1
|
Norouzian P, Horslen BC, Martens KAE. The effects of trait and state anxiety on gait in healthy young adults. Exp Brain Res 2024:10.1007/s00221-024-06800-3. [PMID: 38456925 DOI: 10.1007/s00221-024-06800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024]
Abstract
Stable, personality-based (trait), and fluctuating, situational (state) anxiety have both been shown to consume attentional resources and reduce functional cognitive capacity, which may play a role in gait control. However, the role of attention in the relationship between trait and state anxiety has not yet been investigated formally. This study used a virtual reality-threat environment to evaluate whether changes in attention mediate the effects of state and trait anxiety on gait. Thirty adults aged 19-28 completed five walking trials in four conditions: (i) low threat-walking across a virtual plank (0.5 m wide) on flat ground; (ii) low threat + dual task (auditory digit monitoring); (iii) high threat-walking across a virtual plank elevated above a deep pit; and (iv) high threat + dual task. Trait anxiety levels were determined by the State-Trait Anxiety Inventory, while state anxiety was captured using self-assessment manikins. Higher trait anxiety predicted slower gait velocity and longer time in double support in the high-threat condition compared to low-threat condition (i vs iii), but not when dual tasking, compared to single-task walking, in the absence of threat (ii vs i). Additionally, higher trait anxiety predicted increased step length variability in the high compared to low-threat dual-task condition. Overall, trait anxiety predicts a slower, more cautious gait pattern during threatening conditions while dual tasking during the threat.
Collapse
Affiliation(s)
- Pershia Norouzian
- Neurocognition and Mobility Lab, Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, N2L3G1, Canada
| | - Brian C Horslen
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, N2L3G1, Canada
| | - Kaylena A Ehgoetz Martens
- Neurocognition and Mobility Lab, Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada.
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, N2L3G1, Canada.
| |
Collapse
|
2
|
Uno T, Matsuo T, Asano M, Loh PY. Effects of Simulated Visual Impairment Conditions on Movement and Anxiety during Gap Crossing. Healthcare (Basel) 2023; 12:42. [PMID: 38200948 PMCID: PMC10779388 DOI: 10.3390/healthcare12010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
This study investigated the effects of visual conditions associated with progressive eye disease on movement patterns and anxiety levels during gap-crossing tasks. Notably, 15 healthy young adults performed crossover platforms with a 10 cm gap at three different heights, namely equal (0 cm), raised (+15 cm), and lowered (-15 cm) levels, under four vision conditions, namely normal or corrected eyesight, 10° tunnel vision, 5° tunnel vision, and 5° tunnel vision with 0.04 occlusion. Leg movements during gap crossing were analyzed using three-dimensional motion analysis. The results highlighted a distinct motion pattern in the trajectories of participants' legs under the different visual conditions. Specifically, at the point where the gap-crossing movement began (D1), the normal or corrected eyesight conditions resulted in further separation between the steps compared with the other visual conditions. The highest point of the foot during movement (D2) did not differ between the visual conditions, except for the 0 cm step. Furthermore, anxiety levels, as quantified by the State-Trait Anxiety Inventory (STAI-S) questionnaire, were exacerbated under conditions of restricted visual information. In conclusion, visual impairments associated with progressive ocular diseases may perturb complex motor movement patterns, including those involved in gap-crossing tasks, with heightened anxiety potentially amplifying these disturbances.
Collapse
Affiliation(s)
- Tadashi Uno
- Center of Liberal Arts and Science, Sanyo-Onoda City University, Yamaguchi 756-0884, Japan
| | - Taihei Matsuo
- Graduate School of Design, Kyushu University, Fukuoka 815-8540, Japan;
| | - Masanari Asano
- Faculty of Humanity-Oriented Science and Engineering, Kindai University, Fukuoka 820-8555, Japan;
| | - Ping Yeap Loh
- Department of Life Design and Science, Faculty of Design, Kyushu University, Fukuoka 815-8540, Japan;
| |
Collapse
|
3
|
Tosserams A, Bloem BR, Ehgoetz Martens KA, Helmich RC, Kessels RPC, Shine JM, Taylor NL, Wainstein G, Lewis SJG, Nonnekes J. Modulating arousal to overcome gait impairments in Parkinson's disease: how the noradrenergic system may act as a double-edged sword. Transl Neurodegener 2023; 12:15. [PMID: 36967402 PMCID: PMC10040128 DOI: 10.1186/s40035-023-00347-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/28/2023] [Indexed: 03/28/2023] Open
Abstract
In stressful or anxiety-provoking situations, most people with Parkinson's disease (PD) experience a general worsening of motor symptoms, including their gait impairments. However, a proportion of patients actually report benefits from experiencing-or even purposely inducing-stressful or high-arousal situations. Using data from a large-scale international survey study among 4324 people with PD and gait impairments within the online Fox Insight (USA) and ParkinsonNEXT (NL) cohorts, we demonstrate that individuals with PD deploy an array of mental state alteration strategies to cope with their gait impairment. Crucially, these strategies differ along an axis of arousal-some act to heighten, whereas others diminish, overall sympathetic tone. Together, our observations suggest that arousal may act as a double-edged sword for gait control in PD. We propose a theoretical, neurobiological framework to explain why heightened arousal can have detrimental effects on the occurrence and severity of gait impairments in some individuals, while alleviating them in others. Specifically, we postulate that this seemingly contradictory phenomenon is explained by the inherent features of the ascending arousal system: namely, that arousal is related to task performance by an inverted u-shaped curve (the so-called Yerkes and Dodson relationship). We propose that the noradrenergic locus coeruleus plays an important role in modulating PD symptom severity and expression, by regulating arousal and by mediating network-level functional integration across the brain. The ability of the locus coeruleus to facilitate dynamic 'cross-talk' between distinct, otherwise largely segregated brain regions may facilitate the necessary cerebral compensation for gait impairments in PD. In the presence of suboptimal arousal, compensatory networks may be too segregated to allow for adequate compensation. Conversely, with supraoptimal arousal, increased cross-talk between competing inputs of these complementary networks may emerge and become dysfunctional. Because the locus coeruleus degenerates with disease progression, finetuning of this delicate balance becomes increasingly difficult, heightening the need for mental strategies to self-modulate arousal and facilitate shifting from a sub- or supraoptimal state of arousal to improve gait performance. Recognition of this underlying mechanism emphasises the importance of PD-specific rehabilitation strategies to alleviate gait disability.
Collapse
Affiliation(s)
- Anouk Tosserams
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department of Rehabilitation, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | | | - Rick C Helmich
- Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Roy P C Kessels
- Department of Neuropsychology and Rehabilitation Psychology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Medical Psychology and Radboudumc Alzheimer Center, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Vincent Van Gogh Institute for Psychiatry, Venray, The Netherlands
- Klimmendaal Rehabilitation Center, Arnhem, The Netherlands
| | - James M Shine
- Brain and Mind Centre, Parkinson's Disease Research Clinic, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
- Centre for Complex Systems, The University of Sydney, Camperdown, NSW, Australia
| | - Natasha L Taylor
- Brain and Mind Centre, Parkinson's Disease Research Clinic, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Gabriel Wainstein
- Brain and Mind Centre, Parkinson's Disease Research Clinic, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Simon J G Lewis
- Brain and Mind Centre, Parkinson's Disease Research Clinic, School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Jorik Nonnekes
- Department of Rehabilitation, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.
| |
Collapse
|
4
|
Togo H, Nakamura T, Wakasugi N, Takahashi Y, Hanakawa T. Interactions across emotional, cognitive and subcortical motor networks underlying freezing of gait. Neuroimage Clin 2023; 37:103342. [PMID: 36739790 PMCID: PMC9932566 DOI: 10.1016/j.nicl.2023.103342] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
Freezing of gait (FOG) is a gait disorder affecting patients with Parkinson's disease (PD) and related disorders. The pathophysiology of FOG is unclear because of its phenomenological complexity involving motor, cognitive, and emotional aspects of behavior. Here we used resting-state functional MRI to retrieve functional connectivity (FC) correlated with the New FOG questionnaire (NFOGQ) reflecting severity of FOG in 67 patients with PD. NFOGQ scores were correlated with FCs in the extended basal ganglia network (BGN) involving the striatum and amygdala, and in the extra-cerebellum network (CBLN) involving the frontoparietal network (FPN). These FCs represented interactions across the emotional (amygdala), subcortical motor (BGN and CBLN), and cognitive networks (FPN). Using these FCs as features, we constructed statistical models that explained 40% of the inter-individual variances of FOG severity and that discriminated between PD patients with and without FOG. The amygdala, which connects to the subcortical motor (BGN and CBLN) and cognitive (FPN) networks, may have a pivotal role in interactions across the emotional, cognitive, and subcortical motor networks. Future refinement of the machine learning-based classifier using FCs may clarify the complex pathophysiology of FOG further and help diagnose and evaluate FOG in clinical settings.
Collapse
Affiliation(s)
- Hiroki Togo
- Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Yoshida-Konoe, Sakyo-ku, Kyoto 606-8501, Japan; Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Tatsuhiro Nakamura
- Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Yoshida-Konoe, Sakyo-ku, Kyoto 606-8501, Japan; Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Noritaka Wakasugi
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Takashi Hanakawa
- Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Yoshida-Konoe, Sakyo-ku, Kyoto 606-8501, Japan; Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan.
| |
Collapse
|
5
|
After 55 Years of Neurorehabilitation, What Is the Plan? Brain Sci 2022; 12:brainsci12080982. [PMID: 35892423 PMCID: PMC9330852 DOI: 10.3390/brainsci12080982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/17/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
Neurological disorders often cause severe long-term disabilities with substantial activity limitations and participation restrictions such as community integration, family functioning, employment, social interaction and participation. Increasing understanding of brain functioning has opened new perspectives for more integrative interventions, boosting the intrinsic central nervous system neuroplastic capabilities in order to achieve efficient behavioral restitution. Neurorehabilitation must take into account the many aspects of the individual through a comprehensive analysis of actual and potential cognitive, behavioral, emotional and physical skills, while increasing awareness and understanding of the new self of the person being dealt with. The exclusive adoption by the rehabilitator of objective functional measures often overlooks the values and goals of the disabled person. Indeed, each individual has their own rhythm, unique life history and personality construct. In this challenging context, it is essential to deepen the assessment through subjective measures, which more adequately reflect the patient’s perspective in order to shape genuinely tailored instead of standardized neurorehabilitation approaches. In this overly complex panorama, where confounding and prognostic factors also strongly influence potential functional recovery, the healthcare community needs to rethink neurorehabilitation formats.
Collapse
|
6
|
Quek DYL, Economou K, MacDougall H, Lewis SJG, Ehgoetz Martens KA. The influence of visual feedback on alleviating freezing of gait in Parkinson's disease is reduced by anxiety. Gait Posture 2022; 95:70-75. [PMID: 35453086 DOI: 10.1016/j.gaitpost.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous research has established that anxiety is associated with freezing of gait (FOG) in Parkinson's disease (PD). Although providing body-related visual feedback has been previously suggested to improve FOG, it remains unclear whether anxiety-induced FOG might be improved. RESEARCH QUESTION The current study aimed to evaluate whether body-related visual feedback (VF) improves FOG consistently across low and high threat conditions. METHODS Sixteen PD patients with FOG were instructed to walk across a plank in a virtual environment that was either located on the ground (low threat) or elevated above a deep pit (high threat). Additionally, visual feedback (VF) was either provided (+) or omitted (-) using an avatar that was synchronised in real-time with the participants movements. RESULTS revealed that in the low threat condition (i.e., ground), %FOG was significantly reduced when VF was provided (VF+) compared to when VF was absent (VF-). In contrast, during the elevated high threat condition, there were no differences in %FOG regardless of whether VF was provided or not. SIGNIFICANCE These findings confirm that although VF can aid in the reduction of FOG, anxiety may interfere with freezers' ability to use sensory feedback to improve FOG and hence, in high threat conditions, VF was unable to aid in the reduction of FOG. Future studies should direct efforts towards the treatment of anxiety to determine whether better management of anxiety may improve FOG.
Collapse
Affiliation(s)
- Dione Y L Quek
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.
| | - Kristin Economou
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.
| | | | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia.
| | - Kaylena A Ehgoetz Martens
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia; Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada.
| |
Collapse
|
7
|
Thangavelu K, Hayward JA, Pachana NA, Byrne GJ, Mitchell LK, Wallis GM, Au TR, Dissanayaka NN. Designing Virtual Reality Assisted Psychotherapy for Anxiety in Older Adults Living with Parkinson's Disease: Integrating Literature for Scoping. Clin Gerontol 2022; 45:235-251. [PMID: 31903862 DOI: 10.1080/07317115.2019.1709597] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: This review integrates literature to discuss the potential use of virtual reality (VR) in treatment of anxiety in Parkinson's disease (PD) and inform next steps.Methods: A systematic search was performed to identify studies of VR use in PD, using four databases. Data were reported in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analyzes extension for Scoping Reviews (PRISMA-ScR).Results: Thirty-two studies met the inclusion criteria with four VR studies from the same study group directly assessing the effects of anxiety on motor symptoms in PD. Primary studies implementing a VR protocol in PD identified focus areas of understanding and alleviating freezing of gait (FOG), balance training, and cognitive and motor rehabilitation, and informed design considerations.Conclusion: VR in PD studies suggested established feasibility. With appropriate design considerations, a VR based protocol could improve anxiety outcomes in PD.Clinical implications: VR in PD provides control of a patient's field of view, which can be exploited to induce specific responses, provide visual feedback, analysis of patient actions, and introduce safe challenges in the context of training. VR assisted Cognitive Behavioral Therapy (CBT) tailored to suit subtypes of anxiety disorders in PD have the potential to improve the efficacy and effectiveness of psychotherapy in PD.
Collapse
Affiliation(s)
- Karthick Thangavelu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Joshua A Hayward
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Gerard J Byrne
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Mental Health Service, Royal Brisbane & Woman's Hospital, Brisbane, Australia
| | | | - Guy M Wallis
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Tiffany R Au
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,School of Psychology, The University of Queensland, Brisbane, Australia.,Department of Neurology, Royal Brisbane & Woman's Hospital, Brisbane, Australia
| |
Collapse
|
8
|
Jayasinghe N, Backus S, Gibbons M, Sobel J, Spielman L, Ganz SB, Moallem BI, Ojie MJ, Kakoullis M, Hillstrom H. Brief training of gait and posture using a wearable sensory feedback device with older adults who have fears of falling: A feasibility study. HEALTH AND TECHNOLOGY 2022. [DOI: 10.1007/s12553-021-00623-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
9
|
Quek DYL, Economou K, MacDougall H, Lewis SJG, Ehgoetz Martens KA. Validating a Seated Virtual Reality Threat Paradigm for Inducing Anxiety and Freezing of Gait in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:1443-1454. [PMID: 34057098 DOI: 10.3233/jpd-212619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although prior research has established that freezing of gait (FOG) in Parkinson's disease (PD) is associated with anxiety, only one study to date has directly manipulated anxiety levels to induce FOG. OBJECTIVE The current study aimed to replicate these previous findings and evaluate whether a seated version of a 'threat' virtual reality (VR) paradigm could induce anxiety and provoke FOG. METHODS Twenty-four PD patients with FOG were assessed across various threat conditions in both a walking VR paradigm (Experiment 1) and a seated VR paradigm (Experiment 2). Both paradigms manipulated the height (i.e., elevated vs ground) and width (wide vs narrow) of the planks participants were instructed to walk across. RESULTS Across both experiments, the Elevated + Narrow condition provoked significantly greater number of freezing episodes compared to all other conditions. Higher levels of self-reported anxiety were reported during the Elevated+Narrow condition compared to all other conditions in Experiment 1, and compared to the Ground condition in Experiment 2. CONCLUSION These findings confirm that anxiety contributes to FOG and validates the use of a seated VR threat paradigm for provoking anxiety-related freezing. This enables future studies to combine this paradigm with functional MRI to explore the neural correlates underlying the role of anxiety in FOG.
Collapse
Affiliation(s)
- Dione Y L Quek
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Australia
| | - Kristin Economou
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Australia
| | | | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Australia
| | - Kaylena A Ehgoetz Martens
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Australia.,Department of Kinesiology, University of Waterloo, Canada
| |
Collapse
|
10
|
Chow R, Tripp BP, Rzondzinski D, Almeida QJ. Investigating Therapies for Freezing of Gait Targeting the Cognitive, Limbic, and Sensorimotor Domains. Neurorehabil Neural Repair 2021; 35:290-299. [PMID: 33559531 PMCID: PMC7934156 DOI: 10.1177/1545968321992331] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Freezing of gait (FOG) is arguably the most disabling motor symptom experienced with Parkinson’s disease (PD), but treatments are extremely limited due to our poor understanding of the underlying mechanisms. Three cortical domains are postulated in recent research (ie, the cognitive, limbic, and sensorimotor domains), thus, treatments targeting these mechanisms of FOG may potentially be effective. Cognitive training, cognitive behavioral therapy (CBT, a well-known anxiety intervention), and proprioceptive training may address the cognitive, limbic, and sensorimotor domains, respectively. Objective To investigate whether these 3 treatments could improve functional outcomes of FOG. Methods In a single-blind, randomized crossover design, 15 individuals with PD and FOG were randomized into different, counterbalanced orders of receiving the interventions. Each consisted of eight 1-hour sessions, twice weekly for 4 weeks. FOG severity was assessed as the primary outcome using a novel gait paradigm that was aimed at evoking FOG when the cognitive, limbic, or sensorimotor domains were independently challenged. Results FOG severity significantly improved after the cognitive intervention, with strong trends toward improvement specifically in the baseline and cognitive-challenge assessment conditions. CBT, as the anxiety intervention, resulted in significantly worse FOG severity. In contrast, proprioceptive training significantly improved FOG severity, with consistent trends across all conditions. Conclusions The cognitive and proprioceptive treatments appeared to improve different aspects of FOG. Thus, either of these interventions could potentially be a viable treatment for FOG. However, although the results were statistically significant, they could be sensitive to the relatively small number of participants in the study. Considering the significant results together with nonsignificant trends in both FOG and gait measures, and given equal time for each intervention, proprioceptive training produced the most consistent indications of benefits in this study. (clinicaltrials.gov NCT03065127).
Collapse
Affiliation(s)
- Rebecca Chow
- Wilfrid Laurier University, Waterloo, Ontario, Canada
| | | | | | | |
Collapse
|
11
|
HWANG SEONHONG, REE JAESUN, HWANG JISUN. TEMPORAL AND FRACTAL BEHAVIOR OF THE CENTER OF PRESSURE IN PARKINSONIAN AND HEALTHY ELDERLY COHORTS DURING QUIET STANDING. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420400369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study investigated the quantitative scaling properties of the center of pressure (COP) as well as the spatial-temporal properties of the COP to elucidate the postural control behavior of healthy elderly (HE) adults and adults with Parkinson’s disease (PD) during quiet standing. Eighteen adults with PD and eighteen HE adults participated in this study. The COP movements were recorded while participants stood on either a firm surface or on a foam pad with their eyes either opened or closed. The sway ranges in the anterior–posterior (AP) ([Formula: see text] and medio-lateral (ML) ([Formula: see text] directions, the total length of the trajectory ([Formula: see text], sway area ([Formula: see text], and scaling exponents ([Formula: see text] from detrended fluctuation analysis were computed from the measured COP data. All temporal variables of the COP in all conditions were found to be significantly larger in the PD group than in the HE group. Low scaling exponents obtained for the PD group showed this group possessed diminished postural control ability compared to the HE group. The PD group showed unpredictable open-loop control in both the AP and ML directions. This proprioceptive control became predictable and the time scale relations decreased as the postural challenges increased. The AP and ML closed-loop control of the PD group was more predictable than that of the HE group only when proprioception was distorted using intact visual input, and the visual and proprioceptive inputs were both intact.
Collapse
Affiliation(s)
- SEONHONG HWANG
- Department of Physical Therapy and Basic Science Research Institute, Hoseo University, 20 Hoseo-ro 79beon-gil, Asan-si, Chungceongnam-do 31499, Republic of Korea
| | - JAESUN REE
- Department of Physical Therapy, Graduate School of Hoseo University, 20 Hoseo-ro 79beon-gil, Asan-si, Chungceongnam-do 31499, Republic of Korea
| | - JISUN HWANG
- Department of Physical Therapy, Graduate School of Hoseo University, 20 Hoseo-ro 79beon-gil, Asan-si, Chungceongnam-do 31499, Republic of Korea
| |
Collapse
|
12
|
Sensory focused exercise improves anxiety in Parkinson's disease: A randomized controlled trial. PLoS One 2020; 15:e0230803. [PMID: 32298270 PMCID: PMC7162490 DOI: 10.1371/journal.pone.0230803] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/06/2020] [Indexed: 12/13/2022] Open
Abstract
Anxiety has been implicated as one of the greatest influences on quality of life in Parkinson’s disease (PD). The etiology of anxiety is unclear, although previous work suggests that anxiety may be linked to sensory deficits that cause uncertainty in movement. Thus, the current study examined whether focusing attention on sensory feedback during goal-based exercise has the potential to provide benefits to anxiety in PD. Thirty-five participants with PD were randomized to either a Sensory Attention Focused Exercise (SAFEx) (i.e. internal focus of attention, n = 18) or Sham Exercise control (i.e. external focus of attention, n = 17) and completed 33 one-hour attention-based exercise sessions over 11-weeks. Before and after the program (pre and post), participants completed the Parkinson Anxiety Scale (PAS) questionnaire. The PAS includes three anxiety sections: persistent, episodic, and avoidance. Changes in the total PAS score and within each section of the PAS were subjected to two-factor mixed repeated measures ANCOVA. Significant group by time interactions demonstrated that from pre to post, total PAS scores (p = 0.007) and episodic anxiety scores (p = 0.010) significantly decreased in the SAFEx group only (ΔTotal PAS = -5.2, F(1,27) = 5.41, p = 0.028, ηp2 = 0.17; ΔEpisodic Score = -1.8, F(1,27) = 6.89, p = 0.014, ηp2 = 0.20). In conclusion, focusing attention on sensory feedback while completing goal-based exercises may provide significant benefits to improving anxiety in PD. As such, sensory attention focused exercise may be a critical adjunct therapy for improving anxiety, and ultimately quality of life in people with PD.
Collapse
|
13
|
Okano M, Takahata K, Sugimoto J, Muraoka S. Selegiline Recovers Synaptic Plasticity in the Medial Prefrontal Cortex and Improves Corresponding Depression-Like Behavior in a Mouse Model of Parkinson's Disease. Front Behav Neurosci 2019; 13:176. [PMID: 31427934 PMCID: PMC6688712 DOI: 10.3389/fnbeh.2019.00176] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/16/2019] [Indexed: 12/13/2022] Open
Abstract
In patients with Parkinson’s disease (PD), non-motor symptoms (NMS) including depression and anxiety are often recognized before motor symptoms develop. Monoamine oxidase (MAO)-B inhibitors are therapeutically effective for motor symptoms; however, their effects on NMS in PD are yet to be fully assessed. Here, we aimed to explore the antidepressant-like effects of propargyl MAO-B inhibitors, selegiline and rasagiline, in mice treated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) as a PD model, and to elucidate the mechanisms underlying these effects. Four repeated intraperitoneal injections of MPTP at 17.5 mg/kg to C57BL/6 mice led to a partial reduction in the number of nigrostriatal tyrosine hydroxylase-positive neurons and to the extension of immobility time during the tail suspension test (TST), without any obvious induction of motor deficits. A single subcutaneous administration of selegiline at 10 mg/kg shortened the extended immobility time of MPTP mice in the TST, without any increase in motor activities, suggesting that selegiline exerts antidepressant-like effects. In this test, rasagiline did not produce antidepressant-like effects, although the inhibitory effect of 3 mg/kg rasagiline on brain MAO activity was comparable to that of 10 mg/kg selegiline. The shortened immobility time in the TST correlated with reduced cortical dopamine (DA) turnover rates in MPTP mice treated with selegiline, but not in MPTP mice treated with rasagiline. These results suggest that MAO inhibition does not entirely account for the antidepressant-like effects of selegiline. Administration of selegiline (10 mg/kg), but not rasagiline (1 mg/kg), to MPTP mice restored the impaired long-term potentiation induced by high-frequency stimulation in the medial prefrontal cortex (mPFC), and normalized the reduced phosphorylation of Ca2+/calmodulin-dependent protein kinase IIα, which is known to be involved in neuroplasticity, in the frontal cortex. In MPTP mice, the antiparkinsonian drug pramipexole (0.3 mg/kg), a DA D2 and D3 receptor agonist, that has been shown to be effective in treating depression in PD, ameliorated depression-like behavior and synaptic dysfunction in the mPFC. Taken together, the antidepressant-like effects of selegiline in MPTP mice are attributable to the restoration of impaired synaptic plasticity in the mPFC, suggesting its potential for treating depression in early PD.
Collapse
Affiliation(s)
- Motoki Okano
- Department of Scientific Research, Fujimoto Pharmaceutical Corporation, Osaka, Japan
| | - Kazue Takahata
- Department of Scientific Research, Fujimoto Pharmaceutical Corporation, Osaka, Japan
| | - Junya Sugimoto
- Department of Scientific Research, Fujimoto Pharmaceutical Corporation, Osaka, Japan
| | - Shizuko Muraoka
- Department of Scientific Research, Fujimoto Pharmaceutical Corporation, Osaka, Japan
| |
Collapse
|
14
|
Avanzino L, Lagravinese G, Abbruzzese G, Pelosin E. Relationships between gait and emotion in Parkinson's disease: A narrative review. Gait Posture 2018; 65:57-64. [PMID: 30558947 DOI: 10.1016/j.gaitpost.2018.06.171] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Disturbance of gait is a key feature of Parkinson's disease (PD) and has a negative impact on quality of life. Deficits in cognition and sensorimotor processing impair the ability of people with PD to walk quickly, efficiently and safely. Recent evidence suggests that emotional disturbances may also affect gait in PD. RESEARCH QUESTION We explored if there were relationships between walking ability, emotion and cognitive impairment in people with PD. METHODS The literature was firstly reviewed for unimpaired individuals. The recent experimental evidence for the influence of emotion on gait in people with PD was then explored. The contribution of affective disorders to continuous gait disorders was investigated, particularly for bradykinetic and hypokinetic gait. In addition, we investigated the influence of emotional processing on episodic gait disturbances, such as freezing of gait. Potential effects of pharmacological, surgical and physical therapy interventions were also considered. RESULTS Emerging evidence showed that emotional disturbances arising from affective disorders such as anxiety and depression, in addition to cognitive impairment, could contribute to gait disorders in some people with PD. An analysis of the literature indicated mixed evidence that improvements in affective disorders induced by physical therapy, pharmacological management or surgery improve locomotion in PD. SIGNIFICANCE When assessing and treating gait disorders in people with PD, it is important to take into the account non-motor symptoms such as anxiety, depression and cognitive impairment, in addition to the motor sequalae of this progressive neurological condition.
Collapse
Affiliation(s)
- Laura Avanzino
- Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Giovanna Lagravinese
- Department of Experimental Medicine, Section of Human Physiology and Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy
| | - Giovanni Abbruzzese
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Unit, University of Genoa, Italy
| | - Elisa Pelosin
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Unit, University of Genoa, Italy.
| |
Collapse
|
15
|
Gilat M, Bell PT, Ehgoetz Martens KA, Georgiades MJ, Hall JM, Walton CC, Lewis SJG, Shine JM. Dopamine depletion impairs gait automaticity by altering cortico-striatal and cerebellar processing in Parkinson's disease. Neuroimage 2017; 152:207-220. [PMID: 28263926 DOI: 10.1016/j.neuroimage.2017.02.073] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 12/11/2022] Open
Abstract
Impairments in motor automaticity cause patients with Parkinson's disease to rely on attentional resources during gait, resulting in greater motor variability and a higher risk of falls. Although dopaminergic circuitry is known to play an important role in motor automaticity, little evidence exists on the neural mechanisms underlying the breakdown of locomotor automaticity in Parkinson's disease. This impedes clinical management and is in great part due to mobility restrictions that accompany the neuroimaging of gait. This study therefore utilized a virtual reality gait paradigm in conjunction with functional MRI to investigate the role of dopaminergic medication on lower limb motor automaticity in 23 patients with Parkinson's disease that were measured both on and off dopaminergic medication. Participants either operated foot pedals to navigate a corridor ('walk' condition) or watched the screen while a researcher operated the paradigm from outside the scanner ('watch' condition), a setting that controlled for the non-motor aspects of the task. Step time variability during walk was used as a surrogate measure for motor automaticity (where higher variability equates to reduced automaticity), and patients demonstrated a predicted increase in step time variability during the dopaminergic "off" state. During the "off" state, subjects showed an increased blood oxygen level-dependent response in the bilateral orbitofrontal cortices (walk>watch). To estimate step time variability, a parametric modulator was designed that allowed for the examination of brain regions associated with periods of decreased automaticity. This analysis showed that patients on dopaminergic medication recruited the cerebellum during periods of increasing variability, whereas patients off medication instead relied upon cortical regions implicated in cognitive control. Finally, a task-based functional connectivity analysis was conducted to examine the manner in which dopamine modulates large-scale network interactions during gait. A main effect of medication was found for functional connectivity within an attentional motor network and a significant condition by medication interaction for functional connectivity was found within the striatum. Furthermore, functional connectivity within the striatum correlated strongly with increasing step time variability during walk in the off state (r=0.616, p=0.002), but not in the on state (r=-0.233, p=0.284). Post-hoc analyses revealed that functional connectivity in the dopamine depleted state within an orbitofrontal-striatal limbic circuit was correlated with worse step time variability (r=0.653, p<0.001). Overall, this study demonstrates that dopamine ameliorates gait automaticity in Parkinson's disease by altering striatal, limbic and cerebellar processing, thereby informing future therapeutic avenues for gait and falls prevention.
Collapse
Affiliation(s)
- Moran Gilat
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
| | - Peter T Bell
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Kaylena A Ehgoetz Martens
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Matthew J Georgiades
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Julie M Hall
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Courtney C Walton
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - James M Shine
- Department of Psychology, Stanford University, Stanford, CA, United States of America; Neuroscience Research Australia, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
16
|
Kim A, Darakjian N, Finley JM. Walking in fully immersive virtual environments: an evaluation of potential adverse effects in older adults and individuals with Parkinson's disease. J Neuroeng Rehabil 2017; 14:16. [PMID: 28222783 PMCID: PMC5320768 DOI: 10.1186/s12984-017-0225-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 02/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Virtual reality (VR) has recently been explored as a tool for neurorehabilitation to enable individuals with Parkinson's disease (PD) to practice challenging skills in a safe environment. Current technological advances have enabled the use of affordable, fully immersive head-mounted displays (HMDs) for potential therapeutic applications. However, while previous studies have used HMDs in individuals with PD, these were only used for short bouts of walking. Clinical applications of VR for gait training would likely involve an extended exposure to the virtual environment, which has the potential to cause individuals with PD to experience simulator-related adverse effects due to their age or pathology. Thus, our objective was to evaluate the safety of using an HMD for longer bouts of walking in fully immersive VR for older adults and individuals with PD. METHODS Thirty-three participants (11 healthy young, 11 healthy older adults, and 11 individuals with PD) were recruited for this study. Participants walked for 20 min while viewing a virtual city scene through an HMD (Oculus Rift DK2). Safety was evaluated using the mini-BESTest, measures of center of pressure (CoP) excursion, and questionnaires addressing symptoms of simulator sickness (SSQ) and measures of stress and arousal. RESULTS Most participants successfully completed all trials without any discomfort. There were no significant changes for any of our groups in symptoms of simulator sickness or measures of static and dynamic balance after exposure to the virtual environment. Surprisingly, measures of stress decreased in all groups while the PD group also increased the level of arousal after exposure. CONCLUSIONS Older adults and individuals with PD were able to successfully use immersive VR during walking without adverse effects. This provides systematic evidence supporting the safety of immersive VR for gait training in these populations.
Collapse
Affiliation(s)
- Aram Kim
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E. Alcazar St, CHP 155, Los Angeles, CA 90033 USA
| | - Nora Darakjian
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E. Alcazar St, CHP 155, Los Angeles, CA 90033 USA
| | - James M. Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E. Alcazar St, CHP 155, Los Angeles, CA 90033 USA
| |
Collapse
|
17
|
Šumec R, Rektorová I, Jech R, Menšíková K, Roth J, Růžička E, Sochorová D, Dušek L, Kaňovský P, Rektor I, Pavlík T, Filip P, Bareš M. Motion and emotion: anxiety–axial connections in Parkinson’s disease. J Neural Transm (Vienna) 2016; 124:369-377. [DOI: 10.1007/s00702-016-1652-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 11/12/2016] [Indexed: 12/01/2022]
|
18
|
Ehgoetz Martens KA, Ellard CG, Almeida QJ. Evaluating the Link Between Dopaminergic Treatment, Gait Impairment, and Anxiety in Parkinson's Disease. Mov Disord Clin Pract 2016; 3:389-394. [PMID: 30363509 DOI: 10.1002/mdc3.12298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 09/24/2015] [Accepted: 10/15/2015] [Indexed: 11/07/2022] Open
Abstract
Background Anxiety is the most under-recognized nonmotor symptom of Parkinson's disease (PD), yet it is unclear whether motor impairment exacerbates anxiety observed in PD, or vice versa. The current study examined: (1) whether movement (i.e., walking vs. standing) elevates distress in PD; (2) how dopaminergic treatment influences anxiety specifically while walking; and (3) whether these responses are worse in PD patients with gait impairments (compared to those without). Methods Twenty healthy control participants (HC), 17 PD participants without gait impairments (PD-GI), and 14 PD participants with gait impairments (PD+GI) performed two tasks (stand vs. walk) in two virtual environments: (1) LOW threat; (2) HIGH threat. This protocol was completed in on and off dopaminergic states (to evaluate the effect of exacerbating motor symptoms). Results PD+GI reported greater levels of anxiety compared to PD-GI and HC overall. All participants reported greater levels of anxiety and had higher skin conductance levels (SCLs) when walking compared to standing. The HIGH threat condition also generated greater levels of anxiety in all participants, compared to LOW threat, especially when required to walk. Notably, only PD+GI reported greater levels of anxiety when walking compared to standing in the LOW threat environment. Dopaminergic medication reduced self-reported levels of anxiety, but did not significantly change SCL. Conclusion This study provides evidence that movement exacerbates anxiety in all older adults, but is particularly influential in those with gait impairments, which emphasizes the importance of optimally treating movement impairments as a method of reducing movement driven anxiety.
Collapse
Affiliation(s)
- Kaylena A Ehgoetz Martens
- Sun Life Financial Movement Disorders Research and Rehabilitation Center Wilfrid Laurier University Waterloo Ontario Canada.,Department of Psychology University of Waterloo Waterloo Ontario Canada
| | - Colin G Ellard
- Department of Psychology University of Waterloo Waterloo Ontario Canada
| | - Quincy J Almeida
- Sun Life Financial Movement Disorders Research and Rehabilitation Center Wilfrid Laurier University Waterloo Ontario Canada
| |
Collapse
|
19
|
Beck EN, Ehgoetz Martens KA, Almeida QJ. Freezing of Gait in Parkinson's Disease: An Overload Problem? PLoS One 2015; 10:e0144986. [PMID: 26678262 PMCID: PMC4682987 DOI: 10.1371/journal.pone.0144986] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/26/2015] [Indexed: 11/18/2022] Open
Abstract
Freezing of gait (FOG) is arguably the most severe symptom associated with Parkinson's disease (PD), and often occurs while performing dual tasks or approaching narrowed and cluttered spaces. While it is well known that visual cues alleviate FOG, it is not clear if this effect may be the result of cognitive or sensorimotor mechanisms. Nevertheless, the role of vision may be a critical link that might allow us to disentangle this question. Gaze behaviour has yet to be carefully investigated while freezers approach narrow spaces, thus the overall objective of this study was to explore the interaction between cognitive and sensory-perceptual influences on FOG. In experiment #1, if cognitive load is the underlying factor leading to FOG, then one might expect that a dual-task would elicit FOG episodes even in the presence of visual cues, since the load on attention would interfere with utilization of visual cues. Alternatively, if visual cues alleviate gait despite performance of a dual-task, then it may be more probable that sensory mechanisms are at play. In compliment to this, the aim of experiment#2 was to further challenge the sensory systems, by removing vision of the lower-limbs and thereby forcing participants to rely on other forms of sensory feedback rather than vision while walking toward the narrow space. Spatiotemporal aspects of gait, percentage of gaze fixation frequency and duration, as well as skin conductance levels were measured in freezers and non-freezers across both experiments. Results from experiment#1 indicated that although freezers and non-freezers both walked with worse gait while performing the dual-task, in freezers, gait was relieved by visual cues regardless of whether the cognitive demands of the dual-task were present. At baseline and while dual-tasking, freezers demonstrated a gaze behaviour that neglected the doorway and instead focused primarily on the pathway, a strategy that non-freezers adopted only when performing the dual-task. Interestingly, with the combination of visual cues and dual-task, freezers increased the frequency and duration of fixations toward the doorway, compared to non-freezers. These results suggest that although increasing demand on attention does significantly deteriorate gait in freezers, an increase in cognitive demand is not exclusively responsible for freezing (since visual cues were able to overcome any interference elicited by the dual-task). When vision of the lower limbs was removed in experiment#2, only the freezers' gait was affected. However, when visual cues were present, freezers' gait improved regardless of the dual-task. This gait behaviour was accompanied by greater amount of time spent looking at the visual cues irrespective of the dual-task. Since removing vision of the lower-limbs hindered gait even under low attentional demand, restricted sensory feedback may be an important factor to the mechanisms underlying FOG.
Collapse
Affiliation(s)
- Eric N. Beck
- Sun Life Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Kaylena A. Ehgoetz Martens
- Sun Life Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Quincy J. Almeida
- Sun Life Movement Disorders Research & Rehabilitation Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
- * E-mail:
| |
Collapse
|
20
|
Virtually-induced threat in Parkinson's: Dopaminergic interactions between anxiety and sensory-perceptual processing while walking. Neuropsychologia 2015; 79:322-31. [PMID: 26004056 DOI: 10.1016/j.neuropsychologia.2015.05.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/18/2015] [Accepted: 05/20/2015] [Indexed: 11/20/2022]
Abstract
Research evidence has suggested that anxiety influences gait in PD, with an identified dopa-sensitive gait response in highly anxious PD. It has been well-established that accurate perception of the environment and sensory feedback is essential for gait. Arguably since sensory and perceptual deficits have been noted in PD, anxiety has the potential to exacerbate movement impairments, since one might expect that reducing resources needed to overcome or compensate for sensory-perceptual deficits may lead to even more severe gait impairments. It is possible that anxiety in threatening situations might consume more processing resources, limiting the ability to process information about the environment or one's own movement (sensory feedback) especially in highly anxious PD. Therefore, the current study aimed to (i) evaluate whether processing of threat-related aspects of the environment was influenced by anxiety, (ii) evaluate whether anxiety influences the ability to utilize sensory feedback in PD while walking in threatening situations, and (iii) further understand the role of dopaminergic medication on these processes in threatening situations in PD. Forty-eight participants (24 HC; 12 Low Anxious [LA-PD], 12 Highly Anxious [HA-PD]) completed 20 walking trials in virtual reality across a plank that was (i) located on the ground (GROUND) (ii) located above a deep pit (ELEVATED); while provided with or without visual feedback about their lower limbs (+VF; -VF). After walking across the plank, participants were asked to judge the width of the plank they had just walked across. The plank varied in size from 60-100 cm. Both ON and OFF dopaminergic medication states were evaluated in PD. Gait parameters, judgment error and self-reported anxiety levels were measured. Results showed that HA-PD reported greater levels of anxiety overall (p<0.001) compared to HC and LA-PD, and all participants reported greater anxiety during the ELEVATED condition compared to GROUND (p=0.01). PD had similar judgment error as HC. Additionally, medication state did not significantly influence judgment error in PD. More importantly, HA-PD were the only group that did not adjust their step width when feedback was provided during the GROUND condition. However, medication facilitated a reduction in ST-CV when visual feedback was available only in the HA-PD group. Therefore, the current study provides evidence that anxiety may interfere with information processing, especially utilizing sensory feedback while walking. Dopaminergic medication appears to improve utilization of sensory feedback in stressful situations by reducing anxiety and/or improving resource allocation especially in those with PD who are highly anxious.
Collapse
|