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Mustile M, Kourtis D, Ladouce S, Edwards MG, Volpe D, Pilleri M, Pelosin E, Donaldson DI, Ietswaart M. Investigating the Brain Mechanisms of Externally Cued Sit-to-Stand Movement in Parkinson's Disease. Mov Disord 2024. [PMID: 38984716 DOI: 10.1002/mds.29889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/01/2024] [Accepted: 05/28/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND One of the more challenging daily-life actions for Parkinson's disease patients is starting to stand from a sitting position. Parkinson's disease patients are known to have difficulty with self-initiated movements and benefit from external cues. However, the brain processes underlying external cueing as an aid remain unknown. The advent of mobile electroencephalography (EEG) now enables the investigation of these processes in dynamic sit-to-stand movements. OBJECTIVE To identify cortical correlates of the mechanisms underlying auditory cued sit-to-stand movement in Parkinson's disease. METHODS Twenty-two Parkinson's disease patients and 24 healthy age-matched participants performed self-initiated and externally cued sit-to-stand movements while cortical activity was recorded through 32-channel mobile EEG. RESULTS Overall impaired integration of sensory and motor information can be seen in the Parkinson's disease patients exhibiting less modulation in the θ band during movement compared to healthy age-matched controls. How Parkinson's disease patients use external cueing of sit-to-stand movements can be seen in larger high β power over sensorimotor brain areas compared to healthy controls, signaling sensory integration supporting the maintenance of motor output. This appears to require changes in cognitive processing to update the motor plan, reflected in frontal θ power increases in Parkinson's disease patients when cued. CONCLUSION These findings provide the first neural evidence for why and how cueing improves motor function in sit-to-stand movement in Parkinson's disease. The Parkinson's disease patients' neural correlates indicate that cueing induces greater activation of motor cortical areas supporting the maintenance of a more stable motor output, but involves the use of cognitive resources to update the motor plan. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Magda Mustile
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
- The Psychological Sciences Research Institute, University of Louvain, Louvain-la-Neuve, Belgium
| | - Dimitrios Kourtis
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Simon Ladouce
- Brain and Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Martin G Edwards
- The Psychological Sciences Research Institute, University of Louvain, Louvain-la-Neuve, Belgium
| | - Daniele Volpe
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
| | - Manuela Pilleri
- Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Genoa, Italy
- IRCCS, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - David I Donaldson
- School of Psychology and Neuroscience, University of St Andrews, St. Andrews, United Kingdom
| | - Magdalena Ietswaart
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
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Kim J, Rider JV, Zinselmeier A, Chiu YF, Peterson D, Longhurst JK. Dual-task gait has prognostic value for cognitive decline in Parkinson's disease. J Clin Neurosci 2024; 126:101-107. [PMID: 38865942 DOI: 10.1016/j.jocn.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/31/2024] [Accepted: 06/07/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Cognitive decline frequently occurs in individuals with Parkinson's disease (PD), but the clinical methods to predict the onset of cognitive changes are limited. Given preliminary evidence of the link between gait and cognition, the purpose of this study was to determine if dual task (DT) gait was related to declines in cognition over two years in PD. METHODS A retrospective two-year longitudinal study of 48 individuals with PD using data from the Parkinson's Progression Markers Initiative of the Michael J. Fox Foundation. The following data were extracted at baseline: spatiotemporal gait (during single and DT), demographics (age, sex), PD disease duration (time since diagnosis), motor function (Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS)), and cognition (Montreal Cognitive Assessment (MoCA)), with MoCA scores also extracted after two years. RESULTS A binomial logistic regression was conducted, with all covariates (above) in block 1 and DT effect (DTE) of gait characteristics in block 2 entered in a stepwise fashion. The final model was statistically significant (χ2(6) = 23.20, p < 0.001) and correctly classified 78.7 % of participants by cognitive status after two years. Only DTE of arm swing asymmetry (ASA) (p = 0.030) was included in block 2 such that a 1 % decline in DTE resulted in 1.6 % increased odds of cognitive decline. CONCLUSIONS Individuals with greater change in arm swing asymmetry from single to DT gait may be more likely to experience a decline in cognition within two years. These results suggested that reduced automaticity or poor utilization of attentional resources may be indicative of subtle changes in cognition and indicate that DT paradigms may hold promise as a marker of future cognitive decline.
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Affiliation(s)
- Jemma Kim
- Department of Physical Therapy, University of Delaware, 540 South College Avenue Suite 210 Newark, 19713, DE, USA; Department of Physical Therapy and Athletic Training, Saint Louis University, 3437 Caroline Street, St. Louis 63103, MO, USA.
| | - John V Rider
- School of Occupational Therapy, Touro University Nevada, 874 American Pacific Drive, Henderson 89014, Nevada, USA.
| | - Anne Zinselmeier
- Department of Physical Therapy and Athletic Training, Saint Louis University, 3437 Caroline Street, St. Louis 63103, MO, USA.
| | - Yi-Fang Chiu
- Department of Speech, Language, and Hearing Sciences, Saint Louis University, 3750 Lindell Blvd., St. Louis 63103, MO, USA.
| | - Daniel Peterson
- College of Health Solutions, Arizona State University, 550 N 3rd Street Suite 501, Phoenix, Tempe 85004, AZ, USA.
| | - Jason K Longhurst
- Department of Physical Therapy and Athletic Training, Saint Louis University, 3437 Caroline Street, Suite 1011, St. Louis 63103, MO, USA.
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Timm EC, Purcell NL, Ouyang B, Berry-Kravis E, Hall DA, O’Keefe JA. Potential Prodromal Digital Postural Sway Markers for Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS) Detected via Dual-Tasking and Sensory Manipulation. SENSORS (BASEL, SWITZERLAND) 2024; 24:2586. [PMID: 38676203 PMCID: PMC11054629 DOI: 10.3390/s24082586] [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: 03/14/2024] [Revised: 03/27/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
FXTAS is a neurodegenerative disorder occurring in some Fragile X Messenger Ribonucleoprotein 1 (FMR1) gene premutation carriers (PMCs) and is characterized by cerebellar ataxia, tremor, and cognitive deficits that negatively impact balance and gait and increase fall risk. Dual-tasking (DT) cognitive-motor paradigms and challenging balance conditions may have the capacity to reveal markers of FXTAS onset. Our objectives were to determine the impact of dual-tasking and sensory and stance manipulation on balance in FXTAS and potentially detect subtle postural sway deficits in FMR1 PMCs who are asymptomatic for signs of FXTAS on clinical exam. Participants with FXTAS, PMCs without FXTAS, and controls underwent balance testing using an inertial sensor system. Stance, vision, surface stability, and cognitive demand were manipulated in 30 s trials. FXTAS participants had significantly greater total sway area, jerk, and RMS sway than controls under almost all balance conditions but were most impaired in those requiring vestibular control. PMCs without FXTAS had significantly greater RMS sway compared with controls in the feet apart, firm, single task conditions both with eyes open and closed (EC) and the feet together, firm, EC, DT condition. Postural sway deficits in the RMS postural sway variability domain in asymptomatic PMCs might represent prodromal signs of FXTAS. This information may be useful in providing sensitive biomarkers of FXTAS onset and as quantitative balance measures in future interventional trials and longitudinal natural history studies.
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Affiliation(s)
- Emily C. Timm
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
| | - Nicollette L. Purcell
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
| | - Elizabeth Berry-Kravis
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - Deborah A. Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
| | - Joan Ann O’Keefe
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA; (E.C.T.); (E.B.-K.)
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA; (B.O.); (D.A.H.)
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Zhang T, Meng DT, Lyu DY, Fang BY. The Efficacy of Wearable Cueing Devices on Gait and Motor Function in Parkinson Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2024; 105:369-380. [PMID: 37532166 DOI: 10.1016/j.apmr.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE To summarize the efficacy of wearable cueing devices for improving gait and motor function of patients with Parkinson disease (PWP). DATA SOURCES PubMed, Embase, and Cochrane CENTRAL databases were searched for papers published in English, from inception to October 23, 2022. STUDY SELECTION Randomized controlled trials focusing on the effects of wearable cueing devices on gait and motor function in PWP were included. DATA EXTRACTION Two reviewers independently selected articles and extracted the data. The Cochrane Bias Risk Assessment Tool was used to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the quality of evidence. DATA SYNTHESIS Seven randomized controlled trials with 167 PWP were included in the meta-analysis. Significant effect of wearable cueing devices on walking speed (mean difference [MD]=0.07 m/s, 95% confidence interval [CI]: [0.05, 0.09], P<.00001) was detected; however, after sensitivity analysis, no significant overall effect on walking speed was noted (MD=0.04 m/s, 95% CI: [-0.03, 0.12], P=.25). No significant improvements were found in stride length (MD=0.06 m, 95% CI: [0.00, 0.13], P=.05), the Unified Parkinson's Disease Rating Scale-III score (MD=-0.61, 95% CI: [-4.10, 2.88], P=.73), Freezing of Gait Questionnaire score (MD=-0.83, 95% CI: [-2.98, 1.33], P=.45), or double support time (MD=-0.91, 95% CI: [-3.09, 1.26], P=.41). Evidence was evaluated as low quality. CONCLUSIONS Wearable cueing devices may result in an immediate improvement on walking speed; however, there is no evidence that their use results in a significant improvement in other gait or motor functions.
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Affiliation(s)
- Tian Zhang
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - De-Tao Meng
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Di-Yang Lyu
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Bo-Yan Fang
- Parkinson Medical Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China.
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Li D, Hallack A, Gwilym S, Li D, Hu MT, Cantley J. Investigating gait-responsive somatosensory cueing from a wearable device to improve walking in Parkinson's disease. Biomed Eng Online 2023; 22:108. [PMID: 37974260 PMCID: PMC10652624 DOI: 10.1186/s12938-023-01167-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023] Open
Abstract
Freezing-of-gait (FOG) and impaired walking are common features of Parkinson's disease (PD). Provision of external stimuli (cueing) can improve gait, however, many cueing methods are simplistic, increase task loading or have limited utility in a real-world setting. Closed-loop (automated) somatosensory cueing systems have the potential to deliver personalised, discrete cues at the appropriate time, without requiring user input. Further development of cue delivery methods and FOG-detection are required to achieve this. In this feasibility study, we aimed to test if FOG-initiated vibration cues applied to the lower-leg via wearable devices can improve gait in PD, and to develop real-time FOG-detection algorithms. 17 participants with Parkinson's disease and daily FOG were recruited. During 1 h study sessions, participants undertook 4 complex walking circuits, each with a different intervention: continuous rhythmic vibration cueing (CC), responsive cueing (RC; cues initiated by the research team in response to FOG), device worn with no cueing (NC), or no device (ND). Study sessions were grouped into 3 stages/blocks (A-C), separated by a gap of several weeks, enabling improvements to circuit design and the cueing device to be implemented. Video and onboard inertial measurement unit (IMU) data were analyzed for FOG events and gait metrics. RC significantly improved circuit completion times demonstrating improved overall performance across a range of walking activities. Step frequency was significantly enhanced by RC during stages B and C. During stage C, > 10 FOG events were recorded in 45% of participants without cueing (NC), which was significantly reduced by RC. A machine learning framework achieved 83% sensitivity and 80% specificity for FOG detection using IMU data. Together, these data support the feasibility of closed-loop cueing approaches coupling real-time FOG detection with responsive somatosensory lower-leg cueing to improve gait in PD.
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Affiliation(s)
- Dongli Li
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX2 3PT, UK
| | - Andre Hallack
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX2 3PT, UK
| | - Sophie Gwilym
- Oxfordshire Neurophysiotherapy, The Bosworth Clinic, Quarry Court, Bell Lane, Cassington, OX29 4DS, UK
| | - Dongcheng Li
- Department of Computer Science, University of Texas at Dallas, Richardson, TX, 75082, USA
| | - Michele T Hu
- Oxford Parkinson's Disease Centre, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, Division of Neurology, University of Oxford, Oxford, Oxfordshire, UK
| | - James Cantley
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford, OX2 3PT, UK.
- Division of Systems Medicine, Ninewells Hospital & Medical School, University of Dundee, James Arrott Drive, Dundee, DD1 9SY, UK.
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Sousani M, Rojas RF, Preston E, Ghahramani M. Toward a Multi-Modal Brain-Body Assessment in Parkinson's Disease: A Systematic Review in fNIRS. IEEE J Biomed Health Inform 2023; 27:4840-4853. [PMID: 37639416 DOI: 10.1109/jbhi.2023.3308901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Parkinson's disease (PD) causes impairments in cortical structures leading to motor and cognitive symptoms. While common disease management and treatment strategies mainly depend on the subjective assessment of clinical scales and patients' diaries, research in recent years has focused on advances in automatic and objective tools to help with diagnosing PD and determining its severity. Due to the link between brain structure deficits and physical symptoms in PD, objective brain activity and body motion assessment of patients have been studied in the literature. This study aimed to explore the relationship between brain activity and body motion measures of people with PD to look at the feasibility of diagnosis or assessment of PD using these measures. In this study, we summarised the findings of 24 selected papers from the complete literature review using the Scopus database. Selected studies used both brain activity recording using functional near-infrared spectroscopy (fNIRS) and motion assessment using sensors for people with PD in their experiments. Results include 1) the most common study protocol is a combination of single tasks. 2) Prefrontal cortex is mostly studied region of interest in the literature. 3) Oxygenated haemoglobin (HbO 2) concentration is the predominant metric utilised in fNIRS, compared to deoxygenated haemoglobin (HHb). 4) Motion assessment in people with PD is mostly done with inertial measurement units (IMUs) and electronic walkway. 5) The relationship between brain activity and body motion measures is an important factor that has been neglected in the literature.
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Tosserams A, Bloem BR, Nonnekes J. Compensation Strategies for Gait Impairments in Parkinson's Disease: From Underlying Mechanisms to Daily Clinical Practice. Mov Disord Clin Pract 2023; 10:S56-S62. [PMID: 37637990 PMCID: PMC10448134 DOI: 10.1002/mdc3.13616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/22/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anouk Tosserams
- Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
| | - Jorik Nonnekes
- Department of Rehabilitation, Center of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreNijmegenThe Netherlands
- Department of RehabilitationSint MaartenskliniekNijmegenThe Netherlands
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Wu Y, Dong Y, Tang Y, Wang W, Bo Y, Zhang C. Relationship between motor performance and cortical activity of older neurological disorder patients with dyskinesia using fNIRS: A systematic review. Front Physiol 2023; 14:1153469. [PMID: 37051020 PMCID: PMC10083370 DOI: 10.3389/fphys.2023.1153469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Neurological disorders with dyskinesia would seriously affect older people’s daily activities, which is not only associated with the degeneration or injury of the musculoskeletal or the nervous system but also associated with complex linkage between them. This study aims to review the relationship between motor performance and cortical activity of typical older neurological disorder patients with dyskinesia during walking and balance tasks.Methods: Scopus, PubMed, and Web of Science databases were searched. Articles that described gait or balance performance and cortical activity of older Parkinson’s disease (PD), multiple sclerosis, and stroke patients using functional near-infrared spectroscopy were screened by the reviewers. A total of 23 full-text articles were included for review, following an initial yield of 377 studies.Results: Participants were mostly PD patients, the prefrontal cortex was the favorite region of interest, and walking was the most popular test motor task, interventional studies were four. Seven studies used statistical methods to interpret the relationship between motor performance and cortical activation. The motor performance and cortical activation were simultaneously affected under difficult walking and balance task conditions. The concurrent changes of motor performance and cortical activation in reviewed studies contained the same direction change and different direction change.Conclusion: Most of the reviewed studies reported poor motor performance and increased cortical activation of PD, stroke and multiple sclerosis older patients. The external motor performance such as step speed were analyzed only. The design and results were not comprehensive and profound. More than 5 weeks walking training or physiotherapy can contribute to motor function promotion as well as cortices activation of PD and stroke patients. Thus, further study is needed for more statistical analysis on the relationship between motor performance and activation of the motor-related cortex. More different type and program sports training intervention studies are needed to perform.
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Affiliation(s)
- Yunzhi Wu
- Graduate School, Shandong Sport University, Jinan, Shandong, China
| | - Yuqi Dong
- Graduate School, Shandong Sport University, Jinan, Shandong, China
| | - Yunqi Tang
- College of Art and Design, Shaanxi University of Science and Technology, Xi’an, Shaanxi, China
| | - Weiran Wang
- Graduate School, Shandong Sport University, Jinan, Shandong, China
| | - Yulong Bo
- Graduate School, Shandong Sport University, Jinan, Shandong, China
| | - Cui Zhang
- Graduate School, Shandong Sport University, Jinan, Shandong, China
- Laboratory of Sports Biomechanics, Shandong Institute of Sport Science, Jinan, Shandong, China
- *Correspondence: Cui Zhang,
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Does Cueing Need Attention? A Pilot Study in People with Parkinson's Disease. Neuroscience 2022; 507:36-51. [PMID: 36368603 DOI: 10.1016/j.neuroscience.2022.10.023] [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: 06/12/2022] [Revised: 10/03/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
We previously showed that both open-loop (beat of a metronome) and closed-loop (phase-dependent tactile feedback) cueing may be similarly effective in reducing Freezing of Gait (FoG), assessed with a quantitative FoG Index, while turning in place in the laboratory in a group of people with Parkinson's disease (PD). Despite the similar changes on the FoG Index, it is not known whether both cueing responses require attentional control, which would explain FoG Index improvement. The mechanisms underlying cueing responses are poorly understood. Here, we tested the hypothesis that the salience network would predict responsiveness (i.e., FoG Index improvement) to open-loop and closed-loop cueing in people with and without FoG of PD, as salience network contributes to tasks requiring attention to external stimuli in healthy adults. Thirteen people with PD with high-quality imaging data were analyzed to characterize relationships between resting-state MRI functional connectivity and responses to cues. The interaction of the salience network and retrosplenial-temporal networks was the best predictor of responsiveness to open-loop cueing, presenting the largest effect size (d = 1.16). The interaction between the salience network and subcortical as well as cingulo-parietal and subcortical networks were the strongest predictors of responsiveness to closed-loop cueing, presenting the largest effect sizes (d = 1.06 and d = 0.84, respectively). Salience network activity was a common predictor of responsiveness to both cueing, which suggests that auditory and proprioceptive stimuli during turning may require some level of cognitive and insular activity, anchored within the salience network, which explain FoG Index improvements in people with PD.
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Kang SH, Kim J, Lee J, Koh SB. Mild cognitive impairment is associated with poor gait performance in patients with Parkinson’s disease. Front Aging Neurosci 2022; 14:1003595. [PMID: 36268193 PMCID: PMC9577227 DOI: 10.3389/fnagi.2022.1003595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
Cognitive impairment may be commonly accompanied by gait disturbance in patients with Parkinson’s disease (PD). However, it is still controversial whether gait disturbance is associated with mild cognitive impairment (MCI) and which cognitive function has a more important effect on specific gait parameter. Our objective was to investigate the association of gait parameters with MCI and the correlation between performance on comprehensive neuropsychological tests and gait parameters in PD patients. We enrolled 257 patients with de novo PD (111 PD-normal cognition and 146 PD-MCI). All patients underwent comprehensive neuropsychological tests and gait evaluation using the GAITRite system. We used logistic regression analysis and partial correlation to identify the association between gait parameters and MCI and correlations between neuropsychological performance and gait parameters. Gait velocity (odds ratio [OR] = 0.98, 95% confidence interval [CI] = 0.97−0.99) and stride length (OR = 0.98; 95% CI = 0.97−0.99) were associated with MCI in patients with PD. Specifically, gait velocity, stride length, and double support ratio were only associated with attention and frontal-executive function performance in patients with PD. Our findings provide insight into the relationship between gait disturbance and MCI in patients with PD. Furthermore, the evaluation of gait disturbance is necessary for PD patients with cognitive impairment.
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Das J, Vitorio R, Butterfield A, Morris R, Graham L, Barry G, McDonald C, Walker R, Mancini M, Stuart S. Visual Cues for Turning in Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22186746. [PMID: 36146096 PMCID: PMC9502260 DOI: 10.3390/s22186746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/22/2022] [Accepted: 08/31/2022] [Indexed: 05/07/2023]
Abstract
Turning is a common impairment of mobility in people with Parkinson’s disease (PD), which increases freezing of gait (FoG) episodes and has implications for falls risk. Visual cues have been shown to improve general gait characteristics in PD. However, the effects of visual cues on turning deficits in PD remains unclear. We aimed to (i) compare the response of turning performance while walking (180° and 360° turns) to visual cues in people with PD with and without FoG; and (ii) examine the relationship between FoG severity and response to visual cues during turning. This exploratory interventional study measured turning while walking in 43 participants with PD (22 with self-reported FoG) and 20 controls using an inertial sensor placed at the fifth lumbar vertebrae region. Participants walked straight and performed 180° and 360° turns midway through a 10 m walk, which was done with and without visual cues (starred pattern). The turn duration and velocity response to visual cues were assessed using linear mixed effects models. People with FoG turned slower and longer than people with PD without FoG and controls (group effect: p < 0.001). Visual cues reduced the velocity of turning 180° across all groups and reduced the velocity of turning 360° in people with PD without FoG and controls. FoG severity was not significantly associated with response to visual cues during turning. Findings suggest that visual cueing can modify turning during walking in PD, with response influenced by FoG status and turn amplitude. Slower turning in response to visual cueing may indicate a more cautious and/or attention-driven turning pattern. This study contributes to our understanding of the influence that cues can have on turning performance in PD, particularly in freezers, and will aid in their therapeutic application.
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Affiliation(s)
- Julia Das
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK
| | - Rodrigo Vitorio
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK
| | - Allissa Butterfield
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK
| | - Rosie Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK
| | - Lisa Graham
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK
| | - Gill Barry
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK
| | - Claire McDonald
- Gateshead Health NHS Foundation Trust, Gateshead NE8 2PJ, UK
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle NE1 8ST, UK
- Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK
- Correspondence: ; Tel.: +44-(0)-1912273343
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Yogev-Seligmann G, Krasovsky T, Kafri M. Compensatory movement strategies differentially affect attention allocation and gait parameters in persons with Parkinson’s disease. Front Hum Neurosci 2022; 16:943047. [PMID: 36061510 PMCID: PMC9433535 DOI: 10.3389/fnhum.2022.943047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022] Open
Abstract
Persons with Parkinson’s disease (PwP) are advised to use compensatory strategies such as external cues or cognitive movement strategies to overcome gait disturbances. It is suggested that external cues involve the processing of sensory stimulation, while cognitive-movement strategies use attention allocation. This study aimed to compare over time changes in attention allocation in PwP between prolonged walking with cognitive movement strategy and external cues; to compare the effect of cognitive movement strategies and external cues on gait parameters; and evaluate whether these changes depend on cognitive function. Eleven PwP participated in a single-group pilot study. Participants walked for 10 min under each of three conditions: natural walking, using external cuing, using a cognitive movement strategy. Attention and gait variables were extracted from a single-channel electroencephalogram and accelerometers recordings, respectively. Attention allocation was assessed by the% of Brain Engagement Index (BEI) signals within an attentive engagement range. Cognitive function was assessed using a neuropsychological battery. The walk was divided into 2-min time segments, and the results from each 2-min segment were used to determine the effects of time and condition. Associations between cognitive function and BEI signals were tested. Findings show that in the cognitive movement strategy condition, there was a reduction in the % of BEI signals within the attentive engagement range after the first 2 min of walking. Despite this reduction the BEI did not consistently differ from natural and metronome walking. Spatiotemporal gait variables were better in the cognitive movement strategy condition relative to the other conditions. Global cognitive and information processing scores were significantly associated with the BEI only when the cognitive movement strategy was applied. In conclusion, the study shows that a cognitive movement strategy has positive effects on gait variables but may impose a higher attentional load. Furthermore, when walking using a cognitive movement strategy, persons with higher cognitive function showed elevated attentive engagement. The findings support the idea that cognitive and attentional resources are required for cognitive movement strategies in PwP. Additionally, this study provides support for using single-channel EEG to explore mechanistic aspects of clinical interventions.
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Affiliation(s)
- Galit Yogev-Seligmann
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
- *Correspondence: Galit Yogev-Seligmann,
| | - Tal Krasovsky
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
- Department of Pediatric Rehabilitation, Sheba Medical Center, Edmond and Lily Safra Children’s Hospital, Ramat Gan, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
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13
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Kuan YC, Lin LF, Wang CY, Hu CC, Liang PJ, Lee SC. Association Between Turning Mobility and Cognitive Function in Chronic Poststroke. Front Neurol 2022; 13:772377. [PMID: 35280264 PMCID: PMC8904417 DOI: 10.3389/fneur.2022.772377] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Turning difficulties are common in patients with stroke. The detrimental effects of dual tasks on turning indicate a correlation between turning and cognition. Cognitive impairment is prevalent after stroke, and stroke patients with mild cognitive impairment had a poorer turning performance than did stroke patients with intact cognitive abilities. Therefore, we investigated the association between turning mobility and cognitive function in patients with chronic poststroke. Ninety patients with chronic stroke (>6 months post-stroke) were recruited. Angular velocity was assessed using wearable sensors during 180° walking turns and 360° turning on the spot from both sides. Global cognition and distinct cognitive domains were assessed using the Mini-Mental State Examination. In patients with stroke, turning mobility was significantly associated with global cognitive function and distinct cognitive domains, such as visuospatial ability and language. The balance function and lower limbs strength were mediators of the association between cognition and turning. The association highlights the complexity of the turning movement and dynamic motor and cognitive coordination necessary to safely complete a turn. However, our findings should be regarded as preliminary, and a thorough neuropsychological assessment to provide a valid description of distinct cognitive domains is required.
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Affiliation(s)
- Yi-Chun Kuan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Li-Fong Lin
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Taipei Medical University-Shuang-Ho Hospital, New Taipei City, Taiwan
| | - Chien-Yung Wang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Chia-Chen Hu
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Pei-Jung Liang
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Shu-Chun Lee
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
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14
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Tosserams A, Weerdesteyn V, Bal T, Bloem BR, Solis‐Escalante T, Nonnekes J. Cortical correlates of gait compensation strategies in Parkinson's disease. Ann Neurol 2022; 91:329-341. [PMID: 35067999 PMCID: PMC9306676 DOI: 10.1002/ana.26306] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/07/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022]
Abstract
Objective Gait impairment in persons with Parkinson disease is common and debilitating. Compensation strategies (eg, external cues) are an essential part of rehabilitation, but their underlying mechanisms remain unclear. Using electroencephalography (EEG), we explored the cortical correlates of 3 categories of strategies: external cueing, internal cueing, and action observation. Methods Eighteen participants with Parkinson disease and gait impairment were included. We recorded 126‐channel EEG during both stance and gait on a treadmill under 4 conditions: (1) uncued, (2) external cueing (listening to a metronome), (3) internal cueing (silent rhythmic counting), and (4) action observation (observing another person walking). To control for the effects of sensory processing of the cues, we computed relative power changes as the difference in power spectral density between walking and standing for each condition. Results Relative to uncued gait, the use of all 3 compensation strategies induced a decrease of beta band activity in sensorimotor areas, indicative of increased cortical activation. Parieto‐occipital alpha band activity decreased with external and internal cueing, and increased with action observation. Only internal cueing induced a change in frontal cortical activation, showing a decrease of beta band activity compared to uncued gait. Interpretation The application of compensation strategies resulted in changed cortical activity compared to uncued gait, which could not be solely attributed to sensory processing of the cueing modality. Our findings suggest there are multiple routes to control gait, and different compensation strategies seem to rely on different cortical mechanisms to achieve enhanced central motor activation in persons with Parkinson disease. ANN NEUROL 2022;91:329–341
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Affiliation(s)
- Anouk Tosserams
- Department of Neurology Radboud University Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour; Center of Expertise for Parkinson & Movement Disorders
- Department of Rehabilitation Radboud University Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour; Center of Expertise for Parkinson & Movement Disorders
| | - Vivian Weerdesteyn
- Department of Rehabilitation Radboud University Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour; Center of Expertise for Parkinson & Movement Disorders
| | - Tess Bal
- Department of Rehabilitation Radboud University Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour; Center of Expertise for Parkinson & Movement Disorders
| | - Bastiaan R. Bloem
- Department of Neurology Radboud University Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour; Center of Expertise for Parkinson & Movement Disorders
| | - Teodoro Solis‐Escalante
- Department of Rehabilitation Radboud University Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour; Center of Expertise for Parkinson & Movement Disorders
| | - Jorik Nonnekes
- Department of Rehabilitation Radboud University Medical Centre, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour; Center of Expertise for Parkinson & Movement Disorders
- Department of Rehabilitation Sint Maartenskliniek, Nijmegen The Netherlands
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15
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Kim H, Fraser S. Neural correlates of dual-task walking in people with central neurological disorders: a systematic review. J Neurol 2022; 269:2378-2402. [PMID: 34989867 DOI: 10.1007/s00415-021-10944-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND People with central neurological disorders experience difficulties with dual-task walking due to disease-related impairments. The objective of this review was to provide a comprehensive examination of the neural correlates (structural/functional brain changes) of dual-task walking in people with Parkinson's disease (PD), multiple sclerosis (MS), stroke, and Alzheimer's disease (AD). METHODS A systematic review of the literature was conducted, following PRISMA guidelines, on Medline, Embase, and Scopus. Included studies examined the relationship between structural and functional brain imaging and dual-task walking performance in people with PD, MS, stroke, and AD. Articles that met the inclusion criteria had baseline characteristics, study design, and behavioral and brain outcomes extracted. Twenty-three studies were included in this review. RESULTS Most structural imaging studies (75%) found an association between decreased brain integrity and poor dual-task performance. Specific brain regions that showed this association include the striatum regions and hippocampus in PD and supplementary motor area in MS. Functional imaging studies reported an association between increased prefrontal activity and maintained (compensatory recruitment) or decreased dual-task walking performance in PD and stroke. A subset (n = 2) of the stroke papers found no significant correlations. Increased supplementary motor area activity was associated with decreased performance in MS and stroke. No studies on AD were identified. CONCLUSION In people with PD, MS, and stroke, several neural correlates of dual-task walking have been identified, however, the direction of the association between neural and performance outcomes varied across the studies. The type of cognitive task used and presentation modality (e.g., visual) may have contributed to these mixed findings.
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Affiliation(s)
- Hyejun Kim
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, 125 University Private, Ottawa, ON, K1N 6N5, Canada
| | - Sarah Fraser
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON, K1N 7K4, Canada.
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16
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Park H, Shin S, Youm C, Cheon SM, Lee M, Noh B. Classification of Parkinson's disease with freezing of gait based on 360° turning analysis using 36 kinematic features. J Neuroeng Rehabil 2021; 18:177. [PMID: 34930373 PMCID: PMC8686361 DOI: 10.1186/s12984-021-00975-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Freezing of gait (FOG) is a sensitive problem, which is caused by motor control deficits and requires greater attention during postural transitions such as turning in people with Parkinson's disease (PD). However, the turning characteristics have not yet been extensively investigated to distinguish between people with PD with and without FOG (freezers and non-freezers) based on full-body kinematic analysis during the turning task. The objectives of this study were to identify the machine learning model that best classifies people with PD and freezers and reveal the associations between clinical characteristics and turning features based on feature selection through stepwise regression. METHODS The study recruited 77 people with PD (31 freezers and 46 non-freezers) and 34 age-matched older adults. The 360° turning task was performed at the preferred speed for the inner step of the more affected limb. All experiments on the people with PD were performed in the "Off" state of medication. The full-body kinematic features during the turning task were extracted using the three-dimensional motion capture system. These features were selected via stepwise regression. RESULTS In feature selection through stepwise regression, five and six features were identified to distinguish between people with PD and controls and between freezers and non-freezers (PD and FOG classification problem), respectively. The machine learning model accuracies revealed that the random forest (RF) model had 98.1% accuracy when using all turning features and 98.0% accuracy when using the five features selected for PD classification. In addition, RF and logistic regression showed accuracies of 79.4% when using all turning features and 72.9% when using the six selected features for FOG classification. CONCLUSION We suggest that our study leads to understanding of the turning characteristics of people with PD and freezers during the 360° turning task for the inner step of the more affected limb and may help improve the objective classification and clinical assessment by disease progression using turning features.
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Affiliation(s)
- Hwayoung Park
- Department of Health Sciences, The Graduate School of Dong-A University, Saha-gu, Busan, Republic of Korea
| | - Sungtae Shin
- Department of Mechanical Engineering, College of Engineering, Dong-A University, Saha-gu, Busan, Republic of Korea
| | - Changhong Youm
- Department of Health Sciences, The Graduate School of Dong-A University, Saha-gu, Busan, Republic of Korea.
- Department of Healthcare and Science, College of Health Sciences, Dong-A University, 37 Nakdong‑Daero, 550 Beon‑gil, Hadan 2-dong, Saha-gu, Busan, 49315, Republic of Korea.
| | - Sang-Myung Cheon
- Department of Neurology, School of Medicine, Dong-A University, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea.
| | - Myeounggon Lee
- Department of Health and Human Performance, Center for Neuromotor and Biomechanics Research, University of Houston, Houston, TX, USA
| | - Byungjoo Noh
- Department of Kinesiology, Jeju National University, Jeju-si, Jeju-do, Republic of Korea
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17
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Lin JP, Feng HS, Zhai H, Shen X. Cerebral Hemodynamic Responses to the Difficulty Level of Ambulatory Tasks in Patients With Parkinson's Disease: A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2021; 35:755-768. [PMID: 34171982 DOI: 10.1177/15459683211028548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Ambulatory tasks are the important components of balance training which effectively improve postural stability and functional activities in persons with Parkinson's disease (PD). The difficulty level of an ambulatory task is usually set in the form of attention, direction, speed, or amplitude requirement. Objectives. This study aimed to explore the neural mechanisms of cerebral hemodynamic responses to the difficulty level of ambulatory tasks in persons with PD. Methods. We included ten studies that examined cerebral hemodynamic responses during ambulatory tasks at different difficulty levels in persons with PD. The change in hemodynamic responses was synthesized and meta-analyzed. Results. Patients during "ON" medication had higher relative change in oxygenated hemoglobin (ΔHBO2) in the prefrontal cortex in response to difficulty levels of ambulatory tasks, which is comparable to that in healthy elderly individuals. However, patients during "OFF" medication did not show cortical activation in response to difficulty levels. During the lower-difficulty tasks, patients during "ON" medication demonstrated higher ΔHBO2 than healthy elderly participants and patients during "OFF" medication. Factors found to significantly contribute to the heterogeneity across studies included subjects' type and cognitive status, task duration, setting, and filter used for functional near-infrared spectroscopy (fNIRS) data pre-processing. Conclusions. The findings suggest that ambulatory task at a higher difficulty level could be necessary to train the cortical capacity of PD persons, which should be conducted during "ON" medication; meanwhile, the contributing factors to the heterogeneity of studies would be useful as a reference when designing comparable fNIRS studies.
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Affiliation(s)
- Jin P Lin
- 540176School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Hong S Feng
- 12476Tongji University School of Medicine, Shanghai, China
| | - Hua Zhai
- 540176School of Kinesiology, Shanghai University of Sport, Shanghai, China.,435846Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Xia Shen
- 12476Tongji University School of Medicine, Shanghai, China.,435846Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
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18
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Silva‐Batista C, Ragothaman A, Mancini M, Carlson‐Kuhta P, Harker G, Jung SH, Nutt JG, Fair DA, Horak FB, Miranda‐Domínguez O. Cortical thickness as predictor of response to exercise in people with Parkinson's disease. Hum Brain Mapp 2021; 42:139-153. [PMID: 33035370 PMCID: PMC7721225 DOI: 10.1002/hbm.25211] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022] Open
Abstract
We previously showed that dual-task cost (DTC) on gait speed in people with Parkinson's disease (PD) improved after 6 weeks of the Agility Boot Camp with Cognitive Challenge (ABC-C) exercise program. Since deficits in dual-task gait speed are associated with freezing of gait and gray matter atrophy, here we performed preplanned secondary analyses to answer two questions: (a) Do people with PD who are freezers present similar improvements compared to nonfreezers in DTC on gait speed with ABC-C? (b) Can cortical thickness at baseline predict responsiveness to the ABC-C? The DTC from 39 freezers and 43 nonfreezers who completed 6 weeks of ABC-C were analyzed. A subset of 51 participants (21 freezers and 30 nonfreezers) with high quality imaging data were used to characterize relationships between baseline cortical thickness and delta (Δ) DTC on gait speed following ABC-C. Freezers showed larger ΔDTC on gait speed than nonfreezers with ABC-C program (p < .05). Cortical thickness in visual and fronto-parietal areas predicted ΔDTC on gait speed in freezers, whereas sensorimotor-lateral thickness predicted ΔDTC on gait speed in nonfreezers (p < .05). When matched for motor severity, visual cortical thickness was a common predictor of response to exercise in all individuals, presenting the largest effect size. In conclusion, freezers improved gait automaticity even more than nonfreezers from cognitively challenging exercise. DTC on gait speed improvement was associated with larger baseline cortical thickness from different brain areas, depending on freezing status, but visual cortex thickness showed the most robust relationship with exercise-induced improvements in DTC.
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Affiliation(s)
- Carla Silva‐Batista
- Exercise Neuroscience Research GroupUniversity of São PauloSPBrazil
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | | | - Martina Mancini
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | | | - Graham Harker
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - Se Hee Jung
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Department of Rehabilitation MedicineSeoul National University Boramae Medical CenterSeoulRepublic of Korea
| | - John G. Nutt
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - Damien A Fair
- Department of Behavioral NeuroscienceOregon Health & Science UniversityPortlandOregonUSA
| | - Fay B. Horak
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- Veterans Affairs Portland Health Care System (VAPORHCS)PortlandOregonUSA
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19
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Ranchet M, Hoang I, Cheminon M, Derollepot R, Devos H, Perrey S, Luauté J, Danaila T, Paire-Ficout L. Changes in Prefrontal Cortical Activity During Walking and Cognitive Functions Among Patients With Parkinson's Disease. Front Neurol 2020; 11:601686. [PMID: 33362703 PMCID: PMC7758480 DOI: 10.3389/fneur.2020.601686] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Walking becomes more and more degraded as Parkinson's Disease (PD) progresses. Previous research examined factors contributing to this deterioration. Among them, changes in brain cortical activity during walking have been less studied in this clinical population. Objectives: This study aimed to: (1) investigate changes in dorsolateral prefrontal cortex (DLPFC) activation during usual walking and dual-task walking conditions in patients with PD; (2) examine the association between cortical activity and behavioral/cognitive outcomes; and (3) explore which factors best predict increased activation of the DLPFC during usual walking. Methods: Eighteen patients with early stage PD and 18 controls performed 4 conditions: (1) standing while subtracting, (2) usual walking, (3) walking while counting forward, and (4) walking while subtracting. Cortical activity in DLPFC, assessed by changes in oxy-hemoglobin (ΔHbO2) and deoxy-hemoglobin (ΔHbR), was measured using functional near infrared spectroscopy (fNIRS). Gait performance was recorded using wearables sensors. Cognition was also assessed using neuropsychological tests, including the Trail Making Test (TMT). Results: DLPFC activity was higher in patients compared to controls during both usual walking and walking while subtracting conditions. Patients had impaired walking performance compared to controls only during walking while subtracting task. Moderate-to-strong correlations between ΔHbO2 and coefficients of variation of all gait parameters were found for usual walking and during walking while counting forward conditions. Part-B of TMT predicted 21% of the variance of ΔHbO2 during usual walking after adjustment for group status. Conclusions: The increased DLPFC activity in patients during usual walking suggests a potential compensation for executive deficits. Understanding changes in DLPFC activity during walking may have implications for rehabilitation of gait in patients with PD.
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Affiliation(s)
- Maud Ranchet
- TS2-LESCOT, Univ Gustave Eiffel, IFSTTAR, Univ Lyon, Lyon, France
| | - Isabelle Hoang
- TS2-LESCOT, Univ Gustave Eiffel, IFSTTAR, Univ Lyon, Lyon, France
| | - Maxime Cheminon
- Service de Médecine Physique et de Réadaptation Neurologique, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Lyon, France
| | | | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Stephane Perrey
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mînes Ales, Montpellier, France
| | - Jacques Luauté
- Service de Médecine Physique et de Réadaptation Neurologique, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Lyon, France.,Inserm UMR-S 1028, CNRS UMR 529, ImpAct, Center de Recherche en Neurosciences de Lyon, Université Lyon-1, Bron, France.,Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Teodor Danaila
- Center de Neurosciences Cognitives, Service de Neurologie C, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
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20
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Vitorio R, Stuart S, Mancini M. Executive Control of Walking in People With Parkinson's Disease With Freezing of Gait. Neurorehabil Neural Repair 2020; 34:1138-1149. [PMID: 33155506 DOI: 10.1177/1545968320969940] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Walking abnormalities in people with Parkinson's disease (PD) are characterized by a shift in locomotor control from healthy automaticity to compensatory prefrontal executive control. Indirect measures of automaticity of walking (eg, step-to-step variability and dual-task cost) suggest that freezing of gait (FoG) may be associated with reduced automaticity of walking. However, the influence of FoG status on actual prefrontal cortex (PFC) activity during walking remains unclear. OBJECTIVE To investigate the influence of FoG status on automaticity of walking in people with PD. METHODS Forty-seven people with PD were distributed into 2 groups based on FoG status, which was assessed by the New Freezing of Gait Questionnaire: PD-FoG (n = 23; UPDRS-III = 35) and PD+FoG (n = 24; UPDRS-III = 43.1). Participants walked over a 9-m straight path (with a 180° turn at each end) for 80 seconds. Two conditions were tested off medication: single- and dual-task walking (ie, with a concomitant cognitive task). A portable functional near-infrared spectroscopy system recorded PFC activity while walking (including turns). Wearable inertial sensors were used to calculate spatiotemporal gait parameters. RESULTS PD+FoG had greater PFC activation during both single and dual-task walking than PD-FoG (P = .031). There were no differences in gait between PD-FoG and PD+FoG. Both groups decreased gait speed (P = .029) and stride length (P < .001) during dual-task walking compared with single-task walking. CONCLUSIONS These findings suggest that PD+FoG have reduced automaticity of walking, even in absence of FoG episodes. PFC activity while walking seems to be more sensitive than gait measures in identifying reduction in automaticity of walking in PD+FoG.
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Affiliation(s)
| | - Samuel Stuart
- Oregon Health & Science University, Portland, OR, USA.,Northumbria University, Newcastle upon Tyne, UK
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21
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Vieira-Yano B, Martini DN, Horak FB, de Lima-Pardini A, Almeida F, Santana VP, Lima D, Batista AX, Marquesini R, Lira J, Barbosa ER, Corcos DM, Ugrinowitsch C, Silva-Batista C. The Adapted Resistance Training with Instability Randomized Controlled Trial for Gait Automaticity. Mov Disord 2020; 36:152-163. [PMID: 32955752 DOI: 10.1002/mds.28298] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/06/2020] [Accepted: 08/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Deficits in the cerebellar locomotor region (CLR) have been associated with loss of gait automaticity in individuals with freezing of gait in Parkinson's disease (freezers); however, exercise interventions that restore gait automaticity in freezers are lacking. We evaluated the effects of the adapted resistance training with instability ([ARTI] complex exercises) compared with traditional motor rehabilitation (without complex exercises) on gait automaticity and attentional set-shifting. We also verified associations between gait automaticity change and CLR activation change previously published. METHODS Freezers were randomized either to the experimental group (ARTI, n = 17) or to the active control group (traditional motor rehabilitation, n = 15). Both training groups performed exercises 3 times a week for 12 weeks. Gait automaticity (dual-task and dual-task cost [DTC] on gait speed and stride length), single-task gait speed and stride length, attentional set-shifting (time between Trail Making Test parts B and A), and CLR activation during a functional magnetic resonance imaging protocol of simulated step initiation task were evaluated before and after interventions. RESULTS Both training groups improved gait parameters in single task (P < 0.05), but ARTI was more effective than traditional motor rehabilitation in improving DTC on gait speed, DTC on stride length, dual-task stride length, and CLR activation (P < 0.05). Changes in CLR activation were associated with changes in DTC on stride length (r = 0.68, P = 0.002) following ARTI. Only ARTI improved attentional set-shifting at posttraining (P < 0.05). CONCLUSIONS ARTI restores gait automaticity and improves attentional set-shifting in freezers attributed to the usage of exercises with high motor complexity. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Bianca Vieira-Yano
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil.,School of Arts, Sciences and Humanities, University of São Paulo, Sao Paulo, Brazil
| | - Douglas N Martini
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Fay B Horak
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Filipe Almeida
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil
| | - Vagner P Santana
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil
| | - Daniel Lima
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil
| | - Alana X Batista
- Department of Radiology, University of São Paulo, São Paulo, Brazil
| | - Raquel Marquesini
- Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Jumes Lira
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil.,Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Egberto R Barbosa
- Movement Disorders Clinic, Department of Neurology, School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
| | - Carlos Ugrinowitsch
- Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Carla Silva-Batista
- Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil.,School of Arts, Sciences and Humanities, University of São Paulo, Sao Paulo, Brazil.,Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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22
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Stuart S, Morris R, Giritharan A, Quinn J, Nutt JG, Mancini M. Prefrontal Cortex Activity and Gait in Parkinson's Disease With Cholinergic and Dopaminergic Therapy. Mov Disord 2020; 35:2019-2027. [PMID: 32830901 DOI: 10.1002/mds.28214] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 12/25/2022] Open
Abstract
Degradation of striatal dopamine in Parkinson's disease (PD) may initially be supplemented by increased cognitive control mediated by cholinergic mechanisms. Shift to cognitive control of walking can be quantified by prefrontal cortex activation. Levodopa improves certain aspects of gait and worsens others, and cholinergic augmentation influence on gait and prefrontal cortex activity remains unclear. This study examined dopaminergic and cholinergic influence on gait and prefrontal cortex activity while walking in PD. A single-site, randomized, double-blind crossover trial examined effects of levodopa and donepezil in PD. Twenty PD participants were randomized, and 19 completed the trial. Participants were randomized to either levodopa + donepezil (5 mg) or levodopa + placebo treatments, with 2 weeks with treatment and a 2-week washout. The primary outcome was change in prefrontal cortex activity while walking, and secondary outcomes were change in gait and dual-task performance and attention. Levodopa decreased prefrontal cortex activity compared with off medication (effect size, -0.51), whereas the addition of donepezil reversed this decrease. Gait speed and stride length under single- and dual-task conditions improved with combined donepezil and levodopa compared with off medication (effect size, 1 for gait speed and 0.75 for stride length). Dual-task reaction time was quicker with levodopa compared with off medication (effect size, -0.87), and accuracy improved with combined donepezil and levodopa (effect size, 0.47). Cholinergic therapy, specifically donepezil 5 mg/day for 2 weeks, can alter prefrontal cortex activity when walking and improve secondary cognitive task accuracy and gait in PD. Further studies will investigate whether higher prefrontal cortex activity while walking is associated with gait changes. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Samuel Stuart
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA.,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Rosie Morris
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA.,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Andrew Giritharan
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph Quinn
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - John G Nutt
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Martina Mancini
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
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23
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Miranda-Domínguez Ó, Ragothaman A, Hermosillo R, Feczko E, Morris R, Carlson-Kuhta P, Nutt JG, Mancini M, Fair D, Horak FB. Lateralized Connectivity between Globus Pallidus and Motor Cortex is Associated with Freezing of Gait in Parkinson's Disease. Neuroscience 2020; 443:44-58. [PMID: 32629155 DOI: 10.1016/j.neuroscience.2020.06.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 01/26/2023]
Abstract
Freezing of gait (FoG) is a brief, episodic absence or marked reduction of forward progression of the feet, despite the intention to walk, that is common in people with Parkinson's disease (PD). We hypothesized that not only motor, but higher level cognitive and attention areas may be impaired in freezers. In this study, we aimed to characterize differences in cortical and subcortical functional connectivity specific to FoG. We examined resting state neuroimaging and objective measures of FoG severity and gait from 103 individuals (28 PD + FoG, 36 PD - FoG and 39 healthy controls). Inertial sensors were used to quantify freezing severity and gait. Groups with and without FoG were matched on age, disease severity, cognitive status, and levodopa medication. MRI data was processed using surface-based registration. High-quality imaging data were used to characterize differences in connectivity specific to FoG using a pre-defined set of Regions of Interest (ROIs) and validated using whole-brain connectivity analysis. Associations between functional connectivity and objective measures of FoG were determined via predictive modeling using hold-out cross validation. We found that connectivity between the left globus pallidus (GP) and left somatosensory cortex and between two brain areas in the default and insular/vestibular networks exhibited significant differences specific to FoG and were also strong and significant predictors of FoG severity. Our findings suggest that the interplay among motor, default and vestibular areas of the left cortex are critical in the pathology of FoG.
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Affiliation(s)
- Óscar Miranda-Domínguez
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Anjanibhargavi Ragothaman
- Department of Biomedical Engineering, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Robert Hermosillo
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Eric Feczko
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Rosie Morris
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Patricia Carlson-Kuhta
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - John G Nutt
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Martina Mancini
- Department of Biomedical Engineering, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Damien Fair
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Advanced Imaging Research Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States
| | - Fay B Horak
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Biomedical Engineering, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States; Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States.
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24
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Park H, Youm C, Lee M, Noh B, Cheon SM. Turning Characteristics of the More-Affected Side in Parkinson's Disease Patients with Freezing of Gait. SENSORS 2020; 20:s20113098. [PMID: 32486303 PMCID: PMC7309092 DOI: 10.3390/s20113098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/16/2022]
Abstract
This study investigated the turning characteristics of the more-affected limbs in Parkinson's disease (PD) patients in comparison with that of a control group, and in PD patients with freezing of gait (FOG; freezers) in comparison with those without FOG (non-freezers) for 360° and 540° turning tasks at the maximum speed. A total of 12 freezers, 12 non-freezers, and 12 controls participated in this study. The PD patients showed significantly longer total durations, shorter inner and outer step lengths, and greater anterior-posterior (AP) root mean square (RMS) center of mass (COM) distances compared to those for the controls. The freezers showed significantly greater AP and medial-lateral (ML) RMS COM distances compared to those of non-freezers. The turning task toward the inner step of the more-affected side (IMA) in PD patients showed significantly greater step width, total steps, and AP and ML RMS COM distances than that toward the outer step of the more-affected side (OMA). The corresponding results for freezers revealed significantly higher total steps and shorter inner step length during the 540° turn toward the IMA than that toward the OMA. Therefore, PD patients and freezers exhibited greater turning difficulty in performing challenging turning tasks such as turning with an increased angle and speed and toward the more-affected side.
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Affiliation(s)
- Hwayoung Park
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Busan 49315, Korea; (H.P.); (M.L.)
| | - Changhong Youm
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Busan 49315, Korea; (H.P.); (M.L.)
- Department of Healthcare and Science, College of Health Sciences, Dong-A University, Busan 49315, Korea;
- Correspondence: ; Tel.: +82-51-200-7830; Fax: +82-51-200-7505
| | - Myeounggon Lee
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Busan 49315, Korea; (H.P.); (M.L.)
| | - Byungjoo Noh
- Department of Healthcare and Science, College of Health Sciences, Dong-A University, Busan 49315, Korea;
| | - Sang-Myung Cheon
- Department of Neurology, School of Medicine, Dong-A University, Dongdaesin-dong 3-ga, Seo-gu, Busan 49315, Korea;
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25
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Orcioli-Silva D, Vitório R, Nóbrega-Sousa P, da Conceição NR, Beretta VS, Lirani-Silva E, Gobbi LTB. Levodopa Facilitates Prefrontal Cortex Activation During Dual Task Walking in Parkinson Disease. Neurorehabil Neural Repair 2020; 34:589-599. [DOI: 10.1177/1545968320924430] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background. Although dopaminergic medication improves dual task walking in people with Parkinson disease (PD), the underlying neural mechanisms are not yet fully understood. As prefrontal cognitive resources are involved in dual task walking, evaluation of the prefrontal cortex (PFC) is required. Objective. To investigate the effect of dopaminergic medication on PFC activity and gait parameters during dual task walking in people with PD. Methods. A total of 20 individuals with PD (69.8 ± 5.9 years) and 30 healthy older people (68.0 ± 5.6 years) performed 2 walking conditions: single and dual task (walking while performing a digit vigilance task). A mobile functional near infrared spectroscopy system and an electronic sensor carpet were used to analyze PFC activation and gait parameters, respectively. Relative concentrations of oxygenated hemoglobin (HbO2) from the left and right PFC were measured. Results. People with PD in the off state did not present changes in HbO2 level in the left PFC across walking conditions. In contrast, in the on state, they presented increased HbO2 levels during dual task compared with single task. Regardless of medication state, people with PD presented increased HbO2 levels in the right PFC during dual task walking compared with single task. The control group demonstrated increased PFC activity in both hemispheres during dual task compared with single task. People with PD showed increases in both step length and velocity in the on state compared with the off state. Conclusions. PD limits the activation of the left PFC during dual task walking, and dopaminergic medication facilitates its recruitment.
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Affiliation(s)
- Diego Orcioli-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Rodrigo Vitório
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Priscila Nóbrega-Sousa
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Núbia Ribeiro da Conceição
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Victor Spiandor Beretta
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Ellen Lirani-Silva
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), São Paulo State University (UNESP), Rio Claro, Brazil
- Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
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