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Zadeh AK, Sadeghbeigi N, Safakheil H, Setarehdan SK, Alibiglou L. Connecting the dots: Sensory cueing enhances functional connectivity between pre-motor and supplementary motor areas in Parkinson's disease. Eur J Neurosci 2024. [PMID: 38858176 DOI: 10.1111/ejn.16437] [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: 12/20/2023] [Revised: 05/10/2024] [Accepted: 05/26/2024] [Indexed: 06/12/2024]
Abstract
People with Parkinson's disease often exhibit improvements in motor tasks when exposed to external sensory cues. While the effects of different types of sensory cues on motor functions in Parkinson's disease have been widely studied, the underlying neural mechanism of these effects and the potential of sensory cues to alter the motor cortical activity patterns and functional connectivity of cortical motor areas are still unclear. This study aims to compare changes in oxygenated haemoglobin, deoxygenated haemoglobin and correlations among different cortical regions of interest during wrist movement under different external stimulus conditions between people with Parkinson's disease and controls. Ten Parkinson's disease patients and 10 age- and sex-matched neurologically healthy individuals participated, performing repetitive wrist flexion and extension tasks under auditory and visual cues. Changes in oxygenated and deoxygenated haemoglobin in motor areas were measured using functional near-infrared spectroscopy, along with electromyograms from wrist muscles and wrist movement kinematics. The functional near-infrared spectroscopy data revealed significantly higher neural activity changes in the Parkinson's disease group's pre-motor area compared to controls (p = 0.006), and functional connectivity between the supplementary motor area and pre-motor area was also significantly higher in the Parkinson's disease group when external sensory cues were present (p = 0.016). These results indicate that external sensory cues' beneficial effects on motor tasks are linked to changes in the functional connectivity between motor areas responsible for planning and preparation of movements.
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Affiliation(s)
- Ali K Zadeh
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | | | - Hosein Safakheil
- Department of Neuroscience, School of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Kamaledin Setarehdan
- School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Laila Alibiglou
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, Indiana, USA
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2
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Baarbé J, Brown MJN, Saha U, Tran S, Weissbach A, Saravanamuttu J, Cheyne D, Hutchison WD, Chen R. Cortical modulations before lower limb motor blocks are associated with freezing of gait in Parkinson's disease: an EEG source localization study. Neurobiol Dis 2024; 199:106557. [PMID: 38852752 DOI: 10.1016/j.nbd.2024.106557] [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: 03/26/2024] [Revised: 05/15/2024] [Accepted: 06/05/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Freezing of gait (FOG) is a debilitating symptom of Parkinson's disease (PD) characterized by paroxysmal episodes in which patients are unable to step forward. A research priority is identifying cortical changes before freezing in PD-FOG. METHODS We tested 19 patients with PD who had been assessed for FOG (n=14 with FOG and 5 without FOG). While seated, patients stepped bilaterally on pedals to progress forward through a virtual hallway while 64-channel EEG was recorded. We assessed cortical activities before and during lower limb motor blocks (LLMB), defined as a break in rhythmic pedaling, and stops, defined as movement cessation following an auditory stop cue. This task was selected because LLMB correlates with FOG severity in PD and allows recording of high-quality EEG. Patients were tested after overnight withdrawal from dopaminergic medications ("off" state) and in the "on" medications state. EEG source activities were evaluated using individual MRI and standardized low resolution brain electromagnetic tomography (sLORETA). Functional connectivity was evaluated by phase lag index between seeds and pre-defined cortical regions of interest. RESULTS EEG source activities for LLMB vs. cued stops localized to right posterior parietal area (Brodmann area 39), lateral premotor area (Brodmann area 6), and inferior frontal gyrus (Brodmann area 47). In these areas, PD-FOG (n=14) increased alpha rhythms (8-12 Hz) before LLMB vs. typical stepping, whereas PD without FOG (n=5) decreased alpha power. Alpha rhythms were linearly correlated with LLMB severity, and the relationship became an inverted U-shape when assessing alpha rhythms as a function of percent time in LLMB in the "off" medication state. Right inferior frontal gyrus and supplementary motor area connectivity was observed before LLMB in the beta band (13-30 Hz). This same pattern of connectivity was seen before stops. Dopaminergic medication improved FOG and led to less alpha synchronization and increased functional connections between frontal and parietal areas. CONCLUSIONS Right inferior parietofrontal structures are implicated in PD-FOG. The predominant changes were in the alpha rhythm, which increased before LLMB and with LLMB severity. Similar connectivity was observed for LLMB and stops between the right inferior frontal gyrus and supplementary motor area, suggesting that FOG may be a form of "unintended stopping." These findings may inform approaches to neurorehabilitation of PD-FOG.
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Affiliation(s)
- Julianne Baarbé
- Department of Medicine, University of Toronto and Division of Brain, Imaging & Behaviour, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada.
| | - Matt J N Brown
- Department of Kinesiology, California State University, Sacramento, CA, USA
| | - Utpal Saha
- Department of Medicine, University of Toronto and Division of Brain, Imaging & Behaviour, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Stephanie Tran
- Department of Medicine, University of Toronto and Division of Brain, Imaging & Behaviour, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Anne Weissbach
- Institute of Systems Motor Science, Center of Brain, Behavior and Metabolism, University of Lübeck, Germany
| | - James Saravanamuttu
- Department of Medicine, University of Toronto and Division of Brain, Imaging & Behaviour, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Douglas Cheyne
- Program in Neurosciences and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - William D Hutchison
- Department of Medicine, University of Toronto and Division of Brain, Imaging & Behaviour, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Robert Chen
- Department of Medicine, University of Toronto and Division of Brain, Imaging & Behaviour, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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3
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Aitken CS, Samotus O, Naidu AS, Jog M, Patel RV. Force Control Issues in Upper and Lower Limbs in Parkinson's Disease and Freezing of Gait. IEEE Trans Neural Syst Rehabil Eng 2024; 32:577-586. [PMID: 38236671 DOI: 10.1109/tnsre.2024.3355429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Parkinson's Disease (PD) has been found to cause force control deficits in upper and lower limbs. About 50% of patients with advanced PD develop a debilitating symptom called freezing of gait (FOG), which has been linked to force control problems in the lower limbs, and some may only have a limited response to the gold standard pharmaceutical therapy, levodopa, resulting in partially levodopa-responsive FOG (PLR-FOG). There has been limited research on investigating upper-limb force control in people with PD with PLR-FOG, and without FOG. In this pilot study, force control was explored using an upper-and-lower-limb haptics-enabled robot in a reaching task while people with PD with and without PLR-FOG were on their levodopa medication. A healthy control group was used for reference, and each cohort completed the task at three different levels of assistance provided by the robot. Similar significant proportional force control deficits were found in the upper and lower limbs in patients with PLR-FOG versus those without FOG. Some aspects of force control were found to be retained, including an ability to increase or decrease force in response to changes in resistance while completing a reaching task. Overall, these results suggest there are force control deficits in both the upper and lower limbs in people with PLR-FOG.
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Yu T, Park KW, McKeown MJ, Wang ZJ. Clinically Informed Automated Assessment of Finger Tapping Videos in Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2023; 23:9149. [PMID: 38005535 PMCID: PMC10674854 DOI: 10.3390/s23229149] [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: 09/19/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
The utilization of Artificial Intelligence (AI) for assessing motor performance in Parkinson's Disease (PD) offers substantial potential, particularly if the results can be integrated into clinical decision-making processes. However, the precise quantification of PD symptoms remains a persistent challenge. The current standard Unified Parkinson's Disease Rating Scale (UPDRS) and its variations serve as the primary clinical tools for evaluating motor symptoms in PD, but are time-intensive and prone to inter-rater variability. Recent work has applied data-driven machine learning techniques to analyze videos of PD patients performing motor tasks, such as finger tapping, a UPDRS task to assess bradykinesia. However, these methods often use abstract features that are not closely related to clinical experience. In this paper, we introduce a customized machine learning approach for the automated scoring of UPDRS bradykinesia using single-view RGB videos of finger tapping, based on the extraction of detailed features that rigorously conform to the established UPDRS guidelines. We applied the method to 75 videos from 50 PD patients collected in both a laboratory and a realistic clinic environment. The classification performance agreed well with expert assessors, and the features selected by the Decision Tree aligned with clinical knowledge. Our proposed framework was designed to remain relevant amid ongoing patient recruitment and technological progress. The proposed approach incorporates features that closely resonate with clinical reasoning and shows promise for clinical implementation in the foreseeable future.
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Affiliation(s)
- Tianze Yu
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Kye Won Park
- Pacific Parkinson Research Centre, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (K.W.P.); (M.J.M.)
| | - Martin J. McKeown
- Pacific Parkinson Research Centre, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (K.W.P.); (M.J.M.)
- Department of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Z. Jane Wang
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
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Capato TTC, Rodrigues R, Cury RG, Teixeira MJ, Barbosa ER. Clinical assessment of upper limb impairments and functional capacity in Parkinson's disease: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:1008-1015. [PMID: 37899049 PMCID: PMC10689111 DOI: 10.1055/s-0043-1772769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/19/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Parkinson's disease (PD) may progressively reduce the upper limb's functionality. Currently, there is no standardized upper limb functional capacity assessment in PD in the rehabilitation field. OBJECTIVE To identify specific outcome measurements to assess upper limbs in PD and access functional capacity. METHODS We systematically reviewed and analyzed the literature in English published from August/2012 to August/2022 according to PRISMA. The following keywords were used in our search: "upper limbs" OR "upper extremity" and "Parkinson's disease." Two researchers searched independently, including studies accordingly to our inclusion and exclusion criteria. Registered at PROSPERO CRD42021254486. RESULTS We found 797 studies, and 50 were included in this review (n = 2.239 participants in H&Y stage 1-4). The most common upper limbs outcome measures found in the studies were: (i) UPDRS-III and MDS-UPDRS to assess the severity and progression of PD motor symptoms (tremor, bradykinesia, and rigidity) (ii) Nine Hole Peg Test and Purdue Pegboard Test to assess manual dexterity; (iii) Spiral test and Funnel test to provoke and assess freezing of upper limbs; (iv) Technology assessment such as wearables sensors, apps, and other device were also found. CONCLUSION We found evidence to support upper limb impairments assessments in PD. However, there is still a large shortage of specific tests to assess the functional capacity of the upper limbs. The upper limbs' functional capacity is insufficiently investigated during the clinical and rehabilitation examination due to a lack of specific outcome measures to assess functionality.
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Affiliation(s)
- Tamine T. C. Capato
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Nijmegen, The Netherlands.
| | - Rúbia Rodrigues
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
| | - Rubens G. Cury
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
| | | | - Egberto R. Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo SP, Brazil.
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Stegemöller EL, Berg R, Warnecke A, Hammer M. Comparison of auditory cueing in toe tapping and gait in persons with Parkinson's disease. Front Hum Neurosci 2023; 17:1197247. [PMID: 37727863 PMCID: PMC10505663 DOI: 10.3389/fnhum.2023.1197247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023] Open
Abstract
Introduction Much research has examined the relationship between bradykinesia and gait impairment in persons with Parkinson's disease (PD). Specifically, impairments in repetitive movements of the upper extremity have been associated with freezing of gait. Studies examining lower extremity repetitive movements are limited. Moreover, the use of external cueing has been a treatment strategy for both bradykinesia and gait, but information on how cues should be used is lacking. The purpose of this study was to compare the effects of auditory cueing on one side versus both sides for bilateral repetitive toe tapping and gait, and to determine if there was a relationship between toe tapping and gait. We hypothesize that there will be no difference between the cueing conditions, but that there will be a significant association between repetitive toe tapping performance and gait performance. Methods Twenty-seven persons with PD completed a toe tapping task in which the more affected side was cued at 70 beats per minute (BPM), the less affected side was cued at 70 BPM, and both sides were cued at 140 BPM. The same cueing conditions were completed for the gait task. Inter movement interval and amplitude data was collected and analyzed for the toe tapping task. Stance time, swing time, step length, and step width were collected and analyzed for the gait task. Results Results revealed a significant difference in movement performance between the single side cueing conditions and both sides cued condition for inter movement interval (toe tapping), stance time (gait), step length (gait), and step width (gait). Moreover, results revealed a significant association between inter movement interval and stance time and step length. Discussion These results would suggest that cueing both sides is better than only one side and that there is a relationship between toe tapping and gait performance when both sides are cued in persons with PD. This study adds to the literature exploring possible shared mechanisms between bradykinesia and gait in persons with PD.
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Panyakaew P, Duangjino K, Kerddonfag A, Ploensin T, Piromsopa K, Kongkamol C, Bhidayasiri R. Exploring the Complex Phenotypes of Impaired Finger Dexterity in Mild-to-moderate Stage Parkinson's Disease: A Time-Series Analysis. JOURNAL OF PARKINSON'S DISEASE 2023; 13:975-988. [PMID: 37574743 PMCID: PMC10578277 DOI: 10.3233/jpd-230029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Impaired dexterity is an early motor symptom in Parkinson's disease (PD) that significantly impacts the daily activity of patients; however, what constitutes complex dexterous movements remains controversial. OBJECTIVE To explore the characteristics of finger dexterity in mild-to-moderate stage PD. METHODS We quantitatively assessed finger dexterity in 48 mild-to-moderate stage PD patients and 49 age-matched controls using a simple alternating two-finger typing test for 15 seconds. Time-series analyses of various kinematic parameters with machine learning were compared between sides and groups. RESULTS Both the more and less affected hands of patients with PD had significantly lower typing frequency and slower typing velocity than the non-dominant and the dominant hands of controls (p = 0.019, p = 0.016, p < 0.001, p < 0.001). The slope of the typing velocity decreased with time, indicating a sequence effect in the PD group. A typing duration of 6 seconds was determined sufficient to discriminate PD patients from controls. Typing error, repetition, and repetition rate were significantly higher in the more affected hands of patients with PD than in the non-dominant hand of controls (p < 0.001, p = 0.03, p < 0.001). The error rate was constant, whereas the repetition rate was steep during the initiation of typing. A predictive model of the more affected hand demonstrated an accuracy of 70% in differentiating PD patients from controls. CONCLUSION Our study demonstrated complex components of impaired finger dexterity in mild-to-moderate stage PD, namely bradykinesia with sequence effects, error, and repetition at the initiation of movement, suggesting that multiple neural networks may be involved in dexterity deficits in PD.
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Affiliation(s)
- Pattamon Panyakaew
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Kotchakorn Duangjino
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Apiwoot Kerddonfag
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Teerit Ploensin
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Krerk Piromsopa
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
- Research Group on Applied Computer Engineering Technology for Medicine and Healthcare, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Chanon Kongkamol
- Department of Family and Prevention Medicine, Faculty of Medicine, Prince of Songkla University, Bangkok, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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Wilkins KB, Petrucci MN, Kehnemouyi Y, Velisar A, Han K, Orthlieb G, Trager MH, O’Day JJ, Aditham S, Bronte-Stewart H. Quantitative Digitography Measures Motor Symptoms and Disease Progression in Parkinson’s Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1979-1990. [PMID: 35694934 PMCID: PMC9535590 DOI: 10.3233/jpd-223264] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Assessment of motor signs in Parkinson’s disease (PD) requires an in-person examination. However, 50% of people with PD do not have access to a neurologist. Wearable sensors can provide remote measures of some motor signs but require continuous monitoring for several days. A major unmet need is reliable metrics of all cardinal motor signs, including rigidity, from a simple short active task that can be performed remotely or in the clinic. Objective: Investigate whether thirty seconds of repetitive alternating finger tapping (RAFT) on a portable quantitative digitography (QDG) device, which measures amplitude and timing, produces reliable metrics of all cardinal motor signs in PD. Methods: Ninety-six individuals with PD and forty-two healthy controls performed a thirty-second QDG-RAFT task and clinical motor assessment. Eighteen individuals were followed longitudinally with repeated assessments for an average of three years and up to six years. Results: QDG-RAFT metrics showed differences between PD and controls and provided correlated metrics for total motor disability (MDS-UPDRS III) and for rigidity, bradykinesia, tremor, gait impairment, and freezing of gait (FOG). Additionally, QDG-RAFT tracked disease progression over several years off therapy and showed differences between akinetic-rigid and tremor-dominant phenotypes, as well as people with and without FOG. Conclusions: QDG is a reliable technology, which could be used in the clinic or remotely. This could improve access to care, allow complex remote disease management based on data received in real time, and accurate monitoring of disease progression over time in PD. QDG-RAFT also provides the comprehensive motor metrics needed for therapeutic trials.
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Affiliation(s)
- Kevin B. Wilkins
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew N. Petrucci
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasmine Kehnemouyi
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Anca Velisar
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- The Smith-Kettlewell Eye Research Institute, San Francisco, CA, USA
| | - Katie Han
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerrit Orthlieb
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Megan H. Trager
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Johanna J. O’Day
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Sudeep Aditham
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Helen Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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Amplitude setting and dopamine response of finger tapping and gait are related in Parkinson's disease. Sci Rep 2022; 12:4180. [PMID: 35264705 PMCID: PMC8907286 DOI: 10.1038/s41598-022-07994-8] [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: 08/17/2021] [Accepted: 02/17/2022] [Indexed: 12/03/2022] Open
Abstract
Movement amplitude setting is affected early in Parkinson’s disease (PD), clinically manifesting as bradykinesia. Our objective was to determine if amplitude setting of upper limb bimanual movements and bipedal gait are similarly modulated in PD. 27 PD and 24 control participants were enrolled. Participants performed a bimanual anti-phase finger tapping task wearing gloves with joint angular sensors, and an instrumented gait assessment. Participants performed normal and fast paced assessments to vary motor load. PD participants were evaluated OFF (PD-OFF) and ON (PD-ON) levodopa. PD-OFF participants had smaller tap amplitude, and greater tap amplitude variability than controls in the more affected hands (all p < 0.05). Tap amplitude and stride length (p = 0.030) were correlated in PD-OFF. Tap amplitude was also correlated with motor UPDRS (p < 0.005) and bradykinesia motor (p < 0.05) and ADL (p < 0.005) UPDRS subscores. The relative amount of improvement in tap amplitude and stride length with levodopa was correlated. In PD, upper limb and gait amplitude setting are similarly scaled with motor demand and dopamine supplementation. This suggests these automated motor functions are subserved by common functional networks.
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10
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Fathipour-Azar Z, Azad A, Akbarfahimi M, Behzadipour S, Taghizadeh G. Symmetric and asymmetric bimanual coordination and freezing of gait in Parkinsonian patients in drug phases. Ann N Y Acad Sci 2022; 1511:244-261. [PMID: 35194819 DOI: 10.1111/nyas.14759] [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: 07/17/2021] [Indexed: 11/29/2022]
Abstract
Freezing of gait (FOG) is a debilitating symptom in patients with Parkinson's disease (PD), which may be associated with motor control impairments in tasks other than gait. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in PD with FOG (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. Twenty PD +FOG patients, 20 PD patients without FOG (PD -FOG) performed symmetric and asymmetric functional bimanual tasks (reach to and pick up a box and open a drawer to press a pushbutton inside it, respectively) under single-task and dual-task conditions. PD patients were evaluated during on- and off-drug phases. Kinematic and coordination measures were calculated for each task. PD +FOG patients demonstrated exacerbated impairments of bimanual coordination while performing goal-directed bimanual tasks, which was more evident in the asymmetric bimanual task and under dual-task conditions, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients. Interestingly, 25% and 5% of participants in the PD +FOG and -FOG groups developed upper limb freezing 2 years later, respectively. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in Parkinson's disease with freezing of gait (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. PD +FOG patients demonstrated exacerbated impairment of bimanual coordination while performing goal-directed bimanual tasks, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients.
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Affiliation(s)
- Zeinab Fathipour-Azar
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Azad
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Malahat Akbarfahimi
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Behzadipour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.,Djavad Mowafaghian Research Center for Intelligent Neuro-rehabilitation Technologies, Tehran, Iran
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Cupertino L, Dos Reis TG, Los Angeles E, Costa TM, Shokur S, Bouri M, de Lima-Pardini AC, Coelho DB. Biomechanical aspects that precede freezing episode during gait in individuals with Parkinson's disease: A systematic review. Gait Posture 2022; 91:149-154. [PMID: 34717288 DOI: 10.1016/j.gaitpost.2021.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/30/2021] [Accepted: 10/17/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The freezing episode (FE) management during gait in Parkinson's disease is inefficient with current medications, neurosurgery, and physical interventions. Knowing the biomechanical change patients suffer preceding FE would be the ultimate goal to measure, predict, and prevent these events. OBJECTIVE We performed a systematic review to summarize the kinematic, kinetic, electromyographic, and spatio-temporal characteristics of the events that precede the FE during gait in Parkinson's disease. LITERATURE SURVEY Databases searched included PubMed, Embase, and Cochrane and between 2001 to August 2021. METHODOLOGY The present study was a systematic review registered in the PROSPERO database (CRD42021255082). Three reviewers searched and selected studies with methodologies involving biomechanical changes and kinetic, kinematic, electromyography, and spatiotemporal changes before FE in a patient with Parkinson's disease. The relevant articles that show the events preceding FE in patients with PD were identified. We excluded studies that describe or compare methods or algorithms to detect FE. Studies may include participants with all PD severity, time of disease, and age. SYNTHESIS We selected ten articles for final evaluation. The most consistent results indicate a dramatic reduction of movement excursions with (1) decrease in stride length; (2) decreased gait speed; (3) postural instability with the increased double support phase; (4) incoordination of anterior tibial and gastrocnemius; (5) larger amplitude in the EMG of biceps femoris; (6) decreased range of motion in the sagittal plane at the ankle and hip joints; and (7) anterior pelvic tilt. CONCLUSION FE is characterized by complex motor patterns than normal gait and mismatched gains in the perception and execution of the ongoing movement.
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Affiliation(s)
- Layla Cupertino
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, SP, Brazil
| | | | - Emanuele Los Angeles
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, SP, Brazil
| | - Thaisy Moraes Costa
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, SP, Brazil
| | - Solaiman Shokur
- École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland; The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Mohamed Bouri
- École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Andrea C de Lima-Pardini
- Laboratory of Integrative Motor Behaviour, Centre for Neuroscience Studies, Queen's University, Ontario, Canada
| | - Daniel Boari Coelho
- Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, SP, Brazil.
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12
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D'Cruz N, Nieuwboer A. Can Motor Arrests in Other Effectors Be Used as Valid Markers of Freezing of Gait? Front Hum Neurosci 2021; 15:808734. [PMID: 34975441 PMCID: PMC8716925 DOI: 10.3389/fnhum.2021.808734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/22/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Alice Nieuwboer
- KU Leuven, Department of Rehabilitation Sciences, Neurorehabilitation Research Group, Leuven, Belgium
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13
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Martins NIM, Aguiar MMD, Correa CL. Freezing of Upper Limbs in Parkinson’s Disease: A Systematic Review. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2021.1929658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Núbia Isabela Macêdo Martins
- Graduate Program in Physical Education, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Medicine School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Clynton Lourenço Correa
- Graduate Program in Physical Education, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Faculty of Physical Therapy, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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14
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Sadler CM, Kami AT, Nantel J, Carlsen AN. Transcranial direct current stimulation of supplementary motor area improves upper limb kinematics in Parkinson's disease. Clin Neurophysiol 2021; 132:2907-2915. [PMID: 34412968 DOI: 10.1016/j.clinph.2021.06.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 05/18/2021] [Accepted: 06/20/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Bradykinesia, defined as slowness of movements, is among the most functionally debilitating symptoms of Parkinson's disease (PD). Hypoactivation of cortical neurons in supplementary motor area (SMA) has been linked to the progression of bradykinesia symptoms. This study investigated the influence of transcranial direct current stimulation (tDCS) applied over SMA on upper limb movement for individuals diagnosed with PD. METHODS Thirteen individuals with PD performed a simple reaction time (RT) task involving elbow extension following an auditory go-signal. Sham or anodal tDCS was then applied over SMA for 10 minutes before participants repeated the simple RT task. Participants were unaware of which stimulation they received in each testing session. Electromyography (EMG) and kinematic data were recorded on all trials. RESULTS While there were no significant differences in premotor RT, anodal tDCS applied over SMA led to significantly shorter time to peak displacement (p = .015) and movement time (p = .003) compared to pre-tDCS trials, whereas sham stimulation had no impact on these variables. CONCLUSIONS These results provide evidence that anodal tDCS applied over SMA contributes to improvements in movement kinematics of an upper limb simple RT task. SIGNIFICANCE Anodal tDCS over SMA could be a useful therapy to mitigate bradykinesia associated with PD.
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Affiliation(s)
- Christin M Sadler
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Aline Tiemi Kami
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Nantel
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Anthony N Carlsen
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.
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15
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Action Imagery and Observation in Neurorehabilitation for Parkinson's Disease (ACTION-PD): Development of a User-Informed Home Training Intervention to Improve Functional Hand Movements. PARKINSONS DISEASE 2021; 2021:4559519. [PMID: 34336183 PMCID: PMC8324342 DOI: 10.1155/2021/4559519] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/28/2021] [Accepted: 07/12/2021] [Indexed: 01/21/2023]
Abstract
Background Parkinson's disease (PD) causes difficulties with hand movements, which few studies have addressed therapeutically. Training with action observation (AO) and motor imagery (MI) improves performance in healthy individuals, particularly when the techniques are applied simultaneously (AO + MI). Both AO and MI have shown promising effects in people with PD, but previous studies have only used these separately. Objective This article describes the development and pilot testing of an intervention combining AO + MI and physical practice to improve functional manual actions in people with PD. Methods The home-based intervention, delivered using a tablet computer app, was iteratively designed by an interdisciplinary team, including people with PD, and further developed through focus groups and initial field testing. Preliminary data on feasibility were obtained via a six-week pilot randomised controlled trial (ISRCTN 11184024) of 10 participants with mild to moderate PD (6 intervention; 4 treatment as usual). Usage and adherence data were recorded during training, and semistructured interviews were conducted with participants. Exploratory outcome measures included dexterity and timed action performance. Results Usage and qualitative data provided preliminary evidence of acceptability and usability. Exploratory outcomes also suggested that subjective and objective performance of manual actions should be tested in a larger trial. The importance of personalisation, choice, and motivation was highlighted, as well as the need to facilitate engagement in motor imagery. Conclusions The results indicate that a larger RCT is warranted, and the findings also have broader relevance for the feasibility and development of AO + MI interventions for PD and other conditions.
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16
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Janssen S, Heijs J, Bittner M, Droog E, Bloem BR, Van Wezel R, Heida T. Visual cues added to a virtual environment paradigm do not improve motor arrests in Parkinson's disease. J Neural Eng 2021; 18. [PMID: 33540389 DOI: 10.1088/1741-2552/abe356] [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: 03/27/2020] [Accepted: 02/04/2021] [Indexed: 11/12/2022]
Abstract
Objective. Elucidating how cueing alleviates freezing of gait (FOG) in Parkinson's disease (PD) would enable the development of more effective, personalized cueing strategies. Here, we aimed to validate a visual cueing virtual environment (VE) paradigm for future use in e.g. neuroimaging studies and behavioral studies on motor timing and scaling in PD patients with FOG.Approach. We included 20 PD patients with FOG and 16 age-matched healthy control subjects. Supine participants were confronted with a VE displaying either no cues, bars or staircases. They navigated forward using alternate suppression of foot pedals. Motor arrests (as proxy for FOG), and measures of motor timing and scaling were compared across the three VE conditions for both groups.Main results. VE cues (bars and staircases) did not reduce motor arrests in PD patients and healthy control subjects. The VE cues did reduce pedal amplitude in healthy control subjects, without effects on other motor parameters.Conclusion. We could not validate a visual cueing VE paradigm to study FOG. The VE cues possibly failed to convey the necessary spatial and temporal information to support motor timing and scaling. We discuss avenues for future research.
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Affiliation(s)
- S Janssen
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands.,Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | - Jja Heijs
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands
| | - M Bittner
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands.,Current Address: VicarVision, Amsterdam, The Netherlands
| | - E Droog
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands
| | - B R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson and Movement Disorders, Nijmegen, The Netherlands
| | - Rja Van Wezel
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands.,Department of Biophysics, Donders Institute of Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - T Heida
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, EWI-BSS, Enschede 7500 VB, The Netherlands
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17
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Paz TDSR, de Britto VLS, Yamaguchi B, Israel VL, Swarowsky A, Lourenço Correa C. Hand Function as Predictor of Motor Symptom Severity in Individuals with Parkinson's Disease. Gerontology 2021; 67:160-167. [PMID: 33465766 DOI: 10.1159/000511910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Parkinson's disease (PD) leads to deficits in upper limb strength and manual dexterity and consequently resulting in functional impairment. Handgrip strength is correlated with the motor symptom severity of the disease, but there is a gap in the literature about the influence of freezing in PD patients. OBJECTIVE The objective is to study the correlation between handgrip strength and motor symptom severity considering the freezing phenomenon and to verify variables that can predict Unified Parkinson's Disease Rating Scale (UPDRS) III. METHODS This is a multicenter cross-sectional study in PD. 101 patients were divided into 2 groups: freezing of gait (FOG) (n = 51) and nonfreezing (nFOG) (n = 52). Freezing of Gait Questionnaire (FOGQ); UPDRS II and III sections; Hoehn and Yahr (HY) scale; handgrip dynamometry (HD); 9 Hole Peg Test (9-HPT) were assessed. RESULTS In both groups, HD was correlated to UPDRS III (nFOG: -0.308; FOG: -0.301), UPDRS total (nFOG: -0.379; FOG: -0.368), UPDRS item 23 (nFOG: -0.404; FOG: -0.605), and UPDRS item 24 (nFOG: -0.405; FOG: -0.515). For the correlation to UPDRS II (0.320) and 9-HPT (-0.323), only nFOG group presented significance. For the UPDRS 25 (-0.437), only FOG group presented statistical significance. The UPDRS III can be predicted by 9-HPT, age, and HY in nFOG patients (Adjusted R2 = 0.416). In FOG group, UPDRS III can be predicted by HD, 9-HPT, age, and HY (Adjusted R2 = 0.491). CONCLUSION Handgrip strength showed to be predictive of motor impairment only in the FOG group. Our results showed clinical profile differences of motor symptoms considering freezers and nonfreezers with PD.
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Affiliation(s)
- Thiago da Silva Rocha Paz
- Graduate Program in Physical Education, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Bruna Yamaguchi
- Graduate Program in Physical Education, Universidade Federal do Paraná, Paraná, Brazil
| | - Vera Lúcia Israel
- Graduate Program in Physical Education, Universidade Federal do Paraná, Paraná, Brazil
| | - Alessandra Swarowsky
- Graduate Program in Physiotherapy, Universidade Estadual de Santa Catarina, Florianópolis, Brazil.,BPaRkI-Iniciativa Brasileira de Reabilitação na doença de Parkinson, Florianópolis, Brazil
| | - Clynton Lourenço Correa
- Graduate Program in Physical Education, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil, .,BPaRkI-Iniciativa Brasileira de Reabilitação na doença de Parkinson, Florianópolis, Brazil, .,Graduate Program in Neurology and Neuroscience, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil,
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18
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Choi SM, Cho SH, Kim BC. Association between freezing of gait and bone mineral density in patients with Parkinson's disease. Neurol Sci 2020; 42:2921-2925. [PMID: 33230756 DOI: 10.1007/s10072-020-04920-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/16/2020] [Indexed: 11/27/2022]
Abstract
Parkinson's disease (PD) patients are at risk for developing bone health problems, and freezing of gait (FOG) in PD is associated with a high risk of falling and fracture. This study aimed to determine the association between FOG and bone mineral density (BMD) in patients with PD. We included 148 PD patients. FOG was assessed using the FOG Questionnaire (FOG-Q), and BMD was measured by dual-energy X-ray absorptiometry. Of 148 PD patients, 102 (68.9%) had FOG. PD patients with FOG were older and had longer disease duration, higher levodopa equivalent dose, higher modified Hoehn and Yahr stage, higher Unified PD Rating Scale motor score, higher FOG-Q score, higher total Non-Motor Symptom Scale score, and lower BMD scores in the femoral neck area than those without FOG. Pearson correlation analysis revealed that age, sex, body mass index, and age at onset were significantly correlated with areal BMDs in all areas. FOG-Q scores correlated negatively with areal BMDs in the total hip area and femoral neck, but not with areal BMD in the lumbar spine. Multivariate regression analysis showed that FOG-Q score was significantly correlated with areal BMD in the femoral neck, but not with areal BMDs in the lumbar spine or total hip. FOG in PD patients correlates significantly with BMD in the femoral neck area. Therefore, PD patients with FOG should be screened for osteoporosis.
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Affiliation(s)
- Seong-Min Choi
- Department of Neurology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 58128, South Korea
- National Research Center for Dementia, Gwangju, South Korea
| | - Soo Hyun Cho
- Department of Neurology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 58128, South Korea
| | - Byeong C Kim
- Department of Neurology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 58128, South Korea.
- National Research Center for Dementia, Gwangju, South Korea.
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19
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Schaffert N, Braun Janzen T, Ploigt R, Schlüter S, Vuong V, Thaut MH. Development and evaluation of a novel music-based therapeutic device for upper extremity movement training: A pre-clinical, single-arm trial. PLoS One 2020; 15:e0242552. [PMID: 33211773 PMCID: PMC7676671 DOI: 10.1371/journal.pone.0242552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
Restoration of upper limb motor function and patient functional independence are crucial treatment targets in neurological rehabilitation. Growing evidence indicates that music-based intervention is a promising therapeutic approach for the restoration of upper extremity functional abilities in neurologic conditions such as cerebral palsy, stroke, and Parkinson's Disease. In this context, music technology may be particularly useful to increase the availability and accessibility of music-based therapy and assist therapists in the implementation and assessment of targeted therapeutic goals. In the present study, we conducted a pre-clinical, single-arm trial to evaluate a novel music-based therapeutic device (SONATA) for upper limb extremity movement training. The device consists of a graphical user interface generated by a single-board computer displayed on a 32" touchscreen with built-in speakers controlled wirelessly by a computer tablet. The system includes two operational modes that allow users to play musical melodies on a virtual keyboard or draw figures/shapes whereby every action input results in controllable sensory feedback. Four motor tasks involving hand/finger movement were performed with 21 healthy individuals (13 males, aged 26.4 ± 3.5 years) to evaluate the device's operational modes and main features. The results of the functional tests suggest that the device is a reliable system to present pre-defined sequences of audiovisual stimuli and shapes and to record response and movement data. This preliminary study also suggests that the device is feasible and adequate for use with healthy individuals. These findings open new avenues for future clinical research to further investigate the feasibility and usability of the SONATA as a tool for upper extremity motor function training in neurological rehabilitation. Directions for future clinical research are discussed.
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Affiliation(s)
- Nina Schaffert
- Department of Movement and Training Science, Institute for Human Movement Science, University of Hamburg, Hamburg, Germany
- BeSB GmbH Berlin, Sound Engineering, Berlin, Germany
| | - Thenille Braun Janzen
- Center for Mathematics, Computing and Cognition, Universidade Federal do ABC, São Bernardo do Campo, Brazil
| | - Roy Ploigt
- BeSB GmbH Berlin, Sound Engineering, Berlin, Germany
| | | | - Veronica Vuong
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, Canada
| | - Michael H. Thaut
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, Canada
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20
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Brugger F, Wegener R, Walch J, Galovic M, Hägele-Link S, Bohlhalter S, Kägi G. Altered activation and connectivity of the supplementary motor cortex at motor initiation in Parkinson’s disease patients with freezing. Clin Neurophysiol 2020; 131:2171-2180. [DOI: 10.1016/j.clinph.2020.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/08/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
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21
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Rezvanian S, Litvan I, Standaert D, Jankovic J, Reich SG, Hall D, Shprecher DR, Bordelon Y, Dubinsky R, Kluger B. Understanding the relationship between freezing of gait and other progressive supranuclear palsy features. Parkinsonism Relat Disord 2020; 78:56-60. [PMID: 32731191 DOI: 10.1016/j.parkreldis.2020.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/06/2020] [Accepted: 07/11/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Freezing of gait (FoG) leads to falls and reduces quality of life, but little is known about FoG in progressive supranuclear palsy (PSP). This study aim was to identify the clinical parameters associated with FoG in PSP patients. METHODS 349 patients meeting the National Institute for Neurological Disorders and Society for PSP (NINDS-SPSP) clinical diagnostic criteria were divided into two groups: PSP with FoG (n = 159) and PSP without FoG (n = 190). To determine if FoG in PSP associates with demographics, motor performance, visual difficulties, and executive function, we used the Frontal Assessment Battery (FAB), Mattis Dementia Rating Scale (DRS), Unified Parkinson's Disease Rating Scale (UPDRS), PSP Rating Scale (PSPRS), Modified Hoehn & Yahr staging, and Schwab and England Activities Daily Living (S&EADL) scale. UPDRS was used to identify FoG. Individual items of each clinical assessment with p-value < 0.05 in the univariate logistic regression analyses were included in the backward stepwise multivariate regression analysis. RESULTS Both groups were similar in demographics. 45.6% of patients had FoG, which was present at onset and increased with disease duration. There were no between-group significant associations between FoG and visual disturbances, executive function and overall cognition, but on univariate analyses, FoG was significantly associated with bradykinesia, rigidity, gait, and posture. In the multivariate model FoG was associated with disease duration and speech. CONCLUSIONS Our findings indicate that disease duration and speech have the most significant association with FoG. These findings may suggest that FoG and speech difficulties in PSP share a similar pathophysiology.
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Affiliation(s)
- Saba Rezvanian
- Department of Neurosciences, University of California San Diego, CA, USA
| | - Irene Litvan
- Department of Neurosciences, University of California San Diego, CA, USA.
| | - David Standaert
- Department of Neurology, University of Alabama at Birmingham, AL, USA
| | | | | | - Deborah Hall
- Department of Neurological Sciences, Rush University, IL, USA
| | - David R Shprecher
- University of Utah, UT, USA; Banner Sun Health Research Institute, AZ, USA
| | - Yvette Bordelon
- Department of Neurology, University of California Los Angeles, CA, USA
| | | | - Benzi Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
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22
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Roman-Liu D, Mockałło Z. Effectiveness of bimanual coordination tasks performance in improving coordination skills and cognitive functions in elderly. PLoS One 2020; 15:e0228599. [PMID: 32130219 PMCID: PMC7055901 DOI: 10.1371/journal.pone.0228599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background The purpose of the study was to determine the impact of the performance of bimanual coordination tasks with specific characteristics on the changes in quality of coordination, musculoskeletal load of the upper limbs and cognitive functions. Methods and findings A group of 26 people aged 60–67 years performed 6 sessions of bimanual coordination training. Each session included set of tasks that varied depending on the shape in which the cursor moved, the coordination mode (in-phase, anti-phase, complex) and the tracking mode (imposed or freely chosen speed). Performance was assessed by: Error, Variability and Execution. The load of upper limb muscles was expressed with the value of the normalized EMG amplitude. Cognitive functions were evaluated using the Vienna Test System. The Variability and Error values obtained during the sixth training session decreased by more than 50% of the initial values. Tasks with freely chosen speed showed changes from 15% to 34% for Error and from 45% to 50% for Variability. For tasks with imposed speed and coordination mode anti-phase or complex it was between 51% and 58% for Error and between 58% and 68% for Variability. Statistically significant differences between load during the sixth training session compared to the first session occurred in three out of four muscles and were between 9% to 39%. There were statistically significant differences in motor time and no differences in variables describing attention and working memory. Conclusions Coordination mode is meaningful for improving coordination skills; tasks in the anti-phase and complex are recommended. Tracking mode also plays a role, tasks with an imposed cursor movement speed have greater potential to improve coordination skills than tasks with freely chosen. Improved control skills resulted in the reduction of upper limb musculoskeletal load. It can be assumed that an increase in coordination skills with the use of appropriate training can help to reduce musculoskeletal load.
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Affiliation(s)
- Danuta Roman-Liu
- Department of Ergonomics, Central Institute for Labour Protection—National Research Institute (CIOP-PIB), Warsaw, Poland
- * E-mail:
| | - Zofia Mockałło
- Department of Ergonomics, Central Institute for Labour Protection—National Research Institute (CIOP-PIB), Warsaw, Poland
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23
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Glover A, Pillai L, Doerhoff S, Virmani T. Differential Gait Decline in Parkinson's Disease Enhances Discrimination of Gait Freezers from Non-Freezers. JOURNAL OF PARKINSON'S DISEASE 2020; 10:1657-1673. [PMID: 32925092 PMCID: PMC9171708 DOI: 10.3233/jpd-201961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is a debilitating feature of Parkinson's disease (PD) for which treatments are limited. To develop neuroprotective strategies, determining whether disease progression is different in phenotypic variants of PD is essential. OBJECTIVE To determine if freezers have a faster decline in spatiotemporal gait parameters. METHODS Subjects were enrolled in a longitudinal study and assessed every 3- 6 months. Continuous gait in the levodopa ON-state was collected using a gait mat (Protokinetics). The slope of change/year in spatiotemporal gait parameters was calculated. RESULTS 26 freezers, 31 non-freezers, and 25 controls completed an average of 6 visits over 28 months. Freezers had a faster decline in mean stride-length, stride-velocity, swing-%, single-support-%, and variability in single-support-% compared to non-freezers (p < 0.05). Gait decline was not correlated with initial levodopa dose, duration of levodopa therapy, change in levodopa dose or change in Montreal Cognitive Assessment scores (p > 0.25). Gait progression parameters were required to obtain 95% accuracy in categorizing freezers and non-freezers groups in a forward step-wise binary regression model. Change in mean stride-length, mean stride-width, and swing-% variability along with initial foot-length variability, mean swing-% and apathy scores were significant variables in the model. CONCLUSION Freezers had a faster temporal decline in objectively quantified gait, and inclusion of longitudinal gait changes in a binary regression model greatly increased categorization accuracy. Levodopa dosing, cognitive decline and disease severity were not significant in our model. Early detection of this differential decline may help define freezing prone groups for testing putative treatments.
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Affiliation(s)
- Aliyah Glover
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205 USA
| | - Lakshmi Pillai
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205 USA
| | - Shannon Doerhoff
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205 USA
| | - Tuhin Virmani
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205 USA
- Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR, 72205 USA
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24
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Véron-Delor L, Pinto S, Eusebio A, Azulay JP, Witjas T, Velay JL, Danna J. Musical sonification improves motor control in Parkinson's disease: a proof of concept with handwriting. Ann N Y Acad Sci 2019; 1465:132-145. [PMID: 31599463 DOI: 10.1111/nyas.14252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/06/2019] [Accepted: 09/17/2019] [Indexed: 01/10/2023]
Abstract
A growing number of studies postulate the use of music to improve motor control in patients with Parkinson's disease (PD). The effects of music are greatly variable from one individual to the other and do not always reach the expected benefits. This study aimed to optimize the use of music in the management of movement disorders inherent to PD in a handwriting task. We developed and tested musical sonification (MS), a method that transforms in real-time kinematic variables into music. Twelve patients with PD, on medication, and 12 healthy controls were recruited in a pretest/training/posttest design experiment. Three training sessions were compared, for which participants were asked to produce graphomotor exercises: one session with music (unrelated to handwriting), one with MS (controlled by handwriting), and one in silence. Results showed that the performance in training was better under MS than under silence or background music, for both groups. After training, the benefits of MS were still present for both groups, with a higher effect for PD patients than for control group. Our results provide a proof of concept to consider MS as a relevant auditory guidance strategy for movement rehabilitation in patients with PD.
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Affiliation(s)
- Lauriane Véron-Delor
- CNRS, LNC, Aix-Marseille Université, Marseille, France.,CNRS, LPL, Aix-Marseille Université, Aix-en-Provence, France
| | - Serge Pinto
- CNRS, LPL, Aix-Marseille Université, Aix-en-Provence, France
| | - Alexandre Eusebio
- CNRS, Institut de Neurosciences de La Timone, Aix-Marseille Université, Marseille, France.,Hôpital La Timone, Service de Neurologie et pathologie du mouvement, APHM, Marseille, France
| | - Jean-Philippe Azulay
- CNRS, LNC, Aix-Marseille Université, Marseille, France.,Hôpital La Timone, Service de Neurologie et pathologie du mouvement, APHM, Marseille, France
| | - Tatiana Witjas
- CNRS, Institut de Neurosciences de La Timone, Aix-Marseille Université, Marseille, France.,Hôpital La Timone, Service de Neurologie et pathologie du mouvement, APHM, Marseille, France
| | | | - Jérémy Danna
- CNRS, LNC, Aix-Marseille Université, Marseille, France
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25
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Unilateral elbow joint festination in early Parkinson's disease. Parkinsonism Relat Disord 2019; 65:286-287. [PMID: 31277982 DOI: 10.1016/j.parkreldis.2019.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 11/21/2022]
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26
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Broeder S, Heremans E, Pinto Pereira M, Nackaerts E, Meesen R, Verheyden G, Nieuwboer A. Does transcranial direct current stimulation during writing alleviate upper limb freezing in people with Parkinson’s disease? A pilot study. Hum Mov Sci 2019; 65:S0167-9457(17)30936-3. [DOI: 10.1016/j.humov.2018.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/17/2018] [Accepted: 02/19/2018] [Indexed: 11/15/2022]
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Capato TTC, Nonnekes J, Barbosa ER, Bloem BR. Internal and external compensation strategies to alleviate upper limb freezing in Parkinson's disease. Parkinsonism Relat Disord 2019; 64:335-336. [PMID: 30910504 DOI: 10.1016/j.parkreldis.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Tamine T C Capato
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands; University of São Paulo, Department of Neurology, Movement Disorders Clinic, HC FMUSP, São Paulo, Brazil.
| | - Jorik Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, the Netherlands
| | - Egberto R Barbosa
- University of São Paulo, Department of Neurology, Movement Disorders Clinic, HC FMUSP, São Paulo, Brazil
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
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A new method based on quiet stance baseline is more effective in identifying freezing in Parkinson's disease. PLoS One 2018; 13:e0207945. [PMID: 30475908 PMCID: PMC6258113 DOI: 10.1371/journal.pone.0207945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/08/2018] [Indexed: 11/24/2022] Open
Abstract
Freezing, an episodic movement breakdown that goes from disrupted gait patterns to complete arrest, is a disabling symptom in Parkinson’s disease. Several efforts have been made to objectively identify freezing episodes (FEs), although a standardized methodology to discriminate freezing from normal movement is lacking. Novel mathematical approaches that provide information in the temporal and frequency domains, such as the continuous wavelet transform, have demonstrated promising results detecting freezing, although still with limited effectiveness. We aimed to determine whether a computerized algorithm using the continuous wavelet transform based on baseline (i.e. no movement) rather than on amplitude decrease is more effective detecting freezing. Twenty-six individuals with Parkinson’s disease performed two trials of a repetitive stepping-in-place task while they were filmed by a video camera and tracked by a motion capture system. The number of FEs and their total duration were determined from a visual inspection of the videos and from three different computed algorithms. Differences in the number and total duration of the FEs between the video inspection and each of the three methods were obtained. The accuracy to identify the time of occurrence of a FE by each method was also calculated. A significant effect of Method was found for the number (p = 0.016) and total duration (p = 0.013) of the FEs, with the method based on baseline being the closest one to the values reported from the videos. Moreover, the same method was the most accurate in detecting the time of occurrence, and the one reaching the highest sensitivity (88.2%). Findings suggest that threshold detection methods based on baseline and movement amplitude decreases capture different characteristics of Parkinsonian gait, with the first one being more effective at detecting FEs. Moreover, robust approaches that consider both time and frequency characteristics are more sensitive in identifying freezing.
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Khoshnam M, Häner DMC, Kuatsjah E, Zhang X, Menon C. Effects of Galvanic Vestibular Stimulation on Upper and Lower Extremities Motor Symptoms in Parkinson's Disease. Front Neurosci 2018; 12:633. [PMID: 30254564 PMCID: PMC6141687 DOI: 10.3389/fnins.2018.00633] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/23/2018] [Indexed: 11/17/2022] Open
Abstract
As a neurodegenerative movement disorder, Parkinson’s disease (PD) is commonly characterized by motor symptoms such as resting tremor, rigidity, bradykinesia, and balance and postural impairments. While the main cause of PD is still not clear, it is shown that the basal ganglia loop, which has a role in adjusting a planned movement execution through fine motor control, is altered during this disease and contributes toward the manifested motor symptoms. Galvanic vestibular stimulation (GVS) is a non-invasive technique to influence the vestibular system and stimulate the motor system. This study explores how the motor symptoms of upper and lower extremities in PD are instantly affected by vestibular stimulation. In this regard, direct current GVS was applied to 11 individuals with PD on medication while they were performing two sets of experiments: (1) Instrumented Timed Up and Go (iTUG) test and (2) finger tapping task. The performance of participants was recorded with accelerometers and cameras for offline processing of data. Several outcome measures including coefficient of variation of the step duration, gait phase, phase coordination index, tapping score, and the number and duration of manual motor blocks (MMBs) were considered for objective quantifying of performance. Results showed that almost all of considered outcome measures were improved with the application of GVS and that the improvement in the coefficient of variation of the step duration, the tapping score, and the number of MMBs was statistically significant (p-value < 0.05). The results of this study suggest that GVS can be used to alleviate some of the common motor symptoms of PD. Further research is required to fully characterize the effects of GVS and determine its efficacy in the long term.
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Affiliation(s)
- Mahta Khoshnam
- Menrva Research Group, Schools of Mechatronic Systems and Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Daniela M C Häner
- Menrva Research Group, Schools of Mechatronic Systems and Engineering Science, Simon Fraser University, Burnaby, BC, Canada.,ETH Zürich, Zurich, witzerland
| | - Eunice Kuatsjah
- Menrva Research Group, Schools of Mechatronic Systems and Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Xin Zhang
- Menrva Research Group, Schools of Mechatronic Systems and Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Carlo Menon
- Menrva Research Group, Schools of Mechatronic Systems and Engineering Science, Simon Fraser University, Burnaby, BC, Canada
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Falaki A, Jo HJ, Lewis MM, O'Connell B, De Jesus S, McInerney J, Huang X, Latash ML. Systemic effects of deep brain stimulation on synergic control in Parkinson's disease. Clin Neurophysiol 2018; 129:1320-1332. [PMID: 29573980 PMCID: PMC5938107 DOI: 10.1016/j.clinph.2018.02.126] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/08/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We explored effects of deep brain stimulation (DBS) in patients with Parkinson's disease (PD) on the synergic control of fingers in a multi-finger force production task and of muscles in a task involving vertical posture. METHODS The finger task involved the four fingers of a hand producing accurate total force followed by a targeted quick force pulse. The postural task involved releasing a load from extended arms. The analysis of synergies was performed within the framework of the uncontrolled manifold hypothesis. RESULTS DBS led to no significant changes in indices of stability during steady-state phases. In contrast, DBS improved indices of agility, quantified as anticipatory synergy adjustments that reduced stability of salient performance variables in preparation to their quick change. There were moderate-to-strong correlations between indices of both stability and agility measured in the multi-finger force production and multi-muscle whole-body action. CONCLUSIONS Our results point at systemic changes in synergic control in PD. They show that DBS is effective in improving only one components of synergic control related to agility in performance being relatively ineffective for the stability component. SIGNIFICANCE The results show systemic brain mechanisms of synergies and suggest differential effects of DBS on indices of stability and agility.
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Affiliation(s)
- Ali Falaki
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA
| | - Hang Jin Jo
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miami, FL 33136, USA
| | - Mechelle M Lewis
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Barbara O'Connell
- Departments of Neurosurgery, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Sol De Jesus
- Departments of Neurosurgery, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - James McInerney
- Departments of Neurosurgery, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Xuemei Huang
- Departments of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA; Departments of Pharmacology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA; Departments of Radiology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA; Departments of Neurosurgery, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Mark L Latash
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA.
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Jehu DA, Cantù H, Hill A, Paquette C, Côté JN, Nantel J. Medication and trial duration influence postural and pointing parameters during a standing repetitive pointing task in individuals with Parkinson's disease. PLoS One 2018; 13:e0195322. [PMID: 29621320 PMCID: PMC5886485 DOI: 10.1371/journal.pone.0195322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/20/2018] [Indexed: 11/18/2022] Open
Abstract
We aimed to determine the effects of levodopa medication on the performance of a repetitive pointing task while standing, and to investigate the optimal trial duration in individuals with Parkinson’s disease, and older adults. Seventeen individuals with Parkinson’s disease (5 freezers) and 9 older adults stood on force platforms for 30 s and 120 s while performing a bilateral repetitive pointing task, tracked by motion capture. Participants with Parkinson’s disease were assessed on and off medication and older adults were also assessed on separate days. The main findings were that: 1) on medication, participants with Parkinson’s exhibited greater center of pressure root mean square in the medial-lateral direction, greater velocity in the medial-lateral and anterior-posterior directions, and greater range in the medial-lateral direction than off medication; 2) longer trial durations resulted in greater center of pressure range in the medial-lateral and anterior-posterior directions and greater coefficient of variation in finger pointing on the least affected side; 3) Parkinson’s participants exhibited larger range in the medial-lateral direction compared to older adults; 4) off medication, freezers presented with less range and root mean square in the anterior-posterior direction than non-freezers; and 5) a correlation emerged between the freezing of gait questionnaire and pointing asymmetry and the coefficient of variation of pointing on the most affected side. Therefore, Parkinson’s medication may increase instability during a repetitive pointing task. Longer trials may provide a better depiction of sway by discriminating between those with and without neurological impairment. Individuals with Parkinson’s were less stable than older adults, supporting that they are at a greater risk for falls. The greater restrictive postural strategy in freezers compared to non-freezers is likely a factor that augments fall-risk. Lastly, the link between freezing of gait and upper-limb movement indicates that freezing may manifest first in the lower-limbs.
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Affiliation(s)
- Deborah A. Jehu
- University of Ottawa, School of Human Kinetics, Ottawa, Ontario, Canada
| | - Hiram Cantù
- McGill University, Department of Kinesiology and Physical Education, Montréal, Québec, Canada
| | - Allen Hill
- University of Ottawa, School of Human Kinetics, Ottawa, Ontario, Canada
| | - Caroline Paquette
- McGill University, Department of Kinesiology and Physical Education, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montréal, Québec, Canada
| | - Julie N. Côté
- McGill University, Department of Kinesiology and Physical Education, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation (CRIR), Montréal, Québec, Canada
| | - Julie Nantel
- University of Ottawa, School of Human Kinetics, Ottawa, Ontario, Canada
- * E-mail:
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32
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Keklicek H, Cetin B, Salci Y, Balkan AF, Altinkaynak U, Armutlu K. Investigating the dynamic plantar pressure distribution and loading pattern in subjects with multiple sclerosis. Mult Scler Relat Disord 2018; 20:186-191. [DOI: 10.1016/j.msard.2018.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/12/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
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Thomas M, Lenka A, Kumar Pal P. Handwriting Analysis in Parkinson's Disease: Current Status and Future Directions. Mov Disord Clin Pract 2017; 4:806-818. [PMID: 30363367 PMCID: PMC6174397 DOI: 10.1002/mdc3.12552] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The majority of patients with Parkinson's disease (PD) have handwriting abnormalities. Micrographia (abnormally small letter size) is the most commonly reported and easily detectable handwriting abnormality in patients with PD. However, micrographia is perhaps the tip of the iceberg representing the handwriting abnormalities in PD. Digitizing tablet technology, which has evolved over the last 2 decades, has made it possible to study the pressure and kinematic features of handwriting. This has resulted in a surge of studies investigating graphomotor impairment in patients with PD. METHODS The objectives of this study were to review the evolution of the kinematic analysis of handwriting in PD and to provide an overview of handwriting abnormalities observed in PD along with future directions for research in this field. Articles for review were searched from the PubMed and SCOPUS databases. RESULTS Digitizing tablet technologies have resulted in a shift of focus from the analysis of only letter size to the analysis of several kinematic features of handwriting. Studies based on the kinematic analysis of handwriting have revealed that patients with PD may have abnormalities in velocity, fluency, and acceleration in addition to micrographia. The recognition of abnormalities in several kinematic parameters of handwriting has given rise to the term PD dysgraphia. In addition, certain kinematic properties potentially may be helpful in distinguishing PD from other parkinsonian disorders. CONCLUSION The journey from micrographia to PD dysgraphia is indeed a paradigm shift. Further research is warranted to gain better insight into the graphomotor impairments in PD and their clinical implications.
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Affiliation(s)
- Mathew Thomas
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
| | - Abhishek Lenka
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
- Department of Clinical NeurosciencesNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
| | - Pramod Kumar Pal
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBangaloreKarnatakaIndia
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34
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Freezing during tapping tasks in patients with advanced Parkinson's disease and freezing of gait. PLoS One 2017; 12:e0181973. [PMID: 28886015 PMCID: PMC5590736 DOI: 10.1371/journal.pone.0181973] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/10/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Parkinson’s disease patients with freezing of gait also experience sudden motor blocks (freezing) during other repetitive motor tasks. We assessed the proportion of patients with advanced PD and freezing of gait who also displayed segmental “freezing” in tapping tasks. Methods Fifteen Parkinson’s disease patients with freezing of gait were assessed. Freezing of gait was evaluated using a standardized gait trajectory with the usual triggers. Patients performed repetitive tapping movements (as described in the MDS-UPDRS task) with the hands or the feet in the presence or absence of a metronome set to 4 Hz. Movements were recorded with a video motion system. The primary endpoint was the occurrence of segmental freezing in these tapping tasks. The secondary endpoints were (i) the relationship between segmental episodic phenomena and FoG severity, and (ii) the reliability of the measurements. Results For the upper limbs, freezing was observed more frequently with a metronome (21% of trials) than without a metronome (5%). For the lower limbs, the incidence of freezing was higher than for the upper limbs, and was again observed more frequently in the presence of an auditory cue (47%) than in its absence (14%). Conclusion Although freezing of the lower limbs was easily assessed during an MDS-UPDRS task with a metronome, it was not correlated with the severity of freezing of gait (as evaluated during a standardized gait trajectory). Only this latter was a reliable measurement in patients with advanced Parkinson’s disease.
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35
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Nemanich ST, McNeely ME, Earhart GM, Norris SA, Black KJ. A Case of Apparent Upper-Body Freezing in Parkinsonism while Using a Wheelchair. Front Neurol 2017; 8:205. [PMID: 28555128 PMCID: PMC5431276 DOI: 10.3389/fneur.2017.00205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/27/2017] [Indexed: 11/30/2022] Open
Abstract
Freezing of gait (FOG) is a common, disabling gait disturbance in Parkinson’s disease (PD) and other Parkinsonian syndromes. Freezing also occurs during non-gait movements involving the upper limbs. The mechanisms underlying freezing are complex, likely involving motor, cognitive, and sensory systems that contribute to the episodes. Here, we reported a 60-year-old female with a 24-year history of parkinsonism who experienced significant FOG when ambulatory. Disease progression resulted in her permanent use of a powered wheelchair. While using the power chair, the patient experiences apparent paroxysmal freezing in the hand and arm used to steer and propel the chair. These episodes, some lasting up to several minutes, occur only in circumstances (e.g., entering and leaving an elevator) that are similar to environments known to elicit and exacerbate FOG. Episodes are transient and can be volitionally interrupted by the patient but sometimes require external assistance. Therapeutic intervention for this type of potential freezing has yet to be determined. This case may provide insight into the complex nature of freezing behavior and suggests a need for new approaches to treating non-traditional freezing behavior.
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Affiliation(s)
- Samuel T Nemanich
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Marie E McNeely
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Gammon M Earhart
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,Department of Neuroscience, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Scott A Norris
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Kevin J Black
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,Department of Neuroscience, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.,Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Cerebellar theta burst stimulation does not improve freezing of gait in patients with Parkinson's disease. J Neurol 2017; 264:963-972. [PMID: 28382420 PMCID: PMC5413528 DOI: 10.1007/s00415-017-8479-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 11/09/2022]
Abstract
Freezing of gait (FOG) in Parkinson’s disease (PD) likely results from dysfunction within a complex neural gait circuitry involving multiple brain regions. Herein, cerebellar activity is increased in patients compared to healthy subjects. This cerebellar involvement has been proposed to be compensatory. We hypothesized that patients with FOG would have a reduced ability to recruit the cerebellum to compensate for dysfunction in other brain areas. In this study cerebellar activity was modified unilaterally by either excitatory or inhibitory theta burst stimulation (TBS), applied during two separate sessions. The ipsilateral cerebellar hemisphere, corresponding to the body side most affected by PD, was stimulated. Seventeen patients with PD showing ‘off’ state FOG participated. The presence of FOG was verified objectively upon inclusion. We monitored gait and bimanual rhythmic upper limb movements before and directly after TBS. Gait was evaluated with a FOG-provoking protocol, including rapid 360° turns and a 10-m walking test with small fast steps. Upper limb movement performance was evaluated with a repetitive finger flexion–extension task. TBS did not affect the amount of freezing during walking or finger tapping. However, TBS did increase gait speed when walking with small steps, and decreased gait speed when walking as fast as possible with a normal step size. The changes in gait speed were not accompanied by changes in corticospinal excitability of M1. Unilateral cerebellar TBS did not improve FOG. However, changes in gait speed were found which suggests a role of the cerebellum in PD.
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Maes C, Gooijers J, Orban de Xivry JJ, Swinnen SP, Boisgontier MP. Two hands, one brain, and aging. Neurosci Biobehav Rev 2017; 75:234-256. [PMID: 28188888 DOI: 10.1016/j.neubiorev.2017.01.052] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/18/2016] [Accepted: 01/31/2017] [Indexed: 12/11/2022]
Abstract
Many activities of daily living require moving both hands in an organized manner in space and time. Therefore, understanding the impact of aging on bimanual coordination is essential for prolonging functional independence and well-being in older adults. Here we investigated the behavioral and neural determinants of bimanual coordination in aging. The studies surveyed in this review reveal that aging is associated with cortical hyper-activity (but also subcortical hypo-activity) during performance of bimanual tasks. In addition to changes in activation in local areas, the interaction between distributed brain areas also exhibits age-related effects, i.e., functional connectivity is increased in the resting brain as well as during task performance. The mechanisms and triggers underlying these functional activation and connectivity changes remain to be investigated. This requires further research investment into the detailed study of interactions between brain structure, function and connectivity. This will also provide the foundation for interventional research programs towards preservation of brain health and behavioral performance by maximizing neuroplasticity potential in older adults.
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Affiliation(s)
- Celine Maes
- KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, 3001 Leuven, Belgium
| | - Jolien Gooijers
- KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, 3001 Leuven, Belgium
| | - Jean-Jacques Orban de Xivry
- KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, 3001 Leuven, Belgium
| | - Stephan P Swinnen
- KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, 3001 Leuven, Belgium; KU Leuven, Leuven Research Institute for Neuroscience & Disease (LIND), 3001 Leuven, Belgium
| | - Matthieu P Boisgontier
- KU Leuven, Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, 3001 Leuven, Belgium.
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Changes in movement organization and control strategies when learning a biomechanically constrained gait pattern, racewalking: a PCA study. Exp Brain Res 2016; 235:931-940. [PMID: 27942763 PMCID: PMC5315716 DOI: 10.1007/s00221-016-4853-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 12/02/2016] [Indexed: 12/20/2022]
Abstract
Combining advances from gait analysis and motor learning fields, this study aims to examine invariant characteristics and practice-related changes in the control of walking gait when learning a biomechanically constrained pattern, racewalking (RW). RW’s regulation imposes a straightened knee at the stance phase which differentiates it qualitatively from normal walking. Using 3D motion analysis, we computed key kinematic variables from a whole-body model. Principal component analysis was then used as a tool to evaluate the evolution of normal walking synergies (S0) immediately at the first practice session (S1) and further with practice (S1–S4). Before the start of practice, normal walking was characterized by two predominant control dimensions explaining an upper-extremities/antero-posterior component (PC1) and a lower-extremities/vertical component (PC2). Compared to normal walking, the immediate increase at S1 in the number of PCs needed to explain a significant portion of movement variance could be suggestive of a recruitment of a task-specific component. With practice, the significant decrease in the variance accounted for by PC1 and in the correlations between many variables could indicate a destabilization of spontaneous tendencies to facilitate the adoption of more task-specific coordinative pattern. PC2 seemed to be reinforced with practice where a significant increase in its explained variance was observed. In sum, this study shows that common features in the gait control are preserved with practice, and the movement reorganization, however, seems rather defined by shifts in the relative contribution of some variables within each PC.
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de Freitas PR, Lemos AE, Santos MP, Michaelsen SM, Corrêa CL, Swarowsky A. "Test D'évaluation Des Membres Supérieurs Des Personnes Âgées" (TEMPA) to assess upper limb activity in Parkinson's disease. J Hand Ther 2016; 30:320-327. [PMID: 27899223 DOI: 10.1016/j.jht.2016.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/16/2016] [Accepted: 07/12/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Cross-sectional and observational study. PURPOSE OF THE STUDY Assess upper limb (UL) activity limitations using the "Test d'Evaluation des Membres Supérieurs Des Personnes Agées" (TEMPA) in individuals with Parkinson's disease (PD) and verify its clinimetrics properties. METHODS The following were evaluated: internal consistency, interrater and test-retest reliability; concurrent validity; convergent validity; know group's validity; minimal detectable change, floor and ceiling effects, and the relationship between UL activity limitations and the presence of freezing of gait. RESULTS Excellent reliability and interrater agreement (intraclass correlation coefficient = 0.99 and κ = 0.92) and test-retest reliability (intraclass correlation coefficient = 0.97) were found, as well internal consistency (α = 0.99). A moderate negative correlation was found between TEMPA and section II of the Unified Parkinson's Disease Rating Scale (ρ = -0.58; P = .001), and moderate/low between the test and the Nine Hole Peg Test values of the right UL and moderate for left UL (ρ = 0.56 and ρ = 0.41; P = .001) (ρ = 0.52 and ρ = 0.51; P = .001 and P = .002), respectively. No significant relationship was found with freezing episodes (P = .057). DISCUSSION TEMPA is useful for assessing UL activity limitations in PD, have adequate clinimetrics properties and is capable of detecting the influence of motor symptoms during the carrying out of daily living tasks. No differences were found between freezers and no freezers. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Paula Ruiz de Freitas
- Physical Therapy Department, Experimental Research Laboratory (LAPEX), University of the State of Santa Catarina (UDESC), Florianópolis, Brazil; Physical Therapy Department, Physical Therapy Postgraduate Program, University of the State of Santa Catarina (UDESC), Florianópolis, Brazil
| | - Ana Elisa Lemos
- Physical Therapy Department, Physical Education Postgraduate Program, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Mariana Palla Santos
- Physical Therapy Department, Experimental Research Laboratory (LAPEX), University of the State of Santa Catarina (UDESC), Florianópolis, Brazil; Physical Therapy Department, Physical Therapy Postgraduate Program, University of the State of Santa Catarina (UDESC), Florianópolis, Brazil
| | - Stella Maris Michaelsen
- Physical Therapy Department, Physical Therapy Postgraduate Program, University of the State of Santa Catarina (UDESC), Florianópolis, Brazil
| | - Clynton Lourenço Corrêa
- Physical Therapy Department, Physical Education Postgraduate Program, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Alessandra Swarowsky
- Physical Therapy Department, Experimental Research Laboratory (LAPEX), University of the State of Santa Catarina (UDESC), Florianópolis, Brazil; Physical Therapy Department, Physical Therapy Postgraduate Program, University of the State of Santa Catarina (UDESC), Florianópolis, Brazil.
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Okada KI, Kobayashi Y. Reward and Behavioral Factors Contributing to the Tonic Activity of Monkey Pedunculopontine Tegmental Nucleus Neurons during Saccade Tasks. Front Syst Neurosci 2016; 10:94. [PMID: 27891082 PMCID: PMC5104745 DOI: 10.3389/fnsys.2016.00094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/03/2016] [Indexed: 01/24/2023] Open
Abstract
The pedunculopontine tegmental nucleus (PPTg) in the brainstem plays a role in controlling reinforcement learning and executing conditioned behavior. We previously examined the activity of PPTg neurons in monkeys during a reward-conditioned, visually guided saccade task, and reported that a population of these neurons exhibited tonic responses throughout the task period. These tonic responses might depend on prediction of the upcoming reward, successful execution of the task, or both. Here, we sought to further distinguish these factors and to investigate how each contributes to the tonic neuronal activity of the PPTg. In our normal visually guided saccade task, the monkey initially fixated on the central fixation target (FT), then made saccades to the peripheral saccade target and received a juice reward after the saccade target disappeared. Most of the tonic activity terminated shortly after the reward delivery, when the monkey broke fixation. To distinguish between reward and behavioral epochs, we then changed the task sequence for a block of trials, such that the saccade target remained visible after the reward delivery. Under these visible conditions, the monkeys tended to continue fixating on the saccade target even after the reward delivery. Therefore, the prediction of the upcoming reward and the end of an individual trial were separated in time. Regardless of the task conditions, half of the tonically active PPTg neurons terminated their activity around the time of the reward delivery, consistent with the view that PPTg neurons might send reward prediction signals until the time of reward delivery, which is essential for computing reward prediction error in reinforcement learning. On the other hand, the other half of the tonically active PPTg neurons changed their activity dependent on the task condition. In the normal condition, the tonic responses terminated around the time of the reward delivery, while in the visible condition, the activity continued until the disappearance of the saccade target (ST) after reward delivery. Thus, for these neurons, the tonic activity might be related to maintaining attention to complete fixation behavior. These results suggest that, in addition to the reward value information, some PPTg neurons might contribute to the execution of conditioned task behavior.
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Affiliation(s)
- Ken-Ichi Okada
- Laboratories for Neuroscience, Visual Neuroscience Group, Graduate School of Frontier Biosciences, Osaka UniversityOsaka, Japan; Center for Information and Neural Networks, National Institute of Information and Communications Technology, Osaka UniversityOsaka, Japan
| | - Yasushi Kobayashi
- Laboratories for Neuroscience, Visual Neuroscience Group, Graduate School of Frontier Biosciences, Osaka UniversityOsaka, Japan; Center for Information and Neural Networks, National Institute of Information and Communications Technology, Osaka UniversityOsaka, Japan; Research Center for Behavioral Economics, Osaka UniversityOsaka, Japan
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Snijders AH, Takakusaki K, Debu B, Lozano AM, Krishna V, Fasano A, Aziz TZ, Papa SM, Factor SA, Hallett M. Physiology of freezing of gait. Ann Neurol 2016; 80:644-659. [DOI: 10.1002/ana.24778] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Anke H. Snijders
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Medical Center; Nijmegen the Netherlands
- Maasziekenhuis Pantein; Boxmeer the Netherlands
| | - Kaoru Takakusaki
- Research Center for Brain Function and Medical Engineering; Asahikawa Medical University; Asahikawa Japan
| | - Bettina Debu
- Joseph Fourier University, Grenoble Universities; Grenoble France
| | - Andres M. Lozano
- Division of Neurosurgery; University of Toronto; Toronto Ontario Canada
| | - Vibhor Krishna
- Division of Neurosurgery; University of Toronto; Toronto Ontario Canada
- Department of Neurosurgery; Ohio State University; Columbus OH
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital; University Health Network; Toronto Ontario Canada
| | - Tipu Z. Aziz
- John Radcliffe Hospital; Headington Oxford United Kingdom
| | - Stella M. Papa
- Department of Neurology, Jean and Paul Amos Parkinson's Disease and Movement Disorders Center; Emory University School of Medicine; Atlanta GA
| | - Stewart A. Factor
- Department of Neurology, Jean and Paul Amos Parkinson's Disease and Movement Disorders Center; Emory University School of Medicine; Atlanta GA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health; Bethesda MD
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Stegemöller E, Zaman A, MacKinnon CD, Tillman MD, Hass CJ, Okun MS. Laterality of repetitive finger movement performance and clinical features of Parkinson’s disease. Hum Mov Sci 2016; 49:116-23. [DOI: 10.1016/j.humov.2016.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/27/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
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Cohen ML, Schwab NA, Price CC, Heilman KM. Impaired Switching from Self-Prepared Actions in Mild Parkinson Disease. JOURNAL OF PARKINSONS DISEASE 2016; 5:961-70. [PMID: 27070004 DOI: 10.3233/jpd-150672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Planned and initiated actions frequently need to be terminated in favor of another action. It is known that many individuals with Parkinson's disease (PD) have more difficulty self-initiating movement (i.e., endogenously evoked movement)than moving in response to environmental stimuli (i.e., exogenously evoked movement). However, it is not known if individuals with PD display this same endogenous-exogenous asymmetry when needing to terminate, disengage, and reprogram movements. OBJECTIVE This study used a novel reaction time (RT) paradigm to test whether patients with mild PD have subclinical deficits of endogenous movement initiation and endogenous movement reprogramming. METHODS Twelve non-demented individuals with PD on medication and 15 demographically similar healthy control (HC)participants completed an experimental paradigm that examined their RTs (key press) following self-selected valid action preparation (endogenous cues) versus valid exogenously presented cues. The paradigm also assessed participants' ability to rapidly stop their endogenous or exogenous preparation following an invalid cue and execute an alternative action (key press). RESULTS Participants with PD produced similar RTs as controls following endogenous and exogenous valid cues, and following invalid exogenous cues. However, following invalid endogenous cues, PD participants were slower than HC participants to stop an endogenous preparation and execute an alternative action. CONCLUSIONS Despite having mild disease and being on dopaminergic medication, these individuals with PD displayed deficits in motor disengagement and reprograming of self-selected actions. Future studies should examine how this phenomenon influences every day actions, as well as possible treatments for this deficit.
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Delval A, Rambour M, Tard C, Dujardin K, Devos D, Bleuse S, Defebvre L, Moreau C. Freezing/festination during motor tasks in early-stage Parkinson's disease: A prospective study. Mov Disord 2016; 31:1837-1845. [PMID: 27618808 DOI: 10.1002/mds.26762] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Parkinsonian patients have a tendency to speed up during repetitive motor tasks (festination) and to experience sudden motor blocks (freezing). In this article, we prospectively studied the appearance and progression of these phenomena in 30 early-stage PD patients. METHODS A total of 30 controls and early-stage PD patients were assessed in the "off-drug" condition at baseline and 2 years later. Freezing of gait was evaluated using a standardized gait trajectory with the usual triggers. Patients also performed diadochokinetic tasks with 3 different effectors (repetitive, antiphase movements for the hands and feet, and repetitive syllable production for the orofacial effector) at frequencies ranging from 1 to 7 Hz (in random order). The primary endpoint was the occurrence of freezing and festination. RESULTS At baseline, freezing was observed in 6.5% of the trials in PD patients (43% of the patients) and 2.3% of the trials in controls, and festination was observed in 5.7% of the trials in patients (53% of the patients) and 0.8% of the trials in controls. These proportions were slightly higher in patients 2 years later. None of the patients presented freezing of gait at baseline, but 2 displayed this condition 2 years later. These phenomena occurred more frequently for the limb effectors than for the orofacial effector. Freezing and festination were associated with the akinetic-rigid subtype, although tremor-dominant patients displayed greater rhythm variability outside episodes. CONCLUSION Freezing and festination of the upper and lower limbs are observed soon after the diagnosis of PD and may be early biomarkers for disease progression. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Arnaud Delval
- Université de Lille, INSERM U1171-Troubles cognitifs dégénératifs et vasculaires, Lille, France.,Service de Neurophysiologie Clinique-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille cedex, France
| | - Mélanie Rambour
- Université de Lille, INSERM U1171-Troubles cognitifs dégénératifs et vasculaires, Lille, France.,Service de Neurologie-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille University, Lille cedex, France
| | - Céline Tard
- Université de Lille, INSERM U1171-Troubles cognitifs dégénératifs et vasculaires, Lille, France.,Service de Neurophysiologie Clinique-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille cedex, France.,Service de Neurologie-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille University, Lille cedex, France
| | - Kathy Dujardin
- Université de Lille, INSERM U1171-Troubles cognitifs dégénératifs et vasculaires, Lille, France.,Service de Neurologie-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille University, Lille cedex, France
| | - David Devos
- Université de Lille, INSERM U1171-Troubles cognitifs dégénératifs et vasculaires, Lille, France.,Service de Neurologie-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille University, Lille cedex, France
| | - Séverine Bleuse
- Service de Neurologie-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille University, Lille cedex, France
| | - Luc Defebvre
- Université de Lille, INSERM U1171-Troubles cognitifs dégénératifs et vasculaires, Lille, France.,Service de Neurologie-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille University, Lille cedex, France
| | - Caroline Moreau
- Université de Lille, INSERM U1171-Troubles cognitifs dégénératifs et vasculaires, Lille, France.,Service de Neurologie-Centre Hospitalier Régional Universitaire de Lille, Département d'analyse du mouvement, Lille University, Lille cedex, France
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Cucca A, Biagioni MC, Fleisher JE, Agarwal S, Son A, Kumar P, Brys M, Di Rocco A. Freezing of gait in Parkinson's disease: from pathophysiology to emerging therapies. Neurodegener Dis Manag 2016; 6:431-46. [PMID: 27599588 DOI: 10.2217/nmt-2016-0018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Freezing of gait (FOG) is 'an episodic inability to generate effective stepping in the absence of any known cause other than parkinsonism or high level gait disorders'. FOG is one of the most disabling symptoms in Parkinson's disease, especially in its more advanced stages. Early recognition is important as FOG is related to higher fall risk and poorer prognosis. Although specific treatments are still elusive, there have been recent advances in the development of new therapeutic approaches. The aim of this review is to present the latest knowledge regarding the phenomenology, pathogenesis, diagnostic assessment and conventional treatment of FOG in Parkinson's disease. A review of the evidence supporting noninvasive brain stimulation will follow to highlight the potential of these strategies.
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Affiliation(s)
- Alberto Cucca
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA.,Department of Medicine, Surgery & Health Sciences, University of Trieste, Clinica Neurologica, Trieste, Italy
| | - Milton C Biagioni
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Jori E Fleisher
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Shashank Agarwal
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Andre Son
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Pawan Kumar
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Miroslaw Brys
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
| | - Alessandro Di Rocco
- Department of Neurology, The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, NY 10016, USA
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46
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Heremans E, Nackaerts E, Broeder S, Vervoort G, Swinnen SP, Nieuwboer A. Handwriting Impairments in People With Parkinson's Disease and Freezing of Gait. Neurorehabil Neural Repair 2016; 30:911-919. [PMID: 27094858 DOI: 10.1177/1545968316642743] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent studies show that patients with Parkinson's disease (PD) and freezing of gait (FOG) experience motor problems outside their gait freezing episodes. Because handwriting is also a sequential movement, it may be affected in PD patients with FOG relative to those without. OBJECTIVE The current study aimed to assess the quality of writing in PD patients with and without FOG in comparison to healthy controls (CTs) during various writing tasks. METHODS Handwriting was assessed by the writing of cursive loops on a touch-sensitive writing tablet and by means of the Systematic Screening of Handwriting Difficulties (SOS) test in 30 PD patients with and without freezing and 15 healthy age-matched CTs. The tablet tests were performed at 2 different sizes, either continuously or alternatingly, as indicated by visual target lines. RESULTS Patients with freezing showed decreased writing amplitudes and increased variability compared with CTs and patients without freezing on the writing tablet tests. Writing problems were present during both tests but were more pronounced during writing at alternating compared with writing at continuous size. Patients with freezing also had a higher total score on the SOS test than patients without freezing and CTs, reflecting more extensive handwriting problems, particularly with writing fluency. CONCLUSIONS Writing is more severely affected in PD patients with FOG than in those without FOG. These results indicate that deficient movement sequencing and adaptation is a generic problem in patients with FOG.
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47
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Heremans E, Nackaerts E, Vervoort G, Vercruysse S, Broeder S, Strouwen C, Swinnen SP, Nieuwboer A. Amplitude Manipulation Evokes Upper Limb Freezing during Handwriting in Patients with Parkinson's Disease with Freezing of Gait. PLoS One 2015; 10:e0142874. [PMID: 26580556 PMCID: PMC4651469 DOI: 10.1371/journal.pone.0142874] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/27/2015] [Indexed: 11/19/2022] Open
Abstract
Background Recent studies show that besides freezing of gait (FOG), many people with Parkinson’s disease (PD) also suffer from freezing in the upper limbs (FOUL). Up to now, it is unclear which task constraints provoke and explain upper limb freezing. Objective To investigate whether upper limb freezing and other kinematic abnormalities during writing are provoked by (i) gradual changes in amplitude or by (ii) sustained amplitude generation in patients with and without freezing of gait. Methods Thirty-four patients with PD, including 17 with and 17 without FOG, performed a writing task on a touch-sensitive writing tablet requiring writing at constant small and large size as well as writing at gradually increasing and decreasing size. Patients of both groups were matched for disease severity, tested while ‘on’ medication and compared to healthy age-matched controls. Results Fifty upper limb freezing episodes were detected in 10 patients, including 8 with and 2 without FOG. The majority of the episodes occurred when participants had to write at small or gradually decreasing size. The occurrence of FOUL and the number of FOUL episodes per patient significantly correlated with the occurrence and severity of FOG. Patients with FOUL also showed a significantly smaller amplitude in the writing parts outside the freezing episodes. Conclusions Corroborating findings of gait research, the current study supports a core problem in amplitude control underlying FOUL, both in maintaining as well as in flexibly adapting the cycle size.
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Affiliation(s)
- Elke Heremans
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- * E-mail:
| | - Evelien Nackaerts
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Griet Vervoort
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Sanne Broeder
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Carolien Strouwen
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Stephan P. Swinnen
- Movement Control and Neuroplasticity Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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48
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Sterling NW, Cusumano JP, Shaham N, Piazza SJ, Liu G, Kong L, Du G, Lewis MM, Huang X. Dopaminergic modulation of arm swing during gait among Parkinson's disease patients. JOURNAL OF PARKINSONS DISEASE 2015; 5:141-50. [PMID: 25502948 DOI: 10.3233/jpd-140447] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reduced arm swing amplitude, symmetry, and coordination during gait have been reported in Parkinson's disease (PD), but the relationship between dopaminergic depletion and these upper limb gait changes remains unclear. OBJECTIVE We aimed to investigate the effects of dopaminergic drugs on arm swing velocity, symmetry, and coordination in PD. METHODS Forearm angular velocity was recorded in 16 PD and 17 control subjects (Controls) during free walking trials. Angular velocity amplitude of each arm, arm swing asymmetry, and maximum cross-correlation were compared between control and PD groups, and between OFF- and ON-medication states among PD subjects. RESULTS Compared to Controls, PD subjects in the OFF-medication state exhibited lower angular velocity amplitude of the slower- (p = 0.0018), but not faster- (p = 0.2801) swinging arm. In addition, PD subjects demonstrated increased arm swing asymmetry (p = 0.0046) and lower maximum cross-correlation (p = 0.0026). Following dopaminergic treatment, angular velocity amplitude increased in the slower- (p = 0.0182), but not faster- (p = 0.2312) swinging arm among PD subjects. Furthermore, arm swing asymmetry decreased (p = 0.0386), whereas maximum cross-correlation showed no change (p = 0.7436). Pre-drug angular velocity amplitude of the slower-swinging arm was correlated inversely with the change in arm swing asymmetry (R = -0.73824, p = 0.0011). CONCLUSIONS This study provides quantitative evidence that reduced arm swing and symmetry in PD can be modulated by dopaminergic replacement. The lack of modulations of bilateral arm coordination suggests that additional neurotransmitters may also be involved in arm swing changes in PD. Further studies are warranted to investigate the longitudinal trajectory of arm swing dynamics throughout PD progression.
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Affiliation(s)
- Nicholas W Sterling
- Department of Neurology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Public Health Sciences, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Joseph P Cusumano
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, USA
| | - Noam Shaham
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, USA
| | - Stephen J Piazza
- Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - Guodong Liu
- Department of Public Health Sciences, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Lan Kong
- Department of Public Health Sciences, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Guangwei Du
- Department of Neurology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mechelle M Lewis
- Department of Neurology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Pharmacology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Xuemei Huang
- Department of Neurology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA Department of Pharmacology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Radiology, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA Department of Neurosurgery, The Pennsylvania State University - Milton S. Hershey Medical Center, Hershey, PA, USA
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49
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Delval A, Tard C, Rambour M, Defebvre L, Moreau C. Characterization and quantification of freezing of gait in Parkinson's disease: Can detection algorithms replace clinical expert opinion? Neurophysiol Clin 2015; 45:305-13. [PMID: 26547546 DOI: 10.1016/j.neucli.2015.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 10/22/2022] Open
Abstract
Freezing of gait is a paroxysmal phenomenon that is frequently reported by the parkinsonian patients or their entourage. The phenomenon significantly alters quality of life but is often difficult to characterize in the physician's office. In the present review, we focus on the clinical characterization and quantification of freezing of gait. Various biomechanical methods (based mainly on time-frequency analysis) can be used to determine time-domain characteristics of freezing of gait. Methods already used to study non-gait freezing of other effectors (the lower limbs, upper limbs and orofacial area) are also being developed for the analysis of freezing in functional magnetic resonance imaging protocols. Here, we review the reliability of these methods and compare them with reliability of information obtained from physical examination and detailed analysis of the patient's medical history.
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Affiliation(s)
- A Delval
- U1171, Université de Lille, Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, Lille, France.
| | - C Tard
- U1171, Université de Lille, Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, Lille, France
| | - M Rambour
- U1171, Université de Lille, Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, Lille, France
| | - L Defebvre
- U1171, Université de Lille, Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, Lille, France
| | - C Moreau
- U1171, Université de Lille, Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, Lille, France
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50
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Wu T, Zhang J, Hallett M, Feng T, Hou Y, Chan P. Neural correlates underlying micrographia in Parkinson's disease. Brain 2015; 139:144-60. [PMID: 26525918 DOI: 10.1093/brain/awv319] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/16/2015] [Indexed: 11/14/2022] Open
Abstract
Micrographia is a common symptom in Parkinson's disease, which manifests as either a consistent or progressive reduction in the size of handwriting or both. Neural correlates underlying micrographia remain unclear. We used functional magnetic resonance imaging to investigate micrographia-related neural activity and connectivity modulations. In addition, the effect of attention and dopaminergic administration on micrographia was examined. We found that consistent micrographia was associated with decreased activity and connectivity in the basal ganglia motor circuit; while progressive micrographia was related to the dysfunction of basal ganglia motor circuit together with disconnections between the rostral supplementary motor area, rostral cingulate motor area and cerebellum. Attention significantly improved both consistent and progressive micrographia, accompanied by recruitment of anterior putamen and dorsolateral prefrontal cortex. Levodopa improved consistent micrographia accompanied by increased activity and connectivity in the basal ganglia motor circuit, but had no effect on progressive micrographia. Our findings suggest that consistent micrographia is related to dysfunction of the basal ganglia motor circuit; while dysfunction of the basal ganglia motor circuit and disconnection between the rostral supplementary motor area, rostral cingulate motor area and cerebellum likely contributes to progressive micrographia. Attention improves both types of micrographia by recruiting additional brain networks. Levodopa improves consistent micrographia by restoring the function of the basal ganglia motor circuit, but does not improve progressive micrographia, probably because of failure to repair the disconnected networks.
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Affiliation(s)
- Tao Wu
- 1 Department of Neurobiology, Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China 2 Beijing Key Laboratory on Parkinson's Disease, Parkinson Disease Centre of Beijing Institute for Brain Disorders, Beijing, China
| | - Jiarong Zhang
- 1 Department of Neurobiology, Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China 2 Beijing Key Laboratory on Parkinson's Disease, Parkinson Disease Centre of Beijing Institute for Brain Disorders, Beijing, China
| | - Mark Hallett
- 3 Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Tao Feng
- 2 Beijing Key Laboratory on Parkinson's Disease, Parkinson Disease Centre of Beijing Institute for Brain Disorders, Beijing, China 4 China National Clinical Research Centre for Neurological Diseases, Beijing, China 5 Department of Neurology, Centre for Neurodegenerative Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanan Hou
- 1 Department of Neurobiology, Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China 2 Beijing Key Laboratory on Parkinson's Disease, Parkinson Disease Centre of Beijing Institute for Brain Disorders, Beijing, China
| | - Piu Chan
- 1 Department of Neurobiology, Key Laboratory on Neurodegenerative Disorders of Ministry of Education, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China 2 Beijing Key Laboratory on Parkinson's Disease, Parkinson Disease Centre of Beijing Institute for Brain Disorders, Beijing, China
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