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Milane T, Hansen C, Correno MB, Chardon M, Barbieri FA, Bianchini E, Vuillerme N. Comparison of number of people with freezing of gait in Parkinson's disease with and without sleep disturbances: A systematic review. Sleep Med 2024; 121:32-41. [PMID: 38908269 DOI: 10.1016/j.sleep.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/08/2024] [Accepted: 06/04/2024] [Indexed: 06/24/2024]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder, involving motor and non-motor symptoms (NMS). Sleep disturbances (SD) are the second most common NMS in PD and include rapid eye movement (REM) sleep behavior disorder (RBD), excessive daytime sleepiness and insomnia. Freezing of gait (FOG) is a gait impairment frequently reported in people with PD greatly hampering functional independence and quality of life. Presence of FOG has been associated with increased frequency and severity of NMS, including SD. Thus, the aim of this study was to systematically review the literature comparing the number of people with FOG in PD with (PD + SD) and without SD (PD-SD). By systematically searching PubMed and Web of Science databases to identify original peer-reviewed articles, 8 studies including 5251 people with PD (2025 PD + SD and 3226 PD-SD) met eligibility criteria and were included in the review. In 6 studies (4 studies investigating RBD, 2 studies investigating overall sleep quality), the group of PD + SD had higher prevalence of FOG compared with PD-SD. Although a limited number of studies, our findings suggest that PD + SD present more frequently FOG than PD-SD. More studies are required to investigate the possible mechanism underlying this association between FOG and sleep.
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Affiliation(s)
- Tracy Milane
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Clint Hansen
- Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany.
| | - Mathias Baptiste Correno
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Matthias Chardon
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; São Paulo State University (UNESP), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Fabio Augusto Barbieri
- São Paulo State University (UNESP), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Edoardo Bianchini
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189, Rome, Italy
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000, Grenoble, France; Institut Universitaire de France, 75005, Paris, France.
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van Midden V, Simončič U, Pirtošek Z, Kojović M. The Effect of taVNS at 25 Hz and 100 Hz on Parkinson's Disease Gait-A Randomized Motion Sensor Study. Mov Disord 2024; 39:1375-1385. [PMID: 38757756 DOI: 10.1002/mds.29826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/27/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Transcutaneous electrostimulation of the auricular branch of the vagal nerve (taVNS) has the propensity to reach diffuse neuromodulatory networks, which are dysfunctional in Parkinson's disease (PD). Previous studies support the use of taVNS as an add-on treatment for gait in PD. OBJECTIVES We assessed the effect of taVNS at 25 Hz (taVNS25), taVNS at 100 Hz (taVNS100), and sham earlobe stimulation (sVNS) on levodopa responsive (arm swing velocity, arm range of motion, stride length, gait speed) and non-responsive gait characteristics (arm range of motion asymmetry, anticipatory postural adjustment [APA] duration, APA first step duration, APA first step range of motion), and turns (first turn duration, double 360° turn duration, steps per turn) in advanced PD. METHODS In our double blind sham controlled within-subject randomized trial, we included 30 PD patients (modified Hoehn and Yahr stage, 2.5-4) to assess the effect of taVNS25, taVNS100, and sVNS on gait characteristics measured with inertial motion sensors during the instrumented stand and walk test and a double 360° turn. Separate generalized mixed models were built for each gait characteristic. RESULTS During taVNS100 compared to sVNS arm swing velocity (P = 0.030) and stride length increased (P = 0.027), and APA duration decreased (P = 0.050). During taVNS25 compared to sVNS stride length (P = 0.024) and gait speed (P = 0.021) increased and double 360° turn duration decreased (P = 0.039). CONCLUSIONS We have found that taVNS has a frequency specific propensity to improve stride length, arm swing velocity, and gait speed and double 360° turn duration in PD patients. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Vesna van Midden
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Urban Simončič
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana, Slovenia
- Jozef Stefan Institute, Ljubljana, Slovenia
| | - Zvezdan Pirtošek
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Kojović
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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Cronin P, Collins LM, Sullivan AM. Impacts of gait freeze on quality of life in Parkinson's disease, from the perspectives of patients and their carers. Ir J Med Sci 2024; 193:2041-2050. [PMID: 38639839 PMCID: PMC11294397 DOI: 10.1007/s11845-024-03673-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The World Health Organisation (WHO) reports that morbidity and mortality due to Parkinson's disease (PD) are increasing faster than for other neurodegenerative conditions. People with Parkinson's (PwP) present with a variety of motor symptoms, such as tremor, bradykinesia, and rigidity. Freezing of gait (FoG) is a significant motor symptom that manifests as temporary episodes of inability to move one's feet, despite the intention to walk. AIMS This study examined the impact of FoG on quality of life (QoL) within an Irish cohort of PwP, from the perspectives of both PwP and their carers, using validated questionnaires that had been adapted for online use. METHODS PwP and their carers were recruited by outreach to the Irish Parkinson's Community. Anonymous online questionnaires were distributed, which combined a demographic survey with several clinically validated surveys, including Freezing of Gait Questionnaire (FoG-Q), Parkinson's Disease Questionnaire 8 (PDQ-8), and Parkinson's Disease Carer Questionnaire (PDQ-C). RESULTS There was a strong correlation (p < 0.001) between severity of FoG and lower QoL among PwP. Significant correlation was also found between FoG severity and several motor symptoms, such as postural instability and difficulty with balance, and non-motor symptoms, such as cognitive changes and pain/discomfort. FoG severity correlated with disease progression. Significant correlation was also found between FoG and symptoms, as assessed from the perspective of the patients' carers. CONCLUSIONS This study shows that FoG is a significant detriment to the QoL of PwP, from the perspectives of patients and carers. This method of assessing FoG and QoL using online questionnaires has potential to enhance the reach and flexibility of this type of research. These findings will inform future studies on larger cohorts and highlight unmet clinical needs in PwP.
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Affiliation(s)
- Padraig Cronin
- Department of Anatomy and Neuroscience, School of Medicine, University College Cork, Cork, Ireland
- Parkinson's Disease Research Cluster, University College Cork, Cork, Ireland
| | - Lucy M Collins
- Department of Anatomy and Neuroscience, School of Medicine, University College Cork, Cork, Ireland
- Parkinson's Disease Research Cluster, University College Cork, Cork, Ireland
| | - Aideen M Sullivan
- Department of Anatomy and Neuroscience, School of Medicine, University College Cork, Cork, Ireland.
- Parkinson's Disease Research Cluster, University College Cork, Cork, Ireland.
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Fang Y, Wang J, Nie D, Tang Y. Efficacy of exercise interventions combined with Selegiline in ameliorating freezing of gait in Parkinson's disease patients. Am J Transl Res 2024; 16:2852-2863. [PMID: 39114711 PMCID: PMC11301470 DOI: 10.62347/jtrh2408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/11/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To evaluate the efficacy of exercise interventions combined with Selegiline in ameliorating freezing of gait (FOG) in Parkinson's disease (PD) patients. METHODS A total of 60 PD patients with FOG treated in the First People's Hospital of Fuyang District from January 2020 to January 2023 were retrospectively collected and analyzed. Patients were divided into a control group (n = 28, treated with Selegiline alone) and an observation group (n = 32, treated with Selegiline and exercise interventions). Gait parameters, FOG indices, motor and balance functions, Berg Balance, psychological status, and quality of life were compared between the groups pre- and post-treatment. RESULTS After treatment, the observation group exhibited longer step length, higher step speed, and lower step frequency (P = 0.000, 0.003, 0.001, respectively), with enhanced balance as indicated by lower Timed Up and Go Test and higher Berg Balance Scale scores than the control group (P = 0.000, 0.000, respectively). The Beck Depression Inventory and Beck Anxiety Inventory scores were notably lower in the observation group than those in the control group (P = 0.000, 0.004, respectively). Additionally, the observation group showed better quality of life across several dimensions of the Parkinson's Disease Quality of Life Questionnaire, including mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort (P = 0.000, 0.000, 0.000, 0.000, 0.017, 0.000, 0.000, 0.000, respectively) than the control group. CONCLUSION The combination of exercise interventions and Selegiline effectively rectifies the gait parameters, enhances the balance function, alleviates psychological distress, and improves the overall quality of life in PD patients experiencing FOG.
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Affiliation(s)
- Yueying Fang
- Department of Neurology, The First People's Hospital of Fuyang District Hangzhou 311400, Zhejiang, China
| | - Jian Wang
- Department of Neurology, The First People's Hospital of Fuyang District Hangzhou 311400, Zhejiang, China
| | - Dongliang Nie
- Department of Neurology, The First People's Hospital of Fuyang District Hangzhou 311400, Zhejiang, China
| | - Yihua Tang
- Department of Neurology, The First People's Hospital of Fuyang District Hangzhou 311400, Zhejiang, China
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Holden H, Venkatesh S, Budrow C, Nezaria S, Coyle M, Centner A, Lipari N, McManus G, Bishop C. The effects of L-DOPA on gait abnormalities in a unilateral 6-OHDA rat model of Parkinson's disease. Physiol Behav 2024; 281:114563. [PMID: 38723388 DOI: 10.1016/j.physbeh.2024.114563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/27/2024]
Abstract
Parkinson's Disease (PD) is a neurodegenerative movement disorder characterized by dopamine (DA) cell loss in the substantia nigra pars compacta (SNc). As PD progresses, patients display disruptions in gait such as changes in posture, bradykinesia, and shortened stride. DA replacement via L-DOPA alleviates many PD symptoms, though its effects on gait are not well demonstrated. This study aimed to assess the relationship between DA lesion, gait, and deficit-induced reversal with L-DOPA. To do so, Sprague-Dawley rats (N = 25, 14 males, 11 females) received unilateral medial forebrain bundle (MFB) DA lesions with 6-hydroxydopamine (6-OHDA). An automated gait analysis system assessed spatiotemporal gait parameters pre- and post-lesion, and after various doses of L-DOPA (0, 3, or 6 mg/kg; s.c.). The forepaw adjusting steps (FAS) test was implemented to evaluate lesion efficacy while the abnormal involuntary movements (AIMs) scale monitored the emergence of L-DOPA-induced dyskinesia (LID). High performance liquid chromatography (HPLC) assessed changes in brain monoamines on account of lesion and treatment. Results revealed lesion-induced impairments in gait, inclusive of max-contact area and step-sequence alterations that were not reversible with L-DOPA. However, the emergence of AIMs were observed at higher doses. Post-mortem, 6-OHDA lesions induced a loss of striatal DA and norepinephrine (NE), while prefrontal cortex (PFC) displayed noticeable reduction in NE but not DA. Our findings indicate that hemiparkinsonian rats display measurable gait disturbances similar to PD patients that are not rescued by DA replacement. Furthermore, non-DA mechanisms such as attention-related NE in PFC may contribute to altered gait and may constitute a novel target for its treatment.
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Affiliation(s)
- Hannah Holden
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Shruti Venkatesh
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Carla Budrow
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Sareen Nezaria
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Michael Coyle
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Ashley Centner
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Natalie Lipari
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Grace McManus
- Department of Psychology, Binghamton University, Binghamton, NY, USA
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Salari M, Rashedi R, Momenilandi F, Shirin MB, Etemadifar M. The effects of laser cane cues on the freezing of gait of Parkinson's disease patients: can increasing the laser light beam width play a role? Acta Neurol Belg 2024:10.1007/s13760-024-02592-z. [PMID: 38918305 DOI: 10.1007/s13760-024-02592-z] [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: 12/16/2023] [Accepted: 06/18/2024] [Indexed: 06/27/2024]
Abstract
INTRODUCTION Freezing of gait can be seen in a significant number of people with Parkinson's disease. Disappointingly, the classic standard treatment of Parkinson's disease with dopamine replacement has not shown promising results in improving the freezing of gait. Hence the approach have shifted towards using non-invasive methods to address this problem. OBJECTIVES To assess the effect of laser cane as a visual cue on the freezing of gait of people with Parkinson's disease and further determine the effect of laser light beam width and color on the freezing of gait. METHODS 7 known Parkinson's Disease patients were enrolled in this study, all of whom had at least one episode of freezing at at least one clinical visit. These patients underwent gait analysis in 4 stages: walking without a cane, walking with a thin red light laser cane, a thick red light laser cane, and a green light laser cane. RESULTS Using laser canes effectively improved nearly all parameters of walking, including right and left stride length, step length, the velocity of movement, and rotation time, compared to walking without a stick. Using different colors of laser cane didn't make any significant difference in improving the freezing of gait of our patients. Nevertheless, increasing the laser light beam width significantly improved almost all walking parameters. CONCLUSION This is the first study assessing the effect of laser light beam width on freezing of gait in Parkinson's disease patients and shows promising results in regards to increasing the thickness of laser lights in order to improve walking parameters in Parkinson's disease patients more effectively. Furthermore, this is the second study to evaluate the effect of laser light color, contradicting the previous results by showing no significant correlation between the color of laser light and improvements in walking parameters.
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Affiliation(s)
- Mehri Salari
- Clinical Research Development Unit of Shohada-E Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ronak Rashedi
- Clinical Research Development Unit of Shohada-E Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Neurology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
| | - Feryal Momenilandi
- Clinical Research Development Unit of Shohada-E Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Masoud Etemadifar
- Department of Functional Neurosurgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
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Sun P, Li C, Yang C, Sun M, Hou H, Guan Y, Chen J, Liu S, Chen K, Ma Y, Huang Y, Li X, Wang H, Wang L, Chen S, Cheng H, Xiong W, Sheng X, Zhang M, Peng J, Wang S, Wang Y, Yin L. A biodegradable and flexible neural interface for transdermal optoelectronic modulation and regeneration of peripheral nerves. Nat Commun 2024; 15:4721. [PMID: 38830884 PMCID: PMC11148186 DOI: 10.1038/s41467-024-49166-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 05/23/2024] [Indexed: 06/05/2024] Open
Abstract
Optoelectronic neural interfaces can leverage the photovoltaic effect to convert light into electrical current, inducing charge redistribution and enabling nerve stimulation. This method offers a non-genetic and remote approach for neuromodulation. Developing biodegradable and efficient optoelectronic neural interfaces is important for achieving transdermal stimulation while minimizing infection risks associated with device retrieval, thereby maximizing therapeutic outcomes. We propose a biodegradable, flexible, and miniaturized silicon-based neural interface capable of transdermal optoelectronic stimulation for neural modulation and nerve regeneration. Enhancing the device interface with thin-film molybdenum significantly improves the efficacy of neural stimulation. Our study demonstrates successful activation of the sciatic nerve in rodents and the facial nerve in rabbits. Moreover, transdermal optoelectronic stimulation accelerates the functional recovery of injured facial nerves.
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Affiliation(s)
- Pengcheng Sun
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Chaochao Li
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Can Yang
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Mengchun Sun
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Hanqing Hou
- School of Life Sciences, Tsinghua University, Beijing, 100084, P. R. China
| | - Yanjun Guan
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Jinger Chen
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Shangbin Liu
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Kuntao Chen
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Yuan Ma
- Department of Electronic Engineering, Tsinghua University, Beijing, 100084, P. R. China
| | - Yunxiang Huang
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Xiangling Li
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P. R. China
| | - Huachun Wang
- School of Integrated Circuits, Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P. R. China
| | - Liu Wang
- School of Biological Science and Medical Engineering, Key Laboratory of Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, P. R. China
- School of Engineering Medicine, Beihang University, Beijing, 100083, P. R. China
| | - Shengfeng Chen
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Haofeng Cheng
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Wei Xiong
- Chinese Institute for Brain Research, Beijing, 102206, P. R. China
| | - Xing Sheng
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology, Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
- Institute for Precision Medicine, Tsinghua University, Beijing, 100084, P. R. China
- IDG/McGovern Institute for Brain Research, Tsinghua University, Beijing, 100084, P. R. China
| | - Milin Zhang
- Department of Electronic Engineering, Tsinghua University, Beijing, 100084, P. R. China
| | - Jiang Peng
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226007, P. R. China
| | - Shirong Wang
- MegaRobo Technologies Co. ltd, Beijing, 100085, P. R. China.
| | - Yu Wang
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China.
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226007, P. R. China.
| | - Lan Yin
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China.
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Zheng Y, Shen Y, Feng R, Hu W, Huang P. Research progress on the application of anti-gravity treadmill in the rehabilitation of Parkinson's disease patients: a mini review. Front Neurol 2024; 15:1401256. [PMID: 38882698 PMCID: PMC11176542 DOI: 10.3389/fneur.2024.1401256] [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: 03/15/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms. It is the second most common chronic progressive neurodegenerative disease. PD still lacks a known cure or prophylactic medication. Current treatments primarily address symptoms without halting the progression of PD, and the side effects of dopaminergic therapy become more apparent over time. In contrast, physical therapy, with its lower risk of side effects and potential cardiovascular benefits, may provide greater benefits to patients. The Anti-Gravity Treadmill is an emerging rehabilitation therapy device with high safety, which minimizes patients' fear and allows them to focus more on a normal, correct gait, and has a promising clinical application. Based on this premise, this study aims to summarize and analyze the relevant studies on the application of the anti-gravity treadmill in PD patients, providing a reference for PD rehabilitation practice and establishing a theoretical basis for future research in this area.
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Affiliation(s)
- Yalin Zheng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Yu Shen
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Renzhi Feng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Weiyin Hu
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Peng Huang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
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Cheng Y, Zhao G, Chen L, Cui D, Wang C, Feng K, Yin S. Effects of subthalamic nucleus deep brain stimulation using different frequency programming paradigms on axial symptoms in advanced Parkinson's disease. Acta Neurochir (Wien) 2024; 166:124. [PMID: 38457027 DOI: 10.1007/s00701-024-06005-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND In advanced Parkinson's disease (PD), axial symptoms are common and can be debilitating. Although deep brain stimulation (DBS) significantly improves motor symptoms, conventional high-frequency stimulation (HFS) has limited effectiveness in improving axial symptoms. In this study, we investigated the effects on multiple axial symptoms after DBS surgery with three different frequency programming paradigms comprising HFS, low-frequency stimulation (LFS), and variable-frequency stimulation (VFS). METHODS This study involved PD patients who had significant preoperative axial symptoms and underwent bilateral subthalamic nucleus (STN) DBS. Axial symptoms, motor symptoms, medications, and quality of life were evaluated preoperatively (baseline). One month after surgery, HFS was applied. At 6 months post-surgery, HFS assessments were performed, and HFS was switched to LFS. A further month later, we conducted LFS assessments and switched LFS to VFS. At 8 months after surgery, VFS assessments were performed. RESULTS Of the 21 PD patients initially enrolled, 16 patients were ultimately included in this study. Regarding HFS, all axial symptoms except for the Berg Balance Scale (p < 0.0001) did not improve compared with the baseline (all p > 0.05). As for LFS and VFS, all axial symptoms improved significantly compared with both the baseline and HFS (all p < 0.05). Moreover, motor symptoms and medications were significantly better than the baseline (all p < 0.05) after using LFS and VFS. Additionally, the quality of life of the PD patients after receiving LFS and VFS was significantly better than at the baseline and with HFS (all p < 0.0001). CONCLUSION Our findings indicate that HFS is ineffective at improving the majority of axial symptoms in advanced PD. However, both the LFS and VFS programming paradigms exhibit significant improvements in various axial symptoms.
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Affiliation(s)
- Yifeng Cheng
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300350, China
| | - Guangrui Zhao
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300350, China
| | - Lei Chen
- Department of Neurology, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Deqiu Cui
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Chunjuan Wang
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Keke Feng
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China.
| | - Shaoya Yin
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China.
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10
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Lewis MM, Waltz C, Scelina L, Scelina K, Owen KM, Hastilow K, Zimmerman EM, Rosenfeldt AB, Miller Koop M, Alberts JL. Gait patterns during overground and virtual omnidirectional treadmill walking. J Neuroeng Rehabil 2024; 21:29. [PMID: 38388883 PMCID: PMC10885397 DOI: 10.1186/s12984-023-01286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 11/20/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Omnidirectional treadmills (ODTs) offer a promising solution to the virtual reality (VR) locomotion problem, which describes the mismatch between visual and somatosensory information and contributes to VR sickness. However, little is known about how walking on ODTs impacts the biomechanics of gait. This project aimed to compare overground and ODT walking and turning in healthy young adults. METHODS Fifteen young adults completed forward walk, 180° turn, and 360° turn tasks under three conditions: (1) overground, (2) on the Infinadeck ODT in a virtual environment without a handrail, and (3) on the ODT with a handrail. Kinematic data for all walking trials were gathered using 3D optical motion capture. RESULTS Overall, gait speed was slower during ODT walking than overground. When controlling for gait speed, ODT walking resulted in shorter steps and greater variability in step length. There were no significant differences in other spatiotemporal metrics between ODT and overground walking. Turning on the ODT required more steps and slower rotational speeds than overground turns. The addition of the stability handrail to the ODT resulted in decreased gait variability relative to the ODT gait without the handrail. CONCLUSION Walking on an ODT resembles natural gait patterns apart from slower gait speed and shorter step length. Slower walking and shorter step length are likely due to the novelty of physically navigating a virtual environment which may result in a more conservative approach to gait. Future work will evaluate how older adults and those with neurological disease respond to ODT walking.
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Affiliation(s)
- Morgan McGrath Lewis
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA.
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Colin Waltz
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Logan Scelina
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Kathryn Scelina
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Kelsey M Owen
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Karissa Hastilow
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Eric M Zimmerman
- Neurological Institute, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Anson B Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA.
- Neurological Institute, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA.
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11
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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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12
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Baugher B, Szewczyk N, Liao J. Augmented reality cueing for freezing of gait: Reviewing an emerging therapy. Parkinsonism Relat Disord 2023; 116:105834. [PMID: 37699779 DOI: 10.1016/j.parkreldis.2023.105834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/20/2023] [Accepted: 08/26/2023] [Indexed: 09/14/2023]
Affiliation(s)
- Brendan Baugher
- Heritage College of Osteopathic Medicine, Ohio University, 4180 Warrensville Center Rd, Warrensville Heights, OH, 44122, USA; Cleveland Clinic Center for Neurological Restoration, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Nathaniel Szewczyk
- Heritage College of Osteopathic Medicine, Ohio University, 4180 Warrensville Center Rd, Warrensville Heights, OH, 44122, USA; Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, 45701, USA
| | - James Liao
- Cleveland Clinic Center for Neurological Restoration, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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13
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Vanegas-Arroyave N, Jankovic J. Spinal cord stimulation for gait disturbances in Parkinson's disease. Expert Rev Neurother 2023; 23:651-659. [PMID: 37345383 DOI: 10.1080/14737175.2023.2228492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/18/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Gait disturbances are a major contributor to the disability associated with Parkinson's disease. Although pharmacologic therapies and deep brain stimulation improve most motor parkinsonian features, their effects on gait are highly variable. Spinal cord stimulation, typically used for the treatment of chronic pain, has emerged as a potential therapeutic approach to improve gait disturbances in Parkinson's disease. AREAS COVERED The authors review the available evidence on the effects of spinal cord stimulation in patients with Parkinson's disease, targeting primarily gait abnormalities. They also discuss possible mechanisms, safety, and methodological implications for future clinical trials. This systematic review of originally published articles in English language was performed using The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).
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Affiliation(s)
- Nora Vanegas-Arroyave
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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14
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Gibson AR, Horn KM, Pong M. Nucleus reticularis tegmenti pontis: a bridge between the basal ganglia and cerebellum for movement control. Exp Brain Res 2023; 241:1271-1287. [PMID: 37000205 PMCID: PMC10129968 DOI: 10.1007/s00221-023-06574-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/13/2023] [Indexed: 04/01/2023]
Abstract
Neural processing in the basal ganglia is critical for normal movement. Diseases of the basal ganglia, such as Parkinson's disease, produce a variety of movement disorders including akinesia and bradykinesia. Many believe that the basal ganglia influence movement via thalamic projections to motor areas of the cerebral cortex and through projections to the cerebellum, which also projects to the motor cortex via the thalamus. However, lesions that interrupt these thalamic pathways to the cortex have little effect on many movements, including limb movements. Yet, limb movements are severely impaired by basal ganglia disease or damage to the cerebellum. We can explain this impairment as well as the mild effects of thalamic lesions if basal ganglia and cerebellar output reach brainstem motor regions without passing through the thalamus. In this report, we describe several brainstem pathways that connect basal ganglia output to the cerebellum via nucleus reticularis tegmenti pontis (NRTP). Additionally, we propose that widespread afferent and efferent connections of NRTP with the cerebellum could integrate processing across cerebellar regions. The basal ganglia could then alter movements via descending projections of the cerebellum. Pathways through NRTP are important for the control of normal movement and may underlie deficits associated with basal ganglia disease.
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Affiliation(s)
- Alan R Gibson
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA.
- , 3417 E. Mission Ln, Phoenix, AZ, 85028, USA.
| | - Kris M Horn
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA
- Chamberlain College of Nursing, 1036 E Baylor Ln, Gilbert, AZ, 85296, USA
| | - Milton Pong
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA
- School of Osteopathic Medicine, Arizona, A. T. Still University, 5850 E. Still Circle, Mesa, AZ, 85206, USA
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15
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Pozzi NG, Palmisano C, Reich MM, Capetian P, Pacchetti C, Volkmann J, Isaias IU. Troubleshooting Gait Disturbances in Parkinson's Disease With Deep Brain Stimulation. Front Hum Neurosci 2022; 16:806513. [PMID: 35652005 PMCID: PMC9148971 DOI: 10.3389/fnhum.2022.806513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/16/2022] [Indexed: 01/08/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus or the globus pallidus is an established treatment for Parkinson's disease (PD) that yields a marked and lasting improvement of motor symptoms. Yet, DBS benefit on gait disturbances in PD is still debated and can be a source of dissatisfaction and poor quality of life. Gait disturbances in PD encompass a variety of clinical manifestations and rely on different pathophysiological bases. While gait disturbances arising years after DBS surgery can be related to disease progression, early impairment of gait may be secondary to treatable causes and benefits from DBS reprogramming. In this review, we tackle the issue of gait disturbances in PD patients with DBS by discussing their neurophysiological basis, providing a detailed clinical characterization, and proposing a pragmatic programming approach to support their management.
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Affiliation(s)
- Nicoló G. Pozzi
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Martin M. Reich
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Philip Capetian
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Claudio Pacchetti
- Parkinson’s Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Ioannis U. Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- Parkinson Institute Milan, ASST Gaetano Pini-CTO, Milan, Italy
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16
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Fujikawa J, Morigaki R, Yamamoto N, Oda T, Nakanishi H, Izumi Y, Takagi Y. Therapeutic Devices for Motor Symptoms in Parkinson’s Disease: Current Progress and a Systematic Review of Recent Randomized Controlled Trials. Front Aging Neurosci 2022; 14:807909. [PMID: 35462692 PMCID: PMC9020378 DOI: 10.3389/fnagi.2022.807909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pharmacotherapy is the first-line treatment option for Parkinson’s disease, and levodopa is considered the most effective drug for managing motor symptoms. However, side effects such as motor fluctuation and dyskinesia have been associated with levodopa treatment. For these conditions, alternative therapies, including invasive and non-invasive medical devices, may be helpful. This review sheds light on current progress in the development of devices to alleviate motor symptoms in Parkinson’s disease. Methods We first conducted a narrative literature review to obtain an overview of current invasive and non-invasive medical devices and thereafter performed a systematic review of recent randomized controlled trials (RCTs) of these devices. Results Our review revealed different characteristics of each device and their effectiveness for motor symptoms. Although invasive medical devices are usually highly effective, surgical procedures can be burdensome for patients and have serious side effects. In contrast, non-pharmacological/non-surgical devices have fewer complications. RCTs of non-invasive devices, especially non-invasive brain stimulation and mechanical peripheral stimulation devices, have proven effectiveness on motor symptoms. Nearly no non-invasive devices have yet received Food and Drug Administration certification or a CE mark. Conclusion Invasive and non-invasive medical devices have unique characteristics, and several RCTs have been conducted for each device. Invasive devices are more effective, while non-invasive devices are less effective and have lower hurdles and risks. It is important to understand the characteristics of each device and capitalize on these.
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Affiliation(s)
- Joji Fujikawa
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Ryoma Morigaki
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- *Correspondence: Ryoma Morigaki,
| | - Nobuaki Yamamoto
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Teruo Oda
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Hiroshi Nakanishi
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yuishin Izumi
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yasushi Takagi
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
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17
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Barra A, Rosenfelder M, Mortaheb S, Carrière M, Martens G, Bodien YG, Morales-Quezada L, Bender A, Laureys S, Thibaut A, Fregni F. Transcranial Pulsed-Current Stimulation versus Transcranial Direct Current Stimulation in Patients with Disorders of Consciousness: A Pilot, Sham-Controlled Cross-Over Double-Blind Study. Brain Sci 2022; 12:429. [PMID: 35447961 PMCID: PMC9031379 DOI: 10.3390/brainsci12040429] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 02/01/2023] Open
Abstract
Transcranial direct-current stimulation (tDCS) over the prefrontal cortex can improve signs of consciousness in patients in a minimally conscious state. Transcranial pulsed-current stimulation (tPCS) over the mastoids can modulate brain activity and connectivity in healthy controls. This study investigated the feasibility of tPCS as a therapeutic tool in patients with disorders of consciousness (DoC) and compared its neurophysiological and behavioral effects with prefrontal tDCS. This pilot study was a randomized, double-blind sham-controlled clinical trial with three sessions: bi-mastoid tPCS, prefrontal tDCS, and sham. Electroencephalography (EEG) and behavioral assessments were collected before and after each stimulation session. Post minus pre differences were compared using Kruskal-Wallis and Wilcoxon signed-rank tests. Twelve patients with DoC were included in the study (eight females, four traumatic brain injury, 50.3 ± 14 y.o., 8.8 ± 10.5 months post-injury). We did not observe any side-effects following tPCS, nor tDCS, and confirmed their feasibility and safety. We did not find a significant effect of the stimulation on EEG nor behavioral outcomes for tPCS. However, consistent with prior findings, our exploratory analyses suggest that tDCS induces behavioral improvements and an increase in theta frontal functional connectivity.
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Affiliation(s)
- Alice Barra
- Coma Science Group, GIGA Consciousness-GIGA Research, University of Liège, 4000 Liège, Belgium; (A.B.); (S.M.); (M.C.); (G.M.); (S.L.)
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA; (Y.G.B.); (L.M.-Q.)
| | - Martin Rosenfelder
- Department of Neurology, Therapiezentrum Burgau, Kapuzinerstrasse 34, 89331 Burgau, Germany; (M.R.); (A.B.)
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, 89081 Ulm, Germany
| | - Sepehr Mortaheb
- Coma Science Group, GIGA Consciousness-GIGA Research, University of Liège, 4000 Liège, Belgium; (A.B.); (S.M.); (M.C.); (G.M.); (S.L.)
- Physiology of Cognition Lab, GIGA-Consciousness, University of Liège, 4000 Liège, Belgium
| | - Manon Carrière
- Coma Science Group, GIGA Consciousness-GIGA Research, University of Liège, 4000 Liège, Belgium; (A.B.); (S.M.); (M.C.); (G.M.); (S.L.)
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
| | - Geraldine Martens
- Coma Science Group, GIGA Consciousness-GIGA Research, University of Liège, 4000 Liège, Belgium; (A.B.); (S.M.); (M.C.); (G.M.); (S.L.)
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA; (Y.G.B.); (L.M.-Q.)
| | - Yelena G. Bodien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA; (Y.G.B.); (L.M.-Q.)
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Leon Morales-Quezada
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA; (Y.G.B.); (L.M.-Q.)
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Andreas Bender
- Department of Neurology, Therapiezentrum Burgau, Kapuzinerstrasse 34, 89331 Burgau, Germany; (M.R.); (A.B.)
- Department of Neurology, Ludwig-Maximilians University (LMU), 81377 Munich, Germany
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness-GIGA Research, University of Liège, 4000 Liège, Belgium; (A.B.); (S.M.); (M.C.); (G.M.); (S.L.)
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre CIUSS, University Laval, Quebec, QC G1E1T2, Canada
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness-GIGA Research, University of Liège, 4000 Liège, Belgium; (A.B.); (S.M.); (M.C.); (G.M.); (S.L.)
- Centre du Cerveau, University Hospital of Liège, 4000 Liège, Belgium
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Felipe Fregni
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02114, USA;
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18
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Scanlon JEM, Jacobsen NSJ, Maack MC, Debener S. Stepping in time: Alpha-mu and beta oscillations during a walking synchronization task. Neuroimage 2022; 253:119099. [PMID: 35301131 DOI: 10.1016/j.neuroimage.2022.119099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/18/2022] [Accepted: 03/13/2022] [Indexed: 11/25/2022] Open
Abstract
Interpersonal behavioral synchrony is referred to as temporal coordination of action between two or more individuals. Humans tend to synchronize their movements during repetitive movement tasks such as walking. Mobile EEG technology now allows us to examine how this happens during gait. 18 participants equipped with foot accelerometers and mobile EEG walked with an experimenter in three conditions: With their view of the experimenter blocked, walking naturally, and trying to synchronize their steps with the experimenter. The experimenter walked following a headphone metronome to keep their steps consistent for all conditions. Step behavior and synchronization between the experimenter and participant were compared between conditions. Additionally, event-related spectral perturbations (ERSPs) were time-warped to the gait cycle in order to analyze alpha-mu (7.5-12.5 Hz) and beta (16-32 Hz) rhythms over the whole gait cycle. Step synchronization was significantly higher in the synchrony condition than in the natural condition. Likewise regarding ERSPs, right parietal channel (C4, C6, CP4, CP6) alpha-mu and central channel (C1, Cz, C2) beta power were suppressed from baseline in the walking synchrony condition compared to the natural walking condition. The natural and blocked conditions were not found to be significantly different in behavioral or spectral comparisons. Our results are compatible with the view that intentional synchronization employs systems associated with social interaction as well as the central motor system.
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Affiliation(s)
- J E M Scanlon
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany.
| | - N S J Jacobsen
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - M C Maack
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - S Debener
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany; Cluster of Excellence Hearing4all, University of Oldenburg, Oldenburg, Germany; Center for Neurosensory Science and Systems, University of Oldenburg, Oldenburg, Germany
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19
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Zhou PB, Bao M. Spinal cord stimulation treatment for freezing of gait in Parkinson's disease: A case report. Brain Stimul 2021; 15:76-77. [PMID: 34798352 DOI: 10.1016/j.brs.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Peng-Bo Zhou
- Department of Neurosurgery, Shengjing Hospital of China Medical University, No. 36, Sao Hao Street, Shenyang, Liaoning, 110004, China
| | - Min Bao
- Department of Neurosurgery, Shengjing Hospital of China Medical University, No. 36, Sao Hao Street, Shenyang, Liaoning, 110004, China.
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20
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Huang HC, Chen CM, Lu MK, Liu BL, Li CI, Chen JC, Wang GJ, Lin HC, Duann JR, Tsai CH. Gait-Related Brain Activation During Motor Imagery of Complex and Simple Ambulation in Parkinson's Disease With Freezing of Gait. Front Aging Neurosci 2021; 13:731332. [PMID: 34630069 PMCID: PMC8492994 DOI: 10.3389/fnagi.2021.731332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Freezing of gait (FOG) in Parkinson's disease (PD) is a devastating clinical phenomenon that has a detrimental impact on patients. It tends to be triggered more often during turning (complex) than during forwarding straight (simple) walking. The neural mechanism underlying this phenomenon remains unclear and requires further elucidation. Objective: To investigate the differences in cerebral functional magnetic resonance imaging responses between PD patients with and without FOG during explicitly video-guided motor imagery (MI) of various complex (normal, freezing) and simple (normal, freezing) walking conditions. Methods: We recruited 34 PD patients, namely, 20 with FOG and 14 without FOG, and 15 normal controls. Participants underwent video-guided MI of turning and straight walking, with and without freezing, while their brain blood oxygen level-dependent (BOLD) activities were measured. Gait analysis was performed. Results: While comparing FOG turning with FOG straight walking, freezers showed higher activation of the superior occipital gyrus, left precentral gyrus, and right postcentral gyrus compared with non-freezers. Normal controls also manifest similar findings compared with non-freezers, except no difference was noted in occipital gyrus activity between the two groups. Freezers also displayed a higher effect size in the locomotor regions than non-freezers during imagery of normal turning. Conclusions: Our findings suggest that freezers require a higher drive of cortical and locomotion regions to overcome the overinhibition of the pathways in freezers than in non-freezers. Compared with simple walking, increased dorsal visual pathway and deep locomotion region activities might play pivotal roles in tackling FOG in freezers during complex walking.
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Affiliation(s)
- Hui-Chun Huang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Chun-Ming Chen
- Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Kuei Lu
- Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan
| | - Bey-Ling Liu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Ing Li
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Jui-Cheng Chen
- Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Neurology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Guei-Jane Wang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Department of Health and Nutrition Biotechnology, Asia University, Taichung, Taiwan
| | - Hsiu-Chen Lin
- Department of Physical Therapy, China Medical University, Taichung, Taiwan
| | - Jeng-Ren Duann
- Institute of Education, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Institute for Neural Computation, University of California, San Diego, La Jolla, CA, United States
| | - Chon-Haw Tsai
- Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Neuroscience and Brain Disease Center, College of Medicine, China Medical University, Taichung, Taiwan
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Chang SJ, Cajigas I, Guest JD, Noga BR, Widerström-Noga E, Haq I, Fisher L, Luca CC, Jagid JR. MR Tractography-Based Targeting and Physiological Identification of the Cuneiform Nucleus for Directional DBS in a Parkinson's Disease Patient With Levodopa-Resistant Freezing of Gait. Front Hum Neurosci 2021; 15:676755. [PMID: 34168545 PMCID: PMC8217631 DOI: 10.3389/fnhum.2021.676755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Freezing of gait (FOG) is a debilitating motor deficit in a subset of Parkinson's Disease (PD) patients that is poorly responsive to levodopa or deep brain stimulation (DBS) of established PD targets. The proposal of a DBS target in the midbrain, known as the pedunculopontine nucleus (PPN), to address FOG was based on its observed neuropathology in PD and its hypothesized involvement in locomotor control as a part of the mesencephalic locomotor region (MLR). Initial reports of PPN DBS were met with enthusiasm; however, subsequent studies reported mixed results. A closer review of the MLR basic science literature, suggests that the closely related cuneiform nucleus (CnF), dorsal to the PPN, may be a superior site to promote gait. Although suspected to have a conserved role in the control of gait in humans, deliberate stimulation of a homolog to the CnF in humans using directional DBS electrodes has not been attempted. METHODS As part of an open-label Phase 1 clinical study, one PD patient with predominantly axial symptoms and severe FOG refractory to levodopa therapy was implanted with directional DBS electrodes (Boston Science Vercise CartesiaTM) targeting the CnF bilaterally. Since the CnF is a poorly defined reticular nucleus, targeting was guided both by diffusion tensor imaging (DTI) tractography and anatomical landmarks. Intraoperative stimulation and microelectrode recordings were performed near the targets with leg EMG surface recordings in the subject. RESULTS Post-operative imaging revealed accurate targeting of both leads to the designated CnF. Intraoperative stimulation near the target at low thresholds in the awake patient evoked involuntary electromyography (EMG) oscillations in the legs with a peak power at the stimulation frequency, similar to observations with CnF DBS in animals. Oscillopsia was the primary side effect evoked at higher currents, especially when directed posterolaterally. Directional DBS could mitigate oscillopsia. CONCLUSION DTI-based targeting and intraoperative stimulation to evoke limb EMG activity may be useful methods to help target the CnF accurately and safely in patients. Long term follow-up and detailed gait testing of patients undergoing CnF stimulation will be necessary to confirm the effects on FOG. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT04218526.
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Affiliation(s)
- Stephano J. Chang
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurosurgery, University of British Columbia, Vancouver, BC, Canada
| | - Iahn Cajigas
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - James D. Guest
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Brian R. Noga
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Eva Widerström-Noga
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ihtsham Haq
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Letitia Fisher
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Corneliu C. Luca
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jonathan R. Jagid
- The Miami Project to Cure Paralysis, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
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22
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Yadav AP, Li S, Krucoff MO, Lebedev MA, Abd-El-Barr MM, Nicolelis MAL. Generating artificial sensations with spinal cord stimulation in primates and rodents. Brain Stimul 2021; 14:825-836. [PMID: 34015518 DOI: 10.1016/j.brs.2021.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/01/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
For patients who have lost sensory function due to a neurological injury such as spinal cord injury (SCI), stroke, or amputation, spinal cord stimulation (SCS) may provide a mechanism for restoring somatic sensations via an intuitive, non-visual pathway. Inspired by this vision, here we trained rhesus monkeys and rats to detect and discriminate patterns of epidural SCS. Thereafter, we constructed psychometric curves describing the relationship between different SCS parameters and the animal's ability to detect SCS and/or changes in its characteristics. We found that the stimulus detection threshold decreased with higher frequency, longer pulse-width, and increasing duration of SCS. Moreover, we found that monkeys were able to discriminate temporally- and spatially-varying patterns (i.e. variations in frequency and location) of SCS delivered through multiple electrodes. Additionally, sensory discrimination of SCS-induced sensations in rats obeyed Weber's law of just-noticeable differences. These findings suggest that by varying SCS intensity, temporal pattern, and location different sensory experiences can be evoked. As such, we posit that SCS can provide intuitive sensory feedback in neuroprosthetic devices.
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Affiliation(s)
- Amol P Yadav
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA; Paul and Carole Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - Shuangyan Li
- Department of Neurobiology, Duke University, Durham, NC, 27710, USA; State Key Laboratory of Reliability and Intelligence of Electrical Equipment, School of Electrical Engineering, Tianjin, 300130, PR China; Tianjin Key Laboratory Bioelectromagnetic Technology and Intelligent Health, Hebei University of Technology, Tianjin, 300130, PR China
| | - Max O Krucoff
- Department of Neurosurgery, Medical College of Wisconsin & Froedtert Health, Wauwatosa, WI, 53226, USA; Department of Biomedical Engineering, Marquette University & Medical College of Wisconsin, Milwaukee, WI, 53233, USA
| | - Mikhail A Lebedev
- Center for Neuroengineering, Duke University, Durham, NC, 27710, USA; Skolkovo Institute of Science and Technology, 30 Bolshoy Bulvar, Moscow, 143026, Russia
| | | | - Miguel A L Nicolelis
- Department of Neurosurgery, Duke University, Durham, NC, 27710, USA; Center for Neuroengineering, Duke University, Durham, NC, 27710, USA; Department of Neurobiology, Duke University, Durham, NC, 27710, USA; Department of Biomedical Engineering, Duke University, Durham, NC, 27710, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, 27710, USA; Department of Neurology, Duke University, Durham, NC, 27710, USA; Edmond and Lily Safra International Institute of Neuroscience, Natal, 59066060, Brazil
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23
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Taximaimaiti R, Wang XP. Comparing the Clinical and Neuropsychological Characteristics of Parkinson's Disease With and Without Freezing of Gait. Front Neurosci 2021; 15:660340. [PMID: 33986641 PMCID: PMC8110824 DOI: 10.3389/fnins.2021.660340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Freezing of gait (FOG) is one of the most common walking problems in Parkinson’s disease (PD). Impaired cognitive function is believed to play an important role in developing and aggravating FOG in PD. But some evidence suggests that motor function discrepancy may affect testing results. Therefore, we think it is necessary for PD-FOG(+) and PD-FOG(−) patients to complete neuropsychological tests under similar motor conditions. Methods This study recruited 44 idiopathic PD patients [PD-FOG(+) n = 22, PD-FOG(−) n = 22] and 20 age-matched healthy controls (HC). PD-FOG(+) and PD-FOG(−) patients were matched for age, year of education, and Hoehn and Yahr score (H&Y). All participants underwent a comprehensive battery of neuropsychological assessment, and demographical and clinical information was also collected. Results PD patients showed poorer cognitive function, higher risks of depression and anxiety, and more neuropsychiatric symptoms compared with HC. When controlling for age, years of education, and H&Y, there were no statistical differences in cognitive function between PD-FOG(+) and PD-FOG(−) patients. But PD-FOG(+) patients had worse motor and non-motor symptoms than PD-FOG(−) patients. PD patients whose motor symptoms initiated with rigidity and initiated unilaterally were more likely to experience FOG. Conclusion Traditional neuropsychological testing may not be sensitive enough to detect cognitive impairment in PD. Motor symptoms initiated with rigidity and initiated unilaterally might be an important predictor of FOG.
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Affiliation(s)
- Reyisha Taximaimaiti
- Department of Neurology, Shanghai TongRen Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Ping Wang
- Department of Neurology, Shanghai TongRen Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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24
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Smith MD, Brazier DE, Henderson EJ. Current Perspectives on the Assessment and Management of Gait Disorders in Parkinson's Disease. Neuropsychiatr Dis Treat 2021; 17:2965-2985. [PMID: 34584414 PMCID: PMC8464370 DOI: 10.2147/ndt.s304567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/25/2021] [Indexed: 12/31/2022] Open
Abstract
Gait dysfunction is a key defining feature of Parkinson's disease (PD), and is associated with symptoms of freezing and an increased risk of falls. In this narrative review, we cover the putative mechanisms of gait dysfunction in PD, the assessment of gait abnormalities, and the management of symptoms caused by the inherent difficulty in walking. Our understanding of the causes of gait problems in PD has progressed in recent times, moving from neurocognitive theory to correlates of affected neuronal pathways. In particular, this can be shown to correspond with abnormalities in responses to dual-task paradigms and dysfunction in cholinergic signaling. Great progress has been made in the sophistication and precision of gait assessment; however, it has firmly remained in the research domain. There is significant momentum behind wearable technologies that can be used by patients in their own environment, acting as digital biomarkers that can not only reflect progression but also independently discriminate PD from non-PD individuals. The treatment of gait dysfunction has historically relied on physical therapies and training combined with a view to mitigating the impact of such consequences as falls. Pharmacological therapies that are the mainstay of treatment in PD have tended to address symptoms like bradykinesia; however, optimization of dopaminergic therapies likely has a positive effect on quality of gait. Other targets have been assessed with the goal of improving gait, of which medications that improve cholinergic signaling appear most promising. Neuromodulation techniques are increasingly used in the form of deep-brain stimulation; however, standard targets, such as the globus pallidus interna, have a modest effect on gait. Considerable benefit has been seen through targeting the pedunculopontine nucleus, and a dual-target approach may be warranted. Stimulation of the spinal cord and brain through direct or magnetic approaches has been assessed, but requires further evidence.
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Affiliation(s)
- Matthew D Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
| | - Danielle E Brazier
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Older People's Unit, Royal United Hospital NHS Foundation Trust, Bath, UK
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