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Zhang W, Ling Y, Chen Z, Ren K, Chen S, Huang P, Tan Y. Wearable sensor-based quantitative gait analysis in Parkinson's disease patients with different motor subtypes. NPJ Digit Med 2024; 7:169. [PMID: 38926552 PMCID: PMC11208588 DOI: 10.1038/s41746-024-01163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Gait impairments are among the most common and disabling symptoms of Parkinson's disease and worsen as the disease progresses. Early detection and diagnosis of subtype-specific gait deficits, as well as progression monitoring, can help to implement effective and preventive personalized treatment for PD patients. Yet, the gait features have not been fully studied in PD and its motor subtypes. To characterize comprehensive and objective gait alterations and to identify the potential gait biomarkers for early diagnosis, subtype differentiation, and disease severity monitoring. We analyzed gait parameters related to upper/lower limbs, trunk and lumbar, and postural transitions from 24 tremor-dominant (TD) and 20 postural instability gait difficulty (PIGD) dominant PD patients who were in early stage and 39 matched healthy controls (HC) during the Timed Up and Go test using wearable sensors. Results show: (1) Both TD and PIGD groups showed restricted backswing range in bilateral lower extremities and more affected side (MAS) arm, reduced trunk and lumbar rotation range in the coronal plane, and low turning efficiency. The receiver operating characteristic (ROC) analysis revealed these objective gait features had high discriminative value in distinguishing both PD subtypes from the HC with the area under the curve (AUC) values of 0.7~0.9 (p < 0.01). (2) Subtle but measurable gait differences existed between TD and PIGD patients before the onset of clinically apparent gait impairment. (3) Specific gait parameters were significantly associated with disease severity in TD and PIGD subtypes. Objective gait biomarkers based on wearable sensors may facilitate timely and personalized gait treatments in PD subtypes through early diagnosis, subtype differentiation, and disease severity monitoring.
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Affiliation(s)
- Weishan Zhang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Ling
- GYENNO SCIENCE Co., Ltd. Department of Research, Shenzhen, Guangdong, China
- HUST-GYENNO CNS Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Zhonglue Chen
- GYENNO SCIENCE Co., Ltd. Department of Research, Shenzhen, Guangdong, China
- HUST-GYENNO CNS Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Kang Ren
- GYENNO SCIENCE Co., Ltd. Department of Research, Shenzhen, Guangdong, China
- HUST-GYENNO CNS Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Shengdi Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pei Huang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yuyan Tan
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Choi JW, Malekmohammadi M, Sparks H, Kashanian A, Cross KA, Bordelon Y, Pouratian N. Altered Pallidocortical Low-Beta Oscillations During Self-Initiated Movements in Parkinson Disease. Front Syst Neurosci 2020; 14:54. [PMID: 32792918 PMCID: PMC7390921 DOI: 10.3389/fnsys.2020.00054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/06/2020] [Indexed: 11/20/2022] Open
Abstract
Background Parkinson disease (PD) patients have difficulty with self-initiated (SI) movements, presumably related to basal ganglia thalamocortical (BGTC) circuit dysfunction, while showing less impairment with externally cued (EC) movements. Objectives We investigate the role of BGTC in movement initiation and the neural underpinning of impaired SI compared to EC movements in PD using multifocal intracranial recordings and correlating signals with symptom severity. Methods We compared time-resolved neural activities within and between globus pallidus internus (GPi) and motor cortex during between SI and EC movements recorded invasively in 13 PD patients undergoing deep brain stimulation implantation. We compared cortical (but not subcortical) dynamics with those recorded in 10 essential tremor (ET) patients, who do not have impairments in movement initiation. Results SI movements in PD are associated with greater low-beta (13–20 Hz) power suppression during pre-movement period in GPi and motor cortex compared to EC movements in PD and compared to SI movements in ET (motor cortex only). SI movements in PD are uniquely associated with significant low-beta pallidocortical coherence suppression during movement execution that correlates with bradykinesia severity. In ET, motor cortex neural dynamics during EC movements do not significantly differ from that observed in PD and do not significantly differ between SI and EC movements. Conclusion These findings implicate low beta BGTC oscillations in impaired SI movements in PD. These results provide a physiological basis for the strategy of using EC movements in PD, circumventing diseased neural circuits associated with SI movements and instead engaging circuits that function similarly to those without PD.
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Affiliation(s)
- Jeong Woo Choi
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Mahsa Malekmohammadi
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hiro Sparks
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Alon Kashanian
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Katy A Cross
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Yvette Bordelon
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States.,Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, United States
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Tsubosaka M, Muratsu H, Takayama K, Maruo A, Miya H, Kuroda R, Matsumoto T. Effect of intraoperative soft tissue balance on postoperative recovery of ambulatory and balancing function in posterior-stabilized total knee arthroplasty. J Orthop Sci 2019; 24:507-513. [PMID: 30522924 DOI: 10.1016/j.jos.2018.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/24/2018] [Accepted: 10/30/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND The effectiveness of total knee arthroplasty (TKA) on ambulatory and balancing function recovery should be quantitatively investigated. The present study aimed to evaluate ambulatory function using 3m-timed up and go (TUG) test and balancing function using one-leg standing time (ST) from before and after TKA, and to analyze the effects of intraoperative soft tissue balance on the postoperative improvement of their functions after TKA. METHODS The study included 65 patients with varus-type knee osteoarthritis who underwent primary posterior-stabilized (PS) TKA. The TUG test and ST were performed preoperatively, 1 month and 12 months after TKA. The intraoperative soft tissue balance, medial and lateral joint looseness (MJL, LJL) were evaluated with both femoral trial in place and patellofemoral joint reduced using the OFR tensor® with the knee at 0, 10, 30, 45, 60, 90, 120, and 135°. The influences of MJL and LJL on the improvement in TUG test time and ST and the 2011 Knee Society Knee Scoring System (2011 KSS) 12 months after TKA were investigated. RESULTS The mean TUG test times and ST were 12.7 and 13.1, 13.5 and 15.4, and 10.9 and 19.2 s preoperatively, 1 month and 12 months after TKA, respectively. The MJL at 10, 30 and 90° flexion was significantly negatively correlated with improvement in the TUG test time and the MJL at 0° flexion was significantly negatively correlated with improvement in the ST. However, the LJL was not significantly correlated with improvement in the TUG test time and the ST. The MJL at 45, 60, and 90° flexion was significantly negatively correlated with the 12-month postoperative score on the activities subscale of the 2011 KSS. CONCLUSIONS The higher intraoperative medial knee stability may be associated with the better postoperative improvement in ambulatory function and activities subscale of the 2011 KSS after PS-TKA.
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Affiliation(s)
- Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, Hyogo, 650-0017, Japan; Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1, Yumesaki-chou, Hirohata-ku, Himeji, Hyogo, 671-1122, Japan
| | - Hirotsugu Muratsu
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1, Yumesaki-chou, Hirohata-ku, Himeji, Hyogo, 671-1122, Japan.
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Akihiro Maruo
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1, Yumesaki-chou, Hirohata-ku, Himeji, Hyogo, 671-1122, Japan
| | - Hidetoshi Miya
- Department of Orthopaedic Surgery, Steel Memorial Hirohata Hospital, 3-1, Yumesaki-chou, Hirohata-ku, Himeji, Hyogo, 671-1122, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-chuo, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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Bichsel O, Gassert R, Stieglitz L, Uhl M, Baumann-Vogel H, Waldvogel D, Baumann CR, Imbach LL. Functionally separated networks for self-paced and externally-cued motor execution in Parkinson's disease: Evidence from deep brain recordings in humans. Neuroimage 2018; 177:20-29. [PMID: 29738912 DOI: 10.1016/j.neuroimage.2018.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/12/2018] [Accepted: 05/02/2018] [Indexed: 11/18/2022] Open
Abstract
Spatially segregated cortico-basal ganglia networks have been proposed for the control of goal-directed and habitual behavior. In Parkinson's disease, selective loss of dopaminergic neurons regulating sensorimotor (habitual) behavior might therefore predominantly cause deficits in habitual motor control, whereas control of goal-directed movement is relatively preserved. Following this hypothesis, we examined the electrophysiology of cortico-basal ganglia networks in Parkinson patients emulating habitual and goal-directed motor control during self-paced and externally-cued finger tapping, respectively, while simultaneously recording local field potentials in the subthalamic nucleus (STN) and surface EEG. Only externally-cued movements induced a pro-kinetic event-related beta-desynchronization, whereas beta-oscillations were continuously suppressed during self-paced movements. Connectivity analysis revealed higher synchronicity (phase-locking value) between the STN and central electrodes during self-paced and higher STN to frontal phase-locking during externally-cued movements. Our data provide direct electrophysiological support for the existence of functionally segregated cortico-basal ganglia networks controlling motor behavior in Parkinson patients, and corroborate the assumption of Parkinson patients being shifted from habitual towards goal-directed behavior.
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Affiliation(s)
- Oliver Bichsel
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland; Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland.
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Lennart Stieglitz
- Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland; Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Mechtild Uhl
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Heide Baumann-Vogel
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Daniel Waldvogel
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Lukas L Imbach
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland.
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Galán-Mercant A, Cuesta-Vargas AI. Clinical frailty syndrome assessment using inertial sensors embedded in smartphones. Physiol Meas 2015; 36:1929-42. [DOI: 10.1088/0967-3334/36/9/1929] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fiz JA, Faundez-Zanuy M, Monte-Moreno E, Alcobé JR, Andreo F, Gomez R, Manzano JR. Short term oxygen therapy effects in hypoxemic patients measured by drawing analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 118:330-336. [PMID: 25682736 DOI: 10.1016/j.cmpb.2015.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 01/12/2015] [Accepted: 01/26/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Chronic hypoxemia has deleterious effects on psychomotor function that can affect daily life. There are no clear results regarding short term therapy with low concentrations of O2 in hypoxemic patients. We seek to demonstrate, by measuring the characteristics of drawing, these effects on psychomotor function of hypoxemic patients treated with O2. METHODS Eight patients (7/1) M/F, age 69.5 (9.9) yr, mean (SD) with hypoxemia (Pa O2 62.2 (6.9) mmHg) performed two drawings of pictures. Tests were performed before and after 30 min breathing with O2. RESULTS Stroke velocity increased after O2 for the house drawing (i.e. velocity 27.6 (5.5) mm/s basal, 30.9 (7.1) mm/s with O2, mean (SD), p<0.025, Wilcoxon test). The drawing time 'down' or fraction time the pen is touching the paper during the drawing phase decreased (i.e. time down 20.7 (6.6) s basal, 17.4 (6.3) s with O2, p<0.017, Wilcoxon test). CONCLUSIONS This study shows that in patients with chronic hypoxemia, a short period of oxygen therapy produces changes in psychomotor function that can be measured by means of drawing analysis.
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Affiliation(s)
- José Antonio Fiz
- Pulmonology Department, Hospital Universitari Germans Trias Pujol, Badalona, Spain(1); TALP Research Center, UPC, Barcelona, Spain(3).
| | | | | | - Josep Roure Alcobé
- Escola Universitària Politècnica de Mataró, Tecnocampus Mataró, Spain(2).
| | - Felipe Andreo
- Pulmonology Department, Hospital Universitari Germans Trias Pujol, Badalona, Spain(1).
| | - Rosa Gomez
- Pulmonology Department, Hospital Universitari Germans Trias Pujol, Badalona, Spain(1).
| | - Juan Ruiz Manzano
- Pulmonology Department, Hospital Universitari Germans Trias Pujol, Badalona, Spain(1).
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Sprint G, Cook DJ, Weeks DL. Toward Automating Clinical Assessments: A Survey of the Timed Up and Go. IEEE Rev Biomed Eng 2015; 8:64-77. [PMID: 25594979 DOI: 10.1109/rbme.2015.2390646] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Older adults often suffer from functional impairments that affect their ability to perform everyday tasks. To detect the onset and changes in abilities, healthcare professionals administer standardized assessments. Recently, technology has been utilized to complement these clinical assessments to gain a more objective and detailed view of functionality. In the clinic and at home, technology is able to provide more information about patient performance and reduce subjectivity in outcome measures. The timed up and go (TUG) test is one such assessment recently instrumented with technology in several studies, yielding promising results toward the future of automating clinical assessments. Potential benefits of technological TUG implementations include additional performance parameters, generated reports, and the ability to be self-administered in the home. In this paper, we provide an overview of the TUG test and technologies utilized for TUG instrumentation. We then critically review the technological advancements and follow up with an evaluation of the benefits and limitations of each approach. Finally, we analyze the gaps in the implementations and discuss challenges for future research toward automated self-administered assessment in the home.
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Galán-Mercant A, Cuesta-Vargas AI. Differences in trunk accelerometry between frail and non-frail elderly persons in functional tasks. BMC Res Notes 2014; 7:100. [PMID: 24559490 PMCID: PMC3940296 DOI: 10.1186/1756-0500-7-100] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 02/18/2014] [Indexed: 11/10/2022] Open
Abstract
Background Physical conditions through gait and other functional task are parameters to consider for frailty detection. The aim of the present study is to measure and describe the variability of acceleration, angular velocity and trunk displacement in the ten meter Extended Timed Get-Up-and-Go test in two groups of frail and non-frail elderly people through instrumentation with the iPhone4® smartphone. Secondly, to analyze the differences and performance of the variance between the study groups (frail and non-frail). This is a cross-sectional study of 30 subjects aged over 65 years, 14 frail subjects and 16 non-frail subjects. Results The highest difference between groups in the Sit-to-Stand and Stand-to-Sit subphases was in the y axis (vertical vector). The minimum acceleration in the Stand-to-Sit phase was -2.69 (-4.17 / -0.96) m/s2 frail elderly versus -8.49 (-12.1 / -5.23) m/s2 non-frail elderly, p < 0.001. In the Gait Go and Gait Come subphases the biggest differences found between the groups were in the vertical axis: -2.45 (-2.77 /-1.89) m/s2 frail elderly versus -5.93 (-6.87 / -4.51) m/s2 non-frail elderly, p < 0.001. Finally, with regards to the turning subphase, the statistically significant differences found between the groups were greater in the data obtained from the gyroscope than from the accelerometer (the gyroscope data for the mean maximum peak value for Yaw movement angular velocity in the frail elderly was specifically 25.60°/s, compared to 112.8°/s for the non-frail elderly, p < 0.05). Conclusions The inertial sensor fitted in the iPhone4® is capable of studying and analyzing the kinematics of the different subphases of the Extended Timed Up and Go test in frail and non-frail elderly people. For the Extended Timed Up and Go test, this device allows more sensitive differentiation between population groups than the traditionally used variable, namely time.
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Affiliation(s)
| | - Antonio I Cuesta-Vargas
- Physiotherapy Department, Faculty of Health Sciences, IBIMA, Universidad de Malaga, Av/Arquitecto Peñalosa s/n (Teatinos Campus Expansion), 29009 Málaga, Spain.
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Identifying axial and cognitive correlates in patients with Parkinson's disease motor subtype using the instrumented Timed Up and Go. Exp Brain Res 2013; 232:713-21. [PMID: 24292517 DOI: 10.1007/s00221-013-3778-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 11/12/2013] [Indexed: 10/26/2022]
Abstract
Parkinson's disease (PD) is clinically highly heterogeneous, often divided into tremor dominant (TD) and postural instability gait difficulty (PIGD). To better understand these subtypes and to help stratify patients, we applied an objective marker, i.e., an instrumented version of the traditional "Timed Up and Go" test (iTUG). It is not known whether the iTUG is sensitive to PD motor phenotypes or what are its behavioral and cognitive correlates. Subjects performed the iTUG wearing a body-fixed sensor. Subcomponents were studied including walking, transitions and turning. Gait, balance and cognitive function and the associations between iTUG, behavioral and cognitive domains were assessed. We also compared two representative subtypes, with minimal symptom overlap, referred to here as predominant PIGD (p-PIGD) and predominant TD (p-TD). One hundred and six patients with PD performed the iTUG. Significant correlations were found between iTUG measures and the PIGD score, but not with TD score. Thirty p-PIGD and 31 p-TD patients were identified. Both groups were similar with respect to age and disease duration (p > 0.75). The p-PIGD patients took significantly longer to complete the iTUG (p = 0.026), used more steps (p = 0.031), albeit with similar step duration (p = 0.936). In the sit-to-stand transition, the p-PIGD patients exhibited lower anterior-posterior jerk (p = 0.04) and lower pitch range (p = 0.012). During the turn, the p-PIGD patients had a lower yaw amplitude (p < 0.038). Cognitive domains were correlated with iTUG measures in the p-PIGD patients, but not in the p-TD. These findings demonstrate that a single sensor can identify axial and cognitive correlates using subcomponents of the iTUG and reveals subtle alterations between the PD motor subtypes.
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Differences in trunk kinematic between frail and nonfrail elderly persons during turn transition based on a smartphone inertial sensor. BIOMED RESEARCH INTERNATIONAL 2013; 2013:279197. [PMID: 24369530 PMCID: PMC3863499 DOI: 10.1155/2013/279197] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 10/30/2013] [Accepted: 11/14/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Firstly, to, through instrumentation with the iPhone4 smartphone, measure and describe variability of tridimensional acceleration, angular velocity, and displacement of the trunk in the turn transition during the ten-meter Extended Timed-Get-up-and-Go test in two groups of frail and physically active elderly persons. Secondly, to analyse the differences and performance of the variance between the study groups during turn transition (frail and healthy). DESIGN This is a cross-sectional study of 30 subjects over 65 years, 14 frail subjects, and 16 healthy subjects. RESULTS Significant differences were found between the groups of elderly persons in the accelerometry (P < 0.01) and angular displacement variables (P < 0.05), obtained in the kinematic readings of the trunk during the turning transitions. The results obtained in this study show a series of deficits in the frail elderly population group. CONCLUSIONS The inertial sensor found in the iPhone4 is able to study and analyse the kinematics of the turning transitions in frail and physically active elderly persons. The accelerometry values for the frail elderly are lower than the physically active elderly, whilst variability in the readings for the frail elderly is also lower than the control group.
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Cuesta-Vargas AI, Cano-Herrera C, Formosa D, Burkett B. Electromyographic responses during time get up and go test in water (wTUG). SPRINGERPLUS 2013; 2:217. [PMID: 23705108 PMCID: PMC3657083 DOI: 10.1186/2193-1801-2-217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 05/02/2013] [Indexed: 11/10/2022]
Abstract
The aim of this study was to use sEMG to measure the neuromuscular activity during the TUG task in water, and compare this with the responses for the same task on land. Ten healthy subjects [5 males and 5 females [mean ± SD]: age, 22.0 ± 3.1 yr; body mass, 63.9 ± 17.2 kg. A telemetry EMG system was used on the following muscles on the right side of the body: the quadriceps – rectus femoris [RF], long head of the biceps femoris [BF], tibialis anterior [TA], gastrocnemius medialis [GM], soleus [SOL], rectus abdominis [RA] and erector spinae [ES]. Each subject performed the TUG test three times with five minutes recover between trials in water and on dry land. The % MVC was significantly different (p < 0.05) for majority of the muscles tested during the TUG water compared to dry land. % MVC of RF [p = 0.003, t = 4.07]; BF [p = 0.000, t = 6.8]; TA [p = 0.005, t = 5.9]; and SOL [p = 0.048, t = 1.98]; RA [p = 0.007, t = 3.45]; and ES [p = 0.004, t = 3.78]. The muscle activation of the trunk and the lower limb [VM RF, BF, TA, GM and SOL] were lower in water compared to dry land, when performing a TUG test.
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Affiliation(s)
- Antonio I Cuesta-Vargas
- Department of Physiotherapy, University of Malaga, Av de Martiricos s/n, Malaga, 29071 Spain ; School of Clinical Science, Faculty of Health Science, Queensland University Technology, Queensland, Australia
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Moroz A, Edgley SR, Lew HL, Chae J, Lombard LA, Reddy CC, Robinson KM. Rehabilitation interventions in Parkinson disease. PM R 2011; 1:S42-8; quiz S49-50. [PMID: 19627972 DOI: 10.1016/j.pmrj.2009.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This self-directed learning module provides an evidence-based update of exercise-based rehabilitation interventions to treat Parkinson disease (PD). It is part of the study guide on stroke and neurodegenerative disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This focused review emphasizes treatment of locomotion deficits, upper limb motor control deficits, and hypokinetic dysarthria. New dopaminergic agents and deep brain stimulation are facilitating longer periods of functional stability for patients with PD. Adjunctive exercise-based treatments can therefore be applied over longer periods of time to optimize function before inevitable decline from this neurodegenerative disease. As function deteriorates in patients with PD, the role of caregivers becomes more critical, thus training caregivers is of paramount importance to help maintain a safe environment and limit caregiver anxiety and depression. The overall goal of this article is to enhance the learner's existing practice techniques used to treat PD through exercise-based intervention methods.
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Affiliation(s)
- Alex Moroz
- NYU School of Medicine, Rusk Institute of Rehabilitation Medicine, New York, NY, USA
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Ma HI, Hwang WJ, Fang JJ, Kuo JK, Wang CY, Leong IF, Wang TY. Effects of virtual reality training on functional reaching movements in people with Parkinson’s disease: a randomized controlled pilot trial. Clin Rehabil 2011; 25:892-902. [DOI: 10.1177/0269215511406757] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate whether practising reaching for virtual moving targets would improve motor performance in people with Parkinson’s disease. Design: Randomized pretest–posttest control group design. Setting: A virtual reality laboratory in a university setting. Participants: Thirty-three adults with Parkinson’s disease. Interventions: The virtual reality training required 60 trials of reaching for fast-moving virtual balls with the dominant hand. The control group had 60 practice trials turning pegs with their non-dominant hand. Main outcome measures: Pretest and posttest required reaching with the dominant hand to grasp real stationary balls and balls moving at different speeds down a ramp. Success rates and kinematic data (movement time, peak velocity and percentage of movement time for acceleration phase) from pretest and posttest were recorded to determine the immediate transfer effects. Results: Compared with the control group, the virtual reality training group became faster ( F = 9.08, P = 0.005) and more forceful ( F = 9.36, P = 0.005) when reaching for real stationary balls. However, there was no significant difference in success rate or movement kinematics between the two groups when reaching for real moving balls. Conclusion: A short virtual reality training programme improved the movement speed of discrete aiming tasks when participants reached for real stationary objects. However, the transfer effect was minimal when reaching for real moving objects.
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Affiliation(s)
- Hui-Ing Ma
- Department of Occupational Therapy and Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Juh Hwang
- Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jing-Jing Fang
- Department of Mechanical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Jui-Kun Kuo
- Department of Mechanical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Yi Wang
- Department of Occupational Therapy and Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Iat-Fai Leong
- Department of Mechanical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Tsui-Ying Wang
- Department of Occupational Therapy and Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Kang SY, Wasaka T, Shamim EA, Auh S, Ueki Y, Lopez GJ, Kida T, Jin SH, Dang N, Hallett M. Characteristics of the sequence effect in Parkinson's disease. Mov Disord 2011; 25:2148-55. [PMID: 20669182 DOI: 10.1002/mds.23251] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The sequence effect (SE) in Parkinson's disease (PD) is progressive slowing of sequential movements. It is a feature of bradykinesia, but is separate from a general slowness without deterioration over time. It is commonly seen in PD, but its physiology is unclear. We measured general slowness and the SE separately with a computer-based, modified Purdue pegboard in 11 patients with advanced PD. We conducted a placebo-controlled, four-way crossover study to learn whether levodopa and repetitive transcranial magnetic stimulation (rTMS) could improve general slowness or the SE. We also examined the correlation between the SE and clinical fatigue. Levodopa alone and rTMS alone improved general slowness, but rTMS showed no additive effect on levodopa. Levodopa alone, rTMS alone, and their combination did not alleviate the SE. There was no correlation between the SE and fatigue. This study suggests that dopaminergic dysfunction and abnormal motor cortex excitability are not the relevant mechanisms for the SE. Additionally, the SE is not a component of clinical fatigue. Further work is needed to establish the physiology and clinical relevance of the SE. © 2010 Movement Disorder Society.
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Affiliation(s)
- Suk Yun Kang
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1428, USA
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15
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Redgrave P, Rodriguez M, Smith Y, Rodriguez-Oroz MC, Lehericy S, Bergman H, Agid Y, DeLong MR, Obeso JA. Goal-directed and habitual control in the basal ganglia: implications for Parkinson's disease. Nat Rev Neurosci 2010; 11:760-72. [PMID: 20944662 PMCID: PMC3124757 DOI: 10.1038/nrn2915] [Citation(s) in RCA: 695] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Progressive loss of the ascending dopaminergic projection in the basal ganglia is a fundamental pathological feature of Parkinson's disease. Studies in animals and humans have identified spatially segregated functional territories in the basal ganglia for the control of goal-directed and habitual actions. In patients with Parkinson's disease the loss of dopamine is predominantly in the posterior putamen, a region of the basal ganglia associated with the control of habitual behaviour. These patients may therefore be forced into a progressive reliance on the goal-directed mode of action control that is mediated by comparatively preserved processing in the rostromedial striatum. Thus, many of their behavioural difficulties may reflect a loss of normal automatic control owing to distorting output signals from habitual control circuits, which impede the expression of goal-directed action.
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Affiliation(s)
- Peter Redgrave
- Neuroscience Research Unit, Department of Psychology, University of Sheffield, UK.
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16
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Salarian A, Horak FB, Zampieri C, Carlson-Kuhta P, Nutt JG, Aminian K. iTUG, a sensitive and reliable measure of mobility. IEEE Trans Neural Syst Rehabil Eng 2010; 18:303-10. [PMID: 20388604 DOI: 10.1109/tnsre.2010.2047606] [Citation(s) in RCA: 307] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Timed Up and Go (TUG) test is a widely used clinical paradigm to evaluate balance and mobility. Although TUG includes several complex subcomponents, namely: sit-to-stand, gait, 180 degree turn, and turn-to-sit; the only outcome is the total time to perform the task. We have proposed an instrumented TUG, called iTUG, using portable inertial sensors to improve TUG in several ways: automatic detection and separation of subcomponents, detailed analysis of each one of them and a higher sensitivity than TUG. Twelve subjects in early stages of Parkinson's disease (PD) and 12 age matched control subjects were enrolled. Stopwatch measurements did not show a significant difference between the two groups. The iTUG, however, showed a significant difference in cadence between early PD and control subjects (111.1 +/- 6.2 versus 120.4 +/- 7.6 step/min, p < 0.006) as well as in angular velocity of arm-swing (123 +/- 32.0 versus 174.0+/-50.4 degrees/s, p < 0.005), turning duration (2.18 +/- 0.43 versus 1.79 +/- 0.27 s, p < 0.023), and time to perform turn-to-sits (2.96 +/- 0.68 versus 2.40 +/- 0.33 s, p < 0.023). By repeating the tests for a second time, the test-retest reliability of iTUG was also evaluated. Among the subcomponents of iTUG, gait, turning, and turn-to-sit were the most reliable and sit-to-stand was the least reliable.
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Affiliation(s)
- Arash Salarian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédéral de Lausanne, Lausanne, CH-1015 Lausanne, Switzerland.
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Zampieri C, Salarian A, Carlson-Kuhta P, Aminian K, Nutt JG, Horak FB. The instrumented timed up and go test: potential outcome measure for disease modifying therapies in Parkinson's disease. J Neurol Neurosurg Psychiatry 2010; 81:171-6. [PMID: 19726406 PMCID: PMC3065923 DOI: 10.1136/jnnp.2009.173740] [Citation(s) in RCA: 230] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Timed Up and Go (TUG) test has been used to assess balance and mobility in Parkinson's Disease (PD). However, it is not known if this test is sensitive to subtle abnormalities present in early stages of the disease, when balance and gait problems are not clinically evident but may be detected with instrumented analysis of movement. We hypothesise that postural transitions and arm swing during gait will be the most sensitive characteristics of the TUG for early PD. In the present study, we instrumented the TUG test (iTUG) using portable inertial sensors, and extended the walking distance from 3 m (traditional TUG) to 7 m. Twelve subjects with early-to-moderate, untreated PD and 12 healthy individuals participated. Our findings show that although the stopwatch measure of TUG duration did not detect any abnormalities in early-to-mid-stage PD, the peak arm swing velocity on the more affected side, average turning velocity, cadence and peak trunk rotation velocity were significantly slower. These iTUG parameters were also correlated with the Unified Parkinson's Disease Rating Motor Scale. Thus, the iTUG test is sensitive to untreated PD and could potentially detect progression of PD and response to symptomatic and disease-modifying treatments.
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Affiliation(s)
- Cris Zampieri
- Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR 97006, USA
| | - Arash Salarian
- Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR 97006, USA
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédéral de Lausanne, 1015 Lausanne, Switzerland
| | - Patricia Carlson-Kuhta
- Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR 97006, USA
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédéral de Lausanne, 1015 Lausanne, Switzerland
| | - John G. Nutt
- Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR 97006, USA
- Balance Disorders Laboratory, Department of Physiology and Pharmacology, School of Medicine, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR 97006, USA
| | - Fay B. Horak
- Balance Disorders Laboratory, Department of Neurology, School of Medicine, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR 97006, USA
- Balance Disorders Laboratory, Department of Physiology and Pharmacology, School of Medicine, Oregon Health & Science University, 505 NW 185th Avenue, Beaverton, OR 97006, USA
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18
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Abstract
BACKGROUND Postural instability while standing, walking, and interacting with objects or the environment places individuals with Parkinson disease (PD) at risk for falls, injuries, and self-imposed restrictions in activity. Recent research with motor skills, including those demanding postural stability, has demonstrated performance and learning advantages when performers are instructed to adopt an external rather than an internal focus of attention. Despite the potential benefits in stability-related risk reduction and enhanced movement effectiveness, attentional focus research in individuals challenged with postural instability is limited. OBJECTIVE The present translational research study examined the generalizability of the attentional focus effect to balance in older adults with PD. DESIGN A within-participant design was used to account for potentially substantial individual variations in balancing capabilities. METHODS Fourteen participants diagnosed with idiopathic PD (Hoehn and Yahr stages II and III) participated in the experiment. They were asked to balance on an unstable surface (inflated rubber disk). In counterbalanced orders, they were instructed to focus on reducing movements of their feet (internal focus) or the disk (external focus), or they were not given attentional focus instructions (control). RESULTS The adoption of an external focus resulted in less postural sway relative to both internal focus and control conditions. There was no difference between the internal focus and control conditions. LIMITATIONS Mental functioning was not formally assessed, and comprehensive clinical profiles of participants were not obtained. CONCLUSIONS The results are consistent with previous findings on attentional focus in samples of patients and people without disabilities. Subtle wording distinctions that direct attention to movement effects external to the mover reduce postural instability during standing for individuals with PD relative to an internal focus. The findings have potentially important implications for instructions given by clinicians and the reduction of fall risk.
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Barbarulo AM, Grossi D, Merola S, Conson M, Trojano L. On the genesis of unilateral micrographia of the progressive type. Neuropsychologia 2007; 45:1685-96. [PMID: 17275860 DOI: 10.1016/j.neuropsychologia.2007.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 12/24/2006] [Accepted: 01/07/2007] [Indexed: 11/21/2022]
Abstract
We report a patient who, following a focal ischemic lesion of the left basal ganglia, developed right hand micrographia characterised by progressive reduction of letter size during writing (progressive micrographia). The patient did not show relevant cognitive impairments, but achieved pathological scores in tests for verbal fluency, and cognitive flexibility and monitoring. A systematic investigation of the writing performances demonstrated that micrographia showed a clear length effect in whatever writing style or task, while it was not observed in drawing, or in left hand writing to a comparable extent. Right hand progressive micrographia was not affected by a concurrent motor and cognitive load; instead, switching between two kinds of allographic responses and presenting one letter at a time in copying tasks reduced severity of micrographia significantly. These findings support the view that progressive micrographia in our patient could be ascribed to a defect in regulating the motor output on the basis of self-generated strategies. This conclusion would be consistent with neuroimaging evidence about the role of the basal ganglia in the control of motor sequencing, and could suggest that progressive micrographia might be associated with specific executive defects.
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Affiliation(s)
- Anna Maria Barbarulo
- Neuropsychology Laboratory, Department of Psychology, Second University of Naples, Via Vivaldi 43, 81100 Caserta, Italy
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Guenther FH. Cortical interactions underlying the production of speech sounds. JOURNAL OF COMMUNICATION DISORDERS 2006; 39:350-65. [PMID: 16887139 DOI: 10.1016/j.jcomdis.2006.06.013] [Citation(s) in RCA: 342] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 06/12/2006] [Indexed: 05/11/2023]
Abstract
UNLABELLED Speech production involves the integration of auditory, somatosensory, and motor information in the brain. This article describes a model of speech motor control in which a feedforward control system, involving premotor and primary motor cortex and the cerebellum, works in concert with auditory and somatosensory feedback control systems that involve both sensory and motor cortical areas. New speech sounds are learned by first storing an auditory target for the sound, then using the auditory feedback control system to control production of the sound in early repetitions. Repeated production of the sound leads to tuning of feedforward commands which eventually supplant the feedback-based control signals. Although parts of the model remain speculative, it accounts for a wide range of kinematic, acoustic, and neuroimaging data collected during speech production and provides a framework for investigating communication disorders that involve malfunction of the cerebral cortex and interconnected subcortical structures. LEARNING OUTCOMES Readers will be able to: (1) describe several types of learning that occur in the sensory-motor system during babbling and early speech, (2) identify three neural control subsystems involved in speech production, (3) identify regions of the brain involved in monitoring auditory and somatosensory feedback during speech production, and (4) identify regions of the brain involved in feedforward control of speech.
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Affiliation(s)
- Frank H Guenther
- Department of Cognitive and Neural Systems, Boston University, 677 Beacon Street, Boston, MA 02215, USA.
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21
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Guenther FH, Ghosh SS, Tourville JA. Neural modeling and imaging of the cortical interactions underlying syllable production. BRAIN AND LANGUAGE 2006; 96:280-301. [PMID: 16040108 PMCID: PMC1473986 DOI: 10.1016/j.bandl.2005.06.001] [Citation(s) in RCA: 528] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2004] [Revised: 03/25/2005] [Accepted: 06/08/2005] [Indexed: 05/03/2023]
Abstract
This paper describes a neural model of speech acquisition and production that accounts for a wide range of acoustic, kinematic, and neuroimaging data concerning the control of speech movements. The model is a neural network whose components correspond to regions of the cerebral cortex and cerebellum, including premotor, motor, auditory, and somatosensory cortical areas. Computer simulations of the model verify its ability to account for compensation to lip and jaw perturbations during speech. Specific anatomical locations of the model's components are estimated, and these estimates are used to simulate fMRI experiments of simple syllable production.
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Affiliation(s)
- Frank H. Guenther
- Department of Cognitive and Neural Systems, Boston University, 677 Beacon Street, Boston, MA, 02215, Telephone: (617) 353-5765, Fax Number: (617) 353-7755,
- Speech and Hearing Bioscience and Technology Program Harvard University/Massachusetts Institute of Technology Cambridge, MA 02139
- Athinoula A. Martinos Center for Biomedical Imaging Massachusetts General Hospital Charlestown, MA 02129
| | - Satrajit S. Ghosh
- Department of Cognitive and Neural Systems, Boston University, 677 Beacon Street, Boston, MA, 02215, Telephone: (617) 353-5765, Fax Number: (617) 353-7755,
| | - Jason A. Tourville
- Department of Cognitive and Neural Systems, Boston University, 677 Beacon Street, Boston, MA, 02215, Telephone: (617) 353-5765, Fax Number: (617) 353-7755,
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22
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Kelly VE, Bastian AJ. Antiparkinson medications improve agonist activation but not antagonist inhibition during sequential reaching movements. Mov Disord 2005; 20:694-704. [PMID: 15719427 DOI: 10.1002/mds.20386] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The execution of sequential arm movements is critical to activities of daily living such as eating and grooming. It is known that movement sequences are bradykinetic in people with Parkinson's disease (PD) and that antiparkinson medications improve the speed of movement sequences. However, it is unclear how muscle activity is modulated during sequential movements and what effect antiparkinson medications have on muscle modulation. We studied subjects with PD and age- and gender-matched control subjects making sequential reaching movements. Subjects with PD were tested before and after their morning dose of antiparkinson medications (levodopa and/or dopamine agonists). We examined the effect of antiparkinson medications on the modulation of muscle activity (i.e., the ability to activate and inhibit each muscle throughout the course of a sequence). Results showed that the group with PD, before medication, moved more slowly and modulated muscle activity poorly compared to the control group. Antiparkinson medications improved movement speed as expected, although sequential movements remained slower than normal even after medication. Medication improved the ability to activate agonist muscle activity but did not improve the ability to inhibit antagonist activity. Instead, antagonist activity was also increased, resulting in minimal improvements in muscle modulation during sequential reaching movements.
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Affiliation(s)
- Valerie E Kelly
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA.
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Lehman DA, Toole T, Lofald D, Hirsch MA. Training with Verbal Instructional Cues Results in Near-term Improvement of Gait in People with Parkinson Disease. J Neurol Phys Ther 2005; 29:2-8. [PMID: 16386155 DOI: 10.1097/01.npt.0000282256.36208.cf] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess immediate and near-term effects of an instructional set on select gait parameters in people living with Parkinson disease (PD). SUBJECTS Five individuals with early stage PD participated in a within subject design in Part One. Eleven individuals with early stage PD were randomly assigned to a treatment group (n = 5) or a control group (n = 6) in Part Two. METHODS The treatment consisted of a 10-day training program of walking 1800 feet per day and with the instructions to take long steps. Testing occurred before treatment (baseline), immediately after treatment, one week after treatment, and one month after treatment. Measurements of step length, velocity, and cadence were taken without the use of the instructional set. RESULTS There was a significant increase in step length and velocity and a significant decrease in cadence between baseline and all post-test measures for part one. For part 2, step length of the treatment group significantly increased between baseline and all 3 post-tests and there was a significant difference between the treatment group and control group at all posttests for step length. CONCLUSIONS The instructional set was effective in improving parameters of gait for at least 4 weeks. These data support the concept that people with Parkinson disease have a potential for motor learning.
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Affiliation(s)
- David A Lehman
- Tennessee State University, Department of Physical Therapy, USA.
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Ma HI, Trombly CA, Tickle-Degnen L, Wagenaar RC. Effect of One Single Auditory Cue on Movement Kinematics in Patients with Parkinson???s Disease. Am J Phys Med Rehabil 2004; 83:530-6. [PMID: 15213477 DOI: 10.1097/01.phm.0000130032.97113.e0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether one single auditory cue affected movement kinematics of more than one step in a sequential upper limb task in patients with Parkinson's disease. DESIGN A counter-balanced repeated-measures design was employed. A total of 16 male patients with Parkinson's disease and 16 age-matched male and female controls performed the task under two conditions. In the signal-present condition, the participants were instructed to start the movement when they heard a bell ring. In the signal-absent condition, there was no bell ringing, and they were told to start the movement when they were ready. Kinematic performances for the first two movement segments (i.e., reaching for the pen and bringing the pen to the paper) were compared between conditions. RESULTS The results indicated that the presence of the single auditory cue affected movement kinematics of the patients with Parkinson's disease but not that of the controls. When given external cueing, the patients elicited faster, more forceful, more efficient, more stable, but less smooth movement. CONCLUSIONS The results suggest that therapists should provide external cues according to their treatment goals. In addition, researchers should be aware of the influence of start signals when designing subsequent experiments.
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Affiliation(s)
- Hui-Ing Ma
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Taiwan, Republic of China
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Fama R, Sullivan EV. Motor sequencing in Parkinson's disease: relationship to executive function and motor rigidity. Cortex 2002; 38:753-67. [PMID: 12507044 DOI: 10.1016/s0010-9452(08)70042-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Parkinson's disease (PD) is a movement disorder that also affects central cognitive processing; however, the extent to which high-order cognitive processes disrupted by PD affect complex motor function is incompletely explicated. The present analysis provides an examination of the relative contributions of simple motor versus complex cognitive functions involving sequencing, problem solving, and overall cognitive status to complex motor movements involving sequencing and temporal ordering in PD. Motor sequencing performance was videotaped for quantitative scoring. Compared with an age-matched control group, the PD group was impaired on motor agility and motor sequencing tasks in addition to cognitive sequencing and set shifting tasks. Neither current cognitive functioning, age, disease duration, nor overall intellectual abilities accounted for the relationships between motor sequencing and cognitive sequencing abilities in PD. By contrast, both sequencing and nonsequencing executive functions predicted motor sequencing performance as well as or better than motor rigidity or overall cognitive status. These relationships were strongest for the most challenging motor sequencing task, fist-edge-palm, and did not apply to the least challenging task, which required simple alternations of hand movements. Unlike PD, controls showed correlations between motor sequencing tests and executive functioning only tapping nonsequencing abilities. Thus, despite the predominant motor feature of PD, executive functions, as assessed by sequencing and set formation, predicted motor sequencing performance as well as or better than simple motor performance. The results further suggest that the more complex the motor sequencing task, the more susceptible it is to influence from generalized cognitive sequencing ability.
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