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Wang T, Yang L, Li X, Su P, Meng D. Characteristics of static balance performance in 4-Stage Balance test in the Healthy Older Adults. Int J Neurosci 2024:1-11. [PMID: 38305048 DOI: 10.1080/00207454.2024.2312992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/27/2024] [Indexed: 02/03/2024]
Abstract
Background: The 4-Stage Balance test is one of the most commonly used tests to assess balance for older adults. Although it is generally accepted that the four positions (including side-by-side (SBSS), semi-tandem (STS), tandem (TS), and single-leg stance (SLS)) in this test are progressively more difficult, there are no studies comparing the balance parameters of the four positions in older adults to prove this result. The purpose of this study is to determine the difficulty of 4 positions in the 4-Stage Balance test and the effect of the dominant and non-dominant lower extremities on static balance among healthy older adults; Methods: A total of 115 community-dwelling healthy older adults were included. The postural parameters (including sway range standard deviation (SR), velocity of body sway (V), total sway area (TSA) and sway perimeter (TSP) of the center of pressure) were measured during 8 static postures (including SBSS, left STS, right STS, left TS, right TS, left SLS, right SLS and comfortable stance (CS)). Repeated measures ANOVA was used to analyze the postural parameters in 8 static postures; Results: The static balance stability of the five stances in older adults can be ranked in the following sequence: CS > SBSS/STS > TS > SLS. Moreover, changing foot placement in STS, TS and SLS tasks has no influence on stability. This study has been registered in China Clinical Trial Registry (ChiCTR2200065803). Conclusions: Our findings suggest that it is feasible to simplify the 4-Stage Balance test to a 3-Stage Balance test in the older adults.
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Affiliation(s)
- Tiantian Wang
- Rehabilitation Medical Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Liuxin Yang
- Rehabilitation Medical Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Xuan Li
- Rehabilitation Medical Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Panpan Su
- Department of Rehabilitation Medicine, Shengze Hospital Affiliated to Nanjing Medical University, Suzhou 215200, China
| | - Dianhuai Meng
- Rehabilitation Medical Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
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Bao W, Tan Y, Yang Y, Chen K, Liu J. Correlation of balance posturographic parameters during quiet standing with the berg balance scale in patients with parkinson's disease. BMC Neurol 2023; 23:362. [PMID: 37803250 PMCID: PMC10557353 DOI: 10.1186/s12883-023-03386-1] [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: 04/25/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is often clinically associated with posture instability and more easily falling. The Berg balance scale is a clinical indicator commonly used to subjectively evaluate a patient's balance ability. Meanwhile, computerized force platforms have been used in research on postural control. The various parameters obtained from posturography are interpreted to assess balance ability. The present study aims to explore the correlations between posturographic variables and the BBS, and furthermore to efficiently evaluate postural instability and fall risk of early and moderate PD patients. METHODS A total of 46 PD patients were involved in the experiment. Patients were asked to perform BBS tests and force platform tests under eye open (EO) and eye closed (EC) conditions. The recorded COP signal was analyzed with the time domain statistical method, the frequency domain method of Power Spectral Density (PSD), and structural methods of Stabilogram Diffusion Analysis (SDA), Sway Density Plot (SDP) to retrieve different posturographic variables. The correlation between posturographic variables under EO and EC conditions with BBS was compared statistically. The significantly correlated posturographic parameters were then applied to analyze posturographic differences between different groups: faller vs. non-faller (patients with/without a history of falls in the past 12 months). RESULTS Among the different posturographic parameters, the prediction ellipse area, the slope of the regression line at a high-frequency band of PSD in the medial-lateral (ML) direction, the crossover point of the regression lines of SDA in the anterior-posterior (AP) direction, and the distance between successive peaks of SDP had significant correlations with BBS. These selected BBS-related parameters also showed significant differences between faller and non-faller. The selected posturographic parameters can be used as effective indicators to evaluate the balance ability of Parkinson's disease patients.
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Affiliation(s)
- Wei Bao
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China
| | - Yuyan Tan
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Ying Yang
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China
| | - Kai Chen
- School of Mechanical Engineering, Hangzhou Dianzi University, Hangzhou, 310018, Zhejiang, China.
| | - Jun Liu
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
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Wodarski P, Jurkojć J, Michalska J, Kamieniarz A, Juras G, Gzik M. Balance assessment in selected stages of Parkinson's disease using trend change analysis. J Neuroeng Rehabil 2023; 20:99. [PMID: 37528430 PMCID: PMC10394805 DOI: 10.1186/s12984-023-01229-1] [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: 02/21/2023] [Accepted: 07/28/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Balance disorders in patients diagnosed with Parkinson's disease (PD) are associated with a change in balance-keeping strategy and reflex disorders which regulate the maintenance of vertical body posture. Center of foot pressure (COP) displacement signals were analyzed during quiet standing experiments to define such changes. The research aimed to apply stock exchange indices based on the trend change analyses to the assessment of a level of the Parkinson disease progression on the grounds of the analysis of the COP signals. METHODS 30 patients in two stages of PD, 40 elderly participants, and 20 individuals at a young age were studied. Each person was subjected to 3 measurements with open and closed eyes. A technical analysis of the COP displacement signal was performed, and the following quantities were determined: indices related to the number of trend changes (TCI), indices defining a mean time (TCI_dT), and mean displacement (TCI_dS) and mean velocity (TCI_dV) between such changes. RESULTS The results indicate a higher TCI value for PD than for aged-matched control group (p < 0.05). In the case of PD patients, there was also an increase in the TCI_dS value by 2-5 mm, which mainly contributed to the increase in TCI_dV. Statistically significant differences for the TCI_dT values occurred between all groups in which differences in the average COP velocity were noted. CONCLUSIONS The TCI and TCI_dV results obtained for the healthy participants enabled the development of indices supporting PD diagnostics. The causes of the TCI_dV changes in patients were determined, i.e., whether they resulted from an increase in the TCI_dT or TCI_dS between the moments of trend changes indicated by the developed algorithm. The developed methodology provides new information on the impact of PD on the strategy of maintaining balance, which was impossible to obtain using currently used analyses. Trial registration The conducted research is an observational study and does not include a health care intervention. Participants gave their consent to participate in the research and the procedure was approved by the Institutional Bioethics Committee.
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Affiliation(s)
- Piotr Wodarski
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
| | - Jacek Jurkojć
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
| | - Justyna Michalska
- Department of Human Motor Behavior, Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland
| | - Anna Kamieniarz
- Department of Human Motor Behavior, Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland
| | - Grzegorz Juras
- Department of Human Motor Behavior, Institute of Sport Sciences, Academy of Physical Education in Katowice, Katowice, Poland
| | - Marek Gzik
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Gliwice, Poland
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Sebastia-Amat S, Tortosa-Martínez J, Pueo B. The Use of the Static Posturography to Assess Balance Performance in a Parkinson's Disease Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:981. [PMID: 36673738 PMCID: PMC9859212 DOI: 10.3390/ijerph20020981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 06/17/2023]
Abstract
The literature has shown contradictory results so far about the use of posturography, especially static posturography, to evaluate balance performance in Parkinson’s disease (PD) populations. This study aimed to investigate the use of static posturography as a valid method to evaluate balance in a PD population. Fifty-two participants diagnosed with PD (Hoehn & Yahr stage: 1−3) were included in this cross-sectional study. All participants completed the following assessments: Hoehn and Yahr scale, Movement Disorder Society-Unified Parkinson’s Disease Rating Scale, Tinetti Scale, Berg Balance Scale, Activities-specific Balance Confidence scale, Timed Up and Go test, and Functional Reach Test. Sway parameters were analyzed with a baropodometric platform, under eyes open (EO) and eyes closed (EC) conditions, in a bipodal stance. Small to large correlations were observed between clinical balance tests and static posturography parameters, although the majority of these parameters correlated moderately. Considering posturographic variables, the highest correlation values were detected for total excursion (TE), mean velocity (MV), mean (X-mean), and root-mean-square (X-RMS) displacements in the medio-lateral directions. It was observed that posturographic parameters worsened as the disease progresses, although differences were only significant between the stages 1 and 3 in the H&Y scale (p < 0.05). Regarding the test condition, the visual deprivation worsened significantly all the static posturography parameters (p < 0.05), except the antero-posterior mean displacement (Y-Mean). Comparing visual conditions, the EC presented slightly higher correlation values with the clinical balance tests. Static posturography could be used as an objective complementary tool to clinical balance tests in order to assess and control balance performance, mainly to detect postural instability problems.
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Zawadka-Kunikowska M, Klawe JJ, Tafil-Klawe M, Bejtka M, Rzepiński Ł, Cieślicka M. Cognitive Function and Postural Control Strategies in Relation to Disease Progression in Patients with Parkinson's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912694. [PMID: 36231994 PMCID: PMC9566250 DOI: 10.3390/ijerph191912694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 06/01/2023]
Abstract
AIM This study assessed the influence of performing an additional cognitive task on center of pressure (COP) displacement in the early and advanced stages of patients with Parkinson's disease (PD) compared to age-matched healthy controls (HCs). METHODS The study included 40 HCs and 62 patients with PD: early PD (n = 38) and advanced PD (n = 24). COP parameters were determined by static posturography during quiet standing with open eyes (ST, single task) and simultaneous performance of a cognitive task (DT, dual task). Cognitive functioning was examined with a Mini Mental State Examination, number-counting-backward test, and number of enunciated words during DT. RESULTS In the advanced-PD group, DT significantly reduced the sway radius (p = 0.009), area of stabilogram (p = 0.034), medio-lateral length (p = 0.027), and velocity (p = 0.033) compared to ST. In HCs, DT showed a significant increase in the sway radius (p = 0.006), total length (p = 0.039), sway velocity (p = 0.037), anterior-posterior length, and sway velocity. Both PD groups showed worse cognitive performance compared to HCs. CONCLUSIONS Both early and advanced patients with PD showed significant delay in cognitive performance associated with executive function compared to the HCs. During additional cognitive tasks, patients with advanced stages of PD may reduce stabilographic parameters in medio-lateral direction, and this is probably an adaptive strategy to restore balance.
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Affiliation(s)
- Monika Zawadka-Kunikowska
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Jacek J. Klawe
- Department of Hygiene, Epidemiology, Ergonomy and Postgraduate Education, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
| | - Małgorzata Tafil-Klawe
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Monika Bejtka
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Łukasz Rzepiński
- Department of Neurology, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
- Sanitas-Neurology Outpatient Clinic, Dworcowa 110, 85-010 Bydgoszcz, Poland
| | - Mirosława Cieślicka
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Karłowicza 24, 85-092 Bydgoszcz, Poland
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Zampogna A, Mileti I, Martelli F, Paoloni M, Del Prete Z, Palermo E, Suppa A. Early balance impairment in Parkinson's Disease: Evidence from Robot-assisted axial rotations. Clin Neurophysiol 2021; 132:2422-2430. [PMID: 34454269 DOI: 10.1016/j.clinph.2021.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/27/2021] [Accepted: 06/06/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Early postural instability (PI) is a red flag for the diagnosis of Parkinson's disease (PD). Several patients, however, fall within the first three years of disease, particularly when turning. We investigated whether PD patients, without clinically overt PI, manifest abnormal reactive postural responses to ecological perturbations resembling turning. METHODS Fifteen healthy subjects and 20 patients without clinically overt PI, under and not under L-Dopa, underwent dynamic posturography during axial rotations around the longitudinal axis, provided by a robotic mechatronic platform. We measured reactive postural responses, including body displacement and reciprocal movements of the head, trunk, and pelvis, by using a network of three wearable inertial sensors. RESULTS Patients showed higher body displacement of the head, trunk and pelvis, and lower joint movements at the lumbo-sacral junction than controls. Conversely, movements at the cranio-cervical junction were normal in PD. L-Dopa left reactive postural responses unchanged. CONCLUSIONS Patients with PD without clinically overt PI manifest abnormal reactive postural responses to axial rotations, unresponsive to L-Dopa. The biomechanical model resulting from our experimental approach supports novel pathophysiological hypotheses of abnormal axial rotations in PD. SIGNIFICANCE PD patients without clinically overt PI present subclinical balance impairment during axial rotations, unresponsive to L-Dopa.
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Affiliation(s)
- Alessandro Zampogna
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Ilaria Mileti
- Mechanical Measurements and Microelectronics (M3Lab) Lab, Engineering Department, University Niccolò Cusano, 00166 Rome, Italy
| | - Francesca Martelli
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, 00184 Rome, Italy
| | - Marco Paoloni
- Department of Physical Medicine and Rehabilitation, Sapienza University of Rome, 00161 Rome, Italy
| | - Zaccaria Del Prete
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, 00184 Rome, Italy
| | - Eduardo Palermo
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, 00184 Rome, Italy
| | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; IRCCS Neuromed, 86077 Pozzilli, IS, Italy.
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Cinini A, Cutugno P, Ferraris C, Ferretti M, Marconi L, Morgavi G, Nerino R. Final results of the NINFA project: impact of new technologies in the daily life of elderly people. Aging Clin Exp Res 2021; 33:1213-1222. [PMID: 31587153 DOI: 10.1007/s40520-019-01357-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The paper presents the work carried out within NINFA (iNtelligent Integrated Network For Aged people), a project for the wellbeing of the elderly people at home. AIMS The impact of new technologies on elderly people is evaluated with respect to the three main topics faced by NINFA. METHODS NINFA was structured into three main topics: (1) active user engagement from the very beginning of the planning stage: the use of specially designed questionnaires to evaluate the acceptability of new technology in general and robot caregiver specifically; (2) assessment of the well-being through non-invasive techniques: natural language processing for language change monitoring in elderly subjects; (3) automated assessment of motor and cognitive functions at home: systems to deliver tests and exergames through user interfaces compliant with elderly subjects. RESULTS The analysis shows that there is no a priori closure to support the technology, but it must not be invasive and must allow social interactions. The study of speech transcripts shows that a large variations in the number of words used to describe the same situation could be a sign on the onset of cognitive impairments. The specifically designed systems highlight, after the training period, significant improvements in the performances of the participants and a satisfaction with regards to the systems usability. CONCLUSIONS The outcomes of NINFA project highlight some important aspects of the relationship between elderly people and new technologies concerning: engagement and acceptability, assessment of the wellbeing and of the modifications of motor, cognitive and language functions.
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Dana A, Shams A, Allafan N, Bahrami A. The relationship between attention and static balance disturbance in patients with Parkinson's disease. Neurol Sci 2021; 42:5107-5115. [PMID: 33774761 DOI: 10.1007/s10072-021-05184-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Balance disturbance is one of the main complications of the Parkinson's disease (PD). As studies have shown that impairments in some cognitive processes can lead to balance problems, we investigated the relationship between focused and divided attention and static balance in patients with PD and a healthy control group. METHODS We included 111 patients with PD (M age = 49.41, SD = 6.33 years) and 142 healthy individuals (M age = 50.62, SD = 6.07 years). All participants were evaluated with the Trails Making Test A and B (TMT), and all participants' balance was evaluated with a Wii Balance Board, from which we measured the antero-posterior (AP), medio-lateral (ML), and total center of pressure (COP) velocity. We compared the two groups in terms of TMT-A, TMT-B, and COP velocity tests in both eyes-open and eyes-closed conditions with independent t-tests, and we calculated Pearson's correlation coefficients between the balance board-derived outcomes and the TMT scores. RESULTS The two groups differed significantly on TMT-A and TMT-B scores, in total and ML COP velocity in both eyes-closed and eyes-open conditions, and in AP COP velocity only in eyes-open condition. Among patients with PD, TMT-A and TMT-B scores were positively correlated with total, ML, and AP COP velocity, in both eyes-open and eyes-closed conditions. CONCLUSIONS Associated attention deficits may be among the causes of balance disturbances in patients with PD, though both attention and balance may have a common root in brain circuitry.
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Affiliation(s)
- Amir Dana
- Department of Physical Education, Tabriz Branch, Islamic Azad University, Tabriz, Iran.
| | - Amir Shams
- Department of Motor Behavior, Sport Sciences Research Institute, Tehran, Iran
| | - Nahid Allafan
- Department of Sport Medicine and Health, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran
| | - Alireza Bahrami
- Department of Motor Behavior and Sport Psychology, Faculty of Sport Sciences, Arak University, Arak, Iran
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Tat NM, Tat AM, Oner AF, Karaman K, Kaplan S, Can F. Static postural balance evaluation and an investigation of the relationship with joint health in children with severe haemophilia: a controlled cross-sectional study. Haemophilia 2021; 27:e245-e252. [PMID: 33486846 DOI: 10.1111/hae.14240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/30/2020] [Accepted: 12/12/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Recurrent hemarthroses disturbing force/movement control are likely to impair postural balance. AIM To investigate the possible changes in static postural balance parameters in children with haemophilia (CwH) and to reveal its relationship with Haemophilia Joint Health Score (HJHS). METHODS Twenty-one CwH aged 6-18 who had haemophilic arthropathy in at least one lower limb joint and 21 healthy peers were evaluated by using a force platform. Centre of pressure (CoP) signals were displayed as a map in both anteroposterior direction (APD) and mediolateral direction (MLD) by statokinesigram. Accordingly, the amplitude, velocity and standard deviation of CoP displacements along with the perimeter and ellipse area were measured. Assessments were made under eyes opened and eyes closed in bipedal stance for 60 s. Joint health and muscle strength were evaluated with HJHS and digital dynamometer, respectively. RESULTS Velocity and amplitude of CoP displacements in MLD were increased in CwH (p˂0.05). It was also found that these parameters were moderate correlated with the clinical score of the lower limb joints (p˂0.05). In CwH, standard deviation of CoP displacements in the APD was significantly higher in eyes closed, while standard deviation in MLD was significantly higher in eyes opened (p˂0.05). CONCLUSION Disturbances during bipedal stance reveal the need for balance evaluation in CwH. Increased mediolateral oscillations may be an early sign of disorders of the musculoskeletal system in CwH. In addition to improving joint health, postural balance exercises that increase MLD stability have to be included in the rehabilitation programme of CwH.
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Affiliation(s)
- Necati M Tat
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Necmettin Erbakan University, Konya, Turkey
| | - Ayse M Tat
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Necmettin Erbakan University, Konya, Turkey
| | - Ahmet F Oner
- Faculty of Medicine, Department of Pediatric Hematology and Oncology, Yuzuncu Yil University, Van, Turkey
| | - Kamuran Karaman
- Faculty of Medicine, Department of Pediatric Hematology and Oncology, Yuzuncu Yil University, Van, Turkey
| | - Seyhmus Kaplan
- Faculty of Medicine, Department of Sports Medicine, Yuzuncu Yil University, Van, Turkey
| | - Filiz Can
- Faculty of Physical Therapy and Rehabilitation, Department of Orthopaedic Rehabilitation, Hacettepe University, Ankara, Turkey
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Kamieniarz A, Michalska J, Marszałek W, Stania M, Słomka KJ, Gorzkowska A, Juras G, Okun MS, Christou EA. Detection of postural control in early Parkinson's disease: Clinical testing vs. modulation of center of pressure. PLoS One 2021; 16:e0245353. [PMID: 33434235 PMCID: PMC7802937 DOI: 10.1371/journal.pone.0245353] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Little is known about the early stage balance changes in PD. Many clinicians assume that there are no postural issues in early PD because of failure to identify them on bedside and clinical testing. Here, we quantify balance changes in early and moderate stage PD and compared these values to healthy controls (HC) using clinical assessments of balance and posturography. METHODS We compared 15 HC with 15 early PD (PD-II; Hoehn and Yahr stage II) and 15 moderate PD (PD-III; H&Y stage III). Participants performed various clinical tests of balance and a standing postural task on a force platform. We quantified the spatiotemporal parameters of the center of pressure (COP), the sample entropy and power spectral density (PSD) of the COP. RESULTS The PSD of the COP differentiated PD-II from HC from 0-0.5 Hz and PD-II from PD-III from 0.5-1 Hz. Specifically, PD-II and PD-III manifested greater power than HC from 0-0.5 Hz, whereas PD-III exhibited greater power than PD-II and HC from 0.5-1.0 Hz (p<0.05). However, there were no significant differences between PD-II and HC in all clinical tests and in spatiotemporal parameters of the COP (p>0.05). Although the sample entropy was significantly lower in the PD groups (p<0.05), entropy failed to differentiate PD-II from PD-III. CONCLUSION The low-frequency modulation of the COP in this small cohort differentiated early PD from HC and from moderate PD. Clinicians should be aware that there are early balance deficits in PD. A larger sample size is needed to confirm these findings.
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Affiliation(s)
- Anna Kamieniarz
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Justyna Michalska
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Wojciech Marszałek
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Magdalena Stania
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Kajetan J. Słomka
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Agnieszka Gorzkowska
- Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Juras
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States of America
| | - Evangelos A. Christou
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States of America
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States of America
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Zarucchi A, Vismara L, Frazzitta G, Mauro A, Priano L, Maestri R, Bergna A, Tarantino AG. Efficacy of Osteopathic Manipulative Treatment on postural control in Parkinsonian patients with Pisa syndrome: A pilot randomized placebo-controlled trial. NeuroRehabilitation 2020; 46:529-537. [PMID: 32538880 DOI: 10.3233/nre-203068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Pisa syndrome (PS) is a clinical condition frequently associated with Parkinson's disease (PD). It is characterized by a trunk lateral flexion higher than 10 degrees and reversible when lying. One pathophysiological hypothesis is the altered verticality perception, due to a somatosensory impairment. Osteopathic Manipulative Treatment (OMT) manages fascial-system alterations, linked to somatic dysfunctions. Fascial system showed to be implicated in proprioceptive sensibility. OBJECTIVE The aim of the study was to assess OMT efficacy on postural control in PD-PS patients by stabilometry. METHODS In this single-blinded trial we studied 24 PD-PS patients, 12 of whom were randomly assigned to receive a multidisciplinary physical therapy protocol (MIRT) and sham OMT, while the other 12 received four OMT plus MIRT, for one month. The primary endpoint was the eye closed sway area assessment after the intervention. Evaluation of trunk lateral flexion (TLF) with DIERS formetrics was also performed. RESULTS At one month, the sway area of the OMT group significantly decreased compared to placebo (mean delta OMT - 326.00±491.24 mm2, p = 0.01). In the experimental group TLF showed a mean inclination reduction of 3.33 degrees after treatment (p = 0.044, mean d = 0.54). Moreover, a significant positive association between delta ECSA and delta TLF was observed (p = 0.04, r = 0.46). DISCUSSION Among PD-PS patients, MIRT plus OMT showed preliminary evidence of postural control and TLF improvement, compared to the control group.
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Affiliation(s)
- A Zarucchi
- Department of Brain Injury and Parkinson's Disease Rehabilitation, Ospedale "Moriggia-Pelascini", Gravedona ed Uniti (Como), Italy.,Department of Clinical Research, SOMA Istituto Osteopatia Milano, Italy
| | - L Vismara
- "Rita Levi Montalcini" Department of Neurosciences, University of Turin, Turin, Italy.,Division of Neurology and Neurorehabilitation, IRCCS Istituto Auxologico Italiano Piancavallo-Verbania, Italy.,MANIMA, Not-for-Profit Healthcare and Assistance, Milan, Italy
| | - G Frazzitta
- Department of Brain Injury and Parkinson's Disease Rehabilitation, Ospedale "Moriggia-Pelascini", Gravedona ed Uniti (Como), Italy
| | - A Mauro
- "Rita Levi Montalcini" Department of Neurosciences, University of Turin, Turin, Italy.,Division of Neurology and Neurorehabilitation, IRCCS Istituto Auxologico Italiano Piancavallo-Verbania, Italy
| | - L Priano
- "Rita Levi Montalcini" Department of Neurosciences, University of Turin, Turin, Italy.,Division of Neurology and Neurorehabilitation, IRCCS Istituto Auxologico Italiano Piancavallo-Verbania, Italy
| | - R Maestri
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS, Montescano, Italy
| | - A Bergna
- Department of Clinical Research, SOMA Istituto Osteopatia Milano, Italy
| | - A G Tarantino
- Department of Clinical Research, SOMA Istituto Osteopatia Milano, Italy.,MANIMA, Not-for-Profit Healthcare and Assistance, Milan, Italy
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12
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Liu XH, Li Y, Xu HL, Sikandar A, Lin WH, Li GH, Li XF, Alimu A, Yu SB, Ye XH, Wang N, Ni J, Chen WJ, Gan SR. Quantitative assessment of postural instability in spinocerebellar ataxia type 3 patients. Ann Clin Transl Neurol 2020; 7:1360-1370. [PMID: 32638517 PMCID: PMC7448197 DOI: 10.1002/acn3.51124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022] Open
Abstract
Objective Spinocerebellar ataxia type 3 (SCA3) is one of the most common hereditary neurodegenerative diseases, with balance instability as main symptom. Balance quantification is crucial for evaluating the efficacy of therapeutic interventions. However, balance evaluation in SCA3 is often subject to bias. Here, we aimed to quantitatively evaluate postural instability and investigate the relationship between postural instability and clinical characteristics in SCA3 patients. Methods Sixty‐two SCA3 patients and 62 normal controls were recruited, and their postural balance was measured using a posturographic platform. Principal component analysis was performed as data reduction to identify postural instability factors. Multivariable linear regression was used to investigate potential risk factors for postural instability and to explore whether postural instability predicts the severity and progression of ataxia in SCA3 patients. Results We found SCA3 patients experience postural instability characterized by significant impairment in static and dynamic stability. The condition without visual feedback was the most sensitive measure in differentiating SCA3 from controls. Regression analyses revealed that ataxia severity predicted both static (P = 0.014) and dynamic stability (P = 0.001). Likewise, along with expanded CAG repeats (P < 0.001), both static (P < 0.001) and dynamic stability (P < 0.001) predicted ataxia severity, but not ataxia progression. Interpretation Our findings demonstrate the validity of using the Pro‐kin system for assessing postural instability in SCA3 patients. This type of quantitative assessment of balance dysfunction can contribute to clinical trials and balance rehabilitation in SCA3 patients.
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Affiliation(s)
- Xia-Hua Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ying Li
- Fujian Medical University, Fuzhou, China
| | - Hao-Ling Xu
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Arif Sikandar
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wei-Hong Lin
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Gui-He Li
- Fujian Medical University, Fuzhou, China
| | | | | | | | | | - Ning Wang
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Jun Ni
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wan-Jin Chen
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Shi-Rui Gan
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
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13
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Halmi Z, Dinya E, Málly J. Destroyed non-dopaminergic pathways in the early stage of Parkinson's disease assessed by posturography. Brain Res Bull 2019; 152:45-51. [PMID: 31295517 DOI: 10.1016/j.brainresbull.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The early stage of Parkinson's disease (PD) (Hoehn-Yahr (HY) I-II stages) is characterized by a negative pull test, which clinically excludes postural instability. Previous studies with dynamic posturography detected balance disturbances even at the onset of the disease but the age dependency or prediction of dyskinesia with dynamic posturography are not known. OBJECTIVE/HYPOTHESIS We hypothesized that the postural instability evoked by dynamic posturography was part of the early stage of PD. Furthermore, we studied how we can provoke dyskinesia. METHODS Postural instability with static and dynamic posturography (passing balls with different weights around the body) was studied in 45 patients with PD in their HY I, II stages. They were compared with 35 age-matched healthy controls. Eighteen patients with dyskinesia were involved in the study. Fourteen patients were followed for two years. RESULTS The pathway and velocity of the movement assessed by static and the dynamic posturography were significantly higher in the group >65 years than that of age-matched healthy controls, while the group ≤65 years showed a significant increment only in the antero-posterior sway during dynamic posturography. The imbalance of patients with dyskinesia was significantly (p < 0.05) provoked by dynamic posturography compared to patients with PD without dyskinesia. The results were independent of age. CONCLUSION Postural instability is part of the early symptoms of PD. Non-dopaminergic pathways may be involved in the early stage of PD.
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Affiliation(s)
- Zsófia Halmi
- Dept. Developmental Neurology, Saint Margaret Hospital, Budapest, Hungary
| | - Elek Dinya
- Semmelweis Univ. Digital Health Dept., Budapest, Hungary
| | - Judit Málly
- Inst. of Neurorehabilitation, Sopron, Hungary.
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14
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Massa RE, Rosso A, Metti AL, Sparto PJ, Aizenstein H, Ferrucci L, Divecha A, Rosano C. Neuroimaging correlates of lateral postural control in older ambulatory adults. Aging Clin Exp Res 2019; 31:611-619. [PMID: 30168099 DOI: 10.1007/s40520-018-1028-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/17/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND In older adults, impaired postural control contributes to falls, a major source of morbidity. Understanding central mechanisms may help identify individuals at risk for impaired postural control. AIMS To determine the relationship between gray matter volume (GMV), white matter hyperintensities (WMH), mean diffusivity (MD), and fractional anisotropy (FA) with lateral postural control. METHODS Neuroimaging and postural control were assessed in 193 community-dwelling older adults (mean age 82, 55.4% female, 44.6% black). GMV, WMH, and diffusion tensor-derived markers of microstructure (MD and FA) were quantified for total brain and regions of interest. Lateral postural control was defined as the root mean square error (RMSE) of lateral sway during a visual feedback test. Associations were assessed with linear regression, adjusted for total brain atrophy and risk factors for impaired postural control. RESULTS RMSE was higher for women than men (p < 0.001) and inversely correlated with gait speed (r = - 0.20, p = 0.01), modified mini-mental state (r = - 0.27, p < 0.001), digit symbol substitution test (r = - 0.20, p = 0.01) and quadriceps strength (r = - 0.18, p = 0.01). RMSE was inversely associated with GMV of bilateral precuneus (r = - 0.26, p = 0.01) and FA of corpus callosum and selected tracts in the right hemisphere (anterior thalamic radiation, cingulum, inferior longitudinal and fronto-occipital fasciculi), independent of covariates (r = - 0.34 to - 0.18, p ≤ 0.04). DISCUSSION Lower GMV and microstructural white matter integrity in selected networks can explain worse lateral postural control in older ambulatory adults without neurologic diseases. CONCLUSION Neuroimaging markers of poor postural control in healthy aging may help identify increased fall risk and design preventative fall strategies.
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15
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Feasibility of Home-Based Automated Assessment of Postural Instability and Lower Limb Impairments in Parkinson's Disease. SENSORS 2019; 19:s19051129. [PMID: 30841656 PMCID: PMC6427119 DOI: 10.3390/s19051129] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/01/2019] [Accepted: 02/26/2019] [Indexed: 01/30/2023]
Abstract
A self-managed, home-based system for the automated assessment of a selected set of Parkinson’s disease motor symptoms is presented. The system makes use of an optical RGB-Depth device both to implement its gesture-based human computer interface and for the characterization and the evaluation of posture and motor tasks, which are specified according to the Unified Parkinson’s Disease Rating Scale (UPDRS). Posture, lower limb movements and postural instability are characterized by kinematic parameters of the patient movement. During an experimental campaign, the performances of patients affected by Parkinson’s disease were simultaneously scored by neurologists and analyzed by the system. The sets of parameters which best correlated with the UPDRS scores of subjects’ performances were then used to train supervised classifiers for the automated assessment of new instances of the tasks. Results on the system usability and the assessment accuracy, as compared to clinical evaluations, indicate that the system is feasible for an objective and automated assessment of Parkinson’s disease at home, and it could be the basis for the development of neuromonitoring and neurorehabilitation applications in a telemedicine framework.
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16
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Harro CC, Kelch A, Hargis C, DeWitt A. Comparing Balance Performance on Force Platform Measures in Individuals with Parkinson's Disease and Healthy Adults. PARKINSON'S DISEASE 2018; 2018:6142579. [PMID: 30687494 PMCID: PMC6304814 DOI: 10.1155/2018/6142579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/23/2018] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Postural instability is a known contributing factor to balance dysfunction and increased fall risk in those with Parkinson's disease (PD). Computerized posturography employing a force platform system provides objective, quantitative assessments of postural control impairments. This study examines balance performance as measured by force platform (FP) tests in persons with PD compared to age-matched healthy adults. Secondarily, we examine if these FP measures provide diagnostic and clinically meaningful information about the underlying balance impairments in the PD population. METHODS Participants-42 individuals with PD (Hoehn and Yahr stage = 2.33 ± 0.77) and 55 age-matched healthy adults-were assessed on three standardized balance measures on a computerized force platform system. Between groups, comparisons of FP performance were analyzed using independent t-test. Within the group, comparisons for the PD cohort were analyzed using ANOVA for comparing disease stage and Mann-Whitney U test for PD subtypes. RESULTS The PD cohort demonstrated significantly greater postural instability on the sensory organization test (SOT) measures (P=0.013, CI-95% = 1.286 to 10.37) and slower movement velocity on the limits of stability (LOS) test (P=0.001, CI-95% = 0.597 to 1.595) than the healthy cohort, suggesting that these tests were sensitive to detect sensory integration and voluntary postural control deficits in the PD cohort. Within the PD group, the SOT differentiated between H&Y stages 1-3. The motor control test (MCT) detected changes in reactive postural control mainly in later disease stages. All three FP tests distinguished between PD subtypes, with the Posture Gait Instability subtype demonstrating poorer balance performance than Tremor Dominant subtype. CONCLUSION These findings suggest FP measures provide clinically meaningful, diagnostic information in the examination of balance impairments in individuals with PD. FP measures may inform clinicians regarding intrinsic balance deficits and guide them in designing targeted balance interventions to reduce fall risk in persons with PD.
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Affiliation(s)
- Cathy C. Harro
- Assistance Professor, Physical Therapy, College of Health Professions, Grand Valley State University, Cook DeVos Center for Health Sciences, 301 Michigan Street NE, Suite 268, Grand Rapids, MI 49503, USA
| | - Amanda Kelch
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy Street SE, Grand Rapids, MI 49503, USA
| | - Cora Hargis
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy Street SE, Grand Rapids, MI 49503, USA
| | - Abigail DeWitt
- PT Solutions, 1321 Tusculum Blvd., Greeneville, TN 37743, USA
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17
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Kamieniarz A, Michalska J, Brachman A, Pawłowski M, Słomka KJ, Juras G. A posturographic procedure assessing balance disorders in Parkinson's disease: a systematic review. Clin Interv Aging 2018; 13:2301-2316. [PMID: 30519012 PMCID: PMC6237244 DOI: 10.2147/cia.s180894] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Postural instability is common in Parkinson's disease (PD), often contributing to falls, injuries, and reduced mobility. In the clinical setting, balance disorder is commonly diagnosed using clinical tests and balance scales, but it is suggested that the most sensitive measurement is the force platform. The aim of this systematic review was to summarize the methods and various posturographic procedures used to assess the body balance and gait in PD. A systematic review was conducted of papers published from 2000 to 2017. Databases searched were PubMed and EBSCO. Studies must have involved patients with PD, used force platform or motion analysis system as a measurement tool, and described posturographic procedure. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. A total of 32 studies met the inclusion criteria. The PEDro scores ranged from 5 to 7 points. The analysis of the objective methods assessing balance disorders revealed a large discrepancy in the duration and procedures of measurements. The number of repetitions of each trial fluctuated between 1 and 8, and the duration of a single trial ranged from 10 to 60 seconds. Overall, there are many scales and tests used to assess the balance disorders and disabilities of people with PD. Although in many included studies the authors have used posturography as a method to evaluate the postural instability of PD patients, the results are contradictory. To solve this issue, it is indicated to establish a "gold standard" of procedures of measures of balance.
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Affiliation(s)
- Anna Kamieniarz
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Justyna Michalska
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Anna Brachman
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Michał Pawłowski
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Kajetan J Słomka
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
| | - Grzegorz Juras
- Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland,
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18
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Carpinella I, Nardone A, Bonora G, Bowman T, Cattaneo D, Rabuffetti M, Ferrarin M. Counteracting Postural Perturbations Through Body Weight Shift: a Pilot Study Using a Robotic Platform in Subjects with Parkinson's Disease. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1794-1802. [PMID: 30072335 DOI: 10.1109/tnsre.2018.2862463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Abnormalities of body-weight transfer occur during several motor tasks in people with Parkinson's disease (PwPD). In this study, a novel robotic paradigm for assessment and training of dynamic balance was developed and applied to twelve healthy subjects (HS) and ten PwPD to verify its feasibility and to assess the capability of PwPD to counteract postural perturbations through body-weight shifts. At variance with other robotic paradigms, subjects had to react as fast as possible to the perturbation, bringing the platform back to the horizontal and keeping it until the end of the task. Four randomized perturbations, obtained varying the platform equilibrium angle from 0° to ±6° in sagittal (backward, forward) and frontal (right, left) planes, were repeated 3 times. Compared to HS, PwPD showed, in all perturbation directions, increased delay in counteraction phase onset (p<=0.01), prolonged time to stabilize the platform (p<=0.02), and higher deviation of the final plate inclination from the horizontal (p<=0.04), the deviation being larger during sagittal perturbations. PwPD showed also larger (p=0.01) postural sway around the stabilization angle following frontal perturbations. Results are in keeping with known hypo- and bradykinesia as well as proprioceptive and kinesthetic impairments in PD. We suggest that the proposed approach is feasible and might be included in balance evaluation and training in PD.
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19
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Souza CDO, Voos MC, Barbosa AF, Chen J, Francato DCV, Milosevic M, Popovic M, Fonoff ET, Chien HF, Barbosa ER. Relationship Between Posturography, Clinical Balance and Executive Function in Parkinson´s Disease. J Mot Behav 2018; 51:212-221. [PMID: 29683777 DOI: 10.1080/00222895.2018.1458279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study aimed to evaluate the relationship between posturography, clinical balance, and executive function tests in Parkinson´s disease (PD). Seventy-one people participated in the study. Static posturography evaluated the center of pressure fluctuations in quiet standing and dynamic posturography assessed sit-to-stand, tandem walk, and step over an obstacle. Functional balance was evaluated by Berg Balance Scale, MiniBESTest, and Timed Up and Go test. Executive function was assessed by Trail Making Test (TMT) and semantic verbal fluency test. Step over obstacle measures (percentage of body weight transfer and movement time) were moderately correlated to Timed Up and Go, part B of TMT and semantic verbal fluency (r > 0.40; p < 0.05 in all relationships). Stepping over an obstacle assesses the responses to internal perturbations. Participants with shorter movement times and higher percentage of body weight transfer (higher lift up index) on this task were also faster in Timed Up and Go, part B of TMT, and semantic verbal fluency. All these tasks require executive function (problem solving, sequencing, shifting attention), which is affected by PD and contribute to postural assessment.
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Affiliation(s)
- Carolina de Oliveira Souza
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,b Department of Functional Neurosurgery , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil
| | - Mariana Callil Voos
- c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil.,d Physical Therapy, Occupational Therapy and Speech Therapy Department , University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Alessandra Ferreira Barbosa
- c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil.,d Physical Therapy, Occupational Therapy and Speech Therapy Department , University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Janini Chen
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil
| | - Debora Cristina Valente Francato
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Matija Milosevic
- e Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto , Ontario , Canada.,f Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto , Ontario , Canada
| | - Milos Popovic
- e Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto , Ontario , Canada.,f Rehabilitation Engineering Laboratory, Lyndhurst Centre, Toronto Rehabilitation Institute - University Health Network , Toronto , Ontario , Canada
| | - Erich Talamoni Fonoff
- b Department of Functional Neurosurgery , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil
| | - Hsin Fen Chien
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil.,c ReMove, Rehabilitation in Movement Disorders Research Group , São Paulo , SP , Brazil
| | - Egberto Reis Barbosa
- a Movement Disorders Clinic, Department of Neurology , Clinics Hospital of University of São Paulo, School of Medicine , São Paulo , Brazil
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20
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Ferrazzoli D, Ortelli P, Riboldazzi G, Maestri R, Frazzitta G. Effectiveness of Rotigotine plus intensive and goal-based rehabilitation versus Rotigotine alone in "de-novo" Parkinsonian subjects: a randomized controlled trial with 18-month follow-up. J Neurol 2018; 265:906-916. [PMID: 29442177 PMCID: PMC5878188 DOI: 10.1007/s00415-018-8792-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 01/20/2023]
Abstract
Background Dopamine Replacement Therapy (DRT) represents the most effective treatment for Parkinson’s disease (PD). Nevertheless, several symptoms are unresponsive to treatment and its long-term use leads to serious side effects. To optimize the pharmacological management of PD, dopamine-agonists are often prescribed to “de-novo” patients. Moreover, several studies have shown the effectiveness and the synergic effect of rehabilitation in treating PD. Objective To evaluate the synergism between DRT and rehabilitation in treating PD, by investigating the short and the long-term effectiveness of a multidisciplinary, intensive and goal-based rehabilitation treatment (MIRT) in a group of patients treated with Rotigotine. Materials and methods In this multicenter, single blinded, parallel-group, 1:1 allocation ratio, randomized, non-inferiority trial, 36 “de-novo” PD patients were evaluated along 18 months: 17 were treated with Rotigotine plus MIRT; 19 were treated with Rotigotine alone (R). The primary outcome measure was the total score of Unified Parkinson’s Disease Rating Scale (UPDRS). The secondary outcomes included the UPDRS sub-sections II and III (UPDRS II-III), the 6-Minute Walk Test (6MWT), the Timed Up and Go Test (TUG) and the amount of Rotigotine. Patients were evaluated at baseline (T0), 6 months (T1), 1 year (T2), and at 18 months (T3). Results No differences in UPDRS scores in the two groups (total score, III part and II part, p = 0.48, p = 0.90 and p = 0.40, respectively) were found in the time course. Conversely, a greater improvement in Rotigotine + MIRT group was observed for 6MWT (p < 0.0001) and TUG (p = 0.03). Along time, the dosage of Rotigotine was higher in patients who did not undergo MIRT, at all observation times following T0. Conclusions Over the course of 18 months, the effectiveness of the combined treatment (Rotigotine + MIRT) on the patients’ global clinical status, evaluated with total UPDRS, was not inferior to that of the pharmacological treatment with Rotigotine alone. Importantly, rehabilitation allowed patients to gain better motor performances with lower DRT dosage.
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Affiliation(s)
- D Ferrazzoli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Via Pelascini 3, Gravedona ed Uniti (CO), 22015, Como, Italy.
| | - P Ortelli
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Via Pelascini 3, Gravedona ed Uniti (CO), 22015, Como, Italy
| | - G Riboldazzi
- Parkinson's Disease and Movement Disorders Center, ASST dei Sette Laghi, Varese, Italy
- Parkinson's disease Rehabilitation Center, Fondazione Borghi, Brebbia, Varese, Italy
| | - R Maestri
- Department of Biomedical Engineering, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS, Via per Montescano 3, Montescano, 27040, Pavia, Italy
| | - G Frazzitta
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Via Pelascini 3, Gravedona ed Uniti (CO), 22015, Como, Italy
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21
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Albuquerque JTDC, Macedo TP, Favero FM, Barbosa AF, Caromano FA, Voos MC. Avaliação interdisciplinar da diadococinesia: um estudo piloto. FISIOTERAPIA E PESQUISA 2017. [DOI: 10.1590/1809-2950/17681624042017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Diadococinesia é a capacidade de executar movimentos rápidos, repetidos e alternados. Testes de diadococinesia podem avaliar tanto a fala quanto os membros superiores. O objetivo primário foi apresentar um protocolo interdisciplinar de avaliação da diadococinesia. Os objetivos secundários foram comparar o desempenho com os diferentes fonemas do teste de diadococinesia oral (/papapa/, /tatata/, /kakaka/ e /pataka/), comparar o desempenho com as diferentes condições do teste de diadococinesia de membros superiores (realizado com ambos os membros superiores de forma espelhada, apenas com o membro superior direito, apenas com o membro superior esquerdo, com ambos os membros superiores de forma alternada) e investigar possíveis relações entre diadococinesia oral e de membros superiores. Participaram quinze adultos/idosos saudáveis de 40 a 70 anos. Os dados foram representados por estatística descritiva. Os números de sílabas nas condições /papapa/, /tatata/, /kakaka/ e /pataka/ e os números de movimentos nas condições espelhado, direito, esquerdo e alternado foram comparados por ANOVA e correlacionados pelo teste de Pearson. Não houve diferença significativa nos resultados entre os fonemas do teste de diadococinesia oral (p<0,001). Houve diferença entre as condições avaliadas no teste de diadococinesia dos membros superiores (p<0,001). O número de fonemas repetidos esteve correlacionado com o desempenho alternado de membros superiores. Concluiu-se que a correlação entre os escores dos testes de diadococinesia oral e de membros superiores pode ser explicada pelo fato de a programação motora e a linguagem estarem predominantemente representadas no hemisfério esquerdo. Áreas cerebrais comuns/conectadas ou programas motores em comum podem nortear essas tarefas.
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Affiliation(s)
| | | | | | | | | | - Mariana Callil Voos
- Universidade Federal de São Paulo, Brazil; Universidade de São Paulo, Brazil
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22
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Ahmed MM, Mosalem DM, Alfeeli AK, Baqer AB, Soliman DY. Relationship between Gait Parameters and Postural Stability in Early and Late Parkinson's Disease and Visual Feedback-Based Balance Training Effects. Open Access Maced J Med Sci 2017; 5:207-214. [PMID: 28507630 PMCID: PMC5420776 DOI: 10.3889/oamjms.2017.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/21/2017] [Accepted: 03/05/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Gait disorders or postural instability has been done before. However, lack of reviews has addressed the relation between gait and postural stability in Parkinson's disease (PD). AIM The aim was to evaluate the relation between gait parameters and postural stability in early and late stages of PD. MATERIALS AND METHODS The forty-one idiopathic PD patients were divided into two groups into a group (A) considered as early PD and group (B) considered as late ambulant PD. They were evaluated for postural stability by computerised dynamic posturography (CDP) device and gait analysis using an 8 m-camera Vicon 612 data capturing system set. RESULTS There was a statistically significant improvement of composite equilibrium score, the composite latency of motor response, walking speed and cadence after treatment as compared to before training (p < 0.05) in early PD. However, in the late PD, there was a non-significant change of previous parameters after treatment as compared to before training (p > 0.05). There was a significant correlation between UPDRS motor part score, walking speed and composite equilibrium score after training in early PD (p > 0.05). CONCLUSIONS Both gait analysis and CDP are important quantitative assessment tools of gait and posture instability.
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Affiliation(s)
- Mohieldin M Ahmed
- Amiri Hospital, Physical Medicine and Rehabilitation Department, Ministry of Health, Kuwait
| | - Douaa M Mosalem
- Amiri Hospital, Physical Medicine and Rehabilitation Department, Ministry of Health, Kuwait
| | - Aziz K Alfeeli
- Amiri Hospital, Physical Medicine and Rehabilitation Department, Ministry of Health, Kuwait
| | - Ayyoub B Baqer
- Al-Farwania Hospital, Physical Medicine and Rehabilitation Department, Ministry of Health, Kuwait
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Grassi L, Rossi S, Studer V, Vasco G, Motta C, Patanè F, Castelli E, Rossi S, Cappa P. Quantification of postural stability in minimally disabled multiple sclerosis patients by means of dynamic posturography: an observational study. J Neuroeng Rehabil 2017; 14:4. [PMID: 28069073 PMCID: PMC5223530 DOI: 10.1186/s12984-016-0216-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 12/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is a widespread progressive neurologic disease with consequent impairments in daily activities. Disorders of balance are frequent and equilibrium tests are potentially useful to quantify disability and to verify treatment effectiveness. The fair sensitivity of the widely used not-perturbed tests to detect balance disturbances in MS patients have prompted the development of mechatronic systems capable to impose known equilibrium perturbations, in order to challenge the balance control and, consequently, to better assess the level of impairment. We sought to clarify whether the proposed perturbed-test is capable to discriminate healthy subjects from patients with MS, even in mild or in the absence of clinically evident balance disturbances. METHODS We assessed balance performances of 17 adults with MS and 13 age-matched healthy controls (HC) using both perturbed (PT) and not-perturbed (NPT) postural tests by means of a 3 Degree Of Freedom (DOF) rotational mechatronic platform. Participants stood barefoot on the platform in standing position and their center of pressure (CoP) was gathered by using a pressure matrix. Each trial lasted 30 s and was carried out with and without visual stimuli. Several postural indices were computed for each trial. Correlations between postural indices and clinical scales were analyzed. RESULTS No significant differences were found between groups for all indices when subjects performed NPTs. Conversely, significant differences in postural indices between MS and HC emerged during PTs. Additionally, PTs revealed significant differences between patients without any cerebellar impairment (cerebellar EDSS subscore equal to 0) and HC. The discrimination capability of PTs was confirmed by the ROC analysis. No significant change of the selected metrics occurred in HC when NPTs were performed with eyes closed, while indices presented a significant worsening in MS subjects. CONCLUSIONS Not-perturbed tests showed lower sensitivity than perturbed ones in the identification of equilibrium impairments in minimally disabled MS patients. However, not-perturbed tests allow to better evaluate the influence of visual flow disturbances on balance control in MS. In conclusion, our findings proved that the use of the novel tests based on a 3DOF mechatronic device represents an effective tool to investigate early balance disturbances in MS.
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Affiliation(s)
- Lucia Grassi
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
| | - Stefano Rossi
- Department of Economics and Management, Industrial Engineering, University of Tuscia, Viterbo, Italy.
| | - Valeria Studer
- Dipartimento di Medicina dei Sistemi, Tor Vergata University, Rome, Italy
| | - Gessica Vasco
- Department of Neurosciences, Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Caterina Motta
- Dipartimento di Medicina dei Sistemi, Tor Vergata University, Rome, Italy
| | - Fabrizio Patanè
- School of Mechanical Engineering, "Niccolò Cusano" University, Rome, Italy
| | - Enrico Castelli
- Department of Neurosciences, Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Silvia Rossi
- Neuroimmunology and Neuromuscular Diseases Unit, Foundation Neurological Institute Carlo Besta, Milan, Italy
| | - Paolo Cappa
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Rome, Italy
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Yitayeh A, Teshome A. The effectiveness of physiotherapy treatment on balance dysfunction and postural instability in persons with Parkinson's disease: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2016; 8:17. [PMID: 27274396 PMCID: PMC4895982 DOI: 10.1186/s13102-016-0042-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/02/2016] [Indexed: 11/20/2022]
Abstract
Background Balance dysfunction and postural instability in Parkinson’s disease are among the most relevant determinants of an impaired quality of life. Physiotherapy interventions are essential to reduce the level of disability by treating balance dysfunction and postural instability. The aim of this systematic review with meta-analysis was to test the effectiveness of conventional physiotherapy interventions in the management of balance dysfunction and postural instability in Persons with idiopathic Parkinson’s disease. Method A systematic literature search of the Cochrane Library, PubMed/Medline, PEDro, Rehadat, and Rehab Trials were performed by 2 reviewers (AY and AT) independently. Eligible randomised controlled trials published from September 2005 to June 2015 were included. The selected RCTs, which investigated the effects of conventional physiotherapy treatments in the management of postural instability and balance dysfunction in Persons with Parkinson’s disease, were assessed on a methodological quality rating scale. Included studies differed clearly from each other with regard to patient characteristics, intervention protocol, and outcome measures. Important characteristics and outcomes were extracted, summarized and analyzed. Results Eight trials with a total of 483 participants were eligible for inclusion of which 5 trials provide data for meta-analysis. Benefits from conventional physiotherapy treatment were reported for all of the outcomes assessed. The pooled estimates of effects showed significantly improved berg balance scale (SMD, 0.23; 95 % CI, 0.10–0.36; P < 0.001) after exercise therapy, in comparison with no exercise or sham treatment. Exercise interventions specifically addressing components of balance dysfunction demonstrated the largest efficacy with moderate effect size (SMD, 5.98; 95 % CI, 2.29–9.66; P < 0.001). Little effects were observed for interventions that specifically targeted Falls efficacy scale. The pooled data indicated that physiotherapy exercises decreased the incidence of falling by 6.73 (95 % CI: −14.00, 0.54, p = 0.07) with the overall effect of Z = 1.81. Conclusion Physiotherapy interventions like balance training combined with muscle strengthening, the range of movement and walking training exercise is effective in improving balance in patients with Parkinson’s disease and more effective than balance exercises alone. Highly challenging balance training and incremental speed-dependent treadmill training can also be part of a rehabilitation program for management of balance dysfunction and Postural instability in patients with idiopathic Parkinson’s disease.
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Affiliation(s)
- Asmare Yitayeh
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Teshome
- Department of Dentistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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