-ND-CD, and oldest-old with ND-CD-MED have worse health status compared with other multimorbidity patterns (e.g., CD-MED and OD-CD-MED). CONCLUSION Discrepancies in common patterns of multimorbidity across age groups suggest that caregivers in long-term care facilities should consider changes in multimorbidity patterns with ageing when developing prevention plans for individualized management. Neurological disease concurrent with other diseases was the major determinant of health status, especially for the oldest-old. Interventions targeting multimorbidity need to be focused, yet generic. It is essential to assess complex needs and health outcomes that arise from different multimorbidity patterns and manage them through an interdisciplinary approach and consider their priorities to gain high-quality primary care for older adults living in long-term care facilities.
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Affiliation(s)
- Hong-Li Chen
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiao-Hong Yu
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yue-Heng Yin
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - En-Fang Shan
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ying Xing
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Min Min
- Landsea Long-Term Care Facility, Nanjing, Jiangsu province, China
- Xia Man Yun Jian Social Welfare Development Centre, Shanghai, China
| | - Ya-Ping Ding
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yang Fei
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xian-Wen Li
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu Province, China.
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Bao W, Tan Y, Yang Y, Chen K, Liu J. Correlation of balance posturographic parameters during quiet standing with the berg balance scale in patients with parkinson's disease. BMC Neurol 2023; 23:362. [PMID: 37803250 PMCID: PMC10557353 DOI: 10.1186/s12883-023-03386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is often clinically associated with posture instability and more easily falling. The Berg balance scale is a clinical indicator commonly used to subjectively evaluate a patient's balance ability. Meanwhile, computerized force platforms have been used in research on postural control. The various parameters obtained from posturography are interpreted to assess balance ability. The present study aims to explore the correlations between posturographic variables and the BBS, and furthermore to efficiently evaluate postural instability and fall risk of early and moderate PD patients. METHODS A total of 46 PD patients were involved in the experiment. Patients were asked to perform BBS tests and force platform tests under eye open (EO) and eye closed (EC) conditions. The recorded COP signal was analyzed with the time domain statistical method, the frequency domain method of Power Spectral Density (PSD), and structural methods of Stabilogram Diffusion Analysis (SDA), Sway Density Plot (SDP) to retrieve different posturographic variables. The correlation between posturographic variables under EO and EC conditions with BBS was compared statistically. The significantly correlated posturographic parameters were then applied to analyze posturographic differences between different groups: faller vs. non-faller (patients with/without a history of falls in the past 12 months). RESULTS Among the different posturographic parameters, the prediction ellipse area, the slope of the regression line at a high-frequency band of PSD in the medial-lateral (ML) direction, the crossover point of the regression lines of SDA in the anterior-posterior (AP) direction, and the distance between successive peaks of SDP had significant correlations with BBS. These selected BBS-related parameters also showed significant differences between faller and non-faller. The selected posturographic parameters can be used as effective indicators to evaluate the balance ability of Parkinson's disease patients.
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Affiliation(s)
- Wei Bao
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China
| | - Yuyan Tan
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ying Yang
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China
| | - Kai Chen
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China.
| | - Jun Liu
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
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Zhao Y, Zhang M, Wu H, He X, Todoh M. Neuromechanics-Based Neural Feedback Controller for Planar Arm Reaching Movements. Bioengineering (Basel) 2023; 10:bioengineering10040436. [PMID: 37106623 PMCID: PMC10136284 DOI: 10.3390/bioengineering10040436] [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: 01/23/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 04/29/2023] Open
Abstract
Based on the principles of neuromechanics, human arm movements result from the dynamic interaction between the nervous, muscular, and skeletal systems. To develop an effective neural feedback controller for neuro-rehabilitation training, it is important to consider both the effects of muscles and skeletons. In this study, we designed a neuromechanics-based neural feedback controller for arm reaching movements. To achieve this, we first constructed a musculoskeletal arm model based on the actual biomechanical structure of the human arm. Subsequently, a hybrid neural feedback controller was developed that mimics the multifunctional areas of the human arm. The performance of this controller was then validated through numerical simulation experiments. The simulation results demonstrated a bell-shaped movement trajectory, consistent with the natural motion of human arm movements. Furthermore, the experiment testing the tracking ability of the controller revealed real-time errors within one millimeter, with the tensile force generated by the controller's muscles being stable and maintained at a low value, thereby avoiding the issue of muscle strain that can occur due to excessive excitation during the neurorehabilitation process.
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Affiliation(s)
- Yongkun Zhao
- Division of Human Mechanical Systems and Design, Graduate School of Engineering, Hokkaido University, Sapporo 060-8628, Japan
- Division of Bioengineering, Graduate School of Engineering Science, Osaka University, Osaka 560-8531, Japan
| | - Mingquan Zhang
- State Key Laboratory of Bioelectronics, Jiangsu Provincial Key Laboratory of Remote Measurement and Control, School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China
| | - Haijun Wu
- Division of Mechanical and Aerospace Engineering, Faculty of Engineering, Hokkaido University, Sapporo 060-8628, Japan
| | - Xiangkun He
- Department of Bioengineering, Faculty of Engineering, Imperial College London, London SW7 2AZ, UK
| | - Masahiro Todoh
- Division of Mechanical and Aerospace Engineering, Faculty of Engineering, Hokkaido University, Sapporo 060-8628, Japan
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Bueno MEB, Silva TCOD, de Souza RJ, Volpe RP, Moura FA, Smaili SM. Acute effects of transcranial direct current stimulation combined with physical therapy on the balance and gait in individuals with Parkinson's disease: A randomized controlled trial. Clin Neurol Neurosurg 2023; 226:107604. [PMID: 36739707 DOI: 10.1016/j.clineuro.2023.107604] [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: 12/12/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
Application methods of transcranial direct current stimulation (tDCS) in Parkinson's disease (PD) are quite divergent making it difficult to define the clinical effectiveness of the tDCS on PD. Thus, the aim of this study was to verify the acute effects of tDCS when applied to different targets (Cz or C3-Cz-C4) combined to physical therapy to improve balance and gait in individuals with PD. A randomized controlled trial was conducted, with 50 individuals who were separated into four groups: 1) Real tDCS (Cz) + physical therapy, 2) Real tDCS (C3-Cz-C4) + physical therapy, 3) Sham tDCS + physical therapy and 4) Educational lecture + physical therapy. The current intensity was 2 mA, applied for 20 min. For the instrumental assessment of balance and gait, the 3D motion analysis system was used. For the biomechanical analysis of gait, three different conditions were performed: normal gait, dual task gait and obstacle gait. For balance analysis, the following positions were utilized: Romberg with eyes opened, Romberg with eyes closed, Tandem with eyes opened and Tandem with eyes closed. All evaluations were performed pre-intervention, post-intervention (immediately at the end of the intervention) and were followed-up on (24 h after the end of the intervention). No statistically significant differences were found for all gait and balance outcomes when considering the interaction between time (pre, post and follow-up assessments) versus group (Education, Sham, Cz and C3-Cz-C4). In conclusion, it was found that one session of tDCS, stimulating Cz or C3-Cz-C4 combined with physical therapy, was not effective in improving the balance and gait in people with PD as compared to sham tDCS or educational lecture plus physiotherapy.
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Affiliation(s)
- Maria Eduarda Brandão Bueno
- Neurofunctional Physical Therapy Research Group (GPFIN), Graduate Program in Rehabilitation Sciences - State University of Londrina, Paraná, Brazil.
| | - Taís Caroline Oliveira da Silva
- Neurofunctional Physical Therapy Research Group (GPFIN), Graduate Program in Rehabilitation Sciences - State University of Londrina, Paraná, Brazil.
| | - Rogério José de Souza
- Neurofunctional Physical Therapy Research Group (GPFIN), Graduate Program in Rehabilitation Sciences - State University of Londrina, Paraná, Brazil.
| | - Renata Pasquarelli Volpe
- Neurofunctional Physical Therapy Research Group (GPFIN), Graduate Program in Rehabilitation Sciences - State University of Londrina, Paraná, Brazil.
| | - Felipe Arruda Moura
- Laboratory of Applied Biomechanics, Sport Sciences Department - State University of Londrina, Paraná, Brazil.
| | - Suhaila Mahmoud Smaili
- Department of Physiotherapy, Neurofunctional Physical Therapy Research Group (GPFIN), Master's and Doctoral Degree Program in Rehabilitation Sciences - State University of Londrina, Paraná, Brazil.
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The association of moderate-to-vigorous and light-intensity physical activity on static balance in middle-aged and older-aged adults. Aging Clin Exp Res 2023; 35:541-550. [PMID: 36696017 DOI: 10.1007/s40520-023-02344-8] [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: 09/19/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Falls are the leading cause of injury among adults ≥ 65 years of age. Participation in physical activity (PA) is associated with improved balance, though it is impact in the middle-age population is not well understood. AIM The purpose of the current study was to examine the influence of PA intensity on static balance in middle-aged and older aged individuals. METHODS Included were middle-aged adults (40-64 years) and older adults (≥ 65 years) from the 2003-2004 years of the National Health and Nutrition Evaluation Survey. Light physical activity (LPA) and moderate-vigorous physical activity (MVPA) were collected via accelerometer and static balance via the Romberg Test of Standing Balance. RESULTS No significant odds ratio relationship was found between MVPA or LPA and having good static balance in the middle-aged population; 1.04 (95% CI 0.95, 1.13) p = 0.427 and 1.05 (95% CI 0.97, 1.14) p = 0.182, respectively. Whereas, in older adults, every 60-min increase in LPA was significantly associated with 28% higher odds of good balance (95% CI 1.15, 1.41; p < 0.001), and every 10-min increase in MVPA with 25% higher odds of good balance (95% CI 1.08, 1.45; p = 0.006). DISCUSSION LPA and MVPA were not associated with good static balance in middle-aged adults, but in older adults LPA was significantly associated with good static balance. CONCLUSION A significant relationship is found between age and fall risk, which is a major concern in the aging population.
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Potel SR, Marceglia S, Meoni S, Kalia SK, Cury RG, Moro E. Advances in DBS Technology and Novel Applications: Focus on Movement Disorders. Curr Neurol Neurosci Rep 2022; 22:577-588. [PMID: 35838898 DOI: 10.1007/s11910-022-01221-7] [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] [Accepted: 06/17/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Deep brain stimulation (DBS) is an established treatment in several movement disorders, including Parkinson's disease, dystonia, tremor, and Tourette syndrome. In this review, we will review and discuss the most recent findings including but not limited to clinical evidence. RECENT FINDINGS New DBS technologies include novel hardware design (electrodes, cables, implanted pulse generators) enabling new stimulation patterns and adaptive DBS which delivers potential stimulation tailored to moment-to-moment changes in the patient's condition. Better understanding of movement disorders pathophysiology and functional anatomy has been pivotal for studying the effects of DBS on the mesencephalic locomotor region, the nucleus basalis of Meynert, the substantia nigra, and the spinal cord. Eventually, neurosurgical practice has improved with more accurate target visualization or combined targeting. A rising research domain emphasizes bridging neuromodulation and neuroprotection. Recent advances in DBS therapy bring more possibilities to effectively treat people with movement disorders. Future research would focus on improving adaptive DBS, leading more clinical trials on novel targets, and exploring neuromodulation effects on neuroprotection.
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Affiliation(s)
- Sina R Potel
- Service de Neurologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Sara Marceglia
- Dipartimento Di Ingegneria E Architettura, Università Degli Studi Di Trieste, Trieste, Italy
| | - Sara Meoni
- Service de Neurologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
- Grenoble Institut Neurosciences, INSERM U1416, Grenoble, France
| | - Suneil K Kalia
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Rubens G Cury
- Department of Neurology, Movement Disorders Center, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Elena Moro
- Service de Neurologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France.
- Grenoble Institut Neurosciences, INSERM U1416, Grenoble, France.
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Exley T, Moudy S, Patterson RM, Kim J, Albert MV. Predicting UPDRS Motor Symptoms in Individuals with Parkinsons Disease from Force Plates Using Machine Learning. IEEE J Biomed Health Inform 2022; 26:3486-3494. [PMID: 35259121 DOI: 10.1109/jbhi.2022.3157518] [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: 11/08/2022]
Abstract
Parkinsons disease (PD) is a neurodegenerative disease that affects motor abilities with increasing severity as the disease progresses. Traditional methods for diagnosing PD include a section where a trained specialist scores qualitative symptoms using the motor subscale of the Unified Parkinsons Disease Rating Scale (UPDRS-III). The aim of this feasibility study was twofold. First, to evaluate quiet standing as an additional, out-of-clinic, objective feature to predict UPDRS-III subscores related to motor symptom severity; and second, to use quiet standing to detect the presence of motor symptoms. Force plate data were collected from 42 PD patients and 43 healthy controls during quiet standing (a task involving standing still with eyes open and closed) as a feasible task in clinics. Predicting each subscore of the UPDRS-III could aid in identifying progression of PD and provide specialists additional tools to make an informed diagnosis. Random Forest feature importance indicated that features correlated with range of center of pressure (i.e. the medial-lateral and anterior-posterior sway) were most useful in the prediction of the top PD prediction subscores of postural stability (r = 0.599; p = 0.014), hand tremor of the left hand (r = 0.650; p = 0.015), and tremor at rest of the left upper extremity (r = 0.703; p = 0.016). Quiet standing can detect body bradykinesia (AUC-ROC = 0.924) and postural stability (AUC-ROC = 0.967) with high predictability. Although there are limited data, these results should be used as a feasibility study that evaluates the predictability of individual UPDRS-III subscores using quiet standing data.
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Cury RG, Pavese N, Aziz TZ, Krauss JK, Moro E. Gaps and roadmap of novel neuromodulation targets for treatment of gait in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:8. [PMID: 35017551 PMCID: PMC8752758 DOI: 10.1038/s41531-021-00276-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 11/21/2021] [Indexed: 12/16/2022] Open
Abstract
Gait issues in Parkinson's disease (PD) are common and can be highly disabling. Although levodopa and deep brain stimulation (DBS) of the subthalamic nucleus and the globus pallidus internus have been established therapies for addressing the motor symptoms of PD, their effects on gait are less predictable and not well sustained with disease progression. Given the high prevalence of gait impairment in PD and the limitations in currently approved therapies, there has been considerable interest in alternative neuromodulation targets and techniques. These have included DBS of pedunculopontine nucleus and substantia nigra pars reticulata, spinal cord stimulation, non-invasive modulation of cortical regions and, more recently, vagus nerve stimulation. However, successes and failures have also emerged with these approaches. Current gaps and controversies are related to patient selection, optimal electrode placement within the target, placebo effects and the optimal programming parameters. Additionally, recent advances in pathophysiology of oscillation dynamics have driven new models of closed-loop DBS systems that may or may not be applicable to gait issues. Our aim is to describe approaches, especially neuromodulation procedures, and emerging challenges to address PD gait issues beyond subthalamic nucleus and the globus pallidus internus stimulation.
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Affiliation(s)
- Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Tipu Z Aziz
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
- Center for Systems Neuroscience, Hannover, Germany
| | - Elena Moro
- Division of Neurology, Grenoble Institute of Neurosciences, Grenoble Alpes University, CHU of Grenoble, Grenoble, France
- INSERM U1216, Grenoble Institute of Neurosciences, Grenoble, France
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Dautan D, Kovács A, Bayasgalan T, Diaz-Acevedo MA, Pal B, Mena-Segovia J. Modulation of motor behavior by the mesencephalic locomotor region. Cell Rep 2021; 36:109594. [PMID: 34433068 PMCID: PMC8641693 DOI: 10.1016/j.celrep.2021.109594] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 05/05/2021] [Accepted: 08/02/2021] [Indexed: 11/09/2022] Open
Abstract
The mesencephalic locomotor region (MLR) serves as an interface between higher-order motor systems and lower motor neurons. The excitatory module of the MLR is composed of the pedunculopontine nucleus (PPN) and the cuneiform nucleus (CnF), and their activation has been proposed to elicit different modalities of movement. However, how the differences in connectivity and physiological properties explain their contributions to motor activity is not well known. Here we report that CnF glutamatergic neurons are more electrophysiologically homogeneous than PPN neurons and have mostly short-range connectivity, whereas PPN glutamatergic neurons are heterogeneous and maintain long-range connections, most notably with the basal ganglia. Optogenetic activation of CnF neurons produces short-lasting muscle activation, driving involuntary motor activity. In contrast, PPN neuron activation produces long-lasting increases in muscle tone that reduce motor activity and disrupt gait. Our results highlight biophysical and functional attributes among MLR neurons that support their differential contribution to motor behavior. Dautan et al. show key differences in the connectivity and physiological properties of neurons of the mesencephalic locomotor region. Although activation of CnF neurons elicits involuntary locomotor responses, activation of PPN neurons increases muscle tone and reduces motor activity, suggesting that PPN encodes a readiness signal that precedes locomotion.
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Affiliation(s)
- Daniel Dautan
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ 07102, USA.
| | - Adrienn Kovács
- Department of Physiology, University of Debrecen, Faculty of Medicine, 4012 Debrecen, Hungary
| | - Tsogbadrakh Bayasgalan
- Department of Physiology, University of Debrecen, Faculty of Medicine, 4012 Debrecen, Hungary
| | - Miguel A Diaz-Acevedo
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ 07102, USA
| | - Balazs Pal
- Department of Physiology, University of Debrecen, Faculty of Medicine, 4012 Debrecen, Hungary
| | - Juan Mena-Segovia
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ 07102, USA.
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13
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Conway ZJ, Silburn PA, Perera T, O'Maley K, Cole MH. Low-frequency STN-DBS provides acute gait improvements in Parkinson's disease: a double-blinded randomised cross-over feasibility trial. J Neuroeng Rehabil 2021; 18:125. [PMID: 34376190 PMCID: PMC8353795 DOI: 10.1186/s12984-021-00921-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/02/2021] [Indexed: 02/01/2023] Open
Abstract
Background Some people with Parkinson’s disease (PD) report poorer dynamic postural stability following high-frequency deep brain stimulation of the subthalamic nucleus (STN-DBS), which may contribute to an increased falls risk. However, some studies have shown low-frequency (60 Hz) STN-DBS improves clinical measures of postural stability, potentially providing support for this treatment. This double-blind randomised crossover study aimed to investigate the effects of low-frequency STN-DBS compared to high-frequency stimulation on objective measures of gait rhythmicity in people with PD. Methods During high- and low-frequency STN-DBS and while off-medication, participants completed assessments of symptom severity and walking (e.g., Timed Up-and-Go). During comfortable walking, the harmonic ratio, an objective measures of gait rhythmicity, was derived from head- and trunk-mounted accelerometers to provide insight in dynamic postural stability. Lower harmonic ratios represent less rhythmic walking and have discriminated people with PD who experience falls. Linear mixed model analyses were performed on fourteen participants. Results Low-frequency STN-DBS significantly improved medial–lateral and vertical trunk rhythmicity compared to high-frequency. Improvements were independent of electrode location and total electrical energy delivered. No differences were noted between stimulation conditions for temporal gait measures, clinical mobility measures, motor symptom severity or the presence of gait retropulsion. Conclusions This study provides evidence for the acute benefits of low-frequency stimulation for gait outcomes in STN-DBS PD patients, independent of electrode location. However, the perceived benefits of this therapy may be diminished for people who experienced significant tremor pre-operatively, as lower frequencies may cause these symptoms to re-emerge. Trial registration: This study was prospectively registered with the Australian and New Zealand Clinical Trials Registry on 5 June 2018 (ACTRN12618000944235). Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00921-4.
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Affiliation(s)
- Zachary J Conway
- School of Behavioural and Health Sciences, Australian Catholic University, P.O. Box 456, Brisbane, QLD, 4014, Australia.
| | - Peter A Silburn
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia.,Neurosciences Queensland, Brisbane, QLD, Australia
| | - Thushara Perera
- The Bionics Institute, East Melbourne, VIC, Australia.,Department of Medical Bionics, The University of Melbourne, Parkville, VIC, Australia
| | | | - Michael H Cole
- School of Behavioural and Health Sciences, Australian Catholic University, P.O. Box 456, Brisbane, QLD, 4014, Australia. .,Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia. .,Development and Disability over the Lifespan Program, Healthy Brain and Mind Research Centre, Australian Catholic University, Brisbane, Australia.
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14
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Nakamura A, Suzuki Y, Milosevic M, Nomura T. Long-Lasting Event-Related Beta Synchronizations of Electroencephalographic Activity in Response to Support-Surface Perturbations During Upright Stance: A Pilot Study Associating Beta Rebound and Active Monitoring in the Intermittent Postural Control. Front Syst Neurosci 2021; 15:660434. [PMID: 34093142 PMCID: PMC8175801 DOI: 10.3389/fnsys.2021.660434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
Movement related beta band cortical oscillations, including beta rebound after execution and/or suppression of movement, have drawn attention in upper extremity motor control literature. However, fewer studies focused on beta band oscillations during postural control in upright stance. In this preliminary study, we examined beta rebound and other components of electroencephalogram (EEG) activity during perturbed upright stance to investigate supraspinal contributions to postural stabilization. Particularly, we aimed to clarify the timing and duration of beta rebound within a non-sustained, but long-lasting postural recovery process that occurs more slowly compared to upper extremities. To this end, EEG signals were acquired from nine healthy young adults in response to a brief support-surface perturbation, together with the center of pressure, the center of mass and electromyogram (EMG) activities of ankle muscles. Event-related potentials (ERPs) and event-related spectral perturbations were computed from EEG data using the perturbation-onset as a triggering event. After short-latency (<0.3 s) ERPs, our results showed a decrease in high-beta band oscillations (event-related desynchronization), which was followed by a significant increase (event-related synchronization) in the same band, as well as a decrease in theta band oscillations. Unlike during upper extremity motor tasks, the beta rebound in this case was initiated before the postural recovery was completed, and sustained for as long as 3 s with small EMG responses for the first half period, followed by no excessive EMG activities for the second half period. We speculate that those novel characteristics of beta rebound might be caused by slow postural dynamics along a stable manifold of the unstable saddle-type upright equilibrium of the postural control system without active feedback control, but with active monitoring of the postural state, in the framework of the intermittent control.
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Affiliation(s)
| | | | | | - Taishin Nomura
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Osaka, Japan
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15
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Richmond SB, Fling BW, Lee H, Peterson DS. The assessment of center of mass and center of pressure during quiet stance: Current applications and future directions. J Biomech 2021; 123:110485. [PMID: 34004395 DOI: 10.1016/j.jbiomech.2021.110485] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 11/25/2022]
Abstract
This perspective article provides a brief review of our understanding of how center of pressure (CoP) and center of mass (CoM) are traditionally utilized to measure quiet standing and how technological advancements are allowing for measurements to be derived outside the confines of a laboratory setting. Furthermore, this viewpoint provides descriptions of what CoP and CoM outcomes may reflect, a discussion of recent developments in selected balance outcomes, the importance of measuring instantaneous balance outcomes, and directions for future questions/research. Considering the enormous number and cost of falls annually, conclusions drawn from this perspective underscore the need for more cohesive efforts to advance our understanding of balance performance. As we refine the technology and algorithms used to portably assess postural stability, the question of which measurement (i.e. CoP or CoM) to utilize seems to be highly dependent on the question being asked. Further, the complexity of the question appears to span multiple disciplines and cultivate exploration of the intrinsic mechanisms of stability. Recently developed multi-dimensional methods for assessing balance performance may provide additional insight into balance, improving our ability to predict balance impairments and falls outside the laboratory and in the clinic. However, additional work will be necessary to understand the clinical significance and predictive capacity of these outcomes in various fall-prone populations.
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Affiliation(s)
- Sutton B Richmond
- College of Health and Human Performance, Department of Applied Physiology and Kinesiology, University of Florida, 1864 Stadium Rd., Gainesville, FL 32608, USA
| | - Brett W Fling
- College of Health and Human Sciences, Department of Health and Exercise Science, Colorado State University, 951 Plum St, Fort Collins, CO 80523, USA; Molecular, Cellular and Integrative Neurosciences Program, Colorado State University, 1675 Campus Delivery, Fort Collins, CO 80523, USA
| | - Hyunglae Lee
- School for Engineering of Matter, Transport and Energy, Arizona State University, 501 E Tyler Mall, Tempe, AZ 85287, USA
| | - Daniel S Peterson
- College of Health Solutions, Arizona State University, 425 N 5(th) Street, Phoenix, AZ, USA; Phoenix VA Health Care System, 650 Indian School Rd. Phoenix, AZ, USA.
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16
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The relation between falls risk and movement variability in Parkinson's disease. Exp Brain Res 2021; 239:2077-2087. [PMID: 33914138 DOI: 10.1007/s00221-021-06113-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
Falls are a major health concern for older adults with Parkinson's disease (PD). This study was designed to examine differences in falls risk and its relation to changes in the average and variability (i.e. intra-individual variability) of reaction time (RT), finger tapping, standing balance and walking between healthy older adults and persons with PD. Thirty-nine adults with PD (70.0 ± 8.1 years) and 29 healthy older adults (66.8 ± 10.4 years) participated in this study. Falls risk (using the physiological profile assessment), gait, RT, balance and tapping responses were assessed for all persons. Results demonstrated that individuals with PD exhibited a greater risk of falling coupled with a general slowing of motor function covering declines in walking, RT and finger tapping. In addition, the movement responses of the PD group were more variable than the healthy older adults. Correlation results revealed group differences with regards to the neuromotor measures which were significantly correlated with falls risk. For the PD group, gait measures were highly correlated with their falls risk while, for the healthy older adults, falls risk was linked to balance measures even though PD persons had increased sway. Overall, persons with PD were at greater falls risk, moved slower and with increased variability compared to the healthy older adults. Further, while there are some similarities between the two groups in terms of those measures related to falls risk, there were also several differences which highlight that persons with PD can have different risk factors for falling compared to healthy adults of similar age.
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17
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Tractography patterns of pedunculopontine nucleus deep brain stimulation. J Neural Transm (Vienna) 2021; 128:659-670. [PMID: 33779812 PMCID: PMC8105200 DOI: 10.1007/s00702-021-02327-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/08/2021] [Indexed: 11/11/2022]
Abstract
Deep brain stimulation of the pedunculopontine nucleus is a promising surgical procedure for the treatment of Parkinsonian gait and balance dysfunction. It has, however, produced mixed clinical results that are poorly understood. We used tractography with the aim to rationalise this heterogeneity. A cohort of eight patients with postural instability and gait disturbance (Parkinson’s disease subtype) underwent pre-operative structural and diffusion MRI, then progressed to deep brain stimulation targeting the pedunculopontine nucleus. Pre-operative and follow-up assessments were carried out using the Gait and Falls Questionnaire, and Freezing of Gait Questionnaire. Probabilistic diffusion tensor tractography was carried out between the stimulating electrodes and both cortical and cerebellar regions of a priori interest. Cortical surface reconstructions were carried out to measure cortical thickness in relevant areas. Structural connectivity between stimulating electrode and precentral gyrus (r = 0.81, p = 0.01), Brodmann areas 1 (r = 0.78, p = 0.02) and 2 (r = 0.76, p = 0.03) were correlated with clinical improvement. A negative correlation was also observed for the superior cerebellar peduncle (r = −0.76, p = 0.03). Lower cortical thickness of the left parietal lobe and bilateral premotor cortices were associated with greater pre-operative severity of symptoms. Both motor and sensory structural connectivity of the stimulated surgical target characterises the clinical benefit, or lack thereof, from surgery. In what is a challenging region of brainstem to effectively target, these results provide insights into how this can be better achieved. The mechanisms of action are likely to have both motor and sensory components, commensurate with the probable nature of the underlying dysfunction.
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18
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Effect of pharmacodynamical interaction between nutlin-3a and aspirin in the activation of p53. J Theor Biol 2021; 522:110696. [PMID: 33794285 DOI: 10.1016/j.jtbi.2021.110696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/22/2021] [Accepted: 03/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE p53, an anti-tumour protein, is significantly inactivated in most tumours. A small molecule of nutlin-3a is used to activate its function by repressing (Mouse double minute 2 homolog) Mdm2 protein which inhibits its activity. In cancer patients, a high risk of drug-drug interactions (DDIs) is observed owing to their multi-dosing prescriptions, which may lead them to harmful effects. In the presented work, we have aimed to investigate the effect of pharmacodynamical interaction between two anti-cancer drugs, nutlin-3a and aspirin in the activation of p53 protein. METHODS We have adapted control system techniques and designed a Proportional-Integral-Derivative (PID) controller. This controller is used to activate p53 protein. A drug interaction parameter is used to incorporate the effect of both drugs. Extensive simulation is performed using two different doses of aspirin, i.e. a low and a high dose of aspirin. RESULTS The result shows no harmful effects of pharmacodynamical interaction when a low dose is administered along with nutlin-3a. When a high dose of aspirin is administered it acts as input disturbance and leads to undesirable over-expression of p53 protein. This can further harm other growth cells, thus inducing harmful effects. A comparative analysis is also tabulated with different dosing regimens which shows that a combination of nutlin-3a and a low dose of aspirin provides better results than a high dose of aspirin. CONCLUSION Overall, the work provides an insight to the activation of p53 protein in cancer patients under the presence of pharmacodynamical interaction and might contribute to the effective management of cancer patients.
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19
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Taylor SC, Atkinson G, Dixon J, Robinson JR, Ryan CG. Test-retest reliability of the two-point discrimination test on the sole of the foot in people with multiple sclerosis. Physiol Meas 2020; 41:11NT01. [PMID: 33105127 DOI: 10.1088/1361-6579/abc4c6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Two-point discrimination (TPD) is an assessment of tactile acuity. People with multiple sclerosis (MS) can have reduced foot sole tactile acuity, which has been linked to impaired balance. OBJECTIVE To quantify the test-retest reliability of TPD on the sole of the foot in people with MS. APPROACH 41 participants (32 females), with mean (SD) age of 60 (9) years, and Expanded Disability Status Scale of <7.5, had their TPD measured at the head of the first metatarsal and the heel on two occasions, 2-14 d apart. Mean systematic change, within-subjects SD, limits of agreement (LOA), coefficient of variation and the intraclass correlation coefficient (ICC) were quantified as point estimates (95% CI). MAIN RESULTS Systematic learning effects were evident. The within-subjects SD at the metatarsal and the heel was 6.7 mm (5.5-8.6) and 8.3 mm (6.7-10.8), and the LOAs were 18.6 mm (15.2-24.) and 23.7 mm (18.7-30.1), respectively. ICCs for metatarsal and heel was 0.87 (0.76-0.93) and 0.90 (0.80-0.95), respectively, but these were likely inflated by sample heterogeneity. SIGNIFICANCE In people with MS, TPD on the sole of the foot has an adequate test-retest reliability for research purposes, but there is substantial measurement variability for individual patients.
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Affiliation(s)
- S C Taylor
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
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20
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Ralston JD, Raina A, Benson BW, Peters RM, Roper JM, Ralston AB. Physiological Vibration Acceleration (Phybrata) Sensor Assessment of Multi-System Physiological Impairments and Sensory Reweighting Following Concussion. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:411-438. [PMID: 33324120 PMCID: PMC7733539 DOI: 10.2147/mder.s279521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the utility of a head-mounted wearable inertial motion unit (IMU)-based physiological vibration acceleration (“phybrata”) sensor to support the clinical diagnosis of concussion, classify and quantify specific concussion-induced physiological system impairments and sensory reweighting, and track individual patient recovery trajectories. Methods Data were analyzed from 175 patients over a 12-month period at three clinical sites. Comprehensive clinical concussion assessments were first completed for all patients, followed by testing with the phybrata sensor. Phybrata time series data and spatial scatter plots, eyes open (Eo) and eyes closed (Ec) phybrata powers, average power (Eo+Ec)/2, Ec/Eo phybrata power ratio, time-resolved phybrata spectral density (TRPSD) distributions, and receiver operating characteristic (ROC) curves are compared for individuals with no objective impairments and those clinically diagnosed with concussions and accompanying vestibular impairment, other neurological impairment, or both vestibular and neurological impairments. Finally, pre- and post-injury phybrata case report results are presented for a participant who was diagnosed with a concussion and subsequently monitored during treatment, rehabilitation, and return-to-activity clearance. Results Phybrata data demonstrate distinct features and patterns for individuals with no discernable clinical impairments, diagnosed vestibular pathology, and diagnosed neurological pathology. ROC curves indicate that the average power (Eo+Ec)/2 may be utilized to support clinical diagnosis of concussion, while Eo and Ec/Eo may be utilized as independent measures to confirm accompanying neurological and vestibular impairments, respectively. All 3 measures demonstrate area under the curve (AUC), sensitivity, and specificity above 90% for their respective diagnoses. Phybrata spectral analyses demonstrate utility for quantifying the severity of concussion-induced physiological impairments, sensory reweighting, and subsequent monitoring of improvements throughout treatment and rehabilitation. Conclusion Phybrata testing assists with objective concussion diagnosis and provides an important adjunct to standard concussion assessment tools by objectively ascertaining neurological and vestibular impairments, guiding targeted rehabilitation strategies, monitoring recovery, and assisting with return-to-sport/work/learn decision-making.
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Affiliation(s)
| | - Ashutosh Raina
- Center of Excellence for Pediatric Neurology, Rocklin, CA 95765, USA.,Concussion Medical Clinic, Rocklin, CA 95765, USA
| | - Brian W Benson
- Benson Concussion Institute, Calgary, Alberta T3B 6B7, Canada.,Canadian Sport Institute Calgary, Calgary, Alberta T3B 5R5, Canada
| | - Ryan M Peters
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada
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21
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Moretto GF, Santinelli FB, Penedo T, Mochizuki L, Rinaldi NM, Barbieri FA. Prolonged Standing Task Affects Adaptability of Postural Control in People With Parkinson's Disease. Neurorehabil Neural Repair 2020; 35:58-67. [PMID: 33241729 DOI: 10.1177/1545968320971739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies on short-term upright quiet standing tasks have presented contradictory findings about postural control in people with Parkinson's disease (pwPD). Prolonged trial durations might better depict body sway and discriminate pwPD and controls. OBJECTIVE The aim of this study was to investigate postural control in pwPD during a prolonged standing task. METHODS A total of 26 pwPD and 25 neurologically healthy individuals performed 3 quiet standing trials (60 s) before completing a constrained prolonged standing task for 15 minutes. Motion capture was used to record body sway (Vicon, 100 Hz). To investigate the body sway behavior during the 15 minutes of standing, the analysis was divided into three 5-minute-long phases: early, middle, and late. The following body sway parameters were calculated for the anterior-posterior (AP) and medial-lateral (ML) directions: velocity, root-mean-square, and detrended fluctuations analysis (DFA). The body sway area was also calculated. Two-way ANOVAs (group and phases) and 1-way ANOVA (group) were used to compare these parameters for the prolonged standing and quiet standing, respectively. RESULTS pwPD presented smaller sway area (P < .001), less complexity (DFA; AP: P < .009; ML: P < .01), and faster velocity (AP: P < .002; ML: P < .001) of body sway compared with the control group during the prolonged standing task. Although the groups swayed similarly (no difference for sway area) during quiet standing, they presented differences in sway area during the prolonged standing task (P < .001). CONCLUSIONS Prolonged standing task reduced adaptability of the postural control system in pwPD. In addition, the prolonged standing task may better analyze the adaptability of the postural control system in pwPD.
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Affiliation(s)
| | | | - Tiago Penedo
- São Paulo State University (UNESP), Bauru, Brazil
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22
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Suzuki Y, Nakamura A, Milosevic M, Nomura K, Tanahashi T, Endo T, Sakoda S, Morasso P, Nomura T. Postural instability via a loss of intermittent control in elderly and patients with Parkinson's disease: A model-based and data-driven approach. CHAOS (WOODBURY, N.Y.) 2020; 30:113140. [PMID: 33261318 DOI: 10.1063/5.0022319] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/28/2020] [Indexed: 06/12/2023]
Abstract
Postural instability is one of the major symptoms of Parkinson's disease. Here, we assimilated a model of intermittent delay feedback control during quiet standing into postural sway data from healthy young and elderly individuals as well as patients with Parkinson's disease to elucidate the possible mechanisms of instability. Specifically, we estimated the joint probability distribution of a set of parameters in the model using the Bayesian parameter inference such that the model with the inferred parameters can best-fit sway data for each individual. It was expected that the parameter values for three populations would distribute differently in the parameter space depending on their balance capability. Because the intermittent control model is parameterized by a parameter associated with the degree of intermittency in the control, it can represent not only the intermittent model but also the traditional continuous control model with no intermittency. We showed that the inferred parameter values for the three groups of individuals are classified into two major groups in the parameter space: one represents the intermittent control mostly for healthy people and patients with mild postural symptoms and the other the continuous control mostly for some elderly and patients with severe postural symptoms. The results of this study may be interpreted by postulating that increased postural instability in most Parkinson's patients and some elderly persons might be characterized as a dynamical disease.
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Affiliation(s)
- Yasuyuki Suzuki
- Graduate School of Engineering Science, Osaka University, Osaka 5608531, Japan
| | - Akihiro Nakamura
- Graduate School of Engineering Science, Osaka University, Osaka 5608531, Japan
| | - Matija Milosevic
- Graduate School of Engineering Science, Osaka University, Osaka 5608531, Japan
| | - Kunihiko Nomura
- Department of Information Technology and Social Sciences, Osaka University of Economics, Osaka 5338533, Japan
| | - Takao Tanahashi
- Department of Neurology, Osaka Rosai Hospital, Osaka 5918025, Japan
| | - Takuyuki Endo
- Department of Neurology, Osaka Toneyama Medical Center, Osaka 5608552, Japan
| | - Saburo Sakoda
- Department of Neurology, Osaka Toneyama Medical Center, Osaka 5608552, Japan
| | - Pietro Morasso
- Center for Human Technologies, Istituto Italiano di Tecnologia, Genoa 16163, Italy
| | - Taishin Nomura
- Graduate School of Engineering Science, Osaka University, Osaka 5608531, Japan
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23
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Dijkstra BW, Bekkers EMJ, Gilat M, de Rond V, Hardwick RM, Nieuwboer A. Functional neuroimaging of human postural control: A systematic review with meta-analysis. Neurosci Biobehav Rev 2020; 115:351-362. [PMID: 32407735 DOI: 10.1016/j.neubiorev.2020.04.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/07/2020] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Abstract
Postural instability is a strong risk factor for falls that becomes more prominent with aging. To facilitate treatment and prevention of falls in an aging society, a thorough understanding of the neural networks underlying postural control is warranted. Here, we present a systematic review of the functional neuroimaging literature of studies measuring posture-related neural activity in healthy subjects. Study methods were overall heterogeneous. Eleven out of the 14 studies relied on postural simulation in a supine position (e.g. motor imagery). The key nodes of human postural control involved the brainstem, cerebellum, basal ganglia, thalamus and several cortical regions. An activation likelihood estimation meta-analysis revealed that the anterior cerebellum was consistently activated across the wide range of postural tasks. The cerebellum is known to modulate the brainstem nuclei involved in the control of posture. Hence, this systematic review with meta-analysis provides insight into the neural correlates which underpin human postural control and which may serve as a reference for future neural network and region of interest analyses.
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Affiliation(s)
- Bauke W Dijkstra
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
| | - Esther M J Bekkers
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
| | - Moran Gilat
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
| | - Veerle de Rond
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
| | - Robert M Hardwick
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium; Institute of Neuroscience, Université Catholique De Louvain, Brussels, Belgium.
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Bus 1501, 3001, Leuven, Belgium.
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Meoni S, Cury RG, Moro E. New players in basal ganglia dysfunction in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2020; 252:307-327. [PMID: 32247369 DOI: 10.1016/bs.pbr.2020.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The classical model of the basal ganglia (BG) circuit has been recently revised with the identification of other structures that play an increasing relevant role especially in the pathophysiology of Parkinson's disease (PD). Numerous studies have supported the spreading of the alpha-synuclein pathology to several areas beyond the BG and likely even before their involvement. With the aim of better understanding PD pathophysiology and finding new targets for treatment, the spinal cord, the pedunculopontine nucleus, the substantia nigra pars reticulata, the retina, the superior colliculus, the cerebellum, the nucleus parabrachialis and the Meynert's nucleus have been investigated both in animal and human studies. In this chapter, we describe the main anatomical and functional connections between the above structures and the BG, the relationship between their pathology and PD features, and the rational of applying neuromodulation treatment to improve motor and non-motor symptoms in PD. Some of these new players in the BG circuits might also have a potential intriguing role as early biomarkers of PD.
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Affiliation(s)
- Sara Meoni
- Movement Disorders Unit, Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France; INSERM U1216, Grenoble Institute of Neurosciences, Grenoble, France
| | - Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Elena Moro
- Movement Disorders Unit, Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble, France; INSERM U1216, Grenoble Institute of Neurosciences, Grenoble, France.
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Lin F, Wu D, Lin C, Cai H, Chen L, Cai G, Ye Q, Cai G. Pedunculopontine Nucleus Deep Brain Stimulation Improves Gait Disorder in Parkinson's Disease: A Systematic Review and Meta-analysis. Neurochem Res 2020; 45:709-719. [PMID: 31950450 DOI: 10.1007/s11064-020-02962-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/17/2019] [Accepted: 01/09/2020] [Indexed: 12/14/2022]
Abstract
Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) has been proposed as a treatment strategy for gait disorder in patients with Parkinson's disease (PD). We thus performed a systematic review and meta-analysis of randomized and nonrandomized controlled trials to assess the effect of this treatment on gait disorder in patients with PD. We systematically searched PubMed, Cochrane, Web of Knowledge, Wan Fang and WIP for randomized and nonrandomized controlled trials (published before July 29, 2014; no language restrictions) comparing PPN-DBS with other treatments. We assessed pooled data using a random effects model and a fixed effects model. Of 130 identified studies, 14 were eligible and were included in our analysis (N = 82 participants). Compared to those presurgery, the Unified Parkinson Disease Rating Scale (UPDRS) 27-30 scores for patients were lowered by PPN-DBS [3.94 (95% confidence interval, CI = 1.23 to 6.65)]. The UPDRS 13 and 14 scores did not improve with levodopa treatment [0.43 (- 0.35 to 1.20); 0.35 (- 0.50 to 1.19)], whereas the UPDRS 27-30 scores could be improved by the therapy [1.42 (95% CI 0.34 to 2.51)]. The Gait and Falls Questionnaire and UPDRS 13 and 14 scores showed significant improvements after PPN-DBS under the medication-off (MED-OFF) status [15.44 (95% CI = 8.44 to 22.45); 1.57 (95% CI = 0.84 to 2.30); 1.34 (95% CI = 0.84 to 1.84)]. PPN-DBS is a potential therapeutic target that could improve gait and fall disorders in patients with PD. Our findings will help improve the clinical application of DBS in PD patients with gait disorder.
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Affiliation(s)
- Fabin Lin
- Department of Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, China.,Department of Clinical Medical, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Dihang Wu
- Department of Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, China.,Department of Clinical Medical, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Chenxin Lin
- Department of Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, China.,Department of Clinical Medical, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Huihui Cai
- Department of Clinical Medical, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Lina Chen
- Department of Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Guofa Cai
- College of Information Engineering, Guangdong University of Technology, Guangzhou, 510006, Guangdong, China
| | - Qinyong Ye
- Department of Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Guoen Cai
- Department of Neurology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, China.
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Gay M, Belaid H, Rogers A, Pérez-García F, Roustan M, Bardinet E, François C, Karachi C. Anatomo-Functional Mapping of the Primate Mesencephalic Locomotor Region Using Stereotactic Lesions. Mov Disord 2020; 35:789-799. [PMID: 31922282 DOI: 10.1002/mds.27983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Dysfunction of the mesencephalic locomotor region has been implicated in gait disorders. However, the role of its 2 components, the pedunculopontine and the cuneiform nuclei, in locomotion is poorly understood in primates. OBJECTIVES To analyze the effect of cuneiform lesions on gait and balance in 2 monkeys and to compare them with those obtained after cholinergic pedunculopontine lesions in 4 monkeys and after lesions in both the cuneiform and pedunculopontine nuclei in 1 monkey. METHODS After each stereotactic lesion, we performed a neurological examination and gait and balance assessments with kinematic measures during a locomotor task. The 3-dimensional location of each lesion was analyzed on a common brainstem space. RESULTS After each cuneiform lesion, we observed a contralateral cervical dystonia including an increased tone in the proximal forelimb and an increase in knee angle, back curvature and walking speed. Conversely, cholinergic pedunculopontine lesions increased tail rigidity and back curvature and an imbalance of the muscle tone between the ipsi- and contralateral hindlimb with decreased knee angles. The walking speed was decreased. Moreover, pedunculopontine lesions often resulted in a longer time to waking postsurgery. CONCLUSIONS The location of the lesions and their behavioral effects revealed a somatotopic organization of muscle tone control, with the neck and forelimb represented within the cuneiform nucleus and hindlimb and tail represented within the pedunculopontine nucleus. Cuneiform lesions increased speed, whereas pedunculopontine lesions decreased it. These findings confirm the complex and specific role of the cuneiform and pedunculopontine nuclei in locomotion and suggest the role of the pedunculopontine in sleep control. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Marion Gay
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France
| | - Hayat Belaid
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France.,Department of Neurosurgery, Rothschild Foundation, Paris, France
| | - Alister Rogers
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France.,Department of Neurosurgery, Rothschild Foundation, Paris, France
| | - Fernando Pérez-García
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France.,Center of NeuroImaging Research-CENIR, Paris, France
| | - Maxime Roustan
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France
| | - Eric Bardinet
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France.,Center of NeuroImaging Research-CENIR, Paris, France
| | - Chantal François
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France
| | - Carine Karachi
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, CNRS, INSERM, APHP GH Pitié-Salpêtrière, Institut du cerveau et de la moelle épinière, Paris, France.,AP-HP, Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France
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27
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Watanabe H, Makabe A, Hirai C, Takeda T, Honda K, Demura S, Tsutsumi T. Frequency analyses of posturography using logarithmic translation. Acta Otolaryngol 2020; 140:1-7. [PMID: 31709868 DOI: 10.1080/00016489.2019.1682660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Power-spectral analysis of the centre of pressure (CoP) frequencies of posturography provides exponentially approximated distributions, whereas logarithmic translation enables linear approximation.Objectives: Frequency analyses were adopted for posturography of healthy subjects and patients with spinocerebellar degeneration (SCD) using logarithmic translation to determine its clinical usefulness for managing the elderly and patients with disequilibrium.Material and methods: We included 172 healthy subjects and 47 SCD patients. Posturography was performed with the eyes fixated and closed, with and without foam rubber. The power-spectral data of the CoP were obtained with the maximum entropy method. Power-spectral data were logarithmically translated for quantitative evaluation.Results: For teenagers, high-frequency fluctuations were dominant and attributable to proprioceptive compensation due to immature postural control. In elderly populations, the increased frequency in the lateral direction was characterised by three peaks indicating postural disturbances attributed to three sensory inputs. The disappearance of one peak in the anteroposterior fluctuation indicates a decrease in vestibular contribution. The foam rubber and the closed-eye condition enhanced fluctuations in two peaks. There were differences in power-spectral distributions of two peaks between the healthy subjects and SCD patients.Conclusions: Logarithmic power-spectral data distribution could provide an age- and disease-specific novel and visually-comprehensible parameter.
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Affiliation(s)
- Hiroki Watanabe
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayane Makabe
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chiaki Hirai
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takamori Takeda
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiji Honda
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichi Demura
- College of Human and Social Sciences, Kanazawa University, Kanazawa, Japan
| | - Takeshi Tsutsumi
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
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Xiang M, Glasauer S, Seemungal BM. Quantitative postural models as biomarkers of balance in Parkinson's disease. Brain 2019; 141:2824-2827. [PMID: 31367748 PMCID: PMC6158586 DOI: 10.1093/brain/awy250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Min Xiang
- Brain and Vestibular Group, Neuro-Otology Unit, Division of Brain Sciences, Imperial College London
| | - Stefan Glasauer
- Computational Neuroscience, Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Germany
| | - Barry M Seemungal
- Brain and Vestibular Group, Neuro-Otology Unit, Division of Brain Sciences, Imperial College London
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29
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Garcia-Rill E, Saper CB, Rye DB, Kofler M, Nonnekes J, Lozano A, Valls-Solé J, Hallett M. Focus on the pedunculopontine nucleus. Consensus review from the May 2018 brainstem society meeting in Washington, DC, USA. Clin Neurophysiol 2019; 130:925-940. [PMID: 30981899 PMCID: PMC7365492 DOI: 10.1016/j.clinph.2019.03.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/15/2019] [Accepted: 03/22/2019] [Indexed: 12/12/2022]
Abstract
The pedunculopontine nucleus (PPN) is located in the mesopontine tegmentum and is best delimited by a group of large cholinergic neurons adjacent to the decussation of the superior cerebellar peduncle. This part of the brain, populated by many other neuronal groups, is a crossroads for many important functions. Good evidence relates the PPN to control of reflex reactions, sleep-wake cycles, posture and gait. However, the precise role of the PPN in all these functions has been controversial and there still are uncertainties in the functional anatomy and physiology of the nucleus. It is difficult to grasp the extent of the influence of the PPN, not only because of its varied functions and projections, but also because of the controversies arising from them. One controversy is its relationship to the mesencephalic locomotor region (MLR). In this regard, the PPN has become a new target for deep brain stimulation (DBS) for the treatment of parkinsonian gait disorders, including freezing of gait. This review is intended to indicate what is currently known, shed some light on the controversies that have arisen, and to provide a framework for future research.
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Affiliation(s)
- E Garcia-Rill
- Center for Translational Neuroscience, Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - C B Saper
- Department of Neurology, Division of Sleep Medicine and Program in Neuroscience, Harvard Medical School, Boston, MA, USA
| | - David B Rye
- Department of Neurology, Division of Sleep Medicine and Program in Neuroscience, Harvard Medical School, Boston, MA, USA
| | - M Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - J Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, the Netherlands
| | - A Lozano
- Division of Neurosurgery, University of Toronto and Krembil Neuroscience Centre, University Health Network, Toronto, Canada
| | - J Valls-Solé
- Neurology Department, Hospital Clínic, University of Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Spain
| | - M Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Değer TB, Saraç ZF, Savaş ES, Akçiçek SF. The Relationship of Balance Disorders with Falling, the Effect of Health Problems, and Social Life on Postural Balance in the Elderly Living in a District in Turkey. Geriatrics (Basel) 2019; 4:geriatrics4020037. [PMID: 31108836 PMCID: PMC6630729 DOI: 10.3390/geriatrics4020037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 01/13/2023] Open
Abstract
The aim of this study was to determine the prevalence of balance disorders; the effects of sociodemographic, medical, and social conditions on postural balance; and the relationship between balance and falls in elderly individuals. The study design was cross-sectional. A total of 607 community-dwelling elderly individuals with a mean age of 73.99 ± 6.6 years were enrolled after being selected by stratified random sampling. The study was performed as a face-to-face survey in the homes of elderly individuals. Sociodemographic and medical data were obtained from elderly individuals using the Elderly Identification Form. Balance disorders were determined using the Berg Balance Scale (BBS). In this study, the prevalence of balance disorders was found to be 34.3% in the community-dwelling elderly. Older age, physical disability, having four or more chronic illnesses, the presence of incontinence, having a history of falls, not walking regularly, absence of free time activity, and obesity were found to be associated with an increased prevalence of balance disorders. Balance disorders are commonly seen in the elderly and may be triggered by a variety of biological and social factors. It is crucial to develop and implement national health and social policies to eliminate the causes of this problem, as well as to prioritize preventive health services in the ever-increasing elderly population.
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Affiliation(s)
- Tahsin Barış Değer
- Directorate of Health Affairs, Söke Municipality, Söke, Aydın 09200, Turkey.
| | - Zeliha Fulden Saraç
- Geriatrics Section, Faculty of Medicine, Ege University, Bornova, Izmir 35100, Turkey.
| | - Emine Sumru Savaş
- Geriatrics Section, Faculty of Medicine, Ege University, Bornova, Izmir 35100, Turkey.
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31
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Structure and function of the mesencephalic locomotor region in normal and parkinsonian primates. CURRENT OPINION IN PHYSIOLOGY 2019. [DOI: 10.1016/j.cophys.2019.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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32
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Pantall A, Suresparan P, Kapa L, Morris R, Yarnall A, Del Din S, Rochester L. Postural Dynamics Are Associated With Cognitive Decline in Parkinson's Disease. Front Neurol 2018; 9:1044. [PMID: 30568629 PMCID: PMC6290334 DOI: 10.3389/fneur.2018.01044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 11/19/2018] [Indexed: 11/25/2022] Open
Abstract
Early features of Parkinson's disease (PD) include both motor and cognitive changes, suggesting shared common pathways. A common motor dysfunction is postural instability, a known predictor of falls, which have a major impact on quality of life. Understanding mechanisms of postural dynamics in PD and specifically how they relate to cognitive changes is essential for developing effective interventions. The aims of this study were to examine the changes that occur in postural metrics over time and explore the relationship between postural and cognitive dysfunction. The study group consisted of 35 people (66 ± 8years, 12 female, UPDRS III: 22.5 ± 9.6) diagnosed with PD who were recruited as part of the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation—PD Gait (ICICLE-GAIT) study. Postural and cognitive assessments were performed at 18, 36, and 54 months after enrolment. Participants stood still for 120 s, eyes open and arms by their side. Postural dynamics were measured using metrics derived from a single tri-axial accelerometer (Axivity AX3, York, UK) on the lower back. Accelerometry metrics included jerk (derivative of acceleration), root mean square, frequency, and ellipsis (acceleration area). Cognition was evaluated by neuropsychological tests including the Montreal Cognitive Assessment (MoCA) and digit span. There was a significant decrease in accelerometry parameters, greater in the anteroposterior direction, and a decline in cognitive function over time. Accelerometry metrics were positively correlated with lower cognitive function and increased geriatric depression score and negatively associated with a qualitative measure of balance confidence. In conclusion, people with PD showed reduced postural dynamics that may represent a postural safety strategy. Associations with cognitive function and depression, both symptoms that may pre-empt motor symptoms, suggest shared neural pathways. Further studies, involving neuroimaging, may determine how these postural parameters relate to underlying neural and clinical correlates.
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Affiliation(s)
- Annette Pantall
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom
| | - Piriya Suresparan
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom
| | - Leanne Kapa
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom
| | - Rosie Morris
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom.,Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Alison Yarnall
- The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Silvia Del Din
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom.,The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Tan JL, Perera T, McGinley JL, Yohanandan SAC, Brown P, Thevathasan W. Neurophysiological analysis of the clinical pull test. J Neurophysiol 2018; 120:2325-2333. [PMID: 30110235 DOI: 10.1152/jn.00789.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Postural reflexes are impaired in conditions such as Parkinson's disease, leading to difficulty walking and falls. In clinical practice, postural responses are assessed using the "pull test," where an examiner tugs the prewarned standing patient backward at the shoulders and grades the response. However, validity of the pull test is debated, with issues including scaling and variability in administration and interpretation. It is unclear whether to assess the first trial or only subsequent repeated trials. The ecological relevance of a forewarned backward challenge is also debated. We therefore developed an instrumented version of the pull test to characterize responses and clarify how the test should be performed and interpreted. In 33 healthy participants, "pulls" were manually administered and pull force measured. Trunk and step responses were assessed with motion tracking. We probed for the StartReact phenomenon (where preprepared responses are released early by a startling stimulus) by delivering concurrent normal or "startling" auditory stimuli. We found that the first pull triggers a different response, including a larger step size suggesting more destabilization. This is consistent with "first trial effects," reported by platform translation studies, where movement execution appears confounded by startle reflex-like activity. Thus, first pull test trials have clinical relevance and should not be discarded as practice. Supportive of ecological relevance, responses to repeated pulls exhibited StartReact, as previously reported with a variety of other postural challenges, including those delivered with unexpected timing and direction. Examiner pull force significantly affected the postural response, particularly the size of stepping. NEW & NOTEWORTHY We characterized postural responses elicited by the clinical "pull test" using instrumentation. The first pull triggers a different response, including a larger step size suggesting more destabilization. Thus, first trials likely have important clinical and ecological relevance and should not be discarded as practice. Responses to repeated pulls can be accelerated with a startling stimulus, as reported with a variety of other challenges. Examiner pull force was a significant factor influencing the postural response.
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Affiliation(s)
- Joy Lynn Tan
- Department of Medical Bionics, The University of Melbourne , Parkville, Victoria , Australia.,Department of Neurology, The Royal Melbourne Hospital , Parkville, Victoria , Australia
| | - Thushara Perera
- Department of Medical Bionics, The University of Melbourne , Parkville, Victoria , Australia.,The Bionics Institute, East Melbourne, Victoria , Australia
| | - Jennifer L McGinley
- The Bionics Institute, East Melbourne, Victoria , Australia.,Department of Physiotherapy, The University of Melbourne , Parkville, Victoria , Australia
| | | | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit and Nuffield Department of Clinical Neurosciences, University of Oxford , Oxford , United Kingdom
| | - Wesley Thevathasan
- Department of Neurology, The Royal Melbourne Hospital , Parkville, Victoria , Australia.,The Bionics Institute, East Melbourne, Victoria , Australia.,Department of Medicine, The University of Melbourne , Parkville, Victoria , Australia
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