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Van Criekinge T, Sahu U, Bhatt T. Effect of Explicit Prioritization on Dual Tasks During Standing and Walking in People With Neurologic and Neurocognitive Disorders: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)00824-4. [PMID: 38401769 DOI: 10.1016/j.apmr.2024.02.714] [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: 10/05/2023] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES To examine the effectiveness of explicit task (ie, equal, motor or cognitive) prioritization during dual tasking (DT) in adults with neurologic and neurocognitive disorders (stroke, Parkinson disease [PD], multiple sclerosis, dementia, Alzheimer disease, and mild cognitive impairment). DATA SOURCE A systematic search in 4 databases (PubMed, Web of Science, Embase, and Cochrane Central) yielded 1138 unique studies published up to 2023. STUDY SELECTION Forty-one experimental studies were selected that assessed the effect of explicit prioritization instructions on both motor and cognitive performance during dual-tasks related to standing and walking in selected populations. Primary outcome measures were walking speed and response accuracy. Availability of data allowed us to perform a meta-analysis on 27 of the 41 articles by using inverse variance with a random effects model. DATA EXTRACTION The data including design, subject characteristics, motor and cognitive tasks, prioritization, motor and cognitive outcomes, instructions, and key findings were extracted. Two assessors rated the selected studies for risk of bias and quality using the Quality Assessment Tools of the National Institutes of Health. DATA SYNTHESIS This study examined 1535 adults who were asked to perform motor-cognitive DT in standing or walking, including 381 adults with stroke, 526 with PD, 617 with multiple sclerosis, 10 with dementia, 9 with Alzheimer disease, and 8 with mild cognitive impairment. During all prioritization instructions, participants slowed down during DT (standardized mean difference (SMD)equal=0.43; SMDmotor=0.78; SMDcognitive=0.69, P<.03) while maintaining similar response accuracy (SMDequal=0.12; SMDmotor=0.23; SMDcognitive=-.01, P>.05). However, considerable between-group heterogeneity was observed resulting in different motor and cognitive responses between pathologies. CONCLUSION Motor prioritization was achieved in adults with PD and stroke, unlike adults with neurocognitive disorders who were negatively affected by any type DT prioritizing. The reported within-group heterogeneity revealed that effects of explicit task prioritization are dependent on motor and cognitive task complexity, and the type of instructions. Recommendations are provided to ensure accurate use of instructions during DT paradigms.
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Affiliation(s)
| | - Upasana Sahu
- Department of Physical Therapy, College of Applied Health and Sciences, University of Illinois at Chicago, Chicago, IL
| | - Tanvi Bhatt
- Department of Physical Therapy, College of Applied Health and Sciences, University of Illinois at Chicago, Chicago, IL.
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Safi K, Aly WHF, Kanj H, Khalifa T, Ghedira M, Hutin E. Hidden Markov Model for Parkinson's Disease Patients Using Balance Control Data. Bioengineering (Basel) 2024; 11:88. [PMID: 38247965 PMCID: PMC10813155 DOI: 10.3390/bioengineering11010088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
Understanding the behavior of the human postural system has become a very attractive topic for many researchers. This system plays a crucial role in maintaining balance during both stationary and moving states. Parkinson's disease (PD) is a prevalent degenerative movement disorder that significantly impacts human stability, leading to falls and injuries. This research introduces an innovative approach that utilizes a hidden Markov model (HMM) to distinguish healthy individuals and those with PD. Interestingly, this methodology employs raw data obtained from stabilometric signals without any preprocessing. The dataset used for this study comprises 60 subjects divided into healthy and PD patients. Impressively, the proposed method achieves an accuracy rate of up to 98% in effectively differentiating healthy subjects from those with PD.
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Affiliation(s)
- Khaled Safi
- Computer Science Department, Jinan University, Tripoli P.O. Box 818, Lebanon
| | - Wael Hosny Fouad Aly
- College of Engineering and Technology, American University of the Middle East, Egaila 54200, Kuwait; (H.K.); (T.K.)
| | - Hassan Kanj
- College of Engineering and Technology, American University of the Middle East, Egaila 54200, Kuwait; (H.K.); (T.K.)
| | - Tarek Khalifa
- College of Engineering and Technology, American University of the Middle East, Egaila 54200, Kuwait; (H.K.); (T.K.)
| | - Mouna Ghedira
- Laboratory Analysis and Restoration of Movement (ARM), Henri Mondor University Hospitals, Assistance Publique-Hôpitaux de Paris, 94000 Créteil, France; (M.G.); (E.H.)
| | - Emilie Hutin
- Laboratory Analysis and Restoration of Movement (ARM), Henri Mondor University Hospitals, Assistance Publique-Hôpitaux de Paris, 94000 Créteil, France; (M.G.); (E.H.)
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Borji R, Laatar R, Zarrouk N, Sahli S, Rebai H. Cognitive-motor interference during standing stance across different postural and cognitive tasks in individuals with Down syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 139:104562. [PMID: 37379660 DOI: 10.1016/j.ridd.2023.104562] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Individuals with Down syndrome (DS) presented both cognitive and motor impairments that could influence each other. Therefore, exploring cognitive-motor interference during standing stance is relevant in this population. AIMS This study explored the dual task (DT) effects on postural balance during diverse cognitive tasks and sensory manipulations in individuals with DS, compared to those with typical development (TD). METHODS AND PROCEDURES Fifteen adolescents with DS (age = 14.26 ± 1.27 years; height = 1.50 ± 0.02; weight = 46.46 ± 4.03 kg; BMI =20.54 ± 1.51 kg/m2) and thirteen with TD (age = 14.07 ± 1.11 years; height = 1.50 ± 0.05; weight = 44.92 ± 4.15 kg; BMI =19.77 ± 0.94 kg/m2) participated in this study. Postural and cognitive performances for the selective span task (SST) and the verbal fluency (VF) were recorded during single task (ST) and DT conditions. Postural conditions were: firm eyes open (firm-EO), firm eyes closed (firm-EC) and foam-EO. Motor and cognitive DT costs (DTC) were calculated and analyzed across these different cognitive and postural conditions. OUTCOMES AND RESULTS In the DS group, postural performance was significantly (p < 0.001) altered during all DT conditions, compared to the ST situation. Moreover, the motor DTC was significantly (p < 0.001) higher while performing the VF task than the SST. However, in the control group, postural performance was significantly (p < 0.001) impaired only while performing the VF test in the DT-Firm EO condition. For both groups, cognitive performances were significantly (p < 0.05) altered in all DT conditions compared to the ST one. CONCLUSION Adolescents with DS are more prone to DT effects on postural balance than those with TD.
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Affiliation(s)
- Rihab Borji
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia.
| | - Rabeb Laatar
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Nidhal Zarrouk
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Sonia Sahli
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Haithem Rebai
- Laboratory 'Optimisation de la Performance Sportive, Centre National de Médecine et Sciences du Sport (CNMSS)', Tunis, Tunisia
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Morelli N. Effect and Relationship of Gait on Subcortical Local Field Potentials in Parkinson's Disease: A Systematic Review. Neuromodulation 2023; 26:271-279. [PMID: 36244929 DOI: 10.1016/j.neurom.2022.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/19/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Developments in deep brain stimulation (DBS) technology have enabled the ability to detect local field potentials (LFPs) in Parkinson disease (PD). Gait dysfunction is one of the most prevalent deficits seen in PD. However, no consensus has been reached on the effect of gait on LFPs and the relationship between LFPs and clinical measures of gait. The objective of this systematic review was to synthesize existing research regarding the relationship between gait dysfunction and LFPs in PD. METHODS A systematic search of the literature yielded a total of ten articles, including 132 patients with PD, which met the criteria for inclusion. RESULTS Beta frequency band measures showed low-to-strong correlation to clinical gait measures (r = -0.50 to 0.82). Two studies found decreased beta power during gait; one found increased beta frequency peaks during gait; and one found higher beta power during dual-task gait than during single-task gait. One of the three studies comparing patients with and without freezing found significantly increased beta burst duration and power during gait in freezers compared with nonfreezers. All studies showed moderate-to-high methodologic quality. CONCLUSIONS This review highlights the need to consider the effect of gait on LFP recordings, particularly when used to guide DBS programming. Although sample sizes were small, it appears LFPs are associated to and modulated by gait in patients with PD. This evidence suggests that LFPs have the potential to be used as a biomarker of gait dysfunction in PD.
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Saraiva M, Vilas-Boas JP, Fernandes OJ, Castro MA. Effects of Motor Task Difficulty on Postural Control Complexity during Dual Tasks in Young Adults: A Nonlinear Approach. SENSORS (BASEL, SWITZERLAND) 2023; 23:628. [PMID: 36679423 PMCID: PMC9866022 DOI: 10.3390/s23020628] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Few studies have evaluated the effect of a secondary motor task on the standing posture based on nonlinear analysis. However, it is helpful to extract information related to the complexity, stability, and adaptability to the environment of the human postural system. This study aimed to analyze the effect of two motor tasks with different difficulty levels in motor performance complexity on the static standing posture in healthy young adults. Thirty-five healthy participants (23.08 ± 3.92 years) performed a postural single task (ST: keep a quiet standing posture) and two motor dual tasks (DT). i.e., mot-DT(A)—perform the ST while performing simultaneously an easy motor task (taking a smartphone out of a bag, bringing it to the ear, and putting it back in the bag)—and mot-DT(T)—perform the ST while performing a concurrent difficult motor task (typing on the smartphone keyboard). The approximate entropy (ApEn), Lyapunov exponent (LyE), correlation dimension (CoDim), and fractal dimension (detrending fluctuation analysis, DFA) for the mediolateral (ML) and anterior-posterior (AP) center-of-pressure (CoP) displacement were measured with a force plate while performing the tasks. A significant difference was found between the two motor dual tasks in ApEn, DFA, and CoDim-AP (p < 0.05). For the ML CoP direction, all nonlinear variables in the study were significantly different (p < 0.05) between ST and mot-DT(T), showing impairment in postural control during mot-DT(T) compared to ST. Differences were found across ST and mot-DT(A) in ApEn-AP and DFA (p < 0.05). The mot-DT(T) was associated with less effectiveness in postural control, a lower number of degrees of freedom, less complexity and adaptability of the dynamic system than the postural single task and the mot-DT(A).
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Affiliation(s)
- Marina Saraiva
- RoboCorp Laboratory, i2A, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal
- Faculty of Sports, University of Porto, 4200-450 Porto, Portugal
| | - João Paulo Vilas-Boas
- Faculty of Sports, University of Porto, 4200-450 Porto, Portugal
- LABIOMEP-UP, Faculty of Sports and CIFI2D, University of Porto, 4200-450 Porto, Portugal
| | - Orlando J. Fernandes
- Sport and Health Department, School of Health and Human Development, University of Évora, 7000-671 Évora, Portugal
- Comprehensive Health Research Center (CHRC), University of Évora, 7000-671 Évora, Portugal
| | - Maria António Castro
- RoboCorp Laboratory, i2A, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal
- Department of Mechanical Engineering, University of Coimbra, CEMMPRE, 3030-788 Coimbra, Portugal
- Sector of Physiotherapy, School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal
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Balal M, Demir T, Erdem M, Demirkiran M. Postural stability in blepharospasm: the effects of dual-tasking and botulinum toxin therapy. BMJ Neurol Open 2023; 5:e000403. [PMID: 36919159 PMCID: PMC10008225 DOI: 10.1136/bmjno-2023-000403] [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: 01/02/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
Background Blepharospasm is a focal dystonia that presents as involuntary, intermittent, continuous contractions of the eyelids. Abnormal eyelid contractions in blepharospasm are expected to cause balance problems, but there is no clear information. Objective This study was designed to evaluate the effect of blepharospasm on postural stability (PS) in patients with blepharospasm. As a secondary endpoint, the efficacy of botulinum toxin type-A (BoNT-A) treatment on static balance in patients with blepharospasm was investigated. Methods Twenty-four patients with blepharospasm receiving regular BoNT-A injections and 20 age-matched and sex-matched healthy controls were included in the study. All subjects were evaluated on a static posturography force platform performing four tasks (eyes open (EO), eyes closed (EC), tandem Romberg (TR) and verbal cognitive task (COGT)). Evaluations of the patients were repeated 4 weeks after the injection. Results Pretreatment lateral and anterior-posterior sways, sway area and velocities of the sways were significantly higher in patients than controls during the COGT and TR (p<0.05). In the patient group, with EO and EC, a few parameters improved after BoNT-A injection. On the other hand, in the TR and COGT, most of the sway parameters and velocities improved significantly after treatment (p<0.05). Conclusions Blepharospasm may cause functional blindness in patients. This study demonstrated that PS worsens in patients with blepharospasm under dual-task conditions. BoNT-A injection treats the disease itself and, thus, markedly improves PS under dual-task conditions in blepharospasm.
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Affiliation(s)
- Mehmet Balal
- Department of Neurology, Çukurova Üniversitesi Tıp Fakültesi, Sarıçam, Turkey
| | - Turgay Demir
- Department of Neurology, Çukurova Üniversitesi Tıp Fakültesi, Sarıçam, Turkey
| | - Miray Erdem
- City Hospital of Neurology, University of Health Sciences, Adana, Turkey
| | - Meltem Demirkiran
- Department of Neurology, Çukurova Üniversitesi Tıp Fakültesi, Sarıçam, Turkey
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Virmani T, Landes RD, Pillai L, Glover A, Larson-Prior L, Prior F, Factor SA. Gait Declines Differentially in, and Improves Prediction of, People with Parkinson's Disease Converting to a Freezing of Gait Phenotype. JOURNAL OF PARKINSON'S DISEASE 2023; 13:961-973. [PMID: 37522218 PMCID: PMC10578275 DOI: 10.3233/jpd-230020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is a debilitating, variably expressed motor symptom in people with Parkinson's disease (PwPD) with limited treatments. OBJECTIVE To determine if the rate of progression in spatiotemporal gait parameters in people converting from a noFOG to a FOG phenotype (FOGConv) was faster than non-convertors, and determine if gait parameters can help predict this conversion. METHODS PwPD were objectively monitored longitudinally, approximately every 6 months. Non-motor assessments were performed at the initial visit. Steady-state gait in the levodopa ON-state was collected using a gait mat (Protokinetics) at each visit. The rate of progression in 8 spatiotemporal gait parameters was calculated. FOG convertors (FOGConv) were classified if they did not have FOG at initial visit and developed FOG at a subsequent visit. RESULTS Thirty freezers (FOG) and 30 non-freezers were monitored an average of 3.5 years, with 10 non-freezers developing FOG (FOGConv). FOGConv and FOG had faster decline in mean stride-length, swing-phase-percent, and increase in mean total-double-support percent, coefficient of variability (CV) foot-strike-length and CV swing-phase-percent than the remaining non-freezers (noFOG). On univariate modeling, progression rates of mean stride-length, stride-velocity, swing-phase-percent, total-double-support-percent and of CV swing-phase-percent had high discriminative power (AUC > 0.83) for classification of the FOGConv and noFOG groups. CONCLUSION FOGConv had a faster temporal decline in objectively quantified gait than noFOG, and progression rates of spatiotemporal gait parameters were more predictive of FOG phenotype conversion than initial (static) parameters Objectively monitoring gait in disease prediction models may help define FOG prone groups for testing putative treatments.
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Affiliation(s)
- Tuhin Virmani
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Reid D. Landes
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lakshmi Pillai
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Aliyah Glover
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Linda Larson-Prior
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson’s Disease and Movement Disorder Program, Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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Li Y, Zheng JJ, Wu X, Gao W, Liu CJ. Postural control of Parkinson's disease: A visualized analysis based on Citespace knowledge graph. Front Aging Neurosci 2023; 15:1136177. [PMID: 37032828 PMCID: PMC10080997 DOI: 10.3389/fnagi.2023.1136177] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/02/2023] [Indexed: 04/11/2023] Open
Abstract
Postural control impairment is one of the primary motor symptoms in patients with Parkinson's disease, leading to an increased risk of falling. Several studies have been conducted on postural control disorders in Parkinson's disease patients, but no relevant bibliometric analysis has been found. In this paper, the Web of Science Core Collection database was searched for 1,295 relevant papers on postural control in Parkinson's disease patients from December 2011 to December 2021. Based on the Citespace knowledge graph, these relevant papers over the last decade were analyzed from the perspectives of annual publication volume, countries and institutes cooperation, authors cooperation, dual-map overlay of journals, co-citation literature, and keywords. The purpose of this study was to explore the current research status, research hotspots, and frontiers in this field, and to provide a reference for further promoting the research on postural control in Parkinson's disease patients.
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Affiliation(s)
- Yan Li
- Department of Rehabilitation Medicine, Huadong Hospital, Fudan University, Shanghai, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Jie-Jiao Zheng
- Department of Rehabilitation Medicine, Huadong Hospital, Fudan University, Shanghai, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Shanghai Clinical Research Center for Rehabilitation Medicine, Shanghai, China
- *Correspondence: Jie-Jiao Zheng,
| | - Xie Wu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Wen Gao
- Department of Rehabilitation Medicine, Huadong Hospital, Fudan University, Shanghai, China
- Shanghai Clinical Research Center for Rehabilitation Medicine, Shanghai, China
| | - Chan-Jing Liu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
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ERDEM M, BALAL M, DEMİRKIRAN M. Postural stability in early Parkinson’s disease: effect of cognitive dual-tasking. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1126396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose: The primary aim of this study is to evaluate postural stability by using a static posturography in patients with early Parkinson’s disease (PD). Secondly, this paper addresses the need for illustrating the effect of dual-tasking on postural stability in early PD patients.
Materials and Methods: Twenty-nine early PD patients with maximum 5 years of disease duration were included in this study. The selected group had no clinical PI while their age- and sex-matched healthy controls were carried out. Neurological examination and mini-mental state examination (MMSE) were performed in all subjects. Unified Parkinson Disease Rating Scale (UPDRS) and modified Hoehn and Yahr (H&Y) scores were recorded in PD patients. Postural stability was assessed in all subjects on a static posturography platform under three different conditions: eyes open, eyes closed and a cognitive task of producing words with given letters.
Results: The mean age of the PD was 59.2±10.5 whereas the control groups mean age was 56.3±7.6 (p>0.05). The female-male ratio was 9/20 in the PD and 12/17 in the control group. There was no important difference between the two groups in terms of demographic characteristics. In the PD group, the mean UPDRS was 12.8±4.9. The patients were mostly receiving polytherapy.
Eye closure and cognitive task caused an increase in most sway parameters in both groups.
Conclusion: Early PD patients on medication, postural stability is preserved and cognitive dual-tasking does not affect postural stability in these patients in the early stage.
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Affiliation(s)
- Miray ERDEM
- ADANA CITY TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF NEUROLOGY
| | - Mehmet BALAL
- CUKUROVA UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NEUROLOGY
| | - Meltem DEMİRKIRAN
- CUKUROVA UNIVERSITY, FACULTY OF MEDICINE, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NEUROLOGY
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Morelli N. Patients with Parkinson's disease and a history of falls have decreased cerebellar grey matter volumes in the cognitive cerebellum. Rev Neurol (Paris) 2022; 178:924-931. [PMID: 35871015 DOI: 10.1016/j.neurol.2022.05.002] [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: 12/19/2021] [Revised: 03/17/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
Abstract
The objective of this study was to determine if cerebellar gray matter (GM) structure differs between fallers and non-fallers with Parkinson's disease (PD) and their respective association to cognitive function. A total of 48 fallers and 63 non-fallers with PD were identified from the Parkinson's Progression Markers Initiative database. Fallers were categorized as those who self-reported a fall within the past year. Unified Parkinson's Disease Rating Scale-III (UPDRS-III), Montreal Cognitive Assessment (MoCA), Trail Making Test parts A (TMT-A) and B (TMT-B) scores were collected for each patient. Cerebellar GM volumes were derived from magnetic resonance imaging data. Analyses of covariance were used to compare group differences. Partial Pearson's correlations were used to assess the relationship between cerebellar GM volumes to UPDRS-III and cognitive outcomes. Significance was set at P ≤ 0.01. Fallers had significantly decreased GM volumes in lobules V, Crus-1, Crus-2, and VIIb (P<0.01). Cerebellar GM volumes in non-fallers demonstrated little-to-no relationship with UPDRS-III, MoCA, and TMT-B (P>0.01). However, TMT-A performance demonstrated significant, fair association to GM volumes in lobules I-IV, V, VI, Crus-1, and Crus-2 (r=-0.44 - -0.34, P<0.01) in non-fallers. Patients with PD and a history of falls have significantly decreased GM volumes in cerebellar lobules associated with cognitive functions. However, these lobule volumes become disassociated with cognitive function compared to non-fallers.
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Affiliation(s)
- N Morelli
- Medtronic PLC, Minneapolis, MN, USA.
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Dual task effect on upper and lower extremity skills in different stages of Parkinson's disease. Acta Neurol Belg 2022:10.1007/s13760-022-02007-x. [PMID: 35776407 DOI: 10.1007/s13760-022-02007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/09/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND PURPOSE Loss of automaticity and deteriorated executive function give rise to dual task deficits in Parkinson's disease (PD). This study aimed to compare single task and dual task upper and lower extremity skills in people with PD (PwPD) at different stages of PD and to examine the dual task effect (DTE) on upper and lower extremity skills in PwPD at different stages of PD. The second aim was to investigate the relationship between the DTE and the quality of life in PwPD. METHODS 30 patients divided into 2 groups as mild PD group and moderate PD group according to the Modified Hoehn & Yahr Scale. 15 age matched healthy adults were recruited as the control group. The Unified Parkinson's Disease Rating Scale (UPDRS), the Purdue Pegboard Test (PPT), the Timed Up and Go Test (TUG), the 10 Meter Walk Test (10MWT), and the Parkinson's Disease Questionnaire (PDQ-8) were used for assessments. RESULTS Single task and dual task scores of all assessments of all groups were significantly different. The DTE on PPT was greater in mild and moderate PD groups than control group and significantly lower in mild PD group than moderate PD group. However, DTE on the TUG and 10MWT was not different in mild PD group than control group and DTE significantly lower in both groups than moderate PD group. Significant correlations between the DTE on PPT, TUG and 10MWT and the PDQ-8 in PwPD were observed. CONCLUSION Dual task has a worsening effect on upper and lower extremity skills in PwPD. This effect can be observed earlier in upper extremity skills than lower extremity skills. Also, the DTE and the QoL in PwPD are related.
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Safi K, Aly WHF, AlAkkoumi M, Kanj H, Ghedira M, Hutin E. EMD-Based Method for Supervised Classification of Parkinson’s Disease Patients Using Balance Control Data. Bioengineering (Basel) 2022; 9:bioengineering9070283. [PMID: 35877334 PMCID: PMC9311556 DOI: 10.3390/bioengineering9070283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022] Open
Abstract
There has recently been increasing interest in postural stability aimed at gaining a better understanding of the human postural system. This system controls human balance in quiet standing and during locomotion. Parkinson’s disease (PD) is the most common degenerative movement disorder that affects human stability and causes falls and injuries. This paper proposes a novel methodology to differentiate between healthy individuals and those with PD through the empirical mode decomposition (EMD) method. EMD enables the breaking down of a complex signal into several elementary signals called intrinsic mode functions (IMFs). Three temporal parameters and three spectral parameters are extracted from each stabilometric signal as well as from its IMFs. Next, the best five features are selected using the feature selection method. The classification task is carried out using four known machine-learning methods, KNN, decision tree, Random Forest and SVM classifiers, over 10-fold cross validation. The used dataset consists of 28 healthy subjects (14 young adults and 14 old adults) and 32 PD patients (12 young adults and 20 old adults). The SVM method has a performance of 92% and the Dempster–Sahfer formalism method has an accuracy of 96.51%.
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Affiliation(s)
- Khaled Safi
- Computer Science Department, Strasbourg University, 67081 Strasbourg, France
- Correspondence:
| | - Wael Hosny Fouad Aly
- College of Engineering and Technology, American University of the Middle East, Egaila 54200, Kuwait; (W.H.F.A.); (M.A.); (H.K.)
| | - Mouhammad AlAkkoumi
- College of Engineering and Technology, American University of the Middle East, Egaila 54200, Kuwait; (W.H.F.A.); (M.A.); (H.K.)
| | - Hassan Kanj
- College of Engineering and Technology, American University of the Middle East, Egaila 54200, Kuwait; (W.H.F.A.); (M.A.); (H.K.)
| | - Mouna Ghedira
- Laboratory ARM, EA BIOTN, UPEC, CHU Henri Mondor, 94000 Cŕeteil, France; (M.G.); (E.H.)
| | - Emilie Hutin
- Laboratory ARM, EA BIOTN, UPEC, CHU Henri Mondor, 94000 Cŕeteil, France; (M.G.); (E.H.)
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Effects on intermittent postural control in people with Parkinson's due to a dual task. Hum Mov Sci 2022; 83:102947. [DOI: 10.1016/j.humov.2022.102947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 12/05/2021] [Accepted: 03/17/2022] [Indexed: 11/20/2022]
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Pardoel S, Nantel J, Kofman J, Lemaire ED. Prediction of Freezing of Gait in Parkinson's Disease Using Unilateral and Bilateral Plantar-Pressure Data. Front Neurol 2022; 13:831063. [PMID: 35572938 PMCID: PMC9101469 DOI: 10.3389/fneur.2022.831063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Freezing of gait (FOG) is an intermittent walking disturbance experienced by people with Parkinson's disease (PD). FOG has been linked to falling, injury, and overall reduced mobility. Wearable sensor-based devices can detect freezes already in progress and provide a cue to help the person resume walking. While this is helpful, predicting FOG episodes before onset and providing a timely cue may prevent the freeze from occurring. Wearable sensors mounted on various body parts have been used to develop FOG prediction systems. Despite the known asymmetry of PD motor symptom manifestation, the difference between the most affected side (MAS) and least affected side (LAS) is rarely considered in FOG detection and prediction studies. Methods To examine the effect of using data from the MAS, LAS, or both limbs for FOG prediction, plantar pressure data were collected during a series of walking trials and used to extract time and frequency-based features. Three datasets were created using plantar pressure data from the MAS, LAS, and both sides together. ReliefF feature selection was performed. FOG prediction models were trained using the top 5, 10, 15, 20, 25, or 30 features for each dataset. Results The best models were the MAS model with 15 features and the LAS and bilateral models with 5 features. The LAS model had the highest sensitivity (79.5%) and identified the highest percentage of FOG episodes (94.9%). The MAS model achieved the highest specificity (84.9%) and lowest false positive rate (1.9 false positives/walking trial). Overall, the bilateral model was best with 77.3% sensitivity and 82.9% specificity. In addition, the bilateral model identified 94.2% of FOG episodes an average of 0.8 s before FOG onset. Compared to the bilateral model, the LAS model had a higher false positive rate; however, the bilateral and LAS models were similar in all the other evaluation metrics. Conclusion The LAS model would have similar FOG prediction performance to the bilateral model at the cost of slightly more false positives. Given the advantages of single sensor systems, the increased false positive rate may be acceptable to people with PD. Therefore, a single plantar pressure sensor placed on the LAS could be used to develop a FOG prediction system and produce performance similar to a bilateral system.
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Affiliation(s)
- Scott Pardoel
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Julie Nantel
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- *Correspondence: Julie Nantel
| | - Jonathan Kofman
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Edward D. Lemaire
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Centre for Rehabilitation Research and Development, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Fathipour-Azar Z, Azad A, Akbarfahimi M, Behzadipour S, Taghizadeh G. Symmetric and asymmetric bimanual coordination and freezing of gait in Parkinsonian patients in drug phases. Ann N Y Acad Sci 2022; 1511:244-261. [PMID: 35194819 DOI: 10.1111/nyas.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Indexed: 11/29/2022]
Abstract
Freezing of gait (FOG) is a debilitating symptom in patients with Parkinson's disease (PD), which may be associated with motor control impairments in tasks other than gait. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in PD with FOG (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. Twenty PD +FOG patients, 20 PD patients without FOG (PD -FOG) performed symmetric and asymmetric functional bimanual tasks (reach to and pick up a box and open a drawer to press a pushbutton inside it, respectively) under single-task and dual-task conditions. PD patients were evaluated during on- and off-drug phases. Kinematic and coordination measures were calculated for each task. PD +FOG patients demonstrated exacerbated impairments of bimanual coordination while performing goal-directed bimanual tasks, which was more evident in the asymmetric bimanual task and under dual-task conditions, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients. Interestingly, 25% and 5% of participants in the PD +FOG and -FOG groups developed upper limb freezing 2 years later, respectively. This study aimed to examine whether symmetric and asymmetric bimanual coordination is impaired in Parkinson's disease with freezing of gait (PD +FOG) patients and whether dual-task and drug phases may affect bimanual coordination in these patients. PD +FOG patients demonstrated exacerbated impairment of bimanual coordination while performing goal-directed bimanual tasks, highlighting the need for rehabilitation interventions for bimanual tasks that include different cognitive loads in these patients.
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Affiliation(s)
- Zeinab Fathipour-Azar
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Azad
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Malahat Akbarfahimi
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Behzadipour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.,Djavad Mowafaghian Research Center for Intelligent Neuro-rehabilitation Technologies, Tehran, Iran
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Gérard M, Bayot M, Derambure P, Dujardin K, Defebvre L, Betrouni N, Delval A. EEG-based functional connectivity and executive control in patients with Parkinson’s disease and freezing of gait. Clin Neurophysiol 2022; 137:207-215. [DOI: 10.1016/j.clinph.2022.01.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/08/2021] [Accepted: 01/11/2022] [Indexed: 01/13/2023]
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Peterson DS, Phan V, Richmond SB, Lee H. Effects of dual-tasking on time-to-boundary during stance in people with PD: A preliminary study. Clin Biomech (Bristol, Avon) 2021; 88:105420. [PMID: 34216987 DOI: 10.1016/j.clinbiomech.2021.105420] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 05/16/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Quiet stance is impacted by Parkinson's disease and dual-tasking. Recently developed outcomes such as the time-to-boundary provide unique insight into balance by integrating center of pressure position with base of support. However, little is known about the effects of Parkinson's disease on time-to-boundary. In particular, the effects of distracting cognitive tasks, and how people with Parkinson's disease prioritize balance and cognitive tasks are poorly understood. METHODS 14 people with Parkinson's disease and 13 controls completed quiet standing and cognitive Stroop tasks separately (single-task) and together (dual-task). 2-dimentional, medio-lateral, and anterior-posterior time-to-boundary were calculated via force-plate data. Traditional sway outcomes, including sway area and path length, were also calculated. Cognitive performance was measured as the verbal reaction time after auditory stimulus delivery. Prioritization was assessed by taking the difference between cognitive and postural dual-task interference. FINDINGS Time-to-boundary was worse in Parkinson's disease compared to controls (2-dimentional: p = .019; anterior-posterior: p = .062; medio-lateral: p = .012). Medio-lateral time-to-boundary, but not anterior-posterior, was significantly worse during dual-tasking than single-tasking (p = .024). Neurotypical adults tended to prioritize cognition over medio-lateral postural outcomes. INTERPRETATION People with Parkinson's disease exhibit worse time-to-boundary than their neurotypical peers, and medio-lateral outcomes were sensitive to single to dual-task performance changes. Further, participants generally showed cognitive prioritization, such that cognitive performance was less impacted than medio-lateral postural outcomes by dual-tasking.
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Affiliation(s)
- D S Peterson
- College of Health Solutions, Arizona State University, 425 N 5(th) St., Phoenix, AZ, USA; Phoenix VA Medical Center, 650 E Indian School Rd., Phoenix, AZ, USA.
| | - V Phan
- School for Engineering of Matter, Transport and Energy, Arizona State University, 501 E Tyler Mall, Tempe, AZ, USA
| | - S B Richmond
- Department of Applied Physiology and Kinesiology, University of Florida, 1864 Stadium Rd., Gainesville, FL, USA
| | - H Lee
- School for Engineering of Matter, Transport and Energy, Arizona State University, 501 E Tyler Mall, Tempe, AZ, USA
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Gandolfi M, Fiorio M, Geroin C, Prior M, De Marchi S, Amboni M, Smania N, Tinazzi M. Motor dual task with eyes closed improves postural control in patients with functional motor disorders: A posturographic study. Gait Posture 2021; 88:286-291. [PMID: 34153806 DOI: 10.1016/j.gaitpost.2021.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/12/2021] [Accepted: 06/08/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Functional motor disorders (FMD) are highly disabling neurological conditions in which postural control deficits increase the risk of falls and disability in performing daily living activities. Scattered evidence suggests that such disturbances may depend on abnormal attentional focus and might improve with distraction. RESEARCH QUESTION How do motor and cognitive dual tasks performed under two different sensory conditions shape postural control in patients with FMD. METHODS This posturographic study involved 30 patients with FMD (age, 45.20 ± 14.57 years) and 30 healthy controls (age, 41.20 ± 16.50 years). Postural parameters were measured with eyes open, and eyes closed in quiet stance (single task) and on a motor dual task (m-DT) and a calculation (cognitive) dual task (c-DT). The dual task effect (DTE, expressed in percentage) on motor and cognitive performance was calculated for sway area, length of Center of Pressure (CoP), and velocity of CoP displacement. RESULTS There was a statistically significant three-way interaction between task, condition, and group for the DTE on sway area (p = 0.03). The mean sway area DTE on the motor task in the eyes-closed condition was increased by 70.4 % in the healthy controls, while it was decreased by 1% in the patient group (p = 0.003). No significant three-way interaction was observed for the DTE on length of CoP and velocity of CoP displacement. SIGNIFICANCE This study provides novel preliminary evidence for the benefit of a simple motor dual task in the eyes closed condition as a way to improve postural control in patients with FMD. These findings are relevant for the management of postural control disorders in patients with FMD.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Christian Geroin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Manlio Prior
- Angiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | | | - Marianna Amboni
- Center for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy; IDC Hermitage-Capodimonte, Naples, Italy
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Paired inhibitory stimulation and gait training modulates supplemental motor area connectivity in freezing of gait. Parkinsonism Relat Disord 2021; 88:28-33. [PMID: 34102418 DOI: 10.1016/j.parkreldis.2021.05.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/11/2021] [Accepted: 05/26/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Freezing of gait (FOG) is a debilitating feature of Parkinson's disease (PD). Evidence suggests patients with FOG have increased cortical control of gait. The supplementary motor area (SMA) may be a key structure due to its connectivity with locomotor and cognitive networks. The objectives of this study were to determine (1) if SMA connectivity is disrupted in patients with FOG and (2) if "inhibitory" repetitive transcranial magnetic stimulation can decrease maladaptive SMA connectivity. METHODS Two experiments were performed. In experiment 1 resting-state (T2* BOLD imaging) was compared between 38 PD freezers and 17 PD controls. In experiment 2, twenty PD patients with FOG were randomized to either 10 sessions of real or sham rTMS to the SMA (1 Hz, 110% motor threshold, 1200 pulses/session) combined with daily gait training. RESULTS (Experiment 1) Freezers had increased connectivity between the left SMA and the vermis of the cerebellum and decreased connectivity between the SMA and the orbitofrontal cortex (pFDR-corr <0.05). (Experiment 2) 10 sessions of active TMS reduced SMA connectivity with the anterior cingulate, angular gyrus and the medial temporal cortex, whereas sham TMS did not reduce SMA connectivity. From a behavioral perspective, both groups showed nFOG-Q improvements (F(4, 25.7) = 3.87, p = 0.014). CONCLUSIONS The SMA in freezers is hyper-connected to the cerebellum, a key locomotor region which may represent maladaptive compensation. In this preliminary study, 1 Hz rTMS reduced SMA connectivity however, this was not specific to the locomotor regions. Intervention outcomes may be improved with subject specific targeting of SMA.
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20
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The Influence of Cognitive Dual Tasks on Concussion Balance Test Performance. Motor Control 2021; 25:252-263. [PMID: 33567406 DOI: 10.1123/mc.2020-0075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/10/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the influence of a cognitive dual task on postural sway and balance errors during the Concussion Balance Test (COBALT). METHODS Twenty healthy adults (12 females, eight males; aged 21.95 ± 3.77 years; height = 169.95 ± 9.95 cm; weight = 69.58 ± 15.03 kg) partook in this study and completed single- and dual-task versions of a reduced COBALT. RESULTS Sway velocity decreased during dual-task head rotations on foam condition (p = .021, ES = -0.57). A greater number of movement errors occurred during dual-task head rotations on firm surface (p = .005, ES = 0.71), visual field flow on firm surface (p = .008, ES = 0.68), and head rotations on foam surface (p < .001, ES = 1.61) compared with single-task conditions. Cognitive performance was preserved throughout different sensory conditions of the COBALT (p = .985). DISCUSSION Cognitive dual tasks influenced postural control and destabilized movements during conditions requiring advanced sensory integration and reweighting demands. Dual-task versions of the COBALT should be explored as a clinical tool to identify residual deficits past the acute stages of concussion recovery.
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21
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Demİr T, Balal M, Demİrkİran M. The effect of cognitive task on postural stability in cervical dystonia. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:549-555. [PMID: 32609289 DOI: 10.1590/0004-282x20200038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cervical dystonia (CD) is the most common form of focal dystonia. It is not known exactly whether abnormal head postures in cervical dystonia cause balance problems. Dual-tasking is a common every-day life situation. OBJECTIVE We aimed to evaluate postural stability (PS) in patients with CD and the effect of cognitive task on PS. As a secondary aim, we evaluated the effect of onabotulinum toxin A (BoNT) injection on PS. METHODS A total of 24 patients with CD who were on BoNT treatment for at least one year and 23 healthy controls were included. Posturographic analyses were carried out in all the subjects on static posturography platform under four different conditions: eyes open, eyes closed, tandem stance and cognitive task. In patients, posturographic analysis was carried out just before the BoNT injections and was repeated four weeks later. RESULTS Before treatment, the anterior-posterior sway was significantly higher in CD patients with the eyes open condition compared to the controls (p=0.03). Cognitive task significantly affected several sway velocities. Tandem stance significantly affected many sway parameters, whereas the eyes closed condition did not. After treatment, only two parameters in tandem stance and one in cognitive task improved within the patient group, in a pairwise comparison. CONCLUSIONS Postural control is impaired in CD patients probably due to the impaired proprioceptive and sensorimotor integration. In reference to dual task theories possibly due to divided attention and task prioritization, cognitive dual-task and harder postural task disturbes the PS in these patients.
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Affiliation(s)
- Turgay Demİr
- Çukurova University, Faculty of Medicine, Department of Neurology, Adana, Turkey
| | - Mehmet Balal
- Çukurova University, Faculty of Medicine, Department of Neurology, Adana, Turkey.,Çukurova University, Faculty of Medicine, Movement Disorders Unit, Department of Neurology, Adana, Turkey
| | - Meltem Demİrkİran
- Çukurova University, Faculty of Medicine, Department of Neurology, Adana, Turkey.,Çukurova University, Faculty of Medicine, Movement Disorders Unit, Department of Neurology, Adana, Turkey
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22
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Morelli N, Heebner NR, DeFeo CJ, Hoch MC. The influence of cognitive tasks on sensory organization test performance. Braz J Otorhinolaryngol 2020; 88:841-849. [PMID: 33408062 PMCID: PMC9615532 DOI: 10.1016/j.bjorl.2020.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/13/2020] [Accepted: 11/09/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction Many static postural tasks requiring vestibular contributions are completed while dual- tasking. Objective We investigated the influence of dual-tasks on sensory integration for postural control and cognitive performance during the sensory organization test and examined the relationship between cognitive function and dual-task cost during the sensory organization test. Methods Twenty adults completed single and dual-task versions of the six conditions of the sensory organization test were completed during two visits separated by one week. A subset of 13 participants completed three National Institute of Health (NIH)-toolbox cognitive tests including the Flanker inhibitory control and attention test, dimensional change card sort test and pattern comparison processing speed test. Wilcoxon signed rank tests were used to compare postural sway during single and dual-task sensory organization test. Friedman’s test, with pairwise comparison post-hoc tests, was used to compare single task serial subtraction performance to the 6 dual-task sensory organization test conditions. Spearman’s correlation coefficients were used to assess the relationship between cognitive performance on NIH-toolbox test and postural and cognitive dual-task cost during the sensory organization test. Results Performing a cognitive dual-task during the sensory organization test resulted in a significant increase in postural sway during condition 1 (Z = −3.26, p = 0.001, ES = 0.73), condition 3 (Z = −2.53, p = 0.012, ES = 0.56), and condition 6 (Z = −2.02, p = 0.044, ES = 0.45). Subtraction performance significantly decreased in during condition 6 (Z = −2.479, p = 0.011, ES = 0.55) compared to single-task. The dimensional change card sort test demonstrated moderate correlations with dual-task cost of serial subtraction performance in condition 5 (dimensional change card sort test: r = −0.62, p = 0.02) and condition 6 (dimensional change card sort test: r = −0.56, p = 0.04). Pattern comparison processing speed test scores were significantly correlated with dual-task cost of postural control during condition 2. Conclusion Performing a cognitive task during the sensory organization test resulted in significantly increased postural sway during three conditions, particularly during visual environment manipulation oppose to vestibular and somatosensory manipulation. Cognitive performance decreased during the most complex sensory organization test condition. Additionally, we found participants with poorer executive function had greater dual-task cost during more complex sensory integration demands.
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Affiliation(s)
- Nathan Morelli
- University of Kentucky, College of Health Sciences, Sports Medicine Research Institute, Lexington, United States.
| | - Nicholas R Heebner
- University of Kentucky, College of Health Sciences, Sports Medicine Research Institute, Lexington, United States
| | - Courtney J DeFeo
- University of Kentucky, College of Health Sciences, Sports Medicine Research Institute, Lexington, United States
| | - Matthew C Hoch
- University of Kentucky, College of Health Sciences, Sports Medicine Research Institute, Lexington, United States
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Schlenstedt C, Peterson DS, Mancini M. The effect of tactile feedback on gait initiation in people with Parkinson's disease: A pilot study. Gait Posture 2020; 80:240-245. [PMID: 32559642 DOI: 10.1016/j.gaitpost.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait initiation and turning are common triggers for Freezing of Gait (FOG) in people with Parkinson's disease (PD). Recently, it has been shown that closed-loop tactile feedback (CLTF) can be effective to improve turning performance in people with FOG. RESEARCH QUESTION Does CLTF change the preparation and execution of the first step during gait initiation? METHODS People (n = 36) with PD with FOG (PD + FOG) (n = 18) and without FOG (PD-FOG) (n = 18) were included in the study and performed self-initiated gait with or without CLTF under single and dual task conditions. Anticipatory postural adjustments (APAs) and step kinematics were quantified with inertial measurement units (IMUs). Muscle activity of the right and left tensor fasciae latae (TFL) was measured via EMG recordings. RESULTS PD + FOG and PD-FOG did not differ in age, gender and disease duration and severity (p > 0.05). PD + FOG performed smaller APAs (F = 4.559, p = 0.04) with a higher amount of TFL co-contraction (F = 6.034, p = 0.02) compared to PD-FOG. CLTF had no effect on APAs but led to an increase in first step duration (F = 7.921, p = 0.008). CONCLUSIONS PD + FOG had smaller APAs and higher left and right TFL co-contraction during gait initiation. CLTF did not impact preparation of the first step but led to a slower execution of the first step. We speculate that, similarly to findings from turning, CLTF might result in the participant attending more closely to the first step compared to without CLTF. Whether increased attention on gait initiation is beneficial in diminishing FOG should be investigated in more detail.
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Affiliation(s)
- Christian Schlenstedt
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | | | - Martina Mancini
- Balance Disorders Laboratory, Oregon Health & Science University, Portland, OR, USA.
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Ehgoetz Martens KA, Peterson DS, Almeida QJ, Lewis SJG, Hausdorff JM, Nieuwboer A. Behavioural manifestations and associated non-motor features of freezing of gait: A narrative review and theoretical framework. Neurosci Biobehav Rev 2020; 116:350-364. [PMID: 32603716 DOI: 10.1016/j.neubiorev.2020.06.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022]
Abstract
Over the past decade, non-motor related symptoms and provocative contexts have offered unique opportunities to gain insight into the potential mechanisms that may underpin freezing of gait (FOG) in Parkinson's disease (PD). While this large body of work has informed several theoretical models, to date, few are capable of explaining behavioural findings across multiple domains (i.e. cognitive, sensory-perceptual and affective) and in different behavorial contexts. As such, the exact nature of these interrelationships and their neural basis remain quite enigmatic. Here, the non-motor, behavioural evidence for cognitive, sensory-perceptual and affective contributors to FOG are reviewed and synthesized by systematically examining (i) studies that manipulated contextual environments that provoke freezing of gait, (ii) studies that uncovered factors that have been proposed to contribute to freezing, and (iii) studies that longitudinally tracked factors that predict the future development of freezing of gait. After consolidating the evidence, we offer a novel perspective for integrating these multi-faceted behavioural patterns and identify key challenges that warrant consideration in future work.
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Affiliation(s)
| | - Daniel S Peterson
- College of Health Solutions, Arizona State University, Arizona, USA; Phoenix Veterans Affairs Medical Centre, Arizona, USA
| | - Quincy J Almeida
- Movement Disorders Research & Rehabilitation Centre, Laurier University, Waterloo, ON, Canada
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Dept of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alice Nieuwboer
- Department of Rehabilitation Science, University of Leuven, Leuven, Belgium
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Miner DG, Aron A, DiSalvo E. Therapeutic effects of forced exercise cycling in individuals with Parkinson's disease. J Neurol Sci 2020; 410:116677. [PMID: 31954353 DOI: 10.1016/j.jns.2020.116677] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/23/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
Currently there is no cure for the progressive movement disorders associated with Parkinson's Disease (PD). Pharmacological management of movement disorders in PD are associated with significant negative side effects. Exercise improves the efficacy of anti-parkinsonian medication, but does not ameliorate the side effects. Consensus on the optimal mode of exercise training or dosing to improve motor function for individuals with PD is lacking. The new concept of forced exercise is gaining traction in the literature as a mode of exercise which has the potential to improve motor function in individuals with PD. The purpose of this article is to review the effects of forced exercise on specific components of motor function that would help guide clinical decision making and exercise prescription for the PD patient population. Collectively, the evidence provided in this review suggests that forced exercise may be safely added as an ancillary therapy to the medical management of PD.
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Affiliation(s)
- Daniel G Miner
- Department of Physical Therapy, Radford University, Carilion Roanoke Community Hospital, 8th Floor, 101 Elm Avenue, Roanoke, VA 24013, United States of America.
| | - Adrian Aron
- Department of Physical Therapy, Radford University, Carilion Roanoke Community Hospital, 8th Floor, 101 Elm Avenue, Roanoke, VA 24013, United States of America.
| | - Emily DiSalvo
- Department of Physical Therapy, Radford University, Carilion Roanoke Community Hospital, 8th Floor, 101 Elm Avenue, Roanoke, VA 24013, United States of America.
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Kosutzka Z, Kusnirova A, Hajduk M, Straka I, Minar M, Valkovic P. Gait Disorders Questionnaire-Promising Tool for Virtual Reality Designing in Patients With Parkinson's Disease. Front Neurol 2019; 10:1024. [PMID: 31611840 PMCID: PMC6768968 DOI: 10.3389/fneur.2019.01024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/09/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Gait disorders (GD) are frequent and disabling symptoms in patients with Parkinson's disease, mostly because they significantly limit mobility and often lead to fear of falls or actual falls. Nowadays, rehabilitation is considered to be the most effective nonpharmacological approach to reduce risk of falls. Using paradigms in virtual reality (VR) is a promising tool in neurorehabilitation because of the potential improvement in motor learning and improvement in daily functioning by replicating everyday real-life scenarios. Objective: To identify the most prevalent everyday situations which impair gait in PD that could be simulated in virtual reality (VR) environment. Methods: A newly developed self-report questionnaire consisting of 15 binary response items (YES/NO) encompassing everyday walking situations was administered to 62 patients diagnosed with idiopathic PD according to MDS Clinical Diagnostic Criteria. We included patients able to walk unassisted for at least 10 min and without significant cognitive impairment. Mokken Scale Analysis was used to evaluate psychometric properties of the scale. Results: Questionnaires from 58 patients were analyzed (31 men, age = 63 ± 9.9 y, disease duration = 7.02 ± 4.03 y, LEDD = 1115 ± 549.4 mg, H&Y = 2.4 ± 0.6). Only 10 items (out of 15) were identified as scalable and these were included in Gait Disorders Questionnaire (GDQ). The most prevalent trigger of gait disorders was walking under time pressure, followed by gait in crowded places and walking while dual-tasking. The total score of GDQ significantly correlated with the disease duration (r s = 0.347, p = 0.008) and modified H&Y staging (r s = 0.288, p = 0.028). Conclusion: With the use of GDQ we identified the most prevalent everyday transition activities that provoke gait disorders in patients with PD. The results may be useful for further development and systematic application of VR paradigms for physiotherapy of PD patients.
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Affiliation(s)
- Zuzana Kosutzka
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Alice Kusnirova
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Michal Hajduk
- Department of Psychology, Faculty of Arts, Comenius University, Bratislava, Slovakia.,Department of Psychiatry, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Igor Straka
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Michal Minar
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Peter Valkovic
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Centre of Experimental Medicine, Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia
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Janssen S, Heijs JJA, van der Meijs W, Nonnekes J, Bittner M, Dorresteijn LDA, Bloem BR, van Wezel RJA, Heida T. Validation of the Auditory Stroop Task to increase cognitive load in walking tasks in healthy elderly and persons with Parkinson's disease. PLoS One 2019; 14:e0220735. [PMID: 31386695 PMCID: PMC6684087 DOI: 10.1371/journal.pone.0220735] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/21/2019] [Indexed: 11/18/2022] Open
Abstract
Background The development of treatments for freezing of gait (FOG) in Parkinson’s disease (PD) requires experimental study set-ups in which FOG is likely to occur, and is amenable to therapeutic interventions. We explore whether the ‘Auditory Stroop Task’ (AST) can be used to increase cognitive load (and thereby elicit FOG), simultaneously with visual cues (as a therapeutic intervention for FOG). We additionally examined how these two contrasting effects might interact in affecting gait and FOG parameters. Objectives We investigated whether: (1) the ‘Auditory Stroop Task’ (AST) influences gait in healthy elderly and persons with PD who experience FOG, and increases the frequency of FOG events among PD patients; (2) the AST and visual cues interact; and (3) different versions of the AST exert different cognitive loads. Methods In ‘Experiment 1’, 19 healthy elderly subjects performed a walking task while performing a high and low load version of the AST. Walking with a random numbers task, and walking without cognitive load served as control conditions. In ‘Experiment 2’, 20 PD patients with FOG and 18 healthy controls performed a walking task with the AST, and no additional cognitive load as control condition. Both experiments were performed with and without visual cues. Velocity, cadence, stride length, and stride time were measured in all subjects. FOG severity was measured in patients. Results Compared to the control conditions, the AST negatively affected all gait parameters in both patients and controls. The AST did not increase the occurrence of FOG in patients. Visual cues reduced the decline in stride length induced by cognitive load in both groups. Both versions of the AST exerted similar effects on gait parameters in controls. Conclusions The AST is well-suited to simulate the effects of cognitive load on gait parameters, but not FOG severity, in gait experiments in persons with PD and FOG.
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Affiliation(s)
- S. Janssen
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
- * E-mail:
| | - J. J. A. Heijs
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - W. van der Meijs
- Department of Biophysics, Donders Institute of Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - J. Nonnekes
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M. Bittner
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | | | - B. R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R. J. A. van Wezel
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
- Department of Biophysics, Donders Institute of Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - T. Heida
- Biomedical Signals and Systems Group, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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28
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Schaeffer E, Busch JH, Roeben B, Otterbein S, Saraykin P, Leks E, Liepelt-Scarfone I, Synofzik M, Elshehabi M, Maetzler W, Hansen C, Andris S, Berg D. Effects of Exergaming on Attentional Deficits and Dual-Tasking in Parkinson's Disease. Front Neurol 2019; 10:646. [PMID: 31275234 PMCID: PMC6593241 DOI: 10.3389/fneur.2019.00646] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/31/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: Impairment of dual-tasking, as an attention-based primary cognitive dysfunction, is frequently observed in Parkinson's Disease (PD). The Training-PD study investigated the efficiency of exergaming, as a novel cognitive-motor training approach, to improve attention-based deficits and dual-tasking in PD when compared to healthy controls. Methods: Eighteen PD patients and 17 matched healthy controls received a 6-week home-based training period of exergaming. Treatment effects were monitored using quantitative motor assessment of gait and cognitive testing as baseline and after 6 weeks of training. Results: At baseline PD patients showed a significantly worse performance in several quantitative motor assessment parameters and in two items of cognitive testing. After 6 weeks of exergames training, the comparison of normal gait vs. dual-tasking in general showed an improvement of stride length in the PD group, without a gait-condition specific improvement. In the direct comparison of three different gait conditions (normal gait vs. dual-tasking calculating while walking vs. dual-tasking crossing while walking) PD patients showed a significant improvement of stride length under the dual-tasking calculating condition. This corresponded to a significant improvement in one parameter of the D2 attention test. Conclusions: We conclude, that exergaming, as an easy to apply, safe technique, can improve deficits in cognitive-motor dual-tasking and attention in PD.
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Affiliation(s)
- Eva Schaeffer
- Department of Neurology, Christian-Albrecht-University Kiel, Kiel, Germany
| | - Jan-Hinrich Busch
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Sascha Otterbein
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Pavel Saraykin
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Edyta Leks
- Department of Biomedical Magnetic Resonance, University of Tüebingen, Tüebingen, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Morad Elshehabi
- Department of Neurology, Christian-Albrecht-University Kiel, Kiel, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrecht-University Kiel, Kiel, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Clint Hansen
- Department of Neurology, Christian-Albrecht-University Kiel, Kiel, Germany
| | - Sarah Andris
- Mathematical Image Analysis Group, Faculty of Mathematics and Computer Science, Saarland University, Saarbrücken, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrecht-University Kiel, Kiel, Germany.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
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